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Hildegard Peplau is considered the mother of psychiatric nursing through her development of the interpersonal relations theory (see [2.2 Interpersonal Theories and Therapies\)](#page-64-0). This theory helps nurses understand the importance of therapeutic communication with their clients. According to the theory, there... | {
"Header 1": "CHAPTER 6 Therapeutic Relationships",
"Header 3": "**Phases of the Nurse-Client Relationship**",
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The theory of interpersonal relations is holistic in the way that it uses both verbal and nonverbal communication skills to assist the client in dealing with their illness (Deane & Fain, 2016). The student nurse can learn a lot about communication by using this theory to guide their interactions with their clients. Dea... | {
"Header 1": "CHAPTER 6 Therapeutic Relationships",
"Header 3": "**Building Trust and Rapport**",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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The limits people set to define their levels of comfort when interacting with others are called **boundaries**. Personal boundaries include those in the physical, sexual, intellectual, emotional, and financial areas of people's lives. Boundaries promote safety in relationships at work, home, and with partners by protec... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Boundaries in the Therapeutic Relationship**",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Explain the role of family dynamics in nursing practice
- Discuss how the family systems model builds collaborative relationships with clients and their families
- Describe collaborative relationships in mental health nursing
With app... | {
"Header 1": "**6.2 Family Dynamics**",
"token_count": 222,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The way that the family members interact, communicate, and problem-solve is called **family dynamics**. Functional families work together toward common goals. They support one another and have good communication. Dysfunctional relationships can cause distress and broken ties within the family, leading to poorer mental ... | {
"Header 1": "**6.2 Family Dynamics**",
"Header 3": "**Family Dynamics**",
"token_count": 1783,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
In the 1950s, Murray Bowen developed his family systems theory, which is still the central orientation in family therapy practice (Brown, 1999). The purpose of implementing this theory in practice is to enhance the growth of each family member as well as that of the family as a whole. The main concept in this theory is... | {
"Header 1": "CULTURAL CONTEXT",
"Header 3": "**Family Systems Model**",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Peer support services are those led by a person or persons who have lived experience with mental illness (Muralidharan et al., 2021). A **peer support specialist** is a nonclinical person who uses their experiences with mental illness and recovery to help others (George, 2022). These services can be conducted in an inp... | {
"Header 1": "**6.3 Peer Support**",
"Header 3": "**Peer Support Services**",
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Deinstitutionalization, when people with mental illness were discharged from state hospitals and returned to the community, led to peer self-help groups springing up because the clients being discharged into the communities were mistrustful of health professionals and had difficulty even finding outpatient mental healt... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Functions of Peer Support Services**",
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There are many types of peer support services available as a resource for clients with mental health challenges. What follows is just a small sample of those resources.
- Alcoholics Anonymous (AA) and Narcotics Anonymous (NA): These 12-step programs are examples of peerled support groups. The main purpose of AA and N... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"Header 3": "**Examples of Peer Support Services**",
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Compliance is the term frequently used when discussing people following their mental health treatment plan. Adherence is a more positive and appropriate term because it does not imply a power imbalance in the clinical provider-client relationship. Alliance is an even better term, focused on recovery and the team approa... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Client Engagement in Mental Health Care**",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Apply and define trauma-informed care in child/adolescent populations
- Select nursing interventions incorporating trauma-informed concepts
- Evaluate psychiatric-mental health nursing trauma-informed outcomes of care
In **trauma-info... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**6.5 Trauma-Informed Care**",
"token_count": 472,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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According to Forkey et al. (2021), more than half of all U.S children under the age of eighteen have experienced some type of trauma in their lifetimes. The American Psychological Association (2023) describes **trauma** as an emotional reaction to a disturbing, distressing, and painful experience. While there is a wide... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Application of TIC to Child Development**",
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The CDC has created a short video that highlights ACEs [\(https://openstax.org/r/77ACEs\)](https://openstax.org/r/77ACEs) and things that can be done to help prevent them.
