NR 326 Exam 1 Active Learning Template

Student Name

Chamberlain University

NR-326: Mental Health Nursing

Prof. Name:

Date

Actions the Nurse Should Take to Prevent Lawsuits

To prevent lawsuits, nurses must follow evidence-based practice guidelines, uphold ethical standards, and thoroughly document all interventions. Clear communication, accurate reporting, and respect for patient autonomy are essential. Legal liability may arise from inappropriate restraint use, failure to obtain informed consent, or breaches of confidentiality.

Ethical Principles

Nursing ethics guide professional behavior and ensure patient-centered care. Key principles include:

Autonomy

Autonomy supports a patient’s right to make informed decisions regarding their healthcare. Respecting autonomy involves obtaining consent, providing full disclosure, and allowing patients to refuse treatment.

Beneficence

This principle emphasizes acting with compassion to promote the patient’s well-being. Nurses must choose interventions that maximize benefits and minimize harm.

Nonmaleficence

Nurses are ethically obligated to avoid causing harm. Every action should aim to improve patient outcomes without inflicting injury or discomfort.

Justice

Justice ensures equitable treatment across all patients regardless of socioeconomic or personal characteristics such as age, race, gender, religion, or insurance status.

Assault and Battery

Assault: A threat or act that causes fear of being touched without consent.
Battery: Actual, unauthorized physical contact without patient consent.

False Imprisonment

This occurs when a person is confined without legal authority or consent, such as when restraining a voluntary patient without justification.

Legal Issues in Psychiatric Nursing

Legal Aspect	Key Considerations
Confidentiality	Information may only be shared with written consent from the client.
Disclosure in Emergencies	Must document date, recipient, reason for disclosure, and why consent was not obtained.
Medical Record	Legal document; must be objective, factual, and comprehensive in detailing care and evaluation.
Duty to Warn	Nurses must inform the care team if a patient poses a danger to themselves or others.

Informed consent is central to respecting patient autonomy. Before treatment:

Patients receive written information explaining procedures.
Risks, benefits, and alternatives are discussed.
Patients or legal guardians sign consent forms.

Consent may be bypassed in emergencies or if the patient lacks mental capacity. Clients maintain the right to revoke consent at any time.

Restraints and Seclusion

Restrictive measures must never be punitive or convenient for staff. Alternatives, such as verbal de-escalation or medication, should be attempted first. If used:

Age Group	Order Renewal Frequency
Adults (18+)	Every 4 hours
Children (9–17 years)	Every 2 hours
Children (<9 years)	Every 1 hour

Orders must be discontinued promptly when no longer needed.

Voluntary and Involuntary Hospitalization

Type of Admission	Key Characteristics
Voluntary Admission	Patient agrees to treatment and may leave unless deemed a threat.
Involuntary Commitment	Initiated if the patient is a danger to self/others or is gravely disabled.
Emergency Commitment	Temporary admission due to immediate risk; a court hearing is held within 72 hours.

Types of Lawsuits in Psychiatric Nursing

Common legal claims include:

Breach of confidentiality: Disclosing personal information without consent.
Defamation of character: Making damaging written (libel) or oral (slander) statements.
Invasion of privacy: Conducting unauthorized searches or accessing personal data.

Phases of the Nurse-Client Relationship

Phase	Description
Preinteraction	Gathering patient data and examining one’s own emotions.
Orientation	Establishing trust, defining the therapeutic contract, and clarifying expectations.
Working	Facilitating behavior change and managing patient resistance.
Termination	Concluding the relationship once goals are met or the patient is discharged.

Roles of the Psychiatric Nurse

Resource Person: Answers patient questions in accessible language.
Teacher: Educates the patient and family about health conditions and treatment.
Leader: Encourages patient participation in care planning.
Counselor: Supports emotional adjustment and coping.

Therapeutic Communication

Effective communication relies on self-awareness and empathy.

Element	Description
Rapport	Built through warmth, trust, and nonjudgmental attitudes.
Trust	Confidence in reliability and sincerity of the nurse.
Empathy	Understanding the patient’s perspective without emotional entanglement.
Sympathy	Sharing in the patient’s emotional experience, which can impair objectivity.
Veracity	Ensuring honesty in all communication.
Manipulation	Patient behavior to avoid separation or elicit specific responses, which must be identified.

