{"id":4666,"date":"2019-01-09T17:59:21","date_gmt":"2019-01-09T22:59:21","guid":{"rendered":"https:\/\/www.amyork.ca\/academic\/zz\/?p=4666"},"modified":"2019-05-25T22:40:10","modified_gmt":"2019-05-26T02:40:10","slug":"models-of-care-for-patients","status":"publish","type":"post","link":"https:\/\/www.amyork.ca\/academic\/zz\/mental-health-nursing\/models-of-care-for-patients\/","title":{"rendered":"Models of care for Patients"},"content":{"rendered":"

Mental illness- <\/strong><\/p>\n

\n
A health problem that affects how a person feels\/thinks\/behaves or interacts with other people<\/li>\n
Its diagnosed according to standardised criteria<\/li>\n<\/ul>\n
<\/p>\n
Mental health-\u00a0 <\/strong><\/p>\n
\n
\u201cA state of complete physical, mental and social well-being, and not merely the absence of disease\u201d<\/li>\n<\/ul>\n
\u00a0<\/strong><\/p>\n
Models of care-<\/h2>\n
\u2212 A model of healthcare is a system that\u2019s been formally developed to organise\/guide the way which health professionals deliver healthcare within a particular setting<\/p>\n
<\/p>\n
Influences of a medical model include: <\/strong><\/p>\n
\n
Frameworks for diagnosis<\/li>\n
Treatment decisions<\/li>\n
Illness\/disease driven model<\/li>\n
Clinical leadership<\/li>\n
Focus for pharmacological research<\/li>\n<\/ul>\n
<\/p>\n
Current perspectives-<\/h2>\n
Recovery principles: <\/strong><\/p>\n
\n
Being able to live a meaningful life in a community with or without the presence of mental health issues\n
\n
Real choices \u00d8 Shows dignity and respect<\/li>\n
Aware of attitudes and right \u00d8 Partnership and communication<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
<\/p>\n
Consumer lived experience: <\/strong><\/p>\n
\n
Individuals who define their own experiences in recovering from a mental health disease<\/li>\n
Recovery cant be \u201cdone\u201d to\/for someone with a mental health disease by a health professional<\/li>\n
Reshaping of one\u2019s personal identity through a holistic sense of self that includes psychiatric disability<\/li>\n<\/ul>\n
<\/p>\n
Family and carer lived experience: <\/strong><\/p>\n
\n
Understanding a lived experience through a person who has lived through the same\/similar experience \u00a0 A person who hasn\u2019t had the experience cant know what it \u2018feels like\u2019<\/li>\n<\/ul>\n
<\/p>\n
<\/p>\n
<\/p>\n
Recovery-<\/h2>\n
Traditional concepts of mental illness- <\/strong><\/p>\n
\n
Degenerative, life long and permanently disabling<\/li>\n
Medication is the focus of recovery<\/li>\n
A diagnosis of mental illness doesn\u2019t link to successful, independent living<\/li>\n
Individuals are compliant recipients of care Contemporary concepts of mental illness-\u00a0 <\/strong>\u00a0 Recovery isn\u2019t a straightforward process \u00a0<\/strong><\/li>\n
Treatment in the community is best-practice (a method that\u2019s accepted due to results)<\/li>\n
Practitioners recognize the need of balance b\/w reducing symptoms with acceptable medication regimes<\/em><\/li>\n
Inability to return to premorbid levels of functioning doesn\u2019t conclude failure<\/li>\n<\/ul>\n
\u00a0<\/strong><\/p>\n
<\/p>\n
Working within a recovery framework- <\/strong><\/p>\n
\n
Providing a culture of hope<\/li>\n
Promoting independence & self-motivation<\/li>\n
Focus on strengths<\/li>\n
Holistic and personalised care<\/li>\n
