Transcript: Begins at around 6:30 or 7am Unless they're coming off nightshift Mental Health Nursing NCLEX License - an exam that must be taken at the end of the RN program Mental Health Certificate - can be applied for after 2 years of experience - must write an exam to become certified Qualification - 4 year Bachelor of Science in Nursing (RN) - 2 year RPN dilploma A Typical Day Licensing/ Membership
Transcript: Thank You Demographics of Spanking Not child abuse- when spanking is done correctly no physical or mental harm will result Permissive parents- give up parental authority allowing children to practice bad behavior without any consequence Studies preformed to find the long term effects of spanking often correlate spanking and future adverse/ unintended effects on children Definition Of Spanking These statistics may be skewed because of statistical bias Selection bias must be taken into account when studies of possible negative effects of spanking are considered Serious Harm Resources Punishment Anna-Marie Shannon Viviana Charla Abuse Punishments help children learn that there are consequences for misbehavior and encourage them to make the right choice in the future. physical injury that impairs the child’s health or well being including sprains, bone fractures, internal injury, etc. Mental injuries that demonstrates disorders of the mood or personality that inhibit with normal coping ability, judgment, etc. Selection bias is a statistical bias in which there is an error in choosing the individuals or groups to take part in a scientific study Spanking is However these studies do not include circumstances surrounding the punishment including; Deliberate or impulsive spanking, Whether the parent provided reasoning for the punishment If other forms of discipline were tried first Whether the punishment crossed into physical abuse If the child was also sexually abused, neglected, etc. In the United States, the definition of spanking is not strictly defined but is generally accepted to be striking a child across the buttocks with an open hand lightly enough to NOT leave a mark. Statistical Bias Skewed Statistics How Many Parents spank? Authoritarian parents- tend to use spanking much more frequently. They tend to be punitive, stick to rigid rules, and be more dictatorial. Spanking is often a form of punishment for children A punishment is defined as an action That is taken to enforce rules. The overwhelming majority of American adults approve of corporal punishment of children Close to 100% of Americans report using corporal punishment on toddlers Effective -If children do not respond seriously to other forms of discipline, inflicting pain but no damage helps the child correlate misbehavior with punishment Authoritative parents -may use spanking but also set limits, allow for open discussion, and are more democratic Parenting styles: Effect on Mental Health While the majority of children receive some sort of corporal punishment in childhood, a proportionate few suffer ill effects A child’s perception of spanking as threatening or non threatening is a major factor in the impact the punishment will have on future mental health The primary parenting style the parents employ may play a significant role in how the spanking is used and perceived For your time! Interested in learning more? The information was gathered from.. Cochrane Nursing Resoruce Center Google Scholar PubMed Idebate.org Search terms: “ corporal punishment” Levels of evidence found: Highest: Four level 1 Two level 4 One level 5 Three level 6 Two level 7 Four level 0 The Michigan Penal Code from the Michigan Legislature in 2009 defines Child abuse in the first degree as: “If the person knowingly or intentionally causes serious physical or mental harm to a child” Not detrimental to trust- When spanking is used as a known consequence of misbehavior and is delivered without anger, trust is preserved between the parent and child. Pro Spanking
