INSTRUCTIONAL PACKAGE
NUR 162
Psychiatric and Mental Health Nursing
201510
Fall 2015
INSTRUCTIONAL PACKAGE
Part I: Course Information
Effective Term: 201510
COURSE PREFIX: NUR 162 COURSE TITLE: Psychiatric and Mental Health Nursing
CONTACT HOURS: Fall and Spring Summer
2 class hours per week 3 class hours per week
3 lab/clinical hours per week 4.5 lab/clinical hours per week
CREDIT HOURS: 3
RATIONALE FOR THE COURSE: The course focuses on continuing application and integration of the concepts of safety, teamwork and collaboration, patient centered care, professional behaviors, and clinical decision making. The focus of care centers on patients experiencing mental health alterations. A variety of settings are used for clinical experience
COURSE DESCRIPTION:
This course covers application of critical thinking skills and nursing concepts in the care of adult clients with selected mental health problems in a variety of settings. The course includes the study of dynamics of human behavior ranging from normal to extreme.
PREREQUISITES: NUR 120
REQUIRED MATERIALS:
Arikkian, Veronica.et al. (2014) The Basics. Kaplan.
Videbeck, Sheila L., (2014) Psychiatric Mental Health Nursing, 6th Edition. Philadephia: Lippincott, Williams and Wilkins. ISBN 9781451187892
ADDITIONAL REQUIREMENTS:
1. Current certification in Basic Life Support – Health Care Provider (CPR)
2. Current TB skin testing within the last 9 months
3. Have Professional Liability Insurance Coverage
TECHNICAL REQUIREMENTS: Access to Desire2Learn (D2L), HGTC’s student portal for course materials. WaveNet and D2L email access.
CLASSROOM ETIQUETTE:
As a matter of courtesy to other students and your professor, please turn off cell phones and other communication/entertainment devices before class begins. If you are monitoring for an emergency, please notify your professor prior to class and switch cell phone ringers to vibrate.
Part II: Student Learning Outcomes
COURSE LEARNING OUTCOMES and ASSESSMENTS*
Upon successful completion of this course in the ADN curriculum, the student will be able to:
1. SAFETY - Demonstrate the application of safety concepts when administering health nursing care.
2. CLINICAL DECISION MAKING - Implement nursing care that reflects critical thinking and application of the nursing process for adult patients with selected mental health problems.
3. TEAMWORK AND COLLABORATION - Demonstrate the integration of active teamwork, collaborative processes, and the effective use of appropriate communication in order to facilitate positive patient outcomes.
4. PROFESSIONAL BEHAVIOR - Model behaviors that demonstrate accountability and reflect standards of the profession.
5. PATIENT CENTERED CARE - Respect the rights of individual patients while establishing a caring and empathetic connection with diverse patient populations.
Module 1
Materials Covered: Chapter 1 and 2, focus on neurotransmitters and look at categories of drugs used to treat mental illness
*Assessment(s): Complete class review activity.
Unit Test 1
Learning Outcomes:
1. Contrasted characteristics of mental health and mental illness.
2. Explained the purpose and use of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-V).
3. Analyzed four neurotransmitters.
4. Identified three classes of drugs used in the treatment of mental health disorders.
5. Described key terms used in psychopharmacology.
6. Reviewed student/course learning outcomes for NUR 162 and the HGTC Nursing organizing framework.
Lesson Outline
Application of Organizing Concepts within a mental (behavioral) health environment
A. Safety within the mental (behavioral) health environment
1. Examples of safety concepts related to mental (behavioral) health environment
a. physical safety of client and others
b. environmental safety
c. the use of seclusion and restraints
d. clients at risk for suicide, altered thought processes, aggression and violence
2. Quality Improvement
a. National Patient Safety Goals in the mental (behavioral) health environment
i. identification of clients
ii. inflection control
iii. reconciliation of medications
iv. clients at risk for suicide
b. Quality Improvement studies in mental behavioral health environments; falls, suicide attempts