Involvement of family, carers, support people and significant others<\/li>\n
Community participation<\/li>\n
Awareness to diversity<\/li>\n
Reflection & learning<\/li>\n<\/ul>\n
<\/p>\n
Recovery works when health professionals\u2026 <\/strong><\/p>\n
\n
Align people with the right help at the right time<\/li>\n
Refrain from judgement<\/li>\n
Adopt a holistic approach<\/li>\n
Treat individuals with respect, dignity & equity<\/li>\n
Protect rights<\/li>\n
Provide support when necessary<\/li>\n
rncourage consumer to use services\/support and how to access them<\/li>\n<\/ul>\n
<\/p>\n
Principles of Recovery Model of Practice- <\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\u2022<\/p>\n
\u2022<\/p>\n
\u00a0<\/strong><\/td>\n
Uniqueness of the<\/p>\n
individual \u00a0<\/strong>Real choices \u00a0<\/strong><\/p>\n
\u00a0<\/strong><\/td>\n
\u2022\u00a0 Attitudes and rights \u00a0<\/strong>\u2022\u00a0 Dignity and rights \u00a0<\/strong><\/td>\n \u2022<\/p>\n
\u2022<\/td>\n
Partnership and communication \u00a0<\/strong>rvaluating recovery<\/td>\n<\/tr>\n
\u2022<\/td>\n Promote recovery-<\/td>\n hope, power, purpose, connection<\/td>\n <\/td>\n <\/td>\n<\/tr>\n
\u2022<\/td>\n Strength based-<\/td>\n focus on individuals strengths<\/td>\n <\/td>\n <\/td>\n<\/tr>\n
\u2022<\/td>\n Community focused-<\/td>\n occurs in community context<\/td>\n <\/td>\n <\/td>\n<\/tr>\n
\u2022<\/td>\n Person driven-<\/td>\n self determination<\/td>\n <\/td>\n <\/td>\n<\/tr>\n
\u2022<\/td>\n Culturally responsive-<\/td>\n sensitive to social and cultural needs<\/td>\n <\/td>\n <\/td>\n<\/tr>\n
\u2022<\/td>\n Reciprocity in relationships-<\/td>\n allows for enhanced sense of value<\/td>\n <\/td>\n <\/td>\n<\/tr>\n
\u2022<\/td>\n Grounded in life context-<\/td>\n appreciate the individuals life story\/sense of self<\/td>\n <\/td>\n<\/tr>\n
\u2022<\/td>\n Socioeconomic status-<\/td>\n identify barriers i.e. poverty, housing etc<\/td>\n <\/td>\n<\/tr>\n
\u2022<\/td>\n Relationally mediated-<\/td>\n relationships are central<\/td>\n <\/td>\n<\/tr>\n
\u2022<\/td>\n Optimises natural support-<\/td>\n connections and support<\/td>\n <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
<\/p>\n
<\/p>\n
Stigma, stereotyping and discrimination-<\/h2>\n
Stereotypes<\/strong> are fixed beliefs about particular people or things<\/p>\n
Discrimination <\/strong>is an unjust treatment of a group of people- but also understanding of differences<\/p>\n
Stigma <\/strong>is a sign of disgrace- associated with a particular circumstance, quality or people<\/p>\n
<\/p>\n
\u2212 Language often feeds directly into stigma<\/p>\n
\u2212 Language is powerful<\/p>\n
\u2212 Language effects others\u2019 perceptions of the issue<\/p>\n
<\/p>\n
<\/p>\n
Contributing factors to Mental Health & Wellbeing-<\/h2>\n
<\/p>\n
Mental Health Determinants:<\/u><\/strong><\/p>\n
\n
Individual attributes and behaviours<\/li>\n
Social & economic circumstances<\/li>\n
rnvironmental factors<\/li>\n<\/ol>\n
\u00a0<\/strong><\/p>\n
Therapeutic relationship-<\/h2>\n
\u2212 When a patient feels comfortable being open and honest with the nurse linking to a positive outcome<\/p>\n
<\/p>\n
\u2212 rssential elements to therapeutic relationships:<\/p>\n
\n
Empathy-<\/strong> recognising the emotional perspective of another person<\/li>\n
