“Be anxious for nothing, but in everything by prayer and supplication, with thanksgiving, let your requests be made known to God; and the peace of God, which surpasses all understanding, will guard your hearts and minds through Christ Jesus.” Philippians 4: 6-7
Course Number and Title: NUR 3152 Psychiatric Mental Health Nursing: Clinical
Credit Hours: 2 Credit Hours Wed/ThursPlacement: Junior Year Fall 2015
Course Description:This course provides the clinical component to NUR 3323 and focuses on the implementation of therapeutic relationships with individuals, families, and at-risk groups who have actual and potential mental health stressors. Mental health theories, General System Theory, and the nursing process are used to implement nursing actions to maintain health and wellness across the lifespan. Ethical and legal values and the Christian worldview are interwoven in a culturally congruent process in clinical settings. Critical thinking, therapeutic use of self, and communication skills are utilized in community and acute care mental health and chemical dependency settings.
Prerequisites: NUR 2003, NUR 2013, NUR 2023 Faculty:
Maureen Walsh, EdD, RN, PMHCNS-BC Sandy Gibson, EdD, MSN
Title: Associate Professor of Nursing Title: Adjunct Professor
Office: OCE Phone:754-204-8690
E-mail: Maureen_walsh@pba.edu Email: Sandy_Gibson@Pba.edu
Phone:561-329-9502
Office Hours: by appointment Bri Andrassy, BSN, RN
Title: Adjunct Professor
Diane Esposito, PhD, ARNP, PMHCNS-BC Phone: 561-951-7336
Title: Associate Dean, Graduate Programs Email: Bri_Andrassy@pba.edu Email: Diane_Esposito @pba.edu
Sandra Gall-Ojurongbe, MSN, RN Linda Casale, BHA, RN-C
Title: Assistant Professor of Nursing Title: Adjunct Professor
Office: OV 109 Office: OCE 110
Phone: 803-2834 Phone: 773-531-4955
E-mail: Sandra_gall-ojurongbe@pba.edu Email: Linda_Casale@pba.edu Office Hours: by appointment
Learning Outcomes (BE= Baccalaureate Essentials) (QSEN = Quality & Safety Education for Nurses) Upon satisfactory completion of this course, the student will be able to:
1. Conduct a comprehensive and focused psychiatric/mental status assessment, including substance use disorders and document in electronic health record. BE: VII, VIII, IX QSEN - Patient Centered Care, Informatics
2. Recognize the relationships of genetics and genomics to mental health and psychiatric symptoms using assessment of family history and application of family theory. BE: VI, IX QSEN - Patient Centered Care, Teamwork and Collaboration 3. Apply principles of neuroscience and brain chemistry as they relate to the origins and the treatment of disorders.
BE: I, III, VII, IX QSEN - Evidence Based Practice 4. Communicate effectively with the patient and the patient’s support network.
BE: VI, IX QSEN - Teamwork and Collaboration
5. Incorporate patient self-determination and adherence strategies into patient-centered care.
BE: VIII, IS QSEN - Teamwork and Collaboration, Patient Centered Care
6. Identifies and distinguishes psychiatric symptoms as a basis for developing or changing a plan of care.
BE: VII, VIII, IX QSEN - Evidence Based Practice, Patient Centered Care, Quality Improvement 7. Deliver appropriate patient-centered teaching to patients experiencing psychiatric disorders and their family members.
8. Implement evidence-based nursing interventions as appropriate for promoting health and managing the acute and chronic care of patients, maintenance and recovery across the lifespan.
BE: III, VIII QSEN - Evidence Based Practice
9. Monitor client outcomes to evaluate the effectiveness of bio-psychosocial interventions using standardized assessment tools. BE: IV, VI, VIII QSEN - Quality Improvement, Patient Centered Care
10. Implement patient-centered transitions of care and discharge planning to persons and families experiencing psychiatric disorders and addiction.
BE: II, IV, V QSEN - Patient Centered Care, Teamwork and Collaboration
11. Create a safe care environment that results in high quality outcomes for persons with mental disorders including substance use disorders.