#### **Strengths-Based Care and Client Empowerment**
Care provided should be person-centered, meaning it focuses on the individual needs and des... | {
"Header 1": "LINK TO LEARNING",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Individuals who have a history of trauma may become triggered by engagement with the health-care system. They may experience arousal and reactivity symptoms. As a result of the stimulation of the "fight, flight, or freeze" stress response, the parts of the brain involved in memory, planning, decision-making, and regula... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Nursing and Trauma-Informed Care**",
"token_count": 1006,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### QSEN Competency: Nursing Sensitivity During Assessment
When assessing a client, the nurse must always be conscious of the fact that the interaction with the client may in itself be upsetting for the client and could lead to re-traumatization. Therefore, the organization has to be purposive in working with staff ... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"token_count": 1131,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### **[6.1](#page-182-2) [Nurse-Client Relationship](#page-182-2)**
Therapeutic nurse-client relationships vary in depth, length, and focus. Some may be brief and others will be longer, depending upon the environment and the client's needs. Regardless of length or client need, there are four stages to Peplau's nurse... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "**Summary**",
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**AIDET** mnemonic for Acknowledge, Introduce, Duration, Explanation, and Thank You **barrier** anything that blocks the ability of an individual to get the care that is appropriate for their needs **boundaries** limits set as individuals that define levels of comfort when interacting with others **complex trauma** whe... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "**Key Terms**",
"token_count": 357,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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**FIGURE 7.1** Group therapy can occur in a variety of settings. (credit: "Men Sitting Talking by River Outdoors" by JourneyPure Rehab/flickr, CC BY 2.0)
#### **CHAPTER OUTLINE**
- 7.1 [Collaboration and Coordination of Care](#page-209-0)
- 7.2 [Recovery and Rehabilitative Needs](#pa... | {
"Header 1": "CHAPTER 7 Interprofessional Care",
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The collaborative and organized approach to client care that involves assessing, planning, coordinating, and monitoring services and resources to meet the needs of individuals or groups, often in complex or challenging situations is called **case management** (American Case Management Association, n.d.-a). It is a mult... | {
"Header 1": "**7.1 Collaboration and Coordination of Care**",
"Header 3": "**Case Management Service Models**",
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Virtual health and care coordination are two interrelated concepts that are increasingly important in modern health care. Nursing plays a central role. Virtual health, or telehealth, is the application of electronic information and communication technologies to facilitate remote clinical health care, education for both... | {
"Header 1": "**7.1 Collaboration and Coordination of Care**",
"Header 3": "**Virtual Health and Care Coordination**",
"token_count": 339,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### Telehealth, Mental Health Needs, and COVID-19
During the COVID-19 pandemic that began in 2020, there was a rapid increase in the use of telemedicine, especially among clients with a mental health or substance misuse diagnosis. Many private insurance companies, along with Medicaid, increased their coverage for me... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Discuss four dimensions of recovery
- Provide examples of rehabilitative treatments in PMH nursing
- Provide examples of rehabilitative resources in PMH nursing
Recovery and rehabilitation from mental illness are not isolated events, ... | {
"Header 1": "**7.2 Recovery and Rehabilitative Needs**",
"token_count": 1819,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Explain the role of discharge planning in psychiatric-mental health nursing
- Describe the procedure for transfer of a client
- Describe the procedure for transfer of client health information
Discharge and transfer are crucial times ... | {
"Header 1": "**7.2 Recovery and Rehabilitative Needs**",
"Header 3": "**7.3 Discharge and Transfer**",
"token_count": 1812,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Describe follow-up care for psychiatric-mental health clients after hospitalization
- Explain what mental health and psychosocial support (MHPSS) entails and provide examples
Follow-up care is critical for the successful recovery and ... | {
"Header 1": "**7.4 Continued Support**",
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**Nurse:** Ryan, BSN **Years in Practice:** 7 **Clinical Setting:** Inpatient dual diagnosis unit **Geographic Location:** Large midwestern city
Claire was admitted to our inpatient dual diagnosis unit for treatment for major depressive disorder and alcohol use disorder (AUD). She required medication-assisted detox f... | {
"Header 1": "REAL RN STORIES",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Georgetown Behavioral Hospital provides five tips for a healthy transition [\(https://openstax.org/r/77afterpsychhos\)](https://openstax.org/r/77afterpsychhos) following a stay in a psychiatric hospital.
#### **Mental Health and Psychosocial Support (MHPSS)**
The range of interventions and services that promote men... | {
"Header 1": "LINK TO LEARNING",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### QSEN: Client-Centered Care Competency
The QSEN client-centered care competency recognizes the client as the source of control and a full partner in providing compassionate and coordinated care that respects the client's preferences, values, and needs.
