Glossary of Terms

Aboriginal people

Section 35(2) of Canada’s Constitution Act, 1982, defines “Aboriginal people” as Indian (First Nations), Inuit, and Métis people (Government of Canada, 1982).

Acute Stress Reactions

A psychological condition that involves a rapid response to an abrupt, single, easily identified stressor and often responds positively to some form of intervention. For example, a person may experience acute stress in response to a negative situation such as an unexpected bereavement, conflict in the workplace or commencing a new position (Bergerman, Corabian, & Harstall, 2009; Kendall, Murphy, O’Neill & Bursnall, 2000).

Addiction

“Used as an umbrella term inclusive of substance misuse, substance abuse, substance dependence, and process addictions such as gambling” (Kent-Wilkinson et al., 2015, p. 21).

Advocacy

“Advocacy” is defined as verbal support or argument for a cause or policy. Simply put, it is telling your story to a decision maker, through various means, in order to compel that person to do something. Most commonly, advocacy is directed towards government and decision makers. In the area of mental health, individuals and organizations advocate for a wide variety of reasons, including improved access to services and improved benefits and supports for people with mental illness. A successful advocacy effort can take some time to produce results. But each time you speak on behalf of your chosen issue, you raise awareness and build support (Schizophrenia Society of Canada, 2016).

Burnout

Describes a state of being that is characterized by emotional exhaustion, depersonalization, and a reduced feeling of personal accomplishment. Burnout develops as a result of general occupational stress (National Child Traumatic Stress Network, 2016).

Clinical Supervision

The development of clinical learning within a practice setting between an experienced supervisor and a beginner or novice supervisee. “Supervision occurs in conjunction with working with patients and varies according to the supervisor, the workload of the unit and the atmosphere of the setting” (Haggman et al., 2007, p. 382).

Community Treatment Orders (CTO)

A community treatment order (CTO), a form of mandatory outpatient treatment MOT, is an order to provide a comprehensive plan of community-based treatment to someone with a serious mental disorder. CTOs are only issued for persons with severe mental illness and with a history of hospitalization who have been examined by a physician and been deemed in need of continuing treatment and care while residing in the community (Canadian Mental Health Association [CMHA], 2013). See Resources in Section 6.1. CTOs are less restrictive than being detained in a psychiatric facility and serve as an alternative to hospitalization (CMHA, 2013).

Collaborative Practice

“In health care, occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings. Practice includes both clinical and nonclinical health-related work, such as diagnosis, treatment, surveillance, health communications and management” (World Health Organization, 2010, as cited in Registered Psychiatric Nurse Regulators of Canada [RPNRC], 2014, p. 24).

Competencies

“Competencies are complex know-acts based on combining and mobilizing internal resources (knowledge, skills, attitudes) and external resources and applying them appropriately to specific types of situations” (Tardif, 2006).

Crisis

An emotional upset, arising from situational, developmental, biological, psychological, socio-cultural, and/or spiritual factors. This state of emotional distress results in a temporary inability to cope by means of one’s usual resources and coping mechanisms. Unless the stressors that precipitated the crisis are alleviated and/or the coping mechanisms are bolstered, major disorganization may result. It is recognized that a crisis state is subjective and as such may be defined by the client, the family or other members of the community (Hoff, 1995; Ontario Ministry of Health and Long-Term Care, 1999ab; RNAO, 2006).

Crisis Intervention

A process that focuses on resolution of the immediate problem through the use of personal, social and environmental resources (Hoff, 1995). The goals of crisis intervention are rapid resolution of the crisis to prevent further deterioration, to achieve at least a pre-crisis level of functioning, to promote growth and effective problem solving, and to recognize danger signs to prevent negative outcomes (Hoff, 1995; RNAO 2006).

Critical Reflection

Critical Reflection involves looking back on experience(s) so as to learn from them and gain new or deeper understanding about practice development and/or develop alternative ways of acting when leading and/or facilitating practice development or related activities. It is also about connecting personal learning and ways of knowing with other types of learning and knowledge knowledge (Foundation of Nursing Studies [FoNS], 2013).

Culture

“Culture is commonly understood as learned traditions and unconscious rules of engagement that people use to interpret experience and to generate social behaviour” (Srivastava, 2007, p. 324). Canada’s mental health strategy has emphatically asserted that in service and treatment of mental health, culture counts (Mental Health Commission of Canada [MHCC], 2012).