B. Clinical decision making within the mental behavioral health environment
1. Critical Thinking – effects of values, attitudes, bias, stigma, independent nursing actions.
2. Nursing Process - how is it different
3. Evidenced based practice – medications and outcomes; non-pharmacology interventions and outcomes
4. Information Technology
C. Teamwork and Collaborative relationships within the mental (behavioral) health environment
1. Managing care and decision making; case management
2. Collaborative communication with other team members; discharge planning
D. Professional Behaviors within the mental (behavioral) health environment
1. Legal considerations
a. Confidentiality
b. Patients Rights
c. voluntary versus involuntary admissions
2. Code of ethics and Standards of Care
3. Professional Growth
E. Patient Centered Care within the mental (behavioral) health environment
1. Communication- therapeutic communication techniques – selected examples
a. broad openings
b. active listening
c. empathic statements
d. open/closed questions/statements
2. Diversity and trans-cultural nursing
3. Advocacy - within the mental behavioral health environment
4. Caring – examples of caring within the mental behavioral health environment
5. Teaching and Learning
a. group teaching sessions
b. review of basic teaching principles
c. engagement of learner and active learning
A. Overview of Psychiatric and Mental Health Nursing
a. Mental Health and Mental Illness defined
b. Diagnostic and Statistical Manual of Mental Disorders
c. ANA Standards of Psychiatric and Mental Health Nursing
B. Neurobiological theories and overview of psychopharmacology
a. The nervous system and how it works – (review)
b. The role of major neurotransmitters
i. Dopamine (DA) – schizophrenia and ADHD; antipsychotics block DA from binding to its receptors; stimulant medication enhances DA transmission
ii. Norepinephrine (NE) – stimulates system
iii. Serotonin(5-HT) – depressive and anxiety disorders; antidepressants target the synapse to increase serotonin levels
iv. GABA – inhibitory neurotransmitter; anti-anxiety meds increase effects of GABA
v. Others of mention – acetylcholine (ACH); Glutamate
c. Brain imaging techniques and nurses role
i. Computed tomography (CT)
ii. Magnetic Resonance imaging (MRI)
iii. Positron emission tomography (PET)
d. Neurobiological causes of mental illness
i. Genetics and heredity
ii. Stress and immune system
iii. Infection theory
e. Psychopharmacology introduction and overview
i. Major categories of drugs used to treat mental illness
(a) antipsychotics
(b) antidepressants\mood stabilizers
(c) anxiolytics (anti-anxiety)
(d) substance abuse disorder drugs
(e) dementia drugs
f. Key terms
i. therapeutic effect
ii. half life
iii. off label use
iv. mechanism of action
v. side effects
a). extra-pyramidal side effects
b). anti-cholinergic side effects
g. Nurses Role in Psychopharmacology
i. assessment of client
ii. administration of medication and patient rights
iii. documentation of medication administration
iv. teaching the client/family
v. evaluation and follow up
Module 2
Materials Covered: Videbeck, Chapter 6, Arikian, pgs. 513-515
*Assessment(s): Complete class review activity.
Communication technique in lab and clinical
Unit Test 1
Learning Outcomes:
1. Examine therapeutic communication techniques used in nursing.
2. Practice at least 5 different therapeutic techniques during class/lab practice sessions.
3. Recognize the use of non-therapeutic communication in dialogue.
4. Discuss the role of culture and developmental influences in communication.
Outline
A. Therapeutic Communication
a. Proxemics and privacy
b. Touch
c. Active listening and observation
d. Empathy
B. Verbal Communication Skills
a. Concrete versus abstract messages
b. Basic therapeutic communication techniques
1. Broad openings – general leads - introductions
2. Active listening
3. Clarification
4. Making observations\giving feedback/
5. Presenting reality
6. Reflecting/Paraphrasing
7. Empathic statements versus restating
8. Using open and closed ended statements/phrases
9. Exploring and focusing
10. Silence
11. Summarizing
C. Non Therapeutic Communication
a. Giving advice
b. Agreeing
c. Belittling feelings
d. Challenging/Defending/disagreeing/disapproving
e. Changing the subject
f. Probing
g. Not listening
h. Giving false assurance
i. Being judgmental
j. Rejecting/expressing disapproval
k. advising
D. Nonverbal Communication skills
a. Facial expressions
b. Body language
1. Closed body position
2. Accepting body position
3. Use of gestures
c. Tone of voice/vocal cues/cadence/volume
d. Eye contact
e. Silence
f. Touch
g. Personal space
E. Age appropriate communication considerations
F. Cultural considerations for effective communication
G. Communication with special needs clients – hearing impaired, visually impaired, cognitively impaired, unconscious, non-English speaking
Module 3
Materials Covered: Videbeck, Chapter 3, 4, 5, Arikian, pgs. 512-513, 520, 523-527.