Care for PMH clients following discharge is an example of c... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Online self-help and therapy offer individuals new avenues to address their emotional well-being. These virtual platforms provide a range of resources, tools, and therapeutic interventions that empower users to navigate their mental health challenges from the comfort of their own spaces. Understanding the dynamics and ... | {
"Header 1": "**7.5 Online Self-Help and Therapy**",
"Header 3": "**Understanding Online Self-Help and Therapy**",
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Another important intervention is to assess whether clients are suitable candidates for online self-help and therapy platforms. Factors, such as the severity of a client's mental health condition, their access to technology, and their computer literacy levels, can determine if online self-help and therapy platforms are... | {
"Header 1": "**7.5 Online Self-Help and Therapy**",
"Header 3": "**Understanding Online Self-Help and Therapy**",
"token_count": 214,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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**Nurse:** Lenore, RN **Years in Practice:** 20 **Clinical Setting:** Community mental health center **Geographic Location:** Midwest
In rural areas, there can be a lack of both psychiatrists and psychiatric nurses available to care for clients in the inpatient setting. One thing that hospitals do to combat this is u... | {
"Header 1": "REAL RN STORIES",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Generate Solutions: Helping Clients Find Options for Online Mental Health Assistance Generating solutions involves the identification of the measures, interventions, or actions necessary to address a particular problem or issue. Part of this process involves differentiating between solutions that are appropriate, and t... | {
"Header 1": "REAL RN STORIES",
"Header 3": "CLINICAL JUDGMENT MEASUREMENT MODEL",
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The complexity of mental health services can be seen in the types of services available, the variability of the conditions that mental health professionals treat, and the challenges in accessing these services. One of the nurse's central roles in providing mental health services is care coordination. As previously ment... | {
"Header 1": "**7.6 Challenges to Continuity of Care**",
"Header 3": "**Complexity of Mental Health Services**",
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Discharge and transfer of clients are critical times in client care. Clients should follow up with a mental health provider within thirty (preferably seven) days of discharge. As coordinator of care for the client, the nurse plays a vital role in assisting with this follow-up care in collaboration with other health-car... | {
"Header 1": "**7.6 Challenges to Continuity of Care**",
"Header 3": "**[7.4](#page-217-0) [Continued Support](#page-217-0)**",
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**care coordination** organization and distribution of health-care services across different providers and settings in order to ensure that clients receive the right care at the right time
- **case management** collaborative and organized approach that involves assessing, planning, coordinating, and monitoring servic... | {
"Header 1": "**7.6 Challenges to Continuity of Care**",
"Header 3": "**Key Terms**",
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Identify and discuss two rehabilitative resources that could support Sarah in her recovery journey. How might these resources address her specific needs, and what role can nurses play in facilitating access to these resources?
Rodney is a forty-five-year-old male who presents at the psychiatric inpatient unit followi... | {
"Header 1": "**7.6 Challenges to Continuity of Care**",
"Header 3": "**Assessments**",
"token_count": 2012,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Define Mental Health and Psychosocial Support (MHPSS) and explain its significance in promoting mental health and treating mental health disorders. How do health-care professionals, particularly nurses, contribute to MHPSS interventions, and what are the key components of MHPSS services?
- **12**. Identify organization... | {
"Header 1": "**7.6 Challenges to Continuity of Care**",
"Header 3": "**Assessments**",
"token_count": 484,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Identify cultural influences on beliefs regarding health and illness
- Recognize health disparities among different cultural groups
- Describe various types of healing in different cultures
- Explain how to recognize and address unconsc... | {
"Header 1": "**8.1 Understanding Cultural Differences**",
"token_count": 476,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Competency: Client-Centered Care
Definition: Recognize the client as a full partner in control of all decisions when providing compassionate and coordinated care based on respect for the client's preferences, values, and needs.