BE: II, VII, IX QSEN - Safety
12. Coordinate and manage care for a group of individuals with psychiatric disorders in order to maximize health, independence, and quality of life.
BE: II, VI, VII, IX QSEN - Patient Centered Care, Evidence Based Practice Textbooks/Learning Materials:
Required:
Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: A guide to planning care. (10th ed.).St. Louis, MO: Mosby. ISBN-10: 0323085490 | ISBN-13: 978-0323085496
Arikian, V. P. (2012). The Basics. United States: Kaplan, Inc.
CPI – Participant Workbook: Nonviolent Crisis Intervention (2011). Milwaukee, WI: Author.
Townsend, M.C. (2015) Concepts of Care in Evidence Based Practice - 8th ed . Philadelphia, PA, FA Davis Company. ISBN - 13 978-0-8036-4092-4
Townsend, M.C. (2015). Assessment, Care Plans and Medications. Philadelphia, PA. FA Davis
ISBN - 13 978-0-8036-4237-9 or package/discount - ISBN-13 978-0-8036-4239-3.
Medscape Nursing www.medscape.com
Nursing Central References: http://nursing.unboundmedicine.com Recommended:
American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). American Psychological Association.
Curtis, C., Baker, A., & Tuzo, C., (2013). Psychiatric Mental Health Nursing Success: A Q&A Review Applying Critical Thinking to Test Taking. Phila. Pa: F.A. Davis Company. ISBN 0803629818
Additional Laboratory and Technological Resources Drug calculation practice
All other textbooks previously required in the program are resources. Each resource provides the student with relevant information that informs nursing praxis.
Web based software Computer software Required Readings and Assignments:
These are listed in the Schedule of Course Content, NUR 3113: Theory is correlated with this course, so readings in that course will be concurrently relevant to your practicum.
Written Assignments:
Copies of written assignments may be retained in the School of Nursing for the purposes of faculty review and reference and for program reviews by external accrediting or approval organizations such as the Florida Board of Nursing, Southern Association of Colleges and Schools, and the American Association of colleges of Nursing. Should any of the assignments be used for other means, the student would first be contacted for informed consent.
Teaching/Learning Methods: 1. Discussion
2. Simulated experiences 3. Case studies
4. Auto tutorial and independent learning activities 5. Student Presentations
6. Direct Client Care Course Requirements:
1. Read and prepare all assigned material prior to practicum. 2. Attend scheduled practicum experiences.
3. Be prepared and participate in discussion. 4. Complete all assignments satisfactorily. 5. Treat self and others with respect and dignity.
Methods of Evaluation: All assignments MUST be completed or the student will not receive credit for the course. Due dates are listed in the Schedule of Course Content. Specific Directions are provided later in the syllabus.
1. IPR 10%
2. Mental Status Assessment with 1Nursing Care Plan 10%
3. Full Mental Health Nursing Assessment with 3 Nursing Care Plans 20%
4. Conference Participation and E-Journals 10%
5. Community Experience Paper 5%
6. Simulation Evaluation 5%
7. Patient Educational/Recreational Group 5%
8. Drug Calculation Quiz * 5%
9. Must Know Drug Assignment 5%
10. Clinical Performance. See Evaluation Tool 25%
The student must have a level 2.5 or above in all areas on the evaluation of student clinical performance document by the final evaluation. Any student with an unsatisfactory in any area at the final evaluation will not pass the course.
