GEORGIA BAPTIST COLLEGE OF NURSING OF
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
NUR 411
MENTAL HEALTH NURSING
FALL 2004
COURSE COORDINATOR:
Lana Chase, RN, MN, CNS/PMH
GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNIVERSITY
NUR 411 Mental Health Nursing
Course Syllabus
Course Website: faculty.mercer.edu/keeley_ac
Fall 2004
Course Title: NUR 411 Mental Health Nursing
Course Credits: 6 Semester Hours (4-6-6)
Total Course Hours: Class: 4 hours/week
Total class hours: 60
Clinical 6 hours/week
Total clinical hours: 90
Course Placement: Level (4), Fall and Spring semesters, fourth year
Prerequisites: All Level 1, 2, and 3 courses and PSYC220
Course Description: This course focuses on providing the student with a theoretical and knowledge foundation for the contemporary practice of mental health nursing. Concepts taught in nursing and liberal arts courses will be integrated with current mental health nursing research and theories. Specific attention will be paid to the integration of prior learning of abnormal psychology and pharmacology with course emphasis on nursing practice. Utilizing a holistic view, the course teaches the student mental health nursing skills integrating perspectives of physical, spiritual, social, intellectual, and emotional needs in the promotion of health maintenance and the nursing management of life disruptions. Self-awareness, self-care, empathetic care of others, personal growth and professional development are vital components of the student experience in mental health nursing. Therapeutic communication, case management, critical pathways, psychopharmacology, nursing theories, and psychobiology will be threads throughout this course. Students will become familiar with standard assessment tools used in mental health. Opportunities for clinical application of classroom content will be provided in a variety of mental health settings.
Preparation for class is essential for maximum benefit of the scheduled time. Prior to each class there will be a quiz on the key points in the assignment. Each topic has a Study Guide component that is to be completed prior to class.
Course Faculty: Ann Keeley, RN, MN, LMFT (Coordinator)
Assistant Professor
Office 213, Office telephone: 678-547-6749
keeley_ac@mercer.edu
Kathleen Brewer, RN, PhD, CNS
Associate Professor
Office 236, Office telephone: 678-547-6746
Brewer_mk@mercer.edu
Lana Chase, RN, MN, CNS
Assistant Professor
Office 235, Office telephone: 678-547-6739,
Phone: 770-435-1660, 770-330-3317
Chase_l@mercer.edu
Patricia Troyan, RN, CNM, EdD.
Office 265, Office Telephone: 678-547-6762
Troyan_PJ@mercer.edu
Course Objectives:
Upon successful completion of NUR 411, the student will be able to:
1. Function in the role of a mental health nurse in a variety of clinical
settings.
2. Apply the nursing process to provide mental health nursing care to individuals, families, groups and communities of diverse cultures in a variety of settings.
3. Integrate therapeutic communication skills with the communication skills acquired thus far in the curriculum.
4. Adapt principles of teaching-learning to the provision of care within the realm of mental health nursing.
5. Integrate a professional code of behavior to the practice of mental health nursing.
6. Integrate relevant legal and ethical guidelines in to the practice of mental health nursing.
7. Apply nursing theories of evidence-based practice, case management, and critical pathways to mental health nursing.
8. Synthesize knowledge from the liberal arts and sciences with current theories of mental health nursing practice.
9. Access and utilize print, internet, and community based resources to the practice of mental health nursing.
Required Textbooks:
Boyd, M.A. (2005). Psychiatric nursing: Contemporary practice (3rd Ed.). Lippincott Williams & Wilkins: Philadelphia: PA.
Boyd, M.A., & Foley, M. (2002). Study guide to accompany psychiatric nursing: Contemporary practice (2nd Ed.). Williams & Wilkins: Philadelphia: PA.
(Will be supplied in class)
Pharmacology Textbook from NUR 312
Abnormal Psychology Textbook from pre-requisite course
Required Readings:
American Nurses Association (1985). Code for nurses with interpretative statements. Washington, DC: Author (see Student Handbook).
American Nurses Association (1988). Standards of clinical nursing practice (2nd
Ed.). Washington, DC: Author (on Library Reserve).
Evaluation of Student Learning:
1. Objective Testing
2. Clinical Performance Evaluation
3. Drug Calculation Test
4. Family Project
5. Communication Project
6. Class Assignments
Requirements for Successful Completion of Course:
1. The student must make an average of 75% on objective testing and written course assignments to successfully complete the course.
2. The student must pass a drug calculation test with 90% accuracy. Any student falling below 90% accuracy will have an opportunity for remediation and two additional opportunities to take the test within 3 weeks after the onset of the course.