Knowledge: Describe how diverse cultural, ethnic, and social backgrounds function a... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"token_count": 632,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Take Action: Culturally Sensitive Nursing Interventions for Pain
Even though the ways in which clients experience and express pain are influenced by their cultural background, pain is an individual experience. It is important for the nurse to be aware of cultural differences so that they can treat the individual in a... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "CLINICAL JUDGMENT MEASUREMENT MODEL",
"token_count": 270,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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The nonbiological factors that influence health outcomes, including conditions in which people are born, grow, work, live, and age, and the wider sets of forces and systems shaping the conditions of daily life are called social determinants of health. Health outcomes that are influenced by these social determinants of ... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"Header 3": "**Health Disparities Related to Cultural Differences**",
"token_count": 1571,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Visit the IHS Mental Health Programs [\(https://openstax.org/r/77ihsmenheal\)](https://openstax.org/r/77ihsmenheal) to find federally operated programs, many conducted by individual tribes, that provide mental health services.
Ritual and ceremony hold a key role in traditional Native American healing. Purifying and c... | {
"Header 1": "LINK TO LEARNING",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Everyone holds biases that reflect their own personal belief systems. One type of bias is called explicit bias, a consciously held set of beliefs about a particular group of people based on characteristics. Explicit bias is what we typically think of when we see or hear the word bias. A person might be openly biased ag... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Counteracting Implicit Bias**",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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By the end of this section, you will be able to:
- Identify ways to accommodate different cultural practices
- Explain ethical ways to engage in cultural diversity practices
- Define how nurses can be responsive to diversity and inclusion
As discussed in [8.1 Understanding Cultural Differences](#page-239-0), the co... | {
"Header 1": "**8.2 Ethical Practice in Culture and Diversity**",
"Header 3": "**LEARNING OBJECTIVES**",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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Learning about different cultures is only one step toward providing culturally competent care. How one responds to cultural diversity is what directly affects the nurse-client relationship and outcomes. Being responsive to cultural diversity involves taking lessons learned about other cultures from conversations, exper... | {
"Header 1": "**8.2 Ethical Practice in Culture and Diversity**",
"Header 3": "**Responsiveness to Cultural Diversity**",
"token_count": 1365,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Describe the guidelines for nursing care of different cultural practices
- Explain the importance of cultural competency and transcultural nursing
- Recognize factors that can affect diversity and inclusion in nursing
Cultural compete... | {
"Header 1": "**8.3 Cultural Practice in Nursing**",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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#### How to Perform a Brief Cultural Assessment
**Scenario:** The nurse enters the client's room to perform a cultural assessment. The client is a female from China in the area visiting family whose preferred language is Mandarin. The nurse sets up the video translator to begin the conversation and allows the transla... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
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#### **Physical and Psychological Therapies**
Physical and psychological therapies include a wide range of modalities, such as acupuncture, massage therapy, meditation, reiki, and qigong. Cupping, coining, yoga, art, music, and dance also fall into this category. Acupuncture and cupping are two of the more popular ... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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This video shows [a unique and inspiring discussion about becoming a culturally competent nurse](https://openstax.org/r/77culcomnurse) [\(https://openstax.org/r/77culcomnurse\)](https://openstax.org/r/77culcomnurse) from nurse and professor Jana Lauderdale.
The roots of providing culturally competent care are based o... | {
"Header 1": "LINK TO LEARNING",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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The American Nurses Association recognizes specific factors that negatively affect diversity, equity, and inclusion in nursing. Explicit bias in the form of discrimination due to gender identity, race, ethnicity, sexual orientation, or socioeconomic status negatively impacts the health status of various populations. Im... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Factors Affecting Diversity, Equity, and Inclusion in Nursing**",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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The amount of space that a person surrounds themselves with to feel comfortable is influenced by culture. For example, for some people, it would feel awkward to stand four inches away from another person while holding a social conversation, but for others, a small personal space is appropriate when conversing with anot... | {
"Header 1": "CULTURAL CONTEXT",
"Header 3": "Clients, Personal Space, and Touch",
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#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Define important considerations related to providing equal, diverse, and inclusive nursing care
- Identify factors that can prevent diversity, equity, and inclusion
- Explain how barriers to communication affect diversity, equity, and i... | {
"Header 1": "**8.4 Diversity, Equity, and Inclusion**",
"token_count": 207,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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In nursing, **health equality** means that nurses treat all clients as individuals, show respect for their personal choices and differences, and recognize their dignity and human rights. It assumes equal treatment and support. In contrast, **health equity** speaks to social justice and is when everyone has a fair oppor... | {
"Header 1": "**8.4 Diversity, Equity, and Inclusion**",
"Header 3": "**Health Equity through Diversity and Inclusion**",
"token_count": 1221,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
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The FICA Spiritual Assessment tool [developed by Christina Puchalski, MD, in 1991, provides a framework](https://openstax.org/r/77FICA) [\(https://openstax.org/r/77FICA\)](https://openstax.org/r/77FICA) that may be helpful for obtaining a spiritual history from a client.