* The minimum drug calculation competency test is part of the students’ clinical grade, and students will not be permitted to provide patient care until the competency (score of 100%) has been demonstrated. Drug calculation must count for a minimum of 5% of the course grade, but its weight may be higher as appropriate for course content/outcomes.
i. Minimum competency test 5% 5 points
ii. First retake/mastery 4% 4 points
iii. Second retake/mastery 2% 3 points
iv. Third retake/mastery 0% 0 points
v. Student will be withdrawn from the course if not successful after the third retake/mastery test. Withdraw Date without Academic Penalty: November 13, 2015
Clinical Papers:
Clinical papers are due as indicated by faculty. Only those papers submitted on or before the designated time will receive credit. Clinical assignments will be submitted as directed by clinical instructor. Students who do not submit the papers will not be permitted to participate in the succeeding clinical experience. The previous week’s assignment must be received (although they will receive an Unsatisfactory or points deducted) for the student to be permitted to participate in succeeding practicum experiences. In this event, the student must recognize that they are at risk for not meeting course outcomes and expectations. Please refer to the clinical performance evaluation tool. Your clinical paperwork must be turned in completed as directed by your clinical instructor. Keep all graded assignments for reference during the duration of the course. Your work will not be accepted if it is incomplete. The
assignments will be returned to you and points will be deducted from your grade if your assignments are incomplete or late. Grading Scale: Students must achieve a minimum of a C in each nursing course.
A 93 – 100 A- 90 – 92 B+ 87 – 89 B 84 – 86 B- 82 – 83 C+ 79 – 81 C 75 – 78 D 65-74 F 64-Below
Additional Responsibilities for this Course:
1. 1. Attendance is required at each clinical. Each Student is expected to arrive on time to the clinical facility. The student must notify the instructor 1 HOUR prior to the start of Clinical if you are unable to attend. One must also notify the instructor if you unable to arrive on time. If you are absent, a makeup assignment will be assigned by your clinical instructor and must be completed within one week to be given credit. . Refer to Student Handbook to review guidelines for tardiness and clinical absence. Arriving to clinical after the scheduled time is not acceptable. Two incidents of tardiness equal one absence. This scheduled arrival time will be specified by the professor.
2. Check email and respond appropriately every day. You are required to use your PBAU email account for all communication with your faculty.
3. The following policies are to be followed according to the current edition of the Navigator: a. Computer Usage Policy
b. Dress Code: Appropriate Uniform for this clinical experience is the PBAU community uniform (khaki pants/skirt, PBAU SON polo shirt, regulation shoes. Professional grooming and attire is required at all times. Hair should be pulled back from the face securely.
c. Academic Standards of Conduct: for the Community Value System and the Five Core Values of the PBA Community as well as descriptions of infractions of the standards and the discipline process
4. The following policies are to be followed according to the current edition of the PBA School of Nursing Handbook a. Scholarship and Integrity
b. Professional Behavior and the Care of others
c. Theory, Laboratory, Practicum Attendance and Assignment Submission d. Students with Disability
e. Drug calculation policy posted on myPBA SON
The minimum drug calculation competency test is part of the students’ clinical grade, and students will not be permitted to provide patient care until the competency has been demonstrated. Drug calculation must count for a minimum of 5% of the course grade, but its weight may be higher as appropriate for course content/outcomes.
(Minimum competency for this course is 100 %) 1. Minimum competency test 5% 2. First retake/mastery 4% 3. Second retake/mastery 2% 4. Third retake/mastery 0%
5. Student will be withdrawn from the course if not successful after the third retake/mastery test. The following questions will be included for evaluation:
• Metric conversions (mcg, mg, grams) • Metric/household conversions (tsp, tbs, mL) • Max safe dosage based on weight
• Determining amount of drug or solute in solution Course Schedule
DATES Content Assignments
Week 1 Aug 26/27 Frontloading: CPI Training CPI Training – Mahoney/Gym
Week 2 Sept 2/3 Clinical Orientation- PBAU EJ-1 Week 3 Sept 9/10 Psychopharmacology Must Know Drug Assignment
Due in pre-conference EJ-2
Week 4 Sept 16/17 EJ-3
Week 5 Sept 23/24 IPR
Week 6 Oct 9/30 – 10/1 Drug Calculation Quiz Drug Calculation Quiz EJ-4 Week 7 Oct 7/8 EJ-5 Week 8 Oct 14/15 Mid-term evals MSA – 1 NCP
Week 9 Oct 21/22 EJ -6 Week 10 Oct 28/29 EJ-7 Week 11 Nov 4/5 EJ-8
Week 12 Nov 11/12 MHA-2 – 3NCP
Week 13 Nov 18/19 Community Paper
Week 14 Nov 25/26 OFF - Thanksgiving OFF - Thanksgiving Week 16 Dec 2/3 Final Evaluations Final Evaluations
Guidelines for Interpersonal Process Recording (IPR)
The client's last name is never to be used, rather he or she is to be identified by the first and last initial ex. Mr. F. S.