Unconditional positive regard-<\/strong> relating and accepting the client with genuine care<\/li>\n
Genuineness- <\/strong>honest attitude towards a person<\/li>\n
Therapeutic use of self <\/strong><\/li>\n<\/ul>\n
<\/p>\n
<\/p>\n
Mental State rxam (MSr)-<\/h2>\n
\u2212 An interview between a mental health professional and a patient\u00a0 \u2212 Gathers information in areas of:<\/p>\n
\n
Appearance<\/li>\n
Speech & intelligence<\/li>\n
Motor activity<\/li>\n
Behaviour\/mood<\/li>\n
Alertness\/cognition<\/li>\n
Thoughts<\/li>\n<\/ul>\n
\u2212 Supports the process for clinical decision making<\/p>\n
\u2212 Helps to plan appropriate interventions<\/p>\n
\u2212 Gathers a baseline of data regarding the individual\u00a0 <\/a><\/p>\n
Initial information: <\/strong><\/p>\n
\n
Identify person (preferred name etc), age & DOB<\/li>\n
Present address, phone number<\/li>\n
Language spoken- do they need an interpreter?<\/li>\n
Name of GP\/Psychiatrist<\/li>\n
Next of kin (emergency contact)<\/li>\n
Serology- (TFT, LFT, U&r, CBC, Urinalysis)<\/li>\n
Baseline assessments (temp, respiratory rate, pulse, BP)<\/li>\n
CT scan? (undiagnosed\/unsuspected brain tumour, infection?)<\/li>\n<\/ul>\n
<\/p>\n
Gathering information: <\/strong><\/p>\n
\n
Presenting data- negative\/positive life events<\/li>\n
Socioeconomic status<\/li>\n
Sexual history (could some particular medications affect their libido?)<\/li>\n
Alcohol & drug history<\/li>\n
Medical history<\/li>\n
Psychiatric history<\/li>\n
Family history<\/li>\n
Forensic history<\/li>\n
Values, spirituality, religious<\/li>\n<\/ul>\n
\u00a0<\/strong><\/p>\n
General appearance: <\/strong><\/p>\n
Our first appearance of the client:<\/p>\n
\u2212 Grooming (state of clothing, cleanly dressed)<\/p>\n
\u2212 Weight<\/p>\n
\u2212 Clothing (appropriateness?)<\/p>\n
\u2212 Posture<\/p>\n
\u2212 Malodorous (is there a smell?)<\/p>\n
\u2212 Age (do they appear older\/younger then they state?)<\/p>\n
\u2212 Tattoos, nose rings etc<\/p>\n
\u2212 Glasses, hearing aids etc<\/p>\n
<\/p>\n
Observations, Psychomotor Activity & Attitude\u00a0 <\/strong><\/p>\n
\n
Observe clients behaviour and their degree of arousal<\/li>\n
Type & amount of movement- mannerisms and gestures (tics, grimacing, tremors)<\/li>\n
Hostility, anger, agitation- verbal or physical abuse<\/li>\n
Psychomotor retardation (no movement, no eye contact)<\/li>\n
Social skills- positive or unpleasant habits (shy, withdrawn, overfamiliar etc)<\/li>\n
rvidence of bizarre behaviours<\/li>\n
Degree of cooperation with interview<\/li>\n<\/ul>\n
<\/p>\n
Mood\u00a0 <\/strong><\/p>\n
\n
Mood is an internal state of mind that is shown through feelings\/emotions \u00a0 Subjective data \u00e0 what does the client tell you?<\/li>\n
Is what they tell you congruent? (Stating their upset\/angry but displaying a big smile)- information stated doesn\u2019t match their exterior<\/li>\n
Mood states can be desired as elevated, depressed, anxious, labile, suspicious, euphoric, irritable, euthymic <\/strong><\/li>\n
Ask the client to rate their mood (1-10)<\/li>\n
Moods can fluctuate (labile mood)<\/li>\n
Consider the duration of the mood<\/li>\n<\/ul>\n
<\/p>\n
\n
Appetite<\/strong> can affect mood – increased\/decreased<\/li>\n
Sleep<\/strong> can affect mood – insomnia, hypersomnia, quality of sleep, use of sedatives, do they wake? Why?<\/li>\n