#### **Age**
Older adults struggle with some... | {
"Header 1": "LINK TO LEARNING",
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"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
This stereotype can lead to medical professionals overlooking or dismissing legitimate concerns or symptoms of older clients, attributing them solely to age-related memory decline, which can, in turn, lead to misdiagnosis or delayed treatment. Culturally equitable care extends beyond general knowledge of a cultural gro... | {
"Header 1": "LINK TO LEARNING",
"token_count": 1282,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **[8.1](#page-239-0) [Understanding Cultural Differences](#page-239-0)**
An individual's cultural background influences their beliefs, feelings, and attitudes toward health care. Their culture informs how they view health and illness, how they view healthcare providers, and how receptive they are to treatment pl... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Summary**",
"token_count": 619,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
How can the nurse proactively address unconscious bias when interacting with Maria, considering her cultural background? What strategies can be employed to ensure culturally competent and unbiased care?
Dolores, a forty-five-year-old female, presents at the community health clinic for a routine checkup. She recently ... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Assessments**",
"token_count": 942,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
**FIGURE 9.1** Group therapy can occur in a variety of settings, such as this session in the woods by a river. (credit: "Men Sitting Talking by River Outdoors" by "JourneyPure Rehab:/flickr, CC BY 2.0)
#### **CHAPTER OUTLINE**
9.1 [Death and Dying](#page-273-0) 9.2 [Grief and Loss](#... | {
"Header 1": "CHAPTER 9 Social and Emotional Concerns",
"token_count": 349,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Describe social and legal concerns associated with death and dying
- Discuss emotional, spiritual, and practical concerns associated with death and dying
- Discuss cultural considerations related to death and dying
Understanding the i... | {
"Header 1": "**9.1 Death and Dying**",
"token_count": 213,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Death and dying profoundly impact individuals, families, and communities because death is not solely a biological event but also a social and cultural phenomenon. Losing a loved one triggers intense grief reactions, which can have social implications. Death often carries societal stigmas and taboos, leading to varying ... | {
"Header 1": "**9.1 Death and Dying**",
"Header 3": "**Social and Legal Concerns Associated with Death and Dying**",
"token_count": 1715,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Emotional concerns associated with death and dying encompass various psychological and interpersonal challenges for both clients and health-care professionals. Understanding and addressing these emotional concerns is important for providing holistic and compassionate care during the end-of-life journey. Likewise, resea... | {
"Header 1": "**9.1 Death and Dying**",
"Header 3": "**Emotional, Spiritual, and Practical Concerns Associated with Death and Dying**",
"token_count": 293,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Self-Care for the Nurse
Self-care practices in nursing encompass a spectrum beyond physical well-being, delving into the psychosocial aspects crucial for holistic health maintenance. As caregivers, nurses navigate emotionally demanding situations, underscoring the necessity for robust self-care strategies. Under... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"token_count": 1492,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
When a nurse demonstrates understanding of and respect toward a client's cultural background and beliefs, their end-of-life care can be more effective and compassionate (Six et al., 2023). Some cultures may have specific practices and rituals associated with dying and death. These can range from wanting family members ... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"Header 3": "**Death and Dying Cultural Considerations**",
"token_count": 2022,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
This might influence disclosure and receipt of information about prognosis and end-oflife (Matsumura et al., 2002). Health-care providers also must be mindful of potential language barriers.