Transcript: Voluntary Involuntary Commitment (inpatient OR outpatient) Informed Consent Objectives, benefits, risks of treatments Only competent adults have right to refuse Courts decide competence www.advocacyinc.org/ Answer: 4 Rationale: It is important when assessing for mental illness that social and cultural norms be evaluated. The context of cultural norms determines if behaviors are considered acceptable or aberrant. Belief in reincarnation may be acceptable in one culture and "delusional" in another Documentation Must include: The behavior leading to restraint or seclusion The time put in and taken out of restraints/seclusion Any less restrictive interventions attempted prior to restraint/seclusion However, you must abide by your facilities policy and procedure. Trend is moving AWAY from restraints unless ABSOLUTELY necessary Serious injury and death have occurred. MYTHS ABOUT MENTAL ILLNESS Practice within scope Know established practice standards Use P&P manuals Respect client rights Establish a good interpersonal relationship with client and family Breach of Confidentiality Inappropriate delegation Breach of Confidentiality Defamation of Character Invasion of Privacy Assault/Battery Negligence/Impairment False Imprisonment Violation of boundaries Failure to take action DSM's Five Axis Diagnosis System: Competency and Consent Assault and Battery All patients have a right to courteous and individualized health care by qualified, knowledgeable nurses. MENTAL ILLNESS DEFINED When a decrease in sensory overstimulation is needed (seclusion only). When the patient requests it. 7 indicators: You... *Interpret reality accurately *Have a healthy self-concept *Are able to relate to others *Achieve a sense of meaning in life *Have control of your behavior *Adapt to change and conflict Elopement LAMA Ethical Nursing Practice Guardians may be obtained for legally incompetent clients. May be family, a social worker, or other. In Texas, informed consent is required for every medication given. Mental Health Nursing TERRELL STATE HOSPITAL “A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning), or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom…and is not merely an expectable…response to a particular event.” DSM-IV-TR (APA, 2000) Unconditional positive regard Right to participate in treatment planning and implementation Advocate for client’s wishes ANA Code of Ethics for Nurses pg. 125, Box 7-2 The public may believe that people who suffer from mental illness: Never recover enough to become contributing members of their communities Are fundamentally unstable and unpredictable May be dangerous to those around them Are possessed by evil spirits or curses Are paying the price for some moral wrongdoing Competency must be determined by a judge. Ruling based on “client’s best interests” and if a competent client would have accepted treatment. Look for key words: here, assessment is one of them...options 1-3 are either not an assessment or is not the most important assessment!! Notify physician, hospital administration, and family Notify law enforcement if client considered a danger to himself or others. Facility can be held liable if client is injured, commits suicide, or hurts another individual while away from hospital Support right to decide Acts to benefit others Not causing pain or suffering Telling the truth Keeping promises Treat all equally Types of Psychiatric Admissions Principle Defined as a social condition marked by attitudinal devaluing or demeaning of persons who, because of disfigurement or disability, are not viewed as being capable of fulfilling valued social roles. One of your greatest responsibility as a nurse is your role as Client Advocate Those with mental illness are among the most vulnerable of our population and often are not able to be their own advocate Capacity to understand the consequences of one’s decision. Patients must be considered legally competent until they have been declared incompetent through a legal proceeding. Nursing Responsibilities Person apprehensive (assault) of harmful/offensive touching (battery) Threat to use force with opportunity and ability Treatment without client consent Chapters 1-7 Avoiding Liability Restraints require order from physician or NP Order is time limited. Must be placed by adequately trained person Thorough and ongoing assessment – every 15 minutes is standard or 1 on 1 if necessary. Jami Baker RN, BSN Client Rights Autonomy Beneficence Nonmaleficence Veracity Fidelity Justice Right to treatment Right to refuse treatment Right to informed consent Rights regarding involuntary admissions and advance psychiatric directives Rights regarding restraint and seclusion Rights regarding confidentiality Ethical Action