Libido<\/strong> affects mood \u2013 increased (mania) \/decreased (depression) in some instances?<\/li>\n<\/ul>\n
Affect\u00a0 <\/strong><\/p>\n
\n
Its an observable, objective and visual response to a mood<\/li>\n
Affect is an emotional range<\/li>\n
Affect can be described in terms such as:<\/li>\n<\/ul>\n
\u2212 Appropriate affect<\/p>\n
\u2212 Restricted affect<\/p>\n
\u2212 Blunted affect<\/p>\n
\u2212 Flat affect<\/p>\n
\u2212 Inappropriate affect (i.e. laughing at a death)<\/p>\n
\u2212 Labile affect (i.e. changing moods)<\/p>\n
<\/p>\n
Speech\u00a0 <\/strong><\/p>\n
\n
Speech patterns described as rate of production, quantity, quality and volume<\/li>\n
Rapid, slow, pressured, hesitant, emotional, talkative, loud, dramatic, whispered, slurred, mumbled, spontaneous<\/li>\n
Common terms:<\/u> pressured speech, poverty speech, disorganised speech, latency of speech (pauses)<\/li>\n<\/ul>\n
<\/p>\n
<\/p>\n
Quality of speech-<\/h3>\n\n\n\n\n\n\n\n\n\n\n\n
\u2022<\/td>\n Poverty of speech=<\/td>\n uses few words<\/td>\n<\/tr>\n
\u2022<\/td>\n Poverty of content=<\/td>\n lack of substance in conversation<\/td>\n<\/tr>\n
\u2022<\/td>\n Voluminous=<\/td>\n uses too many words<\/td>\n<\/tr>\n
\u2022<\/td>\n Articulate=<\/td>\n well spoken<\/td>\n<\/tr>\n
\u2022<\/td>\n Congruent=<\/td>\n content makes sense\/easily understood\/relevant<\/td>\n<\/tr>\n
\u2022<\/td>\n Monotonous=<\/td>\n monotone<\/td>\n<\/tr>\n
\u2022<\/td>\n Spontaneous=<\/td>\n conversation flows, without prompting<\/td>\n<\/tr>\n
\u2022<\/td>\n Confabulation=<\/td>\n unconscious placement of fact with false experiences<\/td>\n<\/tr>\n
\u2022<\/td>\n Disorganised=<\/td>\n speech is unstructured (lose track of what they\u2019re saying)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
<\/p>\n
Perception\u00a0 <\/strong><\/p>\n
\n
Looking at hallucinations and illusions<\/li>\n<\/ul>\n
<\/p>\n
\n
Hallucinations <\/strong><\/li>\n<\/ul>\n
\u2212 A false sensory perception of things that aren\u2019t really there\u00a0 \u00a0<\/strong><\/p>\n
\u2212 Hallucinations involves senses<\/u>:<\/p>\n
\n
Auditory (hear)<\/li>\n
Gustatory (taste)<\/li>\n
Visual<\/li>\n
Olfactory (smell)<\/li>\n
Tactile (touch)<\/li>\n
Somatic (beliefs that something is physically wrong with you) Kinaesthetic (movement) \u00a0<\/strong><\/li>\n<\/ul>\n
\u00a0<\/strong><\/p>\n
\u2212 Don\u2019t engage in an argument about voices<\/p>\n
\u2212 Use distraction techniques (listening to music, taking a walk)<\/p>\n
\u00a0<\/strong><\/p>\n
\n
Illusions <\/strong><\/li>\n<\/ul>\n
\u2212 A misinterpretation of a real stimuli \u00a0<\/strong><\/p>\n
\u2212 Occurs in alcohol withdrawal \u00a0<\/strong><\/p>\n
\u00a0<\/strong><\/p>\n
\n
Depersonalisation <\/strong><\/li>\n<\/ul>\n
\u2212 A feeling that you\u2019re not \u201cyourself:<\/p>\n
<\/p>\n
\n
Derealisation <\/strong><\/li>\n<\/ul>\n
\u2212 Unreality\/detachment to surroundings<\/p>\n
Delusions- thought content <\/strong><\/p>\n
\n
Fixed false beliefs<\/li>\n
Delusions are accepted without question, regardless of reality<\/li>\n
Delusions of control:<\/li>\n<\/ul>\n
\u2212 Thought withdrawal<\/p>\n
\u2212 Thought insertion<\/p>\n
\u2212 Thought broadcasting\u00a0 \u2212 Thought control<\/p>\n
<\/p>\n
Formal thought disorder\u00a0 <\/strong><\/p>\n
\n
Describes the way thoughts are connected & expressed<\/li>\n<\/ul>\n
<\/p>\n
Loosening of associations <\/strong><\/p>\n