#### **Vietnamese Americans**
Vietnamese Americans also have unique cultural practices and beliefs surrounding death and dyin... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"Header 3": "**Death and Dying Cultural Considerations**",
"token_count": 1091,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
**Nurse:** Sarah **Years in Practice:** Seven **Clinical Setting:** Senior care facility **Geographic Location:** Ohio
Sarah, a seasoned nurse, was assigned to care for Mrs. Chen, an older Chinese female nearing the end of her life. Mrs. Chen's family filled the room with the aroma of incense and brought offerings of... | {
"Header 1": "REAL RN STORIES",
"token_count": 385,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Discuss social factors that influence grief and loss responses relating to the five stages of grief
- Discover the physical, social, and spiritual impacts of grief and loss
- Describe the impact of grief and loss on the nurse
Grief an... | {
"Header 1": "**9.2 Grief and Loss**",
"token_count": 377,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Social factors play a role in how individuals experience and navigate grief and loss. Cultural norms and traditions, societal expectations, and social support can significantly shape the grieving process. For instance, societies often have prescribed "grieving rules" that dictate who, how, and when people should grieve... | {
"Header 1": "**9.2 Grief and Loss**",
"Header 3": "**Social Factors and Processes That Influence Grief and Loss**",
"token_count": 2036,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Acceptance does not imply happiness or that the individual is "over" the loss. Rather, it signifies understanding and coming to terms with the reality of the loss (Kübler-Ross, 1969). During this stage, individuals often begin to look forward and engage more with life, albeit with the acknowledgment that it will be dif... | {
"Header 1": "**9.2 Grief and Loss**",
"Header 3": "**Social Factors and Processes That Influence Grief and Loss**",
"token_count": 999,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Visit Registered Nursing.org [\(https://openstax.org/r/77regnursingorg\)](https://openstax.org/r/77regnursingorg) for more information on supporting clients and families with dying and grief.
#### **Emotional**
Grief and loss profoundly trigger various complex emotions. Feelings of sadness and despair are common, a... | {
"Header 1": "LINK TO LEARNING",
"token_count": 281,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Applying the CJMM to the Stages of Grief
Walter has recently been diagnosed with dementia and is a new resident in the memory unit attached to the assisted living facility (ALF). Walter receives palliative care through the local hospice and already has legal documents in place to assist with his ongoing care.
... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "CLINICAL JUDGMENT MEASUREMENT MODEL",
"token_count": 608,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Read this article [for more information on spiritual well-being tools](https://openstax.org/r/77spiritualsupp) (https://openstax.org/r/77spiritualsupp) and how to support your own well-being.
Spirituality can also serve as a vital source of comfort and resilience in the face of loss. Many individuals find solace in t... | {
"Header 1": "LINK TO LEARNING",
"token_count": 234,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The impact of grief and loss on nurses is significant, involving emotional, physical, and psychological components.
Due to the nature of their work, nurses often develop close relationships with clients and their families, making them susceptible to feelings of loss when a client dies (Üstükuş & Eskimez, 2021). Emoti... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Impact of Grief and Loss on the Nurse**",
"token_count": 280,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Cultural Stigma: Potential for Nurses' Compassion Fatigue
Psychiatric and physical symptoms combine in culture-bound syndromes, which are mental health conditions specific to the client's primary social group. Perceived experience with spiritual phenomena, or altered engagement in culture-based activities or rit... | {
"Header 1": "CULTURAL CONTEXT",
"token_count": 381,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Interventions for Assisting a Teenage Client with Grief After Loss **Psychoeducation**
Understanding the stages and process of grief can be helpful for a teenager, particularly if this is their first significant loss. It can normalize their experience and reduce feelings of confusion or isolation. It can also pr... | {
"Header 1": "LIFE-STAGE CONTEXT",
"token_count": 510,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Understand and define anger and aggression
- Review the cycle of abuse and types of abuse and violence
- Learn prominent risk factors for anger, abuse, and violence
- Comprehend the social problems relating to anger, abuse, and violence... | {
"Header 1": "LIFE-STAGE CONTEXT",
"Header 3": "**9.3 Anger, Abuse, and Violence**",
"token_count": 291,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Anger and aggression are two interrelated yet distinct constructs in psychology. The subjective, emotional state characterized by antagonism toward someone or something perceived as causing harm or offense is called **anger**. By contrast, **aggression** pertains to behaviors intended to harm or assert dominance over o... | {
"Header 1": "LIFE-STAGE CONTEXT",
"Header 3": "**Anger and Aggression Defined**",
"token_count": 678,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Visit this website [for more information on abuse and intimate partner violence](https://openstax.org/r/77prtnerviolence) (https://openstax.org/r/ [77prtnerviolence\)](https://openstax.org/r/77prtnerviolence) from the Centers for Disease Control.