Transcript: Perpetuating Factors No psychiatrist involvement with medication regime No contact with psychologist or GP to encourage healthy coping strategies Chronic pain and illness Postponement of court appearance Sexual abuse/trauma history not being dealt with appropriately Physical health deterioration Low self-esteem and confidence Poor diet, sleep and exercise Poor coping strategies Bullying Grief Sexual Identity Panic attacks Body image issues Nursing Goal 1 Risk Assessment 4. Importance of reflective practice References Precipitating Factors Take Home Lessons 2. Value of a methodical approach to assessment Predisposing Factors MSE Suicide attempt at age 15 (overdose) Chronic health concerns: neuromyelitis, lupus and rheumatoid arthritis. Causes pain and had a terminal diagnosis at age 8 Undergone several rounds of chemo and therapy, some resulted in her having pneumonia 17x, and being in a coma for a week History of sexual abuse (step-grandfather from ages 3-13; best friends dad from age 15-18 Biological mother committed suicide when aged 15 Abandoned by biological father when born Unresolved grief Poor sleep, eating and exercise regime Body image issues Low self-esteem Family history of mental illness Anxiety 5. Self care to avoid compassion fatigue and vicarious trauma Plan/Recovery action plan Nursing Goal 3 Other Nursing Goals Positive Factors We acknowledge the Traditional Custodians of the land on which we live, work and study: the Gubbi Gubbi people. We pay respect to local Indigenous Elders past, present and emerging and recognise the strength, resilience and capacity of all Aboriginal and Torres Strait Islander people. Access to health care professionals (neurologist, psychologist, psychiatrist and GP once organised in the community) Supportive Aunty, stepparents and step siblings Close group of friends Insightful Community supports (such as sexual abuse support group, suicide hotline) 3. Feeling comfortable talking about the uncomfortable Implementation of Case Formulation in Mental Health Nursing Fear and anxiety over court case being postponed with no date being provided, when already not wanting to go ahead with trial Fear, anxiety and stress relating to physical health concerns (MRI +/- chemo) Emotional needs not being met Chronic pain Traumatic history Prejudicial childhood involving chronic sexual abuse Poor coping mechanisms in place Presenting Issues Complete a formal recovery plan with Monica Develop a safety plan with Monica and her step-mother and document in the care plan Complete a care plan Involving social worker to discuss up coming court case and access to government payments Discussion with treating team regarding recommendations of therapies and psychologists to see in the community Providing a safe environment removing access to means Encourage avoiding making decisions at this point in time, until MS improved 19 year old female Chronic depression, presenting voluntarily for suicidal ideation and thoughts of self harm Chronic physical pain due to illness (neuromyelitis for which she is considered terminal; lupus and rheumatoid arthritis). Needs further investigations +/- more chemotherapy Unresolved trauma surrounding mothers suicide Court case regarding sexual assault has been postponed due to COVID 19, with no date provided Moved from Brisbane to Sunshine Coast due to COVID 19, resulting in a loss of community GP and psychologist support as well as being isolated from friends Insomnia due to night terrors regarding sexual assault and court case, as well as physical health nightmares Father who abandoned her when she was a baby now wants to start a relationship with her 1. Importance of a therapeutic relationship Case Formulation - what is it? Case formulation involves turning a consumer's narrative and all of the information collected from interviews and reports into a coherent story to help develop a treatment plan (Henderson & Martin 2014) Evidence suggests that case formulation can impact on therapeutic relationships, the clinicians understanding of the consumer and the overall health outcomes of consumers (Hartley et al 2016) Nursing Goal 2 Monica Australian College of Mental Health Nurses, ACMHN. (2010). Standards of Practice in Mental Health Nursing. Australia: ACMHN. http://www.acmhn.org/publications/standards-of-practice Cahill, J., Paley, G. & Hardy G. (2012). What do patients find helpful in psychotherapy? Implications for the therapeutic relationship in mental health nursing. in Journal of Psychiatric and Mental Health Nursing, vol 20, 9. https://doi.org/10.1111/jpm.12015 Hartley, S., Jovanoska, J., Roberts, S., Burden, N., & Berry, K. (2016). Case formulation in clinical practice: Associations with psychological mindedness, attachment and burnout in staff working with people experiencing psychosis. Psychology & Psychotherapy: Theory, Research & Practice, 89(2), 133-147. doi:10.1111/papt.12074 Juan David Palacio, M. D. M. S. (2017). IACAPAP Textbook of Child and