\u2212 Poor progression of thoughts, ideas change rapidly<\/p>\n
\u2212 Unrelated\/unconnected ideas from one topic to another<\/p>\n
<\/p>\n
Flight of ideas <\/strong><\/p>\n
\u2212 Continued flow of accelerated speech which changes abruptly<\/p>\n
\u2212 Rapid thinking in its extreme<\/p>\n
<\/p>\n
Tangentiality<\/strong><\/p>\n
\u2212 Indirect replies to questions in an irrelevant way<\/p>\n
<\/p>\n
Circumstantiality <\/strong><\/p>\n
\u2212 A delay in reaching to the goal due to irrelevant details<\/p>\n
<\/p>\n
Word salad <\/strong><\/p>\n
\u2212 A jumbled mixture of words<\/p>\n
<\/p>\n
Neologisms\u00a0 <\/strong><\/p>\n
\u2212 A new creation of a word<\/p>\n
<\/p>\n
Clanging\/clang association\u00a0 <\/strong><\/p>\n
\u2212 Words chosen for their sound, not meaning (rhyming)<\/p>\n
<\/p>\n
Punning\u00a0 <\/strong><\/p>\n
\u2212 Plays on words that are clever\/humorous<\/p>\n
<\/p>\n
Thought blocking\u00a0 <\/strong><\/p>\n
\u2212 Abrupt gaps in the flow of thought<\/p>\n
<\/p>\n
Echolalia\u00a0 <\/strong><\/p>\n
\u2212 Imitating words of others (mocking a person)<\/p>\n
<\/p>\n
Sensorium & cognition<\/h2>\n
\n
Organic brain functioning and IQ<\/li>\n
Insight <\/strong><\/li>\n<\/ul>\n
\u2212 Ability to understand the reasons for & meanings of behaviour\/feelings<\/p>\n
\n
Judgement <\/strong><\/li>\n<\/ul>\n
\u2212 Ability to understand consequences of actions<\/p>\n
\n
Cognition <\/strong><\/li>\n<\/ul>\n
\u2212 Issues with consciousness usually involve organic brain impatient<\/p>\n
\u2212 Memory (remote, recent-past, recent & immediate)<\/p>\n
\u2212 Concentration<\/p>\n
\n
Abstract & concrete thinking <\/strong><\/li>\n<\/ul>\n
ACRONYMS– <\/strong><\/h2>\n
\u00a0\u00a0 <\/strong><\/p>\n\n\n\n
PAMS GOT JIMI <\/strong><\/p>\n
P<\/strong>erception<\/p>\n
A<\/strong>ffect<\/p>\n
M<\/strong>ood & Memory<\/p>\n
S<\/strong>peech<\/p>\n
G<\/strong>eneral Appearance<\/p>\n
O<\/strong>rientation<\/p>\n
T<\/strong>hought<\/p>\n
J<\/strong>udgement<\/p>\n
I<\/strong>nsight<\/p>\n
M<\/strong>emory<\/p>\n
I<\/strong>ntelligence<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/td>\n
BATOMI-PJR <\/strong><\/p>\n
B<\/strong>ehaviour & appearance<\/p>\n
A<\/strong>ffect<\/p>\n
T<\/strong>hought form & content<\/p>\n
O<\/strong>rientation<\/p>\n
M<\/strong>ood<\/p>\n
I<\/strong>nsight<\/p>\n
P<\/strong>erception<\/p>\n
J<\/strong>udgement<\/p>\n
R<\/strong>isk<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/p>\n
<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"
Mental illness- A health problem that affects how a person feels\/thinks\/behaves or interacts with other people Its diagnosed according to standardised criteria Mental health-\u00a0 \u201cA state of complete… Continue Reading Models of care for Patients<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[121],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4666"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4666"}],"version-history":[{"count":1,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4666\/revisions"}],"predecessor-version":[{"id":4789,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4666\/revisions\/4789"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4666"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4666"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4666"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}