Any references used should be footnoted and a bibliography attached. Credit will be deducted for spelling and grammatical errors. The rubric for evaluation for the IPR should be read before writing this paper. An introduction is an essential part of the IPR in order to acquaint the reader with the setting, and circumstances in which the interaction took place. This should include the client's facial expression, voice quality, and appropriateness of dress and grooming.
CLIENT VERBATIM NURSE VERBATIM
These sections should include the verbatim statements of the nurse and the client during the interaction. Time lapses and silences should be noted, as well as the length of the silence. This section is to be written in an objective fashion, without any interpretations on the part of the student. Six client verbatim with corresponding six nurse verbatim is the minimum submission for this assignment. NON VERBAL BEHAVIOR OF NURSE AND CLIENT
This section is to be used for recording communication and behavior that is not verbalized. Significant gestures, facial expressions, body postures, tones of voice, eye contact, etc., should be noted both the client's and the nurse's. For example, it should be recorded that the voice dropped to a whisper when he spoke about his mother's death. Examples of behavioral "clues" to anxiety should be included.
INTERPRETATION OF INTERACTION
You should give your ideas as to what was going on in a dynamic sense during the interaction. How did you perceive the client to feel? How did you feel? You should also note any disorders of mental status or thought process that were present and defense mechanisms that were employed by the nurse or client. Any shifts in the conversation made by either the client or the nurse should be noted. Your interpretations should be supported with theoretical knowledge. You should identify what type of therapeutic (or non-therapeutic) communication technique is demonstrated by your statement.
ALTERNATE RESPONSES
This is one of the most important parts of the IPR and is heavily weighted in terms of evaluation. This section provides the student with an opportunity to look back on the interaction and to formulate responses that might have been more effective than the one used. Although the interaction itself may have been ineffective in achieving the stated goal, it can still be a learning experience, and be a guide for future interactions. Each alternative response should be accompanied by a rationale (either theoretical or your own logic) as to why it might promote more effective communication. Every student response must have an alternate or it will be returned to be redone.
*SUMMARY EVALUATION
Each IPR should include a concise summary evaluation, particularly in relation to the established goal of the interaction. The student should include the strengths and weaknesses of the interaction as well as writing objectives for client care based on her interpretation. The student should include objectives for his or her own improvement. The participation of both the nurse and the client should be evaluated. References should be cited in a bibliography.
REFERENCES
References should be listed according to APA format. This paper must have theoretical perspectives in the analysis, and your sources should be cited on the last page.
Guidelines for Mental Status Assessment – 1 Nursing Care Plan
Instructions for Mental Status AssessmentMental Status Assessment and Care Plan Form template is available in e college.
The completion of a Mental Status Assessment will require a substantial interview with a patient to whom you are assigned in the clinical setting. You should coordinate this assessment with your clinical instructor, and it may be completed with the assistance of the patient’s nurse or mental health technician.
Mental Status Assessment and Care Plan RUBRIC Guidelines Maximum Score Achieved Score Comments Mental Status Exam : Orientation 1
Appearance 1
Speech 1
Language 1
Mood and Affect 1
Perceptual Disturbance 1
Thought Process 1
Thought Content 1
Suicidal or Violent Ideation 1
Insight 1
Judgment 1
Memory 1
Fund of Knowledge 1
Priority NANDA Nursing Diagnosis 1
Patient Goals and Outcome Criteria 2
Interventions and Rationales 2
Evaluation based on Outcome Criteria 2
TOTAL 20
Guidelines for Full Mental Health Assessment – 3 Nursing Care Plan
***Note: There is a different Template for the Mental Health Assessment – It is a more detailed comprehensive Nursing Assessment and includes prioritizing top 3 problem areas and writing 3 Nursing Care Plans to address them.*** Template is in e-college.