#### **Physical Abuse**
The intentional use of physical force that re... | {
"Header 1": "LINK TO LEARNING",
"token_count": 2021,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
These disparities underscore the systemic issues inherent in the provision of services for abuse and violence victims. They also underscore a lack of access for people for whom early intervention may prevent later violence. Racial and ethnic disparities in care also persist. Victims from marginalized racial and ethnic ... | {
"Header 1": "LINK TO LEARNING",
"token_count": 752,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Anger has long been associated with a range of social problems. This emotion, when unregulated, can damage interpersonal relationships, disrupt the workplace environment, and pose significant barriers to effective communication. When unmanaged, anger can escalate into aggression, leading to antisocial behaviors and eve... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Social Problems Related to Anger, Abuse, and Violence**",
"token_count": 1099,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Visit this website [for more information on trauma and the effects of adverse childhood experiences \(ACEs\)](https://openstax.org/r/77adverschildhd) [\(https://openstax.org/r/77adverschildhd\)](https://openstax.org/r/77adverschildhd) from the Centers for Disease Control.
#### **Substance Misuse**
Substance misuse ... | {
"Header 1": "LINK TO LEARNING",
"token_count": 2012,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
When dealing with anger and aggression in clinical situations, understand that these emotions may stem from fear, frustration, or a loss of control related to clients' medical conditions (Llor-Esteban et al., 2017). Nurses most often
encounter types of verbal aggression in clinical settings. This type of aggression i... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Anger, Abuse, and Violence in Clinical Settings**",
"token_count": 2026,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Training should also include clear instructions on organizational policies and procedures related to managing violence and abuse, such as reporting incidents and implementing safety measures like medication, seclusion, or restraints, should they be necessary (NICE, 2015). Training should also address staff well-being a... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "**Anger, Abuse, and Violence in Clinical Settings**",
"token_count": 384,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Safety: Procedures for Initiating PRN to Manage Behavioral Crises
Pro re nata (PRN): This Latin term refers to medication taken "as needed." It is frequently used in psychiatric settings to manage behavioral crises, including violent or aggressive behavior.
Common PRN medications: The most commonly used PRN me... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"token_count": 667,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Controversy Surrounding the Use of Seclusion and Restraint in Clinical Environments Seclusion and restraint are considered last-resort interventions to manage violent or aggressive behavior in healthcare settings. They are only to be used (1) when all less restrictive methods have proven ineffective, and (2) for as sho... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"token_count": 259,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Grief and loss are profound, deeply emotional experiences that occur in response to significant events, such as the death of a loved one, the ending of a relationship, the loss of a job, or a decline in health. This emotional journey is unique to every individual and does not follow a specific, predictable course.
Th... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"Header 3": "**[9.2](#page-281-0) [Grief and Loss](#page-281-0)**",
"token_count": 514,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
**aggression** behaviors intended to harm or assert dominance over others
- **anger** subjective, emotional state characterized by antagonism toward someone or something perceived as causing harm or offense
- **assisted dying** intentionally ending a life to prevent further pain and suffering
- **burnout** state of c... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"Header 3": "**Key Terms**",
"token_count": 346,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
**FIGURE 10.1** Understanding all of the legal and ethical issues surrounding client care is critical to ensure the nurse can support a client who is unable to make their own choices and carry out their own actions. (credit: "Legal Gavel & Open Law Book" by "howtostartablogonline.net"/Wi... | {
"Header 1": "CHAPTER 10 Legal and Ethical Guidelines",
"token_count": 332,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The federal government has enacted multiple legal protections so that protected health information remains private and protected. This has become very important in the digital age where health information is easier to access by health-care providers and clients, but also by those who would use the information for secon... | {
"Header 1": "CHAPTER 10 Legal and Ethical Guidelines",
"Header 3": "**HIPAA**",
"token_count": 1243,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The Top 20 Worst HIPAA Violations [\(https://openstax.org/r/77violations\)](https://openstax.org/r/77violations) includes real-life examples of some of the most severe HIPAA violations to date.