Transcript: Why is Mental Health Nursing unpopular? Welcome! Let us explore the intriguing, fascinating, exciting, & challenging world of mental health nursing! What is mental health nursing? A U.S. study suggests that mental health nurses are viewed negatively by other nurses (Hetchen, 2008) -Promote mental, emotional & physical health/wellness -Assess behaviors & mental states indicative of potential danger to self & others -Integrate psychopharmacology & psychotherapy in treatment plan -Assess barriers to effective treatment & recovery -Develop cultural competence to effectively deal with clients -Utilize therapeutic communication -Sample: 122 nurses from 2 Ohio psychiatric hospitals -Least popular specialty; ranked lowest out of 10 specialty fields -Mental health nurses viewed as "unskilled, illogical, idle, disrespected" -Attitude not confined to U.S. -"Courtesy stigma" -Source: Nursing Times.Net, 2008. Taken from Archives of Psychiatric Nursing (2008), 22:1, 20-26. Therapeutic Communication Use nursing process to: Promote mental, emotional & physical health/wellness Assess behavio & mental states of potential danger to self & others Integrate psychopharmacology & psychotherapy in treatment plan Assess barriers to efective treatment & recovery Develop cultural competence to effectively deal clients Utilize therapeutic communication -Verbal -Non-Verbal DATA: (from NAMI) -1 in 4 (61.5 M Americans)experiences mental illness in a given year -Abt. 20% ages 13-18 experience severe mental disorders in a given year -Abt. 18.1% of American Adults (42M) live with anxiety disorders (i.e. panic disorder, OCD, PTSD, generalized phobias) -Abt 2.6 % of American adults (6.1 M ) live with bipolar disorder -Abt. 26%of homeless adults in shelters w/serious mental illness; 46% with severe mental illness &/or substance abuse disorders Communication Mental Health Nursing -Most powerful tool in mental health nursing -The foundation for nurse-patient relationship - -The process utilized to drive the nursing process
Transcript: The NCLEX is coming... PEDIATRICS: KATHY GRAY NOW IS THE TIME FOR... Transferring theory to practice Learning from your clinical rotations Asking questions Thinking critically We may not give you all the answers...BUT we teach you the concepts to apply and figure out the answer on your own ✳✱* Thursdays 0900-1000 except next week... Friday (4/29/16) 0900-1000 CONGRATULATIONS ON FINISHING SECOND SEMESTER! THESE ARE YOUR TEXTBOOKS How to be successful in NUR 1131 QUESTIONS ABOUT THE TEST? Individual Assessments Group Assessments Case Studies Discussion Role Playing And MORE!!! Mental Health, Pediatric, OB/MCH Nursing WELCOME TO NUR 1131! Be prepared for class! Read the chapters before class Listen to MP3s that are posted Review unit objectives Review PowerPoints TEST APPEAL POLICY REMAINS THE SAME DIRECT ANY QUESTIONS ABOUT THE TEST OR APPEALS TO THE APPROPRIATE INSTRUCTOR CLASS WILL BE ACTIVE, NOT PASSIVE THE FLIPPED CLASSROOM CONTINUES MENTAL HEALTH: SARAH BILLINGS-BERG Three Subjects, ONE EXAM WEEKLY BRING A POSITIVE ATTITUDE! https://evolve.elsevier.com/ Use your resources! Students learn best and get the most out of class time when they are motivated to participate OB/Maternal Child Health: JADE PARNABY
Transcript: Now mental health nurses work in a variety of places..and there is now no such thing as a madhouse or mental asylum. Crisis teams are used across the entire country. They are available 24/7 anywhere they are needed. Used in emergency situation for urgent support. They have the combination of understanding within and outside of the mental health field. Societies expectations It has been formed to contribute to the 1983 mental health act. Responsibility to listen, comunicate and have intellectual understanding Support people mentally e.g. their mental state if self-harm is involved, also the physical implaications e.g. to dress the wound. However other believe nurses are educators and role models Patient referals Within adult inpatient wards in accute hospitals recommend to provide a sympathetic approach. Where would you think to find a Mental Health Nurse?????? They can also direct an individual to the appropriate service they might need, as well as sometimes being able to giving counselling