The completion of a Mental Health Assessment will require a substantial interview with a patient to whom you are assigned in the clinical setting. You should coordinate this assessment with your clinical instructor, and it may be completed with the assistance of the patient’s nurse or mental health technician. This must be a different client/patient than you used for the first Mental Status Assessment.
Full Mental Health Assessment RUBRIC
Guidelines Maximum Score Achieved Score Comments Clinical History 10 Medical Information 5
Mental Status Exam and Mini Mental 5 Assessment of Danger to self and others 5
Multi-Axis Assessment 4
NANDA Nursing Care Plans
#1 Dx – 1 point, Goals and outcomes – 2 points, Interventions and rationales – 2 points, and Evaluation – 2 points
7
#2 Dx – 1 point, Goals and outcomes – 2 points, Interventions and rationales – 2 points, and Evaluation – 2 points
7 #3 Dx – 1 point, Goals and outcomes – 2 points, Interventions and rationales – 2 points, and Evaluation – 2 points
7
TOTAL 50
Guidelines for Community Experience Assignment: (5 points)
Students will be assigned ½ clinical day for their Simulation experience, and receive ½ day off to attend or compensate their attendance of community experience of attending one open AA or other 12 Step meeting such as: Celebrate Recovery, SAM-Substance Abuse Ministry, Alanon, Narcotics Anonymous, Nar-Anon, Overeaters Anonymous, Co-Dependents Anonymous, or Adult Children of Alcoholics. A one page typed paper, which includes the date and time and contact person from the agency is due to your clinical instructor before your last clinical day as assigned.
Guidelines for Conference participation and E-Journal Reflection assignments: (10 points)
Students will submit E-Journal Reflection assignments to their clinical instructor within one week of the clinical day. They must be submitted via drop box or email prior to the next clinical day. On dates where a major clinical paper is due, such as a Mental Status or Nursing Care Plan, reflective journal prompts will not be assigned. Please refer to your E-College for your reflective prompts. These additional reflection assignments are considered part of your clinical documentation and participation grade.
Clinical Expectations and Guidelines
I. General clinical expectations - Required preparation and written work is specific to the acute care site, rotation, and student progress. Clinical faculty will modify requirements accordingly. The following are guidelines.
A. Students are expected to review the Procedure Manual of the clinical agency for implementing any nursing care procedure to ensure adherence to agency protocols.
B. For each clinical assignment, the student is expected to be prepared to discuss the following for assigned clients:
1. Medical diagnoses according to DSM IV or 5 (etiologies, signs, symptoms, and expected treatment) 2. Medical regimen (drugs, treatments, activity, nutrition, etc.) and the related scientific rationale 3. Mental Status Assessment, priorities, and plan for nursing care (this must be documented) The following preparation is required as determined by the faculty:
1. Reflective Journal Assignments (E-Journal via neehr perfect or email as directed by faculty)
2. Comprehensive (addressing holistic client needs) nursing care plan generated from current assessment data, based upon the student’s current theoretical knowledge with a focus on the clinical objectives 3. Mental Status Assessment and Full Mental Health Assessment
4. Recent lab data with interpretation and rational for abnormal values
5. Complete list of medications, with indication, side effects, and nursing implications
C. A current medication resource is expected to be used. Before medication administration, the following
information must be known. Your clinical instructor may require a list of these medications with classification, rational, safe administration, and evaluation.
1. Medication, dose route, frequency, scheduled times (appropriate calculations for delivery of safe doses over time)
2. Classification specific to client
3. Rationale for individual client receiving medication to include therapeutic and physiologic actions 4. Adverse effects / Interactions
5. Nursing implications specific to client and route
D. Clinical paperwork will be submitted as required by your instructor.
E. The student is expected to prepare for post conferences and contribute to discussion. Preparation includes the organization of nursing care and time management so that conferences begin on time.