Phenothiazines and First-Generation Antipsychotics

Use: Manage schizophrenia and psychotic disorders.
Examples: Phenothiazines, Haloperidol.
Effects: Reduce positive symptoms, may exacerbate negative ones.
Historical Significance: Facilitated deinstitutionalization and enhanced understanding of mental illness.

Stress Response

Systems Involved: Autonomic nervous system (ANS), HPA axis, and sympathetic-adrenal-medullary system.
Presentation: Dilated pupils, increased BP and HR, bladder contraction.
Fight-or-Flight: May be maladaptive in modern society.

Zoloft (Sertraline)

Class: SSRI antidepressant.
Use: Approved for obsessive-compulsive disorder (OCD).
Dosage: 50–100 mg/day; may need higher for OCD.
Side Effects: Insomnia, headache, restlessness.

Conversion Disorder (Somatic Symptom Disorder)

Etiology: Psychological conflict repressed into unconscious.
Symptoms: Aphonia, anosmia, pseudocyesis.
Interventions: Health teaching, emotional expression, and coping strategies.

Anger vs. Aggression

Concept	Description
Anger	Emotional reaction to threat or frustration; often learned.
Aggression	Intentional behavior to harm or intimidate another.

Cognitive Therapy

Purpose: Help clients alter harmful thought patterns.
Indications: Depression, anxiety, OCD, PTSD, eating disorders, schizophrenia.
Effectiveness: Measured by reduced symptoms and improved self-awareness.

Lithium

Class: Mood stabilizer.
Toxicity Signs: Vomiting, diarrhea.
Monitoring: Serum levels (0.6–1.2 mEq/L), checked 12 hours after last dose.
Patient Education: Consistent sodium intake is important.

Voluntary vs. Involuntary Commitment

Commitment Type	Description
Voluntary	Patient consents to admission and treatment.
Involuntary	Legal process when a person is a danger to self/others or gravely disabled.

Types of Amnesia

Type	Description
Localized	Memory loss limited to specific time/event.
Selective	Partial memory loss related to a specific incident.
Generalized	Loss of entire life history and identity.
Retrograde	Loss of pre-event memories.

Guided Imagery

Use: Reduce anxiety and enhance mindfulness.
Techniques: Breathing exercises, visualization, meditation.
Socratic Dialogue: Therapist prompts client to explore underlying thought processes.

Obsessive-Compulsive Disorder (OCD)

Obsessions: Persistent, intrusive thoughts.
Compulsions: Repetitive behaviors to reduce anxiety.
Management: Teach anxiety-reduction strategies such as exercise, deep breathing, and meditation.

Defense Mechanisms

Mechanism	Description
Compensation	Emphasizing strength to cover a weakness.
Rationalization	Justifying behavior with logical excuses.
Denial	Refusing to accept reality.
Reaction Formation	Acting opposite to one’s true feelings.
Displacement	Redirecting emotions to a safer outlet.
Regression	Reverting to earlier developmental stages.
Identification	Emulating admired traits in others.
Intellectualization	Using logic to avoid emotional expression.
Sublimation	Channeling unacceptable urges into acceptable behaviors.
Introjection	Absorbing external beliefs/values as one’s own.
Suppression	Conscious inhibition of thoughts.
Isolation	Detaching emotional content from thoughts.
Undoing	Making amends for perceived wrongdoing.
Projection	Attributing one’s flaws to others.

Electroconvulsive Therapy (ECT)

Indications: Severe depression, treatment-resistant bipolar disorder, schizophrenia.
Procedure: Use of anticholinergics, anesthetics, and muscle relaxants.
Side Effects: Temporary confusion, memory loss, nausea.
Pre-Procedure Care: Encourage hydration, compliance with NPO status, and emotional support.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Publishing.

Townsend, M. C. (2020). Psychiatric mental health nursing: Concepts of care in evidence-based practice (10th ed.). F.A. Davis.