NURSING III MENTAL HEALTH PSYCHIATRIC CARE NURS 322 CLINICAL COMPONENT TO NURS 320 CLINICAL COURSE MATERIAL FALL 2007

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1 NURSING III MENTAL HEALTH PSYCHIATRIC CARE NURS 322 CLINICAL COMPONENT TO NURS 320 CLINICAL COURSE MATERIAL FALL 2007 Nurs 320_322.F07

2 SHEPHERD UNIVERSITY Department of Nursing Education BSN NURS 322 NURSING III: MENTAL HEALTH/PSYCHIATRIC CARE CLINICAL COMPONENT Credit Hours: Placement: 2 Credits - 2 to 1 Ratio of Clock Hours to Credit Hours Junior Level, Spring Semester Prerequisites: NURS 311/315 Faculty: Office Hours/Phone: Charlotte Anderson, PhD TBA Course Description The student will meet the clinical objectives during the clinical experiences caring for clients using the following guides: General Principles of Psychiatric Nursing, Practical Hints for Psych Students, Guide to the One-to-One Relationship, Observation of the Clinical Environment and the Group Process Recordings. Weekly clinical focuses will guide the student in applying theory from NURS 320 to patients in a variety of clinical settings, including acute inpatient units and community mental health settings. Clinical Objectives Upon completion of this clinical rotation, the student will be able to: 1. Perform biopsychosocial assessment of psychiatric patients from culturally diverse groups. 2. Design a plan of care for a patient with a major psychiatric disorder, using the nursing process, focusing on patient stressors and assisting the patient in adaptation to the environment. 3. Use critical thinking and decision making in forming or changing personal attitudes and behaviors in caring for and in advocacy of the mentally ill. 4. Demonstrate therapeutic nurse-patient relationship principles when working with clients in a variety of psychiatric/mental health settings in order to promote maximum self-integration. 5. Apply the principles of group process while participating, observing, and documenting a client group. 6. Plan and teach clients families about psychiatric medications and their side effects. 7. Use the appropriate roles of the nurse in primary, secondary, tertiary prevention of mental illness to clients from culturally diverse backgrounds throughout the life cycle. 8. Apply ethical principles and understandings of the laws related to the psychiatric healthcare system. 9. Discuss current nursing and health care articles relating research implications and application to clinical practice. 10. Utilize professional accountability and identify own learning needs for personal and 1 Nurs 320_322.F07

3 professional. Course Competencies Upon completion of the course the student will demonstrate the following competencies: Communication 1. Use effective therapeutic communication skills. 2. Utilize group process Assess and apply group process principles in peer group Analyze group dynamics in therapeutic groups Lead a group activity Critical Thinking 1. Apply nursing research findings to practice in a psychiatric/mental health setting. Therapeutic Nursing Intervention 1. Conduct a biopsychosocial assessment. 2. Lead a group activity using group process principles. 3. Utilize methods of advocacy to address stigma of mental illness. Clinical Policies 1. Students are expected to comply with all policies of assigned clinical sites. Failure to do so may result in being removed from the facility and may result in a failing grade for the course. 2. Late written work, illegible or poorly constructed written work, tardiness to assigned clinical site, unprofessional appearance or behavior, unexcused absence from clinical will be penalized by a deduction on the professional growth portion of the evaluation tool and may result in a failing grade for this course. 3. Breech in confidentiality, falsifying medical records, performance of patient care in a manner that is unsafe for the patient or the nurse (student) will result in failure of this course. 4. Absence from clinical needs to be reported to the clinical instructor 1 hour prior to the clinical experience, one excused absence may be made up on the one make-up clinical day at the end of the rotation (excused absence, student illness, death in the immediate family). Unexcused absences from clinical cannot be made up. 5. (1) or (0) on the clinical evaluation tool, at the time of the final clinical evaluation will result in failure of the course. 2 Nurs 320_322.F07

4 Methods of Instruction A. Clinical experience - Thursdays, pre & post conference B. Observational Experiences 1. Alcoholics Anonymous Meeting Each student will plan their own experience using the AA Meeting Directory. Two students at a time to visit an Open Meeting. 2. Others as assigned Community Agencies C. Written Work Method of Evaluation Clinical Evaluation Tool Written Assignments Written evaluation of the clinical agency and the clinical instructor on the completion of the course. A letter grade is given for clinical, and a grade of C or 78% is required to pass. Clinical Grade Evaluation Written AA report Medication test (take-home) Nursing Care Design Weekly Notebook Clinical Clinical Evaluation Tool 3 Nurs 320_322.F07

