Ways we respond to deviant behavior:
Want to comfort ourselves: joking around
Might become afraid we also have the disease
A lot of students jump into the counseling centers here on campus
Diagnoses help w:
Labels serve us to feel comfortable and like symptoms are explained. They allow us to make prognoses and treatment plans. Helps w/ research.
No where is stigma more obvious than in mental illness.
The new asylums: a film we get. In march. We’ve come back to the 13th century in how we treat mental illness: we put people in jail b/c they get better treatment than they do in the community.
This is the #1 disability in western countries, but you don’t see a “bonkers fundraising marathon”
How diagnosis works: Axis format w/ a person.
5 routes/axes:
Axis 1: clinical disorder, mental illness groups
Axis 2: personality disorders, mental retardation
Diff btwn these 2: they are more ‘developmental’ apparent in early devel: usually seem to show up in childhood/be inborn. Axis 1 can be more treatable.
Axis 3: medical conditions
Axis 4: psych/soc and environmental. Stressors/events.
Axis 5: GAF: global assessment of functioning: and we mean ADL’s and stuff like Freeman’s clients being “high functioning” The other axes add up to these abilities
This is all subjective, on scale from 0 to 100.
Let’s say we have mild mental retardation. Lives in a group home, has a global function of 45. How are they functioning now?
Example; hypothyroidism, Mild MR, Bipolar 1; GAF last year 45; GAF today 15; Fighting w/ members of group home
So these sort out like this:
A1: Bipolar 1
A2: MMR
A3: Hypothyroid
A4: fighting w/ home
A5: GAF’s
Mental health nursing is a lot about empowering the client. No one gets change from therapy unless they’re into it—need buy in. Asking client to help plan care helps with buy in. Taking decisions away don’t motivate anyone.
You need to synthesize your knowledge. We teach psych early b/c we want people to be ready for hosp patients.
What to believe or not to believe from pts? If someone believes they are being followed by the mafia, its really true for them.
Top priorities:
Safety first. To be committed: danger to self, others or unable to meet basic needs.
Clinical will have outpatient hosp: these pts may be involuntarily committed. To be released from an acute psych setting: you have to do whatever the people there tell you do and they’ll let you go. TO be committed you have to be out of ADL’s not for some organic reason; like organic brain damage.
Health: if someone has aids
Water: sometimes pts get dry mouth from meds and overdrink water
Intrapersonal problems: addiction, impulsivity
Interpersonal problems: fights w/ group home members, prob at home, job, etc.
Anxiety is not allowed: hugging the charts and break rooms will be noticed. Don’t fear conversations, you won’t kill anyone. Notice your feelings, stereotyping, reactions. If you’re really nervous about what you’re going to say, don’t say it and start listening. You don’t have to be on stage. Pts want to be listened to.
What if someone wants to share a secret with you? “I’m glad you trust me and that you want to share, and I won’t be able to hold information from your staff.”
Pts have a right to refuse. They have a right to be angry. And tell you to fuck off. We don’t want to have people get so angry that they damage stuff.
Dwell on strengths, not deficits. Play on their strengths.
ACT: means “assertive community treatment”
RNs do most health management on a psych floor.
In long term care fac. do more education than therapy or med admin.
Nurses
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