Cultural Competence

Cultural competence is the application of knowledge, skills, attitudes, and personal attributes required by nurses to maximize respectful relationships with diverse populations of patients (patients may be individuals, families, groups, or populations) and co-workers. “Underlying values for cultural competence are inclusivity, respect, valuing differences, equity and commitment” (CNA, 2010; RNAO, 2007, p. 19). Cultural competence is considered an entry-to-practice competence that is evident in quality practice environments and improves health outcomes (CNA, 2010). Cultural competence is an ongoing process and requires continuous skill development, self-evaluation, and growing knowledge about different cultural groups (Kersey-Matusiak, 2012, p. 34).

Cultural Safety

Cultural competence and cultural safety are prerequisites for working effectively in global health (CNA, 2010). Cultural safety is both a process and an outcome whose goal is greater equity. It focuses on root causes of “power imbalances and inequitable social relationships in health care” (Aboriginal Nurses Association et al., 2009; Kirkham & Browne, 2006, as cited in Browne et al., 2009, p. 168).

Family

A term used to refer to individuals who are related (biologically, emotionally, or legally) to and/or have close bonds (friendships, commitments, shared households and child rearing responsibilities, and romantic attachments) with the person receiving health care. A person’s family includes all those whom the person identifies as significant in his or her life (e.g., parents, caregivers, friends, substitute decision-makers, groups, communities, and populations) (RNAO, 2015). The person receiving care determines the importance and level of involvement of any of these individuals in their care based on his or her capacity (Saskatchewan Ministry of Health, 2011).

Harm Reduction

“‘Harm Reduction’ refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community” (International Harm Reduction Association, 2010, p. 1).

Human Rights

In accordance with the objectives of the UN Charter and international agreements, a fundamental basis for mental health legislation is human rights. Key rights and principles include equality and nondiscrimination, the right to privacy and individual autonomy, freedom from inhuman and degrading treatment, the principle of the least restrictive environment, and the rights to information and participation (Kent-Wilkinson, 2015, p. 36; UN, 1991).

Mandatory Outpatient Treatment (MOT)

Mandatory outpatient treatment (MOT) involves legal provisions requiring people with a mental illness to comply with a treatment plan while living in the community (O’Reilly et al., 2003).

Mental Disorder

“A health condition characterized by alterations in several factors that include mood, affect, behaviours, thinking and cognition. The disorders are associated with various degrees of distress and impaired functioning” (Austin & Boyd, 2009, as cited in CFMHN, 2014, p. 13).

Mental Health

A term used to mean all diagnosable mental disorders (Austin and Boyd, 2010).

Mental Illness

“Characterized by alterations in thinking, mood or behaviour—or some combination thereof— associated with significant distress and impaired functioning. The symptoms of mental illness vary from mild to severe, depending on the type of mental illness, the individual, the family and the socio-economic environment. Mental illnesses take many forms, including mood disorders, schizophrenia, anxiety disorders, personality disorders, eating disorders and addictions such as substance dependence and gambling” (PHAC, 2006, para 2).

Mental Health Act

A Mental Health Act is a law that gives certain powers and sets the conditions (including time limits) for those powers, to stipulated health-care professionals and designated institutions regarding the admission and treatment of individuals with a mental disorder. It also provides a framework for mental health delivery of services and establishes rules and procedures that govern the commitment of persons suffering from mental disorders (Government of Saskatchewan, 2013).

Mental Health Legislation

The fundamental aim of mental health legislation is to protect, promote, and improve the lives and mental well-being of citizens (WHO, 2005).

Mentoring

The act of engaging in mentorship. Mentoring is less formal than preceptoring and involves a longer-term professional relationship between a novice nurse or nursing student and a more experienced nurse. Mentoring tends to be less formally instructional and more encouraging of positively influencing those with less experience through role modeling and guidance (CNA, 2004).

Not Criminally Responsible due to a Mental Disorder (NCRMD)

Separate from mental health legislation are the legal provisions that can require people to follow treatment as a condition of probation. The law allows for persons to be found Not Criminally Responsible due to a Mental Disorder for an offence if they are suffering from a mental disorder that makes them incapable of appreciating the nature of the act or knowing that what they did was wrong. In these cases, the mentally ill offender needs to comply with treatment monitored by the Criminal Code Review Boards (Kent-Wilkinson, 2015).

Occupational Stress

An individual’s physiological and psychosocial response to work stress that can result in harm psychologically, emotionally and physically. Depending on professional, personal and workplace factors, occupational stress often influences an individual’s capacity to cope with workplace situations and function at their professional and personal capacities (WHO, 2016; Bergerman, Corabian, & Harstall, 2009).

