1. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. Chapter 4 Psychiatric Mental Health Nursing in Acute Care Settings

2. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2 Inpatient Psychiatric Care Admissions reserved forAdmissions reserved for –Suicidal –Homicidal or –Extremely disabled in need of short-term acute care

3. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3 Funding Psychiatric Mental Health Care Private pay insurancePrivate pay insurance Managed care plansManaged care plans –Health maintenance organizations (HMOs) –Preferred provider organizations (PPOs) –Managed behavioral health care organizations (MBHOs) MedicaidMedicaid MedicareMedicare

4. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4 Mental Health Funding Legislation Paul Wellstone and Peter Domenici Mental Health and Addiction Equity Act of 2008Paul Wellstone and Peter Domenici Mental Health and Addiction Equity Act of 2008 –Restricts insurance companies from requiring higher co-payments or higher deductibles for mental health or substance abuse

5. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5 Uninsured Patients MedicareMedicare MedicaidMedicaid Social SecuritySocial Security –Social Security Disability Income (SSDI) –Supplemental Security Income (SSI) Veterans AdministrationVeterans Administration

6. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6 Inpatient Psychiatric Care Admission optionsAdmission options –Direct admission –Hospital emergency department Criteria to justify admissionsCriteria to justify admissions –Danger to self or others or unable to care for basic needs Voluntary or involuntaryVoluntary or involuntary

7. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7 Patient Rights Hospitalized patients retain their rights as citizensHospitalized patients retain their rights as citizens Obligation to balance patient's needs for safety with patient's rights as a citizenObligation to balance patient's needs for safety with patient's rights as a citizen Mental health facilities have written statements of patient's rights and applicable state lawsMental health facilities have written statements of patient's rights and applicable state laws

8. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8 Multidisciplinary Treatment Team Meet within 72 hours of patient's admissionMeet within 72 hours of patient's admission Multidisciplinary treatment plan or clinical pathway is guideline for patient’s care during hospital stayMultidisciplinary treatment plan or clinical pathway is guideline for patient’s care during hospital stay

9. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9 Nursing Care Admission assessmentAdmission assessment Ensuring safetyEnsuring safety Physical health assessmentPhysical health assessment Milieu managementMilieu management

10. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10 Nursing Care Continued Structured group activitiesStructured group activities DocumentationDocumentation Medication administrationMedication administration Medication adherenceMedication adherence

11. Elsevier items and derived items © 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11 Nursing Care Continued Pain managementPain management Crisis managementCrisis management –Medical crises –Behavioral crises Preparation for discharge to communityPreparation for discharge to community