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NURS 3514 Midterm Questions With Complete Solutions About Suicide Correct Answer Tragic and distressing, negative effects on families, friends, and communities Taboo topic, used to be illegal in Canada, highly stigmatized Stimulates fear in others Sometimes difficult to know a person's intentions Reporting practices and judgments differ widely making it difficult to get accurate information Focus of risk assessment & suicide prevention strategies including upstream approaches After a Restraint Has Been Used Correct Answer Debriefing is key
- For the person affected; For the staff; For other patients or visitors if appropriate A chance to reflect, learn and to modify the care plan to prevent recurrence Important in the context of recovery Anxiety Disorders Correct Answer Generalized anxiety disorder Phobias - including social phobia and agoraphobia
Panic disorders Obsessive-compulsive disorder Anxiety Disorders (Theoretical Links) Correct Answer Genetic Predisposition
- Runs in families Biochemistry
- Involves neurotransmitters - serotonin, dopamine, norepinephrine, GABA Environmental Factors/Life Experience
- Early G&D/family environment; trauma/stressful events Bahviouralist Theory
- Anxiety is learned Cognitive Theory
- Anxiety because of irrational beliefs; Persons believe or predict that the result of a specific situation will be embarrassing or harmful Anxiety Medications Correct Answer SSRIs
- Moderate to severe anxiety; Current first line of treatment; Few side effects/safer in overdose Benzodiazepines
- Major side effects: Faster onset than antidepressants; Treat acute panic and anxiety
- short term (prns); This can lead to dependence; Intense
"Anxiety is an emotion characterized by apprehension or dread of a potentially threatening or uncertain outcome. It is triggered by the perception of a threat and is manifested in physical, emotional, cognitive, and/or behavioural ways." Asking About Suicide Correct Answer Express concern as a lead in to asking about suicide
- Many people feel hopeless at times and may consider suicide - have you had any thoughts about suicide? (this type of approach helps to reduce stigma & shame associated with suicide) Gather information
- Are you currently having any thoughts of killing yourself? Do you currently have any desire to kill yourself? Do you have a specific plan to kill yourself? Do you intend to carry out this plan? Explore protective factors/future orientation
- What kept you going in the past when you had suicidal thoughts? What things would lead you to feel more hopeful about the future? Aspects of Stigma Correct Answer Public or social stigma - stereotyping Labelling - "schizophrenic" Avoidance of seeking care Separating "them" from "us"
Stigma by health care professionals Self-stigma Discrimination - employment/housing Cultural variations Research funding Asylum Era: Institutionalization Correct Answer Custodial care Overcrowding - numbers grew (no effective treatment) Patients cut off from society Treatments (eg: hydrotherapy, insulin shock, lobotomy) Occurrences of abuse Confinement - insanity act Behavioural Theories (John Watson; B.F. Skinner) Correct Answer Dispute Freud's claim that a person's destiny was carved in stone at a very early age - behaviourists have no concern with inner conflicts but argue that personality simply consists of learned behaviours Behaviour can be influenced by conditioning
Changing Direction, Changing Lives - Mental Health Strategy Correct Answer Six strategic directions: Promotion & prevention; Recovery & rights; Access to services; Disparities & diversity; First Nations, Inuit & Metis; Leadership & collaboration Client Interview Correct Answer How would you rate your anxiety (scale of 1 to 10)? How long have you been experiencing your current level of anxiety? Are you aware of anything that may have precipitated or triggered your anxiety? What has helped you in the past to deal with your anxiety? What do you perceive would be helpful now to lower your anxiety? Rule out the organic
- Medical conditions; Medication-induced; Stimulant intake Co-occurring disorders
- Psychiatric history; Other mental health diagnoses/mental health problems Psychosocial variables
- Stressors/home situation; Available supports; Cultural consideration Cognitive Behaviour Therapy (CBT) Correct Answer Recognize automatic negative thoughts (catastrophic thoughts) Learn methods to challenge and control the thoughts with realistic & calming thoughts (not positive thinking) Face fears one step at a time through gradual exposure Acceptance of unpredictability of life Cognitive Theories (Aaron Beck; Albert Ellis) Correct Answer Rather than thinking of people as passive recipients of environmental conditioning (psychodynamic + behavioural), cognitive theorists propose that there is a dynamic interplay between individuals and the environment Beck believes we all have schemata or unique assumptions about ourselves, others, and the world around us Cognitive Distortions = automatic thoughts that are irrational and lead to false assumptions and misinterpretations (eg: if a person all experiences in terms of whether they are competent and adequate, thinking may be dominated by the cognitive distortion "unless I do everything perfectly, I'm a failure" Communication Difficulties Correct Answer Inability to communicate effectively
Evidence from Australia, Canada, Japan, New Zealand, the United States and Europe shows that restricting access to these means can help to stop people from committing suicide Components of a Therapeutic Relationship Correct Answer Respect - responsibility to understand the dignity and rights of the clients Empathy - is the expression of understanding, validating and resonating with the meaning that the health care experience holds for the client Trust - necessitates the nurse to act in the client's best interest Power - there is an imbalance of power favouring the nurse Professional Intimacy - client discloses personal information, therapeutic closeness Components of Mental Status Exam Correct Answer General observations
- Appearance, behavior, manner of relating Speech characteristics; Mood and Affect; Thoughts (Content and process); Perception; Sensorium/cognition; Insight; Judgment Crisis Intervention Correct Answer Time-limited 4-6 weeks Goal is to return the individual to at least pre-crisis level of functioning
A threat/opportunity
- Open to new learning A turning point in life Addresses the immediate crisis Nurse's role is active and directive Crisis Intervention - A Crisis is... Correct Answer A state of psychological disequilibrium in response to "an obstacle or problem" Usual resources (coping, supports) are ineffective Acute emotional turmoil
