Psychiatric
Transcript: Orientation to a psychiatric unit Alyssa Potter Types of Commitment Types of Commitment Voluntary commitment occurs when a patient is willing to seek treatment and agrees to be hospitalized. They have a right to leave the hospital whenever they desire, as long as they do not meet the requirement to be involuntarily committed. Voluntary involuntary Involuntary commitment occurs when a patient is deemed a clear and present danger to themselves or others. This occurs in cases of suicide attempts or threats to the safety of others. The client can be detained for 48 to 72 hours on an emergency basis until a hearing can be had as to whether or not they should be committed. What is a therapeutic relationship? therapeutic relationship A therapeutic relationship is relationship that develops between a nurse and a client. The relationship focuses on the needs of the client only. The purpose is to create a safe and nourishing environment for the client to grow and heal. use nurse-client contracts A nurse-client contract is typically verbal and informal, but can sometimes be written. It includes the time, place, and length of sessions. It also includes who will be involved and what their responsibilities will be. #1 maintain confidentiality #2 The nurse must maintain patient confidentiality to keep the patient's trust. The nurse needs to respect the patient's right to keep their mental and physical health and related care confidential. The only exception to this is if a patient is harming themselves or others, threatens to, or is experiencing abuse that needs to be reported. use therapeutic communication techniques #3 The nurse should use therapeutic communication with the client in order to help the client work through what they are experiencing. This also helps maintain professionalism and avoid patient dependency. What is the Bill of Rights? Bill of rights The bill of rights is a list of rights that is there to protect them patients. It affords them their civil rights. The American Psychological Association (APA) developed principles and most treatment centers and states have their own bill of rights. least restrictive environment to meet needs The client's right to the least restrictive environment means that if a patient is eligible to be treated in a group home or outpatient setting than they should not be hospitalized. It also means that client should not be restrained or secluded unless absolutely necessary. confidentiality Patient's with mental health and substance abuse conditions have a right to confidentiality under the Health Insurance Portability and Accountability Act (HIPPA) just as any other patient does. nondiscrimination Patients in a psychiatric facility have a right to not be discriminated against for their race, gender identity, sexual orientation, religion, or any other such characteristic just like any other patient or person. Common admitting diagnoses diagnoses Schizophrenia Schizophrenia is a syndrome or disease process made up of many different symptoms. It causes patients to have distorted thinking and behavior. Symptoms are categorized as either hard/positive symptoms or soft/negative symptoms. hard symptoms ambivalence associative looseness delusions echopraxia flight of ideas hallucinations idea of reference perseveration bizarre behavior soft symptoms Alogia anhedonia apathy asociality blunted affect catatonia flat effect avolition inattention Schizoaffective disorder Schizoaffective disorder is diagnosed in clients who are severely ill and have both psychotic and mood symptoms. Symptoms may be simultaneous or alternating. Bipolar disorder Bipolar disorder is a mood disorder characterized by extremes of mood, whether mania, hypomania, or a depressive episode. Mania is characterized by an extreme elevation in mood that prevents a person from functioning. mania hypomania Hypomania is characterized by the same elevation in mood as mania but allows a patient to function. depressive episode In bipolar disorder, depressive episodes last two weeks or more and consist of depressed mood and loss of pleasure with associated symptoms and a significant impairment in functioning. In major depressive disorder clients have symptoms that last at least 2 weeks and impair functioning in multiple areas of life. Symptoms include but are not limited to: changes in eating habits changes in sleeping habits exhaustion feelings of hopelessness, guilt, worthlessness, and more. inability to cope with daily life major depressive disorder psychosis Psychosis is not a disease or syndrome itself but is a collection of positive symptoms of schizophrenia such as delusions, hallucinations, and disordered thinking. It may also be caused by other disorders or factors. Common Safety measures & rationales Safety Measures Engagement #1 Nurses need to engage and de-escalate patients who are agitated. This helps reduce the need for use of seclusion and restraints. Space and Equipment #2 Psychiatric units should be safe and Safe
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