11/17/23, 6:38 PM ATI Mental Health
ATI MENTAL HEALTH
CH 2 LEGAL AND ETHICAL ISSUES
180 days is the longest time someone can be under involuntary hold
Seclusion and/or restraints should be ordered for the shortest duration necessary, and only if
less restrictive measures are not sufficient. They are for the physical protection of the client
and/or the protection of other clients and staff.
Restraints can be either physical or chemical.
Seclusion and/or restraint must never be used for:
o Convenience of the staff
o Punishment of the client
o Clients who are extremely physically or mentally unstable
o Clients who cannot tolerate the decreased stimulation of a seclusion room
RN can apply restraints without an order, however:
o A written order must be obtained within 15-30min!!!
o The treatment must be ordered by the PCP in writing
o The order must specify the duration of treatment
o The provider must rewrite the order, specifying the type of restraint, every 24hr or
the frequency of the time specified by the facility policy
Nursing responsibilities must be identified in the protocol, including how often the client
should be:
o Assessed (including for safety and physical needs), and the client’s behavior
documented
Physical restraints require one-on-one observation
o Offered food and fluid
o Toileted
o Monitored for VS
o Complete documentation includes
Precipitating events and behavior of the client prior to seclusion or restraint
Alternative actions taken to avoid seclusion or restraint
The time treatment began
The client’s current behavior, what foods or fluids were offered and taken,
needs provided for, and VS
Medication administration
Tort
o False imprisonment confining a client to a specific area, such as a seclusion
room, is false imprisonment if the reason for such confinement is for the convenience
of the staff.
o Assault making a THREAT to a client’s person, such as approaching the client
in a threatening manner with a syringe in hand, is considered assault.
o Battery touching a client in a harmful or offensive way is considered battery. This
would occur if the nurse threatening the client with a syringe actually grabbed the
client and gave an injection.
Basic Mental Health Nursing Concepts
• Therapeutic Strategies in the Mental Health Setting
Counseling
o Using therapeutic communication skills
o Assisting with problem solving
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,11/17/23, 6:38 PM ATI Mental Health
o Crisis intervention
o Stress management
Milieu therapy
o Orienting the client to the physical setting
o Identifying rules/boundaries of the setting
o Ensuring a safe environment for the patient
o Assisting the patient to participate in appropriate activities
Promotion of self-care activities
o Offering assistance with self-care tasks
o Allowing time for the patient to complete self-care tasks
o Setting incentives to promote client self-care
Psychobiological interventions
o Administering prescribed medications
o Providing teaching for the patient/family about medications
o Monitoring for adverse effects and effectiveness of pharmacological therapy
Cognitive and behavioral therapies
o Modeling
o Operant conditioning
o Systematic desensitization
Health teaching
o Teaching social/coping skills
Health promotion and health maintenance
o Assisting the patient with cessation of smoking
o Monitoring other health conditions
Case management
o Coordinating holistic care to include medical, mental health, and social services
Types of Admission to a Mental Health Facility:
Voluntary admission: client or client’s guardian chooses admission in order to obtain
treatment— has right to apply for release at any time. The pt is also considered competent,
and has the right to refuse medication/treatment
Temporary emergency admission: pt is admitted for emergent mental health care due to the
inability to make decisions regarding care—healthcare provider may initiate the admission
which is then evaluated by mental healthcare provider. Usually does not exceed 15 days.
Involuntary admission: against his/her will for an indefinite period of time. Pt may be risk of
harm to self or others or unable to provide self-care. Usually, 2 physicians are required to
certify that the pt’s condition requires commitment varies from state to state. Limited to 60
days. Are still considered competent and have right to refuse treatment.
Long-term involuntary admission: usually 60-180 days
Legal Rights of Clients in the Mental Health Setting:
Guaranteed the same rights as any other civilian
o Right to humane treatment and care
o Right to vote
o Right to informed consent and right to refuse treatment
o Right to confidentiality
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,11/17/23, 6:38 PM ATI Mental Health
o Right to communication with people outside the mental health facility
CH 3 EFFECTIVE COMMUNICATION
Nonverbal communication
o Nurses should be aware of how they communicate nonverbally. The nurse should
assess the client’s nonverbal communications for the meaning being conveyed,
remembering that culture impacts interpretation. Attention to the following behaviors is
important, as it is compared to the verbal message being conveyed
Appearance
Posture
Gait
Facial expressions
Eye contact
Gestures
Sounds
Personal space
Silence
Therapeutic communication is the PURPOSEFUL use of communication to build and
maintain helping relationships with clients, families, and significant others.
Characteristics of therapeutic communication include:
o Client centered – not social or reciprocal
o Purposeful, planned, and goal-directed
Barriers to effective communication (KNOW THESE; KNOW
THERAPEUTIC COMMUNICATION)
o Asking irrelevant personal questions
o Offering personal opinions
o Giving advice
o Giving false reassurance
o Minimizing feelings
o Changing the topic
o Asking “why” questions
o Offering value judgments
o Excessive questioning
o Disagreeing
o Interpreting
o Introducing an unrelated topic
o Reassuring
o Requesting an explanation
o Rejecting
o Probing
o Using denial
o Responding approvingly or disapprovingly
Effective Communication Skills:
Silence: allows time for meaningful reflection
Active listening
Clarifying techniques
o Restating
o Reflecting
o Paraphrasing
o Exploring
Offering self
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, 11/17/23, 6:38 PM ATI Mental Health
Encouraging expression
Exploring
Formulating a plan of action
Making observations
Presenting reality
Translating into feelings
Touch (if appropriate)
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ATI MENTAL HEALTH
CH 2 LEGAL AND ETHICAL ISSUES
180 days is the longest time someone can be under involuntary hold
Seclusion and/or restraints should be ordered for the shortest duration necessary, and only if
less restrictive measures are not sufficient. They are for the physical protection of the client
and/or the protection of other clients and staff.