Post Traumatic Stress Disorder

Develops as a delayed and/or deferred response to an acute stressful event or situation (either short- or long-lasting). This event usually has a particularly threatening or catastrophic nature, with the potential to cause pervasive distress in almost anyone (Nowrouzi et al., 2015).

Preceptor

An experienced nurse who provides individual guidance to a student (Bourbonnais & Kerr, 2007). A “frequently employed teaching and learning method using nurses as clinical role models. It is a formal, one-to-one relationship of pre-determined length, between an experienced nurse (preceptor) and a novice (student/preceptee) designed to assist the novice in successfully adjusting to and performing a new role” (CNA, 2004, p. 13).

Recovery

“Recovery involves a process of growth and transformation as the person moves beyond the acute distress often associated with a mental health problem or illness and develops new-found strengths and new ways of being” (MHCC, 2009; RNAO, 2015).

Recovery-Oriented Practice

A recovery-oriented approach is “inclusive, participatory, and seek involvement of patients, families, and staff to advance mental health and well-being” (MHCC, 2015). Unlike other models of care, which often involve symptom alleviation and clinical recovery, recovery-oriented health care seeks to understand the unique lived experiences of patients and families, and to personalize the recovery process (Allott & Loganathan, 2002).

Reflective Practice

Reflective practice is the process of examining ones actions and experiences for the purpose of developing one’s practice and clinical knowledge with the outcome of acquiring a new understanding and appreciation of the situation (Boud, Keogh, & Walker, 1985; Caldwell, 2013).

Role Modeling

The process of an experienced nurse demonstrating skills and behaviours to beginner or novice nursing students. Role modeling is more than simply imitation of behavior; it requires repetition, reinforcement, and reward in the form of feedback (Donaldson & Carter, 2005).

Self-care

Self-care refers to activities and practices engaged on a regular basis to reduce stress and maintain and enhance short- and longer-term health and well-being. Self-care is necessary for effectiveness and success in honouring professional and personal commitments (University at Buffalo, 2016).

Secondary Trauma

Secondary trauma refers to the emotional duress that results when an individual hears about the first-hand trauma experiences of another. Individuals affected by secondary stress may find themselves re-experiencing personal trauma or notice an increase in arousal and avoidance reactions related to the indirect trauma exposure. They may also experience changes in memory and perception; alterations in their sense of self-efficacy; a depletion of personal resources; and disruption in their perceptions of safety, trust, and independence (NCTSN, 2016).

Social Determinants of Health

The conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at the global, national and local levels. The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries (WHO, 2014, “What are social determinants of health”, para. 1). The social determinants of heath include income and  social status, education, biology and genetics, and health services, among other determinants. Health inequities—the differences in the health of individuals that result largely from the social determinants—are socially produced (and therefore modifiable), systemic in their distribution across the population, and unfair (National Collaborating Centre for Determinants of Health, 2013).

Stigma

Stigma is the negative, unfavourable attitudes and the behaviour they produce associated with a particular trait displayed by or activity engaged in by an individual or group (MHCC, 2013a).

Substitute Decision Maker

“If a person is incapable of making a decision with respect to a treatment, consent may be given or refused on his /her behalf by another person. In order of hierarchy, the substitute decision-maker is: the incapable person’s court-appointed guardian; attorney for personal care; a representative appointed by the Consent and Capacity Board; a spouse or partner; a child or parent; a parent of the incapable person who has only a right of access; a brother or sister; or any other relative (Health Care Consent Act, 1996, s. 20[1]). The provincial Public Guardian and Trustee is the substitute decision-maker of last resort if there is no other appropriate person to act for the incapable person (Government of Ontario, 1999).

A substitute decision-maker may give or refuse consent only if he or she (Health Care Consent Act, 1996, s. 20):

1. Is capable of understanding the proposed treatment;
2. Is at least 16 years old, unless he or she is the incapable person’s parent;
3. Is not prohibited legally from having access to the incapable person or giving or refusing consent on his or her behalf;
4. Is available; and
5. Is willing to assume the responsibility of giving or refusing consent.

A patient/resident cannot name a health-care practitioner, their health team or anyone else who provides them with health care as their attorney in a power of attorney for personal care, unless that person is a spouse, partner or relative (Substitute Decisions Act, 2992, s. 46[3]). The substitute decision-maker will cease to act on behalf of an incapable person if he/she should regain capacity” (RNAO, 2011, p. 93)

Therapeutic Relationship

“A relationship grounded in an interpersonal process that occurs between the nurse and the client(s). The therapeutic relationship is purposeful, goal-directed relationship intended to advance the best interest and outcome of the client” (RNAO, 2002 b, as cited in CFMHN, 2014, p. 13).