directly. The Department of Health Policy and Implementation guides suggest that in any mental health team there is a fully integrated psychiatrist in team. Mental Health nursing The of conduct requests essential knowledge and skill for mental health nursing. Acting on flattery is a big no no! Patients homes The key to this code is to promote trust through professionalism and preserving legal rights They work with people of all ages, with issues arised since birth or since changes/accidents in life. The impact of Policy Thank you for listening... A community mental health team (CMHT) work with adults diagnosed with medium or long-term mental health related issues. Mental health is the the level of a persons health in regards to their physiological and emotional well-being. Mental health nursing is a very specific field of Nursing...the focus is to meet the needs of the service user, and building a support network for the family. Role of Psychiartrists Role of occupational theapist The 18th century 'madhouse' What is it??? The right to refuse medication This act is following a strategy of 'no health without mental health' Public image oftenbased on old school stereotypes..still. Did you know.. 25% of women and 15% men show symptoms of psychosis...bearing in mind only 4% of the general public are diagnosed. The 1992 patients Bill of rights says that any patient can refuse any treatment/medication but need to made aware of the consequences. Eating disorder units Mental health nursing was now recognised as a very specialised role Advise patients of certain therapy session or interactive activities Nurse's must withhold from gaining pleasure at the patient expense Working with who??? Moving onto asylums in the Victorian and Edwardian era. If you feel you need support from a nurse about your mental health, you can visit your local GP. Ethical considerations It is a way to uphold a certain level of care across the field NICE is the The National Institute for Health and Care Excellence. 19th century proper qualifications were put in place. Mental health nurses can visit patient in their homes to adminsister medication or provide pysical care. The team can be made up of community psychiatric nurses, social workers, psychologists, occupational therapists and psychiatrists. Social media...a nurses personal life online can and will affect their work life NHS. 2015. Mental health nurse. [online]. (updated 2015). Available at: https://www.healthcareers.nhs.uk/explore-roles/nursing/mental-health-nurse. [Accessed 4/12/15] JLO Productions. 2014. BBC Mental A History of the Madhouse FULL DOCUMENTARY. [online]. Available at: [Accessed 7/12/15] Ritchie, D., Hall, C. 2009. What is Nursing? Exploring Theory and Practice. Second Eotion. Cornwall. Learning Matters Ltd. Nursing Link. 2015. How to Handle Mental Health Patients. [online]. Available at: http://nursinglink.monster.com/benefits/articles/5360-how-to-handle-mental-health-patients. [Accessed 8/12/15] The code of conduct is a guideline for all nurses. The first nursing union was formed in 1910 and was called the National Asylum Workers Union. The Mental Health Act 2007 Bibliography 1.6 million people accross the UK have been diagnosed with an eating disorder- making up 2% of the popuation. Variety in results... Younger females from primary research have a much more positive view of nurses. Others seem to have not such a nice view... The field of mental health was one of the first in which people of different roles worked together. Most effective changes in regards to children and adolescents The right to the least restrictive treatment Multi- disciplinary teams Role of a Social Worker GP surgery Social workers in mental health are able to advise on practicalities of day to day life such as accommodation and benefit schemes or day care. Creating the balance between the service user and Nurse/care giver. Has the responsibility of handling medico-legal and ethical concerns. Some studies