Restraints can be either physical or chemical.
Seclusion and/or restraint must never be used for:
o Convenience of the staff
o Punishment of the client
o Clients who are extremely physically or mentally unstable
o Clients who cannot tolerate the decreased stimulation of a seclusion room
RN can apply restraints without an order, however:
o A written order must be obtained within 15-30min!!!
o The treatment must be ordered by the PCP in writing
o The order must specify the duration of treatment
o The provider must rewrite the order, specifying the type of restraint, every 24hr or
the frequency of the time specified by the facility policy
Nursing responsibilities must be identified in the protocol, including how often the client
should be:
o Assessed (including for safety and physical needs), and the client’s behavior
documented
Physical restraints require one-on-one observation
o Offered food and fluid
o Toileted
o Monitored for VS
o Complete documentation includes
Precipitating events and behavior of the client prior to seclusion or restraint
Alternative actions taken to avoid seclusion or restraint
The time treatment began
The client’s current behavior, what foods or fluids were offered and taken,
needs provided for, and VS
Medication administration
Tort
o False imprisonment confining a client to a specific area, such as a seclusion
room, is false imprisonment if the reason for such confinement is for the convenience
of the staff.
o Assault making a THREAT to a client’s person, such as approaching the client
in a threatening manner with a syringe in hand, is considered assault.
o Battery touching a client in a harmful or offensive way is considered battery. This
would occur if the nurse threatening the client with a syringe actually grabbed the
client and gave an injection.
Basic Mental Health Nursing Concepts
• Therapeutic Strategies in the Mental Health Setting
Counseling
o Using therapeutic communication skills
o Assisting with problem solving
about:blank 1/55
,11/17/23, 6:38 PM ATI Mental Health
o Crisis intervention
o Stress management
Milieu therapy
o Orienting the client to the physical setting
o Identifying rules/boundaries of the setting
o Ensuring a safe environment for the patient
o Assisting the patient to participate in appropriate activities
Promotion of self-care activities
o Offering assistance with self-care tasks
o Allowing time for the patient to complete self-care tasks
o Setting incentives to promote client self-care
Psychobiological interventions
o Administering prescribed medications
o Providing teaching for the patient/family about medications
o Monitoring for adverse effects and effectiveness of pharmacological therapy
Cognitive and behavioral therapies
o Modeling
o Operant conditioning
o Systematic desensitization
Health teaching
o Teaching social/coping skills
Health promotion and health maintenance
o Assisting the patient with cessation of smoking
o Monitoring other health conditions
Case management
o Coordinating holistic care to include medical, mental health, and social services
Types of Admission to a Mental Health Facility:
Voluntary admission: client or client’s guardian chooses admission in order to obtain
treatment— has right to apply for release at any time. The pt is also considered competent,
and has the right to refuse medication/treatment
Temporary emergency admission: pt is admitted for emergent mental health care due to the
inability to make decisions regarding care—healthcare provider may initiate the admission
which is then evaluated by mental healthcare provider. Usually does not exceed 15 days.
Involuntary admission: against his/her will for an indefinite period of time. Pt may be risk of
harm to self or others or unable to provide self-care. Usually, 2 physicians are required to
certify that the pt’s condition requires commitment varies from state to state. Limited to 60
days. Are still considered competent and have right to refuse treatment.
Long-term involuntary admission: usually 60-180 days
Legal Rights of Clients in the Mental Health Setting:
Guaranteed the same rights as any other civilian
o Right to humane treatment and care
o Right to vote
o Right to informed consent and right to refuse treatment
o Right to confidentiality
about:blank 2/55
,11/17/23, 6:38 PM ATI Mental Health
o Right to communication with people outside the mental health facility
CH 3 EFFECTIVE COMMUNICATION
Nonverbal communication
o Nurses should be aware of how they communicate nonverbally. The nurse should
assess the client’s nonverbal communications for the meaning being conveyed,
remembering that culture impacts interpretation. Attention to the following behaviors is
important, as it is compared to the verbal message being conveyed
Appearance
Posture
Gait
Facial expressions
Eye contact
Gestures
Sounds
Personal space
Silence
Therapeutic communication is the PURPOSEFUL use of communication to build and
maintain helping relationships with clients, families, and significant others.
Characteristics of therapeutic communication include:
o Client centered – not social or reciprocal
o Purposeful, planned, and goal-directed
Barriers to effective communication (KNOW THESE; KNOW
THERAPEUTIC COMMUNICATION)
o Asking irrelevant personal questions
o Offering personal opinions
o Giving advice
o Giving false reassurance
o Minimizing feelings
o Changing the topic
o Asking “why” questions
o Offering value judgments
o Excessive questioning
o Disagreeing
o Interpreting
o Introducing an unrelated topic
o Reassuring
o Requesting an explanation
o Rejecting
o Probing
o Using denial
o Responding approvingly or disapprovingly
Effective Communication Skills:
Silence: allows time for meaningful reflection
Active listening
Clarifying techniques
o Restating
o Reflecting
o Paraphrasing
o Exploring
Offering self
about:blank 3/55
, 11/17/23, 6:38 PM ATI Mental Health
Encouraging expression
Exploring
Formulating a plan of action
Making observations
Presenting reality
Translating into feelings
Touch (if appropriate)
about:blank 4/55