- Anxiety, tension rises Functional impairment Types: Situational (response to an external and unanticipated event), developmental (physical/mental developmental changes trigger internal conflict), adventitious (events not part of everyday life - war, natural disaster, etc...) Defense Mechanisms Correct Answer Acting Out → behaviours related to emotional conflicts such that the conflicts are dealt with through actions rather than reflections or feelings (Example = a child becomes markedly more restless and disruptive in class
(Example = a child is very angry at a parent but accuses the parent of being angry) Rationalization → concealing the true motivations for one's own thoughts, actions, or feelings through the elaboration of reassuring or self-serving but incorrect explanations (Example = a man is rejected by his girlfriend, but he explains to his friends that her leaving was best because she was Defining Attributes of Recovery Correct Answer Experience isolation, hopelessness, & suffering Discovery of the inner self and intrinsic value of life motivated by hope Comes from the individual in an incremental manner according to one's sense of self Perseverance, resilience, and a fighting spirit Capacity for decision-making, personal empowerment, and autonomy Defining Mental Health Correct Answer Mental Health →a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (WHO) The capacity to feel, think, act in ways that enhance our ability to enjoy life and deal with the challenges we face (WRHA)
Adaptability is critical Definition of Recovery Correct Answer Recovery is a process, a way of life, an attitude and a way of approaching the day's challenges. It is not a perfectly linear process. At times our course is erratic, and we falter, slide back and regroup and start again... The need to meet the challenge of disability and to re- establish new and valued sense of integrity and purpose within and beyond the limitations of disability, the aspiration is to live, work and love in a community in which one makes a difference Evidence of recovery and rehabilitation has emerged, with multiple studies over the past 30 years refuting the historical assertion that severely mentally ill people are destined to lives of disability and chaos Deinstitutionalization Correct Answer "Deinstitutionalization"
- shift to community care - 1970s The Vision of Community Mental Health Care - availability and equal access to all levels of mental health prevention, treatment and services would be available to those experiencing mental health problems Development of Crisis Theory Correct Answer 1940s - Erich Lindemann 1960s - Gerald Caplan
than the risks associated with using these practices; To help the patient re-establish behaviour control; Should be used ONLY when ALL OTHER LESS RESTRICTIVE MEASURES have proven ineffective and should be used for the least amount of time possible Form 1 Application for Involuntary Medical Exam Correct Answer Completed by any member of the public under oath in writing before a magistrate Must meet 3 criteria: possible mental disorder, danger to self or others, at risk for mental or physical deterioration Application is considered by the magistrate and if granted a Form 2 is sent to the peace officer for the patient to be detained for an involuntary medical examination Form 13 Voluntary Patient Request for Discharge Correct Answer A voluntary patient who wishes to leave a facility contrary to medical advice must first sign a request for discharge The patient is to be examined within 24 hours - to determine whether the discharge is granted, not granted, or status is changed to involuntary (if warranted) Form 14 AWOL Correct Answer Order for return - patient gone AWOL Whether the patient is voluntary or involuntary police are called to find and return the patient
A voluntary patient must be promptly assessed Form 15 Leave Certificate Correct Answer Leave Certificate or Extension of Leave Meant for: less restrictive treatment in the community Summary: "You have to follow this treatment as an outpatient, if you do not you will be brought back" Form 3 Notice to Person in Custody Correct Answer A form is given to the person by a peace officer to indicate why they are being detained, where they are being taken and why as well as their right to retain counsel Form 4 Psychiatric Assessment Correct Answer Criteria
- Suffering from a mental disorder
- Because of mental disorder likely to cause harm to self or other or suffer substantial mental or physical deterioration
- Is unwilling to go or is not mentally competent to consent Form 6 Involuntary Admission Certificate Correct Answer Involuntary Admission Certificate Signed by a psychiatrist - *NOT SAME PERSON WHO SIGNED FORM 4
Mixed anxiety-depression Affects 2.6% of the population in Canada Goals of Crisis Intervention Correct Answer Resolving immediate problem Regaining emotional equilibrium Return to previous/higher level of functioning Risk alert: suicides can happen impulsively in moments of crisis with a breakdown in the ability to deal with daily stress Guiding Principles of Recovery Correct Answer Coming to terms with the mental illness Restoration of hope
- Clinician's initial emphasis on "hope" and optimism influences recovery Is not linear & takes time Individual's needs, goals, interests, strengths Clinicians/individuals work collaboratively - develop a recovery management plan Recovery involves a holistic approach
Family involvement may enhance recovery Hildegard Peplau Leader - Psychiatric Nursing Correct Answer Introduced change in publishing her nursing theory in Interpersonal Relations for Nursing (1952) - describing the phases of the therapeutic nurse-client relationship Historical Perspectives of Mental Health Care & Mental Illness Correct Answer Evil spirits, demonic possessions, brain disturbances Individuals were killed, left to die, trephined People with mental illness were banished outside the "city walls" Belief that people were affected by the moon Churches sometimes looked after those with mental illness Humanistic Theories (Abraham Maslow; Carl Rogers) Correct Answer Maslow contended that the focus of psychology must go beyond experiences of hate, pain, misery, guilt, and conflict to include love, compassion, happiness, exhilaration, and well- being Interpersonal Theories (Harry Stack Sullivan; Hildegard Peplau) Correct Answer Sullivan defined personality as a behaviour that can be observed within interpersonal relationships