#### **The Affordable Care Act**
The Patient Protection and Affordable Care Act (PPACA) or Affordable Care Act (ACA) was s... | {
"Header 1": "LINK TO LEARNING",
"token_count": 416,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **LEARNING OBJECTIVES**
By the end of this section, you will be able to:
- Discuss the laws applicable to nursing practice
- Explain the laws and rights protecting clients receiving health care
- Understand nursing challenges to protecting these client rights
- Describe the role of the nurse in forensic servic... | {
"Header 1": "**10.2 Legal Issues Relating to Mental Health Nursing**",
"token_count": 2015,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
If the nurse does not act on those expressions and place the safeguards as per policy and the client acts on those thoughts, the nurse is responsible for the negligent action of not acting and therefore causing harm when it could have been avoided. Not performing timely and appropriate assessment and evaluation can als... | {
"Header 1": "**10.2 Legal Issues Relating to Mental Health Nursing**",
"token_count": 214,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
**Nurse:** RaDonda Vaught **Years in Practice:** Two **Clinical Setting:** Large university hospital **Geographic Location:** Tennessee
In March 2022, nurse RaDonda Vaught was found guilty of criminally negligent homicide and gross neglect of an impaired adult. The client was a seventy-five-year-old woman who was rec... | {
"Header 1": "REAL RN STORIES",
"token_count": 1349,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
The Patient Care Partnership [\(https://openstax.org/r/77PtCarePartner\)](https://openstax.org/r/77PtCarePartner) replaced the Patient Bills of Rights in 2001.
#### **Mental Health Bill of Rights**
Psychiatric-mental health clients deserve to be treated with dignity and have the same rights and protections as other... | {
"Header 1": "LINK TO LEARNING",
"token_count": 2041,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### **The Right to Obtain One's Medical Record**
The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996, discussed earlier in the chapter, provides clients with a legal, enforceable right to see and receive copies upon request of their medical and other health records, including bills main... | {
"Header 1": "LINK TO LEARNING",
"token_count": 1024,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
| Topic (QSEN) | Nonbehavioral<br>Restraints | Violent or Self-Destructive Restraints ... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"token_count": 1968,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
If a client is restrained in a prone position, the client's airway must be unobstructed at<br>all times and the expansion of the client's lungs not restricted.<br>•<br>Ensure call light is readily accessible to any client without continuous observation.<br>•<br>Provide emotional/psychological support.<br>•<br>Explain a... | {
"Header 1": "CLINICAL SAFETY AND PROCEDURES (QSEN)",
"token_count": 974,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
Temple Health published a toolkit on informed consent that contains a lot of helpful information, including [a](https://openstax.org/r/77InformConsent) checklist [\(https://openstax.org/r/77InformConsent\)](https://openstax.org/r/77InformConsent) to assess and evaluate the informed consent form.
One point to keep in ... | {
"Header 1": "LINK TO LEARNING",
"token_count": 219,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Competency to Stand Trial and the Insanity Defense
Mental health clients have a right to a determination of whether or not they are competent to make decisions on their own behalf. This comes up in informed consent but also arises when these clients have encounters with the law. They have the right to an evaluat... | {
"Header 1": "PSYCHOSOCIAL CONSIDERATIONS",
"token_count": 372,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Ethics in Using an Interpreter
Age and culture may affect the steps a nurse takes to ensuring client confidentiality. For example, a sensory deficit, such as hearing loss, or cultural differences, such as language barriers, may require an interpreter to be present when explaining and providing care. This may com... | {
"Header 1": "CULTURAL CONTEXT",
"token_count": 641,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
There are twelve exceptions of the Privacy Act of 1974 [\(https://openstax.org/r/77privacyexcept\)](https://openstax.org/r/77privacyexcept) that dictate when a client's medical record can be disclosed without written consent of the individual.
#### **Client Rights in Facilities**
Clients with acute mental health sy... | {
"Header 1": "LINK TO LEARNING",
"token_count": 877,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
#### Applying the CJMM to Legal Guidelines
Rachel is a psychiatric nurse working in an inpatient psychiatric unit. She is assigned to care for Walter, a thirtyfive-year-old male with a history of schizophrenia who was admitted involuntarily due to paranoid delusions and aggressive behavior. Walter has a history of no... | {
"Header 1": "LINK TO LEARNING",
"Header 3": "CLINICAL JUDGMENT MEASUREMENT MODEL",
"token_count": 1495,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Psychiatric-Mental_Health_Nursing-WEB.pdf"
} |
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