Torts: unintentional torts- negligence: forgetting to setthe bed alarm for a patient who is at risk for
falling and falls out of bed.
Malpractice-
... [Show More] giving the wrong medication to the patient, error that harms the patient.
Intentional torts:
Assault vs Battery:
• Assault is if you threaten someone, “If you do not take this pill, I will smack you.”
• Battery: when you actually hurtsomeone, “You actually act by smacking the patient.”
• False imprisonment: Nurse will purposely restrain the patient or give them a chemical to a pt.
for the nurse convenience, instead of doing alternatives techniques.
Six Ethical Principles
• Beneficence – Doing good by the patient, what is best for the patient. Making the patient feel
safe in the environment that their in.
• Autonomy- respecting their rights by what they decide for their health care. Clients making
decisions but the patient must accept consequences of those decisions.
• *Veracity- truthfulness “Being honest with the patient’s treatment”
• Justice- fair/equal rightsfor everyone.
• *Fidelity- being loyal to the patient, keeping promises.
• Non-maleficence: Doing No Harm
Legal Rights of the patients in Mental Health
• Pt has the right to refuse treatment even if they’re in a mental health facility.
• Pts confidentiality: HIPPA: cannot be released without the consent of the patient
• Ifsomeone calls the unit asking about the patient refer them to contact the patient’s
family regarding the patient well being
• Over hear a conversation in a public place: tell them to go have the conversation in a
private setting.
• Mandated that abuse is reported, with a child or an older adult.
• Our duty to warn third parties if they’re at risk for harm.
Informed Consent: Provider:
• Communicate the purpose of the procedure
• Give a clear description of the procedure in the patient primary language.
• Explain the risks vs the benefits
• Other options in treating the condition
RN Role:
• make sure the provider givesthis information to the patient.
• Pt is competent in receiving the information, they must be an adult or an emancipated
child, THERE CAN BE NO IMPAIRMENTS!
• If they do not understand the information then we do not answer the questions, have
the provider answer the questions.
Restraints:
• Physical- vest, belt, and mittens. LAST RESORT
• Chemical-sedative/antipsychotic medications
• Alternatives before restraints: verbal interventions, calm/quiet environment, diversions.
• Prescriptions must be written
• Write an order for restraints to be placed on patient. If the orders need to be renewed it hasto
be renewed within 24 hours.
•
Care for the Patient:
• Assessing the patient vital signs q 15 mins
• Offer them food and fluid- Every hour
• Make sure they get the chance to toilet- Every hour
• Monitor vital signs.
Emergency Restraints Placed:
• get an order from the doctor within 15-30 mins
• Time limits: 18 and older: 4 hours, 9-17: 2 hours, 8 and under= 1-hour, extra documentation:
event that caused the restraints to be placed, alternative interventions that were attempted,
time treatment began, med administered, patient assessmentincluding current behavior, v/s,
pain. Pts care provided: food, helping them to the bathroom.
Therapeutic Communication:
• *Always try to get more information from the patient. You never want to shut down
communication between you and the patient. *“Always go for tell me more response”
• Intrapersonal communication:self-talk, thinking thoughts, not verbalizing them.
• Interpersonal communication: one on one communication with another person.
• Open ended questions: promote interactive discussions “Tell me more, can you share more
about x y,z
• Closed ended= when looking for a specific answer/ Medical History. Yes/no answers
Clarifying techniques:
Restating = repeating back the patient exact words
Reflecting= returning focus back to the patient
Paraphrasing = restating the patients’ feelings and thoughtsto confirm what has been
communicated. “What I think I hear you saying is this”
Exploring= gathering more information aboutsomething that the patient has mentioned. “You
mentioned this can you tell me little more about that.”
General leads= allowsthe patient to guide the discussion
*Presenting reality= focus on what is actually happening to stop the hallucination, delusions,
faulty beliefs. “Must be really scary to hear voices can you tell me what their saying”
Offering self: demonstrates a willingnessto spend time, and the nurse has a genuine concern.
Barriers:
• Do not offer personal opinions: Neversay “ You should do this”
• Do not give advice
• Do not give false reassurance.
• *NEVER ASK WHY!
• Never offer value judgements
• Don’t do excessive questioning.
• Respond approvingly or disapprovingly
• Alwaysstay neutral while talking. “ I know exactly how you feel” Neversay this!
Best Practices when working with older adults:
Minimize distractions, discuss health in a private setting, face the patient when speaking, use a
low-pitched voice, in the beginning of the interview identify the concerns/needs of the patient,
limit the number of items on the questionnaire,* give the patient plenty of time to respond to
questions when gathering data*
Defense Mechanisms:
• *Repression: putting unacceptable ideas out of unconscious awareness. “ Pushing it out of your
mind and not thinking about it actively.