*Assessment(s): Complete class review activity.
Assess in lab/clinical
Unit Test 1
Learning Outcomes:
1. Assessed the level of anxiety in a client/scenario.
2. Practiced nursing crisis intervention techniques.
3. Examined the use of groups in treatment and the role of the nurse.
4. Contrasted the difference between nurse and therapist roles, and professional and social relationships.
5. Compared three different mental health treatment settings.
6. Reviewed the components of a therapeutic nurse-client relationship.
7. Analyzed the differences between the orientation, working, and termination phases of a nurse-client relationship.
Outline
A. Anxiety Levels- (Chapter 3 - Peplau)
a. Mild
b. Moderate
c. Severe
d. Panic
e. Nurses role
i. Assessment of reaction to stress
ii. Recognize level of anxiety by signs and symptoms
iii. Use communication appropriate to level of anxiety
iv. Provide care appropriate to level of anxiety
v. Teach effective coping skills
B. Crisis and Crisis Care Management – (Chapter 3)
a. Crisis defined – acute time limited – an emotional response that can not be managed with normal coping mechanisms
b. Nurses role and Crisis Intervention/management
i. Assess- listen carefully, reflect feelings, convey acceptance, ask open ended questions, assess lethality
ii. Identify goals for crisis intervention – help brainstorm, set priorities, set specific short term goals, assist with problem solving
iii. Implementation with directive and supportive interventions – provide encouragement and feedback
iv. Evaluation
C. Treatment Modalities – (Chapter 3)
a. Individual psychotherapy by a therapist nurses don’t do therapy, therapist do)
b. Group therapy –participate in a session with a group of people, sharing a common purpose, benefit self and others; learn new ways of problem solving, interacting with others, coping, gain new information, feeling of acceptance, inspires hope; education groups, support groups, social interaction groups, self help groups
i. Role of the nurse in groups
1. explain purpose and rules
2. introduce members
3. promote group cohesiveness
4. focus on group process
5. encourage participation
6. role model
7. facilitate communication
8. set limits
D. Treatment settings and therapeutic programs – (Chapter 4)
a. Inpatient hospital
b. Partial hospitalization programs
c. Residential and community settings
d. Complementary and Alternative Therapies – define
e. Psychiatric Rehabilitation
E. Therapeutic Relationships – (Chapter 5)
a. Components of a therapeutic nurse-client relationship
i. Trust
ii. Genuine interest
iii. Empathy
iv. Acceptance
v. Positive regard
vi. Therapeutic use of self
b. Therapeutic versus social relationship
c. Phases of a therapeutic relationship
i. Orientation phase
ii. Working phase
iii. Termination phase
d. Roles of the nurse in therapeutic relationships – nurse is responsible for the outcome
G. Review of theorists and ego defense mechanisms (from previous classes).
Module 4
Materials Covered: Videbeck, Ch 8 and 9, Arikian, pgs. 511
*Assessment(s): Complete class review activity.
Practice lab/clinical
Unit Test 1
Learning Outcomes
1. Compare and contrast the various components of a mental status assessment.
2. Use a mental status assessment tool in skills lab.
3. Analyze involuntary and voluntary admissions.
4. Discuss the concept of least restrictive care.
5. Explain the nurse’s role with the use of restraints and seclusion.
6. Examine various nursing liability issues in a psychiatric setting.
7.
Outline
A. Mental Health Nursing Assessment (Psychosocial Assessment)
a. Content of the mental status assessment
i. History and chief complaint
ii. General appearance and motor behavior/activity
iii. Mood/ affect/ attitude
iv. Thought process, thought content
v. Perceptual disturbances
vi. Memory and Cognition
vii. Judgment and Insight
b. Psychiatric diagnosis- DSM-V (compare to DSM IV)
B. Legal and Ethical Considerations
a. Voluntary versus involuntary hospitalization
b. Least Restrictive Environment
i. Restraints
ii. Seclusion
c. Confidentiality and right to privacy
d. Nursing liability issues
i. Right to treatment
ii. Right to refuse treatment
iii. Right to informed consent
Module 5
Materials Covered: Videbeck, Ch 11, 12 and 13, Arikian, pgs. 553-556.
*Assessment(s): Complete class review activity.
Assessment in lab/clinical
Unit Test 1
Learning Outcomes
1. Examine the cycle of violence.
2. Describe common clinical features of posttraumatic stress disorder (PTSD) and Dissociative Disorder.
3. Examine treatment issues and nursing care planning for PTSD.
4. Examine violence and consequences related to nursing assessment, intervention and outcomes.
5. Describe psychiatric disorders that may be associated with an increased risk of hostility and physical aggression in clients.
6. Describe nursing actions based on the phases of the aggression cycle.
7. Analyze a nursing care plan for aggressive behavior
Lesson Outline
A. Anger, hostility and aggression – definitions and overview
B. Causes/theories/cultural considerations
C. Management of Anger and Treatment considerations
a. Therapeutic milieu
b. Five phase aggression cycle
d. Communication approaches (note: this varies depending on behavior at time)
i. active listening – anger often reflects frustration; disappointment often reflects hurt
ii. empathic comments – “Having words with your brother has made you angry and upset”
iii. in their words – explain situation
iv. clarification – non-judgmental; don’t get angry, don’t take it personal , don’t get into escalation
v. use assertive voice – use “I” not “You” (you = blame and is defensive)
vi. be aware of body posture, eye contact, tone of voice
D. Nursing Care Plan for aggressive behavior
E. Violence: Abuse, PTSD, Dissociative Disorder
a. Clinical picture of abuse and violence, “The Cycle of Violence”.
b. Characteristics of violent families
c. Cultural considerations
d. Spouse/partner abuse, child abuse, elder abuse, rape and sexual assault
e. Post-Traumatic Stress Disorder (PTSD)
i. Violent life threatening experience, nightmares, flashbacks, hyper-arousal for more than one month
ii. Event is persistently re-experienced
iii. Intense psychological distress at exposure to internal or external cues that symbolize the event
iv. Treatment
1. Behavior therapy, group and family therapy by a therapist
2. Medications (see medication listed within the chapter)– SSRIs (Paxil , Zoloft), BZDP, anti-hypertensives (beta blockers-Inderal)
v. Nursing process and care planning
f. Dissociative disorders
i. Subconscious defense mechanism to protect emotional self from traumatic event
ii. Usually history of severe abuse, symptoms similar to trauma and abuse survivors
iii. Cognitive Behavior Therapy (CBT), group therapy, anti-anxiety, and anti-depressants (Zoloft, Paxil)
iv. Promote safety and interpersonal relationship
Module 6
Materials Covered: Videbeck, Ch. 14 and 15, Arikian, pgs. 517-522
*Assessment: Complete class review activity.
Assess in lab/clinical
Unit Test 2
Learning Outcomes:
1. Practice at least one of the following: deep breathing, guided imagery, progressive muscle relaxation, stretching exercises (as a therapeutic means of reducing anxiety and improving coping).
2. Examine the clinical characteristics of panic attacks and panic disorders, phobias, OCD, and GAD.
3. Review the influence of heredity, culture, environment and stress in the development of anxiety disorders.
4. Review anti-anxiety medications used in the treatment of anxiety disorders
Outline
A. Anxiety and Stress Related Illness
a. Anxiety defined
b. Anxiety as a response to stress - review
i. Sympathetic nervous system response
ii. Parasympathetic nervous system response
iii. Cognitive, physiological and psychomotor responses
c. Levels of anxiety and response - review
i. mild – sensory stimulation helps focus attention
ii. moderate – disturbing, can still process new information solve problems with assistance
iii. severe – primitive skills take over, cognitive skills decrease, trouble thinking, problem solving, and reasoning
iv. panic – cannot process, loss of rational thought
d. Nurses working with anxious clients
i. assess level of anxiety
ii. determine interventions based on anxiety level
1. mild – teachable
2. moderate – refocus, redirect check for understanding, keep it simple
3. severe – can’t pay attention- nurse to reduce level of anxiety, remain with client, calm and soothing
4. panic – safety is primary; can’t process or problem solve, need quiet comfort and a safe place
B. Anxiety disorders – experience significant distress over time impairing daily routines, social lives, and occupational functioning
a. Panic Disorder and panic attacks