ATI MENTAL HEALTH
NURSING
,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
)
, 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
)
, 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
)
NURSING
,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
)
, 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
)
, 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
)