• Displacement: Substituting a different target, Ex: A person who loses his job at work but comes
home and destroys his son favorite toy.
• *Disassociation: temporarily blocking memoriesfrom consciousthought. “Going through a
sexual assault, forgetting who they are, having an out of body experience”
• *Projection: projecting your thoughts on someone else. “Other people are having your feeling”
• Denial: Not happening, pretending the truth is not reality to manage anxiety.
• Rationalization: creating an excuse or unacceptable reason forsomeone’s behavior. “I had to do
this .to do this thing”
• Altruism: dealing with anxiety but reaching out to others, if their experiencing a loss or anxiety
cope by reaching out to others.
• Sublimination: “Substitute” negative impulsesinto an acceptable form of expression. “Really
angry go to the gym and work out really hard”
• Suppression: voluntarily denying unpleasant thoughts/feelings. “Putting it in the back of your
mind and not wanting to think about it”
• Regression=reverting back to child like behaviors that do not go with the adult developmental
stage. “When a new baby enters the family, the older child decides to not utilize the bathroom
even though they have already been toilet trained.”
• Reaction: overcompensating/demonstrating the opposite behavior of what isfelt. “I love nursing
exams; I love select all that apply questions”
• Undoing= performing an act, to make up for prior behavior “Husband hits wife, then brings
home flowers to make up for that behavior”
• Compensation= emphazing strengthsto make up for weakness. “disabled person is
compensating by being great at academics”
• Identification= adopting one’sideas from a group or individual
• Intellectualization=Separating emotions/feelingsfromlogical factsto help with coping.
• Conversion= responding to stress through unconscious development of physical symptoms not
caused by physical illness “A person experiences deafness after his partner tells him he wants a
divorce.
• ***Splitting = in ability to recognize positive/negative attributes of others orself “All or nothing
mentality”
Levels of Anxiety:
• Mild: daily occurrence; can be a good thing; increase one’s ability to perceive reality, gets one to
focus. Negative symptom: fidgeting, restlessness, toe tapping, irritability.
• Moderate: Increase HR, RR. Reduction of perception of reality, other side effectsinclude
headache, back ache, insomnia. Pacing, difficulty concentrating
• Severe: greatly reduced perception of field. Have feeling of impending doom,tachycardia, loud
and rapid speech, hyperventilation, aimless activity, learning and problem solving cannot
happen, cannot take direction from others.
• Panic: marking disturbed behavior, lose touch with reality,severe hyperactivity orflight,
hallucinations, severe withdraw symptoms, dilatated pupils.
Nursing Interventions: Mild: * evaluate the patients pts coping mechanisms that have helped in the
past *, “What have you done in the past to help with coping?”, Active listening, assist patient with
problem solving, teach relaxation techniques: Abd breathing exercises, encourage exercise to reduce
anxiety
Severe: Provide a quiet environment/ No stimulation, remain with patient,set limits with short
simple statements, help patient focus on reality.
Milieu Therapy: environment that patient is in. Make sure that it is safe and therapeutic.
Stages of a Therapeutic Relationship:
• Stage 1- Orientation Phase: Introduce, discuss confidentiality with the patient, set goal and
expectations with the patient, set boundaries and parameters.
• Stage 2: Working: Assessment, help to understand their needs, help them with problem-solving
* Evaluate coping strategiesthat were successful in the past, thisis with crisis, suicide and
grieving process., introduce others on unit, readvise plans and goals as needed.
• Stage 3: Termination: how they feel about the end of the relationship. Summarize
achievements, discuss how to incorporate new healthy behaviors into their life.
Transference vs Countertransference:
• Transference: Nurse remindsthe patient ofsomeone they know. It can be positive or negative
• Countertransference: When the patient reminds the nurse ofsomeone they know from their
past. Be alert for behaviors changes. You may be irritable, have to have yourself assigned to
another patient.
Theories:
• Psychoanalysis Theory: dive into past relationships, assess unconscious thoughts or feelings,
stem from early childhood experiences, Ex: relationship with mother or father.
• Free association: Having the patientsay whatever comes to mind
• Cognitive reframing: identifies negative thoughts, examinesthe cause, replacesthe thoughts
with more constructive thinking. “Positive thoughtstatements” “Stop thinking =reframing”
• Dream analysis:
• Cognitive Therapy: Goal: to ch.........................................................CONTINUED [Show Less]