3. Satisfactory clinical performance
4. Completion of ATI Achievement Examinations
5. Completion of all clinical and classroom assignments
Course Grading System:
Exam I 20%
Exam II 20%
Exam III 20%
Comprehensive Exam 20%
Communication Project 10%
Family Project 10%
Total 100%
A project with a failing grade will be read by a second faculty member. The
student will receive the highest grade of the two grades.
Make-up exams will follow the policy set forth in the Student Handbook. Please
note* the make-up exam will cover the same content but may be of a
different format and the questions may vary in number.
It is the policy of Georgia Baptist College of Nursing of Mercer University to
adhere to all Health Insurance Portability and Accountability Act (H.I.P.A.A)
guidelines. All discussions and/or documents related to confidential
patient/client health information will only be written or electronically
transmitted using the client/patent initials. Furthermore, this information
will only be shared with faculty involved in the student’s education
process. Client/patient discussions will only be held in designated areas of
the university or clinical facility.
NUR 411: Syllabus: Keeley.Chase.11/22/02.Rev. Chase/08/04
GEORGIA BAPTIST COLLEGE OF NURSING
OF MERCER UNIVERSITY
INCLEMENT WEATHER CLOSING ACTION PLAN
In cooperation with the overall inclement weather plan of Mercer’s Cecil B. Day Campus/Atlanta and the off-campus centers in Griffin, Douglas County, and Covington, the College of Nursing will follow a predetermined plan to disseminate information to students, faculty and staff:
1. The decision to close any one (or all) of the multiple Atlanta area campuses will be made by Dr. Bartling (School of Pharmacy) in consultation with Dr. Dattilo (College of Nursing). Dr. Bartling will consult with designated administrative individual(s) to determine how each school will respond to the weather crisis. For example, morning clinical experiences for nursing may be affected differently from evening business or education classes.
2. Dr. Bartling will notify the University Relations and Marketing Office and a staff member in this office will do the following:
□ A message for each school will be recorded on the University Weather Hot-line telephone number (see below).
□ An e-mail broadcast message will be sent to faculty, staff and students
□ A scrolling red message bar will appear on the home page of Mercer’s web site at mercer.edu
□ A general message will be given to WSB TV (channel 2) and WSB radio (AM 750) to put on the air.
IMPORTANT: Faculty, staff, and students should rely on the phone hot-line message, the web page or their e-mail to get the most accurate information about the specific plan for our college.
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
STUDENT NAME:
COURSE: DATE:
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HONOR SYSTEM CREED
As a member of the Georgia Baptist College of Nursing community, I am bound by honor to uphold standards of honesty and integrity; to pursue full intellectual, ethical, spiritual, and moral development; and to accept my personal, academic, professional responsibilities in the community. To attain these ideals, I embrace this Honor System as my way of life.
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H.I.P.A.A. Statement
It is the policy of Georgia Baptist College of Nursing of Mercer University to adhere to all Health Insurance Portability and Accountability Act (H.I.P.A.A.) guidelines. All discussions and/or documents related to confidential patient/client health information shall be held in strict confidence. Information will only be written or electronically transmitted using the client/patient initials. Further, this information will only be shared with faculty involved in the student’s education process. Client/patient discussions will only be held in designated areas of the university or clinical facility.
Permission for Posting Grades
In accordance with the Buckley Amendment to the Family Educational Rights and Privacy Act of 1974, we cannot post any exam or course grades without the express permission of the student. Therefore, we would like to ask each of you to indicate whether or not you desire to have your grades posted in a public place.
I would like to have grades for the above course posted by an identification number on a designated bulletin board. YES__________ NO___________
Signature:__________________
Code Number:______________
(Choose a four digit number; which
will be followed by three (3) zeros.)
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Statement of Understanding
I have read the Course Outline for the above stated course. I understand the objectives and requirements of this course and have no questions regarding them. I also have read the Honor System Creed, the H.I.P.A.A. Statement, and the Permission for Posting Grades Statement. I understand the purposes and requirements of the above statements.
Signature:____________________________________
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
H.I.P.A.A. Background Information
In 1996, Congress enacted the Health Insurance Portability and Accountability Act, or H.I.P.A.A. The primary purpose was continuity of health insurance coverage if you change jobs, but it also provided standards for health information transactions and confidentiality and security of patient data. This confidentiality portion affects the day-to-day education process of nursing students. Permission must be received from the patient prior to ANY disclosure.
H.I.P.A.A. Enforcement
The Privacy Rule was published in April 2001 