NGN ATI MENTAL HEALTH HESI EXIT NOTES LATEST 2023/2024 100% PASS
EBP (evidence based practice) Using the best available research evidence, clinical
... [Show More] expertise, & patient preferences to make clinical decisions
The 5 A’s of integrating best evidence into clinical practices includes: Asking
Acquiring Appraising Applying Assessing
The mental health recovery model is one of helping people with psychiatric disabilities effectively manage their symptoms, reduce psychosocial disability, and find a meaningful life in a community of their choosing.
3 specific areas are inherent within the art of nursing: caring, attending & patient advocacy.
Basic Brain Anatomy- what do the different part of brain control?
oFrontal Lobe: Thought Processes & Voluntary Movement (decision making)
oTemporal Lobe: Auditory Processes (language, speech, connects to Limbic system)
oOccipital Lobe: Vision (interprets visual images)
oParietal Lobe: Sensory & Motor (L/R orientation, reading, math, proprioception)
oHypothalamus: maintains homeostasis, regulates BP, Temp, libido, hunger, thirst, and sleep/wake cycles.
oCerebellum: Balance, Skeletal Muscle Coordination
oNeurons: Nerves that translate electrical impulses into chemical signals released at the synapse
Synapse- The space between neurons in which neurotransmitters are released and either inhibit/excite the adjacent neuron. The 4 NT’s are dopamine, norepinephrine, serotonin and acetylcholine.
Milieu Therapy: Creating a SAFE, structured inpatient/outpatient setting where the mentally ill can test new behaviors and coping mechanisms with others.
oClimate is essential to healing: paint color, relaxed environments are conducive to the healing process.
oFlorence Nightingale believed that the environment helps heal
Maslow’s Hierarchy of needs
oBasic Needs: food, oxygen, water, sleep, sex, and a constant body temperature. If all the needs were deprived, this level would take priority.
oSafety Needs: Security, protection, freedom from fear/anxiety/chaos, and the need for law, order, and limits.
oBelonging and Love Needs: intimate relationship, love, affection, and belonging, having a family and a home and being part of identifiable groups.
oEsteem Needs: If self-esteem needs are met, we feel confident, valued, and valuable. When self-esteem is compromised, we feel inferior, worthless, and helpless.
oSelf-actualization: Reaching our full potential to feel inner peace and fulfillment.
Peplau’s Theory of Interpersonal Relations
oCreated the Nurse-Patient Partnership increasing individual and family roles in recovery. (Based off of Sullivan’s Interpersonal Theory). Relationships greatly influence recovery
Freud- contributed to psychiatric setting -Unconscious thoughts
oId – unconscious mind, instincts (this is dominant)
oEgo – sense of self, use of defense mechanisms
oSuperego – our conscious and is greatly influenced by our parents morals and ethical stances
Erickson’s
oTrust vs. Mistrust (infant 0- 1 ½) trust developed if caregivers give affection, love, care, attention, and reliability. (Feeding)
oAutonomy vs. Shame (toddlers 1 ½ - 3) kids need to develop a sense of personal control. (Toilet Training)
oInitiative vs. Guilt (children 3-6) children need to have power to explore their environment and not receive disapproval from parents. (Exploration)
oIndustry vs. Inferiority: (school aged kids 6-12) Kids dealing with new social and academic demands. Success leads to a sense of competence. (School)
oIdentity vs. Role Confusion (teens 12-20) Teens need to develop self-identity and personal identity to stay true to themselves. (Social Relationships)
oIntimacy & Solidarity vs. Isolation (young adults 20-30) Young Adults need to form intimate, loving relationships. (Relationships)
oGenerativity vs. Self-Absorption: (adults 30-65) Need to create/nurture things by having children. (Work & Parenthood)
oIntegrity vs. Despair (elderly 65+) Need to look back and feel fulfilled by accomplishments; have wisdom and no regrets (Reflection on Life)
Sullivan Personalities are influenced during childhood and mostly by the MOTHER.
Therapeutic Communication: goal directed, professional, scientifically based. The goal is to get information so that you can plan care for the patient.
oActive Listening
Clarifying: promotes understanding of the patient’s statement
Restating: repeating the same key words the patient has just spoken to echo their feelings. (Ex: If a patient remarks, “My life is empty…it has no meaning,” additional information may be gained by restating, “Your life has no meaning?”)
Reflecting: helps people understand their own thoughts better; summarizes (Ex: For example, to reflect a patient's feelings about his or her life, a good beginning might be, “You sound as if you have had many disappointments.”)
Exploring: use of open-ended questions or statements to allow the patient to express thoughts/feelings. (Ex: “Tell me more…”, “Give me an example of…”)
Communication Technique Examples in Different Scenarios
oFor Suicidal Patients: “These thoughts are very serious Mr. Adams. I do not want any harm to come to you. Can you tell me what you were feeling and if there were any circumstances that led you to this decision?”
oFor Patients who start Crying: Stay with your patient and reinforce that it is all right to cry & offer tissues. “You seem upset, what are you thinking right now?”
oFor Patients who say they “don’t want to talk”: “Its alright. I would like to spend time with you. We don’t have to talk.” Or reapproach at a later time, “Our 5 minutes is up. I will be back at 10am and spend another 5 minutes with you.”
oFor Patients who ask the nurse to keep a secret: Nurses cannot make such promises, as it may be important to share that information with other staff for safety reasons. “I cannot make that promise Mr. Adams as it might be important for me to share it with the other staff”.
oNon-Verbal:
Tone of voice (tone, pitch, intensity, stuttering, silence, pausing)
Facial expressions (frown, smile, grimaces, raises eyebrows, licks lips)
Posture (slumps over, puts face in hands, taps feet, fidgets with fingers)
Amount of eye contact (angry, suspicious or accusatory looks, wandering)
Sighs/Hand gestures (fidgeting, snapping fingers)
Yawning [Show Less]