Transcript: Nursing in Mental Health Laura Eguia, Michelle Guidice, Devin Pino What is Nursing in Mental Health? What is Nursing? Nursing: According to the WHO, nursing is a medical profession that includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying persons (2018). Being a nurse requires both independent and collaborative work abilities care is given too: all ages all races all communities in all settings regardless of sick or well (World Health Organization, 2018) Mental Health Nursing What is Mental Health Nursing? Psychiatric mental health nursing is a specialization within the career for nursing that helps individuals with psychiatric disorders overcome their diagnosis and stigma Nurses who decide to work in the mental health field work with: individuals families groups communities Responsible for assessing, diagnosing, and treating both individuals and families with various psychiatric disorders (Nurse Journal, 2018) (Best Master of Science, 2018) Mental Health Nurses What do Mental Health Nurses do? experts in: assessing diagnosing treating they work as part of a patient care team to create individualized treatment plans Have several duties: evaluate mental health needs of said patient create treatment plans supply psychotherapy services help patient with personal care needs communicate important information with all other doctors, and family give the patient medications respond to distressed patients by using de-escalation techniques (help manage anger) Organize social events (Best Master of Science, 2018) (Nurse Journal, 2018) Start by interviewing and assessing patients: symptoms history illnesses daily routines/habits Work with patients that have: anxiety disorders mood disorders substance abuse Alzheimer's disease and various forms of dementia (Nurse Journal, 2018) Mental Health Nursing Cont' Mental Health Nurses Vs Practitioner Mental health nurses can practice with just their BSN and complete all of the previously stated duties Mental health nurse practitioners have the ability to prescribe medications Masters degree- usually can prescribe under a psychiatrists watch Doctorate degree- can prescribe on their own Education and Credentials Psychiatric Mental Health Nurse PMH Nurse Practitioner PMH Clinical Nurse Specialist PMH Advaned Practice Registered Nurse Educated in: Physical, developmental, mental health assessment Diagnosis and evaluation Psycho pharmacology Psychotherapy Education Education 2yr programs for associate's 3yrs for diploma 4yrs for BSN (cont.) Masters and Doctoral: Psychiatric PCP Psychotherapist Educator Education (cont.) Certified by American Nurses Credentialing Center -RN license -2yrs as full-time RN -minimun of 2000hrs of clinicals in past 3 yrs -30hrs of continuing PMH nursing in past 3yrs Credentials Credentials *after finishing program and passing the National Council Licensure Examination* Licensing varied by states -PMHNP -PMHCNS -determines title and scope of practice Credentials (cont.) (cont.) History of the Profession 1950's The Evolution of Psychiatric Nursing First typical anti-psychotic medication 1948 Brown Report resulted in psychiatric nursing to become an education requirement for the National League of Nursing (NLN) accreditation Peplau's Interpersonal Relationships in Nursing provided framework for psychiatric nursing Clinical nurse specialists as the first advanced practice nurses (Hein & Scharer, 2015, p. 49-50) 1960's The Evolution of Psychiatric Nursing (cont.) The Comprehensive Community Mental Health Centers Act enacted Medicare enacted Nurse Training Act passed and assisted nurses to pursue graduate study 1970's First survey of mental health since the 1950's The National Alliance for the Mentally Ill (NAMI) founded Beginning of focus on child mental health due to Advocated for Child Psychiatric Nursing Nurse practitioners began to develop a number of specialties (Hein & Scharer, 2015, p. 49-50) 1980's The Evolution of Psychiatric Nursing (cont.) Mental Health Systems Act changed focus of mental heath services to prevention First SSRI's The American Psychiatric Nurses Association (APNA) was founded 1990's Americans with Disabilities Act helped mentally and physically ill Americans against discrimination Predominant role of psychiatric staff nurses was counseling patients Nurse Practitioners that were involved with psychiatric patients allowed to sit for Psychiatric-Mental health Nurse Practitioner Exam (Hein & Scharer, 2015, p. 49-50) 2000's The Evolution of Psychiatric Nursing (cont.) World Health Organization (WHO) stress the importance of nurses in care, decision-making, and mental health advocacy and policy Affordable Care Act (Hein & Scharer, 2015, p. 49-50) Mental Health nurses currently work in a variety of practice settings, including: Current Practice Settings Practice Settings General hospitals Psychiatric hospitals Substance abuse centers Home healthcare facilities Community mental health centers
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