5 Psychopharmacology Students will not be passing medications, but need to have a working knowledge of the following drugs, including: [classification, desired effect, dosage range, form of administration, and side effects]. Knowledge will be evaluated on tests in NURS 320, in the clinical area, and medication test. Loxitan (Loxapine Succinate) Thorazine (Chlorpromazine) Haldol (Haloperidol) Prolixin (Fluphenazine) Xanax (Alprogolom) Librium (Chlordiazepoxide) Stelazine (Triffluoperazine) Cogentin Lithium preparations Elavil (Amitreptylene) Tofranil (Imipramine) Parnate (Tranylcypromine) Navane (Thiothixine) Prozac (Fluoxetine Hydrochloride) Clozaril Zoloft (Zoloft) Moban-Molindone Compazine Mellaril Valium Serax Paxil Wellbutrin Risperdal 4 Nurs 320_322.F07

6 CLINICAL NOTEBOOK The Clinical Notebook serves several purposes: 1. To help you identify your feelings. 2. To assist you assimilate, synthesize, analyze, and reflect upon your clinical experience. 3. To communicate with your instructor in another medium. Your instructor will provide directions each time. You will have access to resources while writing. The entries will be confidential and will be read only by your instructor. Because they will contain personal and professional information, it will be important that you keep your notebook secure. 5 Nurs 320_322.F07

7 ALCOHOLICS ANONYMOUS MEETING 1. Before attending an AA meeting, read textbook Stuart & Laraia, Chapter During the meeting, observe: A. Composition of group. 1. Age, sex, sociocultural background B. Source of financial support. C. Membership requirements D. Guidelines for members as stated in: 1. Guidelines 12 Steps of A.A. members 2. Guidelines 12 Traditions of a.aa members E. Conduct of the meeting as observed in: 1. Leader role 2. Individuals' roles 3. Group dynamics F. Participant's behaviors, verbal and non-verbal, which indicate: 1. Personal worth 2. Self-esteem 3. Anxiety - internal conflict 4. Guilt a. altered self-directed role to recovery b. effect on family integrity 5. Defeat 6. Hope a. recognition of self-directed b. recognition of members supporting role in the rehabilitation process G. Achievement as measured by: a. society b. rehabilitation 1. vocational 2. interpersonal relationships H. Availability of literature I. References to: Steps of A.A. members Traditions of A.A. members 3. Objectives: At the end of the meeting, the student will be able to: A. Describe the function of Alcoholics Anonymous in its attempt to rehabilitate alcoholics. B. Analyze the individual's presentation of the effects of alcohol on self and family. C. Explain the approach used by the group to support the individual's efforts. D. Evaluate the effectiveness of this approach in the management of alcoholism. 4. Within 1 week of visit, turn in a 1-3 page report to your Clinical Instructor using the following format: 6 Nurs 320_322.F07

8 REPORT FORMAT 1. Location, date, time of meeting. 2. In what ways was the meeting what you expected based upon your prior reading? In what ways was it different from your expectations? 3. What was your role? What was your response? 4. What characteristics were apparent in the persons participating in the meeting? 5. What evidence of support did you observe? 6. These groups are successful - what are some reasons that you can see for their success? 7. How has your view of alcoholism been affected by this experience? 7 Nurs 320_322.F07

9 GUIDELINES FOR CLINICAL 1. Do not give out ANY personal information, such as where you live or your phone number. 2. No contact with patients or staff outside of clinical hours. 3. Your instructor s role is to help you deal with problems that may arise with patients or staff. Inform your instructor of any and all problems that may arise BEFORE trying to deal with them yourself. 4. Professional looking attire. NO short skirts, revealing blouses, casual outfits, sneakers or open-toe shoes. Look as though you were going to work, not to a social occasion. Females always wear stockings with skirts. Inappropriate appearance will result in being sent home. 5. Do not clump together on the unit. Locate yourselves in separate physical areas on the unit as much as possible. You are more approachable and available when not talking to each other. 6. Avoid hanging out in the staff areas. There is not enough room, and you need to spend your time out with the patients. 7. Strict rules of confidentiality apply to everything you learn about patients. Information is shared only with staff and your instructor. 8. Do not forget to use STANDARD PRECAUTIONS with all patients. Even though we are not in a medical-surgical setting, we are dealing with patients who may be from high-risk populations. 9. Do not allow patients to put you in a position of keeping their secrets. As a member of the treatment team, you must share all information about patients with staff. 10. After finishing your clinical experience, you are not allowed any further contact with patients. 11. During all clinical experiences, the student will be expected to share his/her experiences with the group in post-conference. 12. Students are reminded of the professional s code of ethics regarding confidentiality of patient information. Students are expected to comply with all policies of assigned clinical sites. Failure to do so may result in being removed from the facility and may result in a failing grade for the course. 13. Breach in confidentiality, falsifying medical records, performance of patient care in a manner that is unsafe for the patient or the nurse student will result in failure of this course. Absence/Attendance (Refer to Policy #113 in the Nursing Program Policy Manual) 8 Nurs 320_322.F07

10 GROUP PROCESS The purpose of this observation is to focus on group dynamics of group process. Be prepared to share your observations in post clinical conferences. Climate 1. Physical set-up a. place, time, date b. type of group, activity, therapy c. ventilation, distractions, number of members present 2. Emotional accepting, judgmental, friendly, cold, etc. 3. Why are members present? Interaction 1. Who talks to whom draw a diagram. 2. Who did the most talking? 3. Who did the least talking? 4. Incidents affecting interactions (arguments, late arrival, etc.) 5. Size of group (too large?) 6. Was participation relevant to task? Cohesion 1. How well does the group work together? 2. What are the common standards (norms)? Who does not conform? Is there pressure on the deviant to conform? 3. Is there a sense of we-ness? Productivity 1. Goals a. Were there stated goals? b. Were the goals realistic and clearly understood? c. Did members contribute to goals? d. How far did the group get in terms of goals? What helped/hindered? 2. Did the discussion stay on track? Why not? In therapy groups, note any curative factors present. (altruism, universality, interpersonal learning, guidance, catharsis, identification, family reenactment, insights, installation of hope, existential factors). Leadership 1. Is the leadership shared? If so, with whom? How (struggle, cooperation, etc.)? 2. How did the leader encourage participation? 3. What roles did staff members perform? Your participation, your feelings and reactions during the meeting. 9 Nurs 320_322.F07

11 NURS 322 NURSING CARE DESIGN (Includes Parts I III) PART I: ASSESSMENT Write an assessment of your patient. Cover the following areas in outline form. A. Basic Background Assessment; Predisposing factors 1. Demographics 2. Developmental assessment 3. Socio-economic cultural assessment 4. Genera 5. Psychiatric and medical history and diagnoses B. Precipitating Stressors C. Coping Resources 1. Personal abilities 2. Social support 3. Material assets 4. Positive beliefs D. Mental Status Examination 1. General Observations a. Appearance b. Motor behavior (describe) c. Affect crying, laughing, etc. 2. Thought a. Speech pattern b. Content of thought (quote patient) c. Disorders of perception delusions, hallucinations 3. Intellectual Functioning a. Orientation (3 spheres) b. Memory (recent, remote) c. Abstract thinking d. Insight 4. Patient s Perception of the problem (verbatim if possible) E. Erikson Developmental Level 10 Nurs 320_322.F07

12 NURS 322 NURSING CARE DESIGN PART II: FORMAT PROCESS PAPER NEED Nursing Diagnosis #1 Patient Goal Nursing Interventions 1. Intervention #1 2. Intervention #2 3. Intervention #3 Evaluation of goal NEED Nursing Diagnosis #2 Patient Goal Nursing Interventions 1. Intervention #1 2. Intervention #2 3. Intervention #3 Evaluation of goal NURS 322 NURSING CARE DESIGN 11 Nurs 320_322.F07

13 PART III: GUIDELINES INTERPERSONAL PROCESS RECORDING (IPR) Analysis of nurse-patient interactions allows you to identify both therapeutic and non-therapeutic techniques with the intention of improving future interactions. As soon as possible after interacting with the patient, record the word for word conversation and communication that occurred between patient and nursing student. Include non-verbal communication, feelings and thoughts. RECORDING FORMAT Assessment (Specific, objective data only not interpretive) Client - What the client is wearing, activity/motor behavior during conversation, eye contact, affect, speech patterns, level of orientation and thought processes, body posture. Self - What the student is wearing, non-verbal behavior, etc. Environment - Room temperature, noise, light, other clients, seating arrangements, etc., during conversations Plan Student s goal or purpose of conversation. Include subject, verb, content and time, i.e., the patient will discuss the death of his mother for five minutes. Implementation Actual excerpts of conversation with client while identifying who said what. In parenthesis, add any non-verbal observed at the time of the statement. Evaluation This section is the interpretation of the following: 1. Identification of type of question/statement. 2. Identification of therapeutic value of question/statement/technique. 3. If non-therapeutic, write what you could have said to make your response therapeutic. 4. Interpretation of client verbal/non-verbal communication 5. Interpretation of student verbal/non-verbal communication 6. Was goal for this interaction met? 12 Nurs 320_322.F07

14 Shepherd University Department of Nursing Education Nurs 322 Clinical Self-Evaluation Tool Psychiatric/Mental Health Care Date: Facility: Student: Strengths Identified Opportunities for Growth Plan for Growth Comments: Comments: Comments: Student s Signature: Date: Faculty Signature: Date: 13 Nurs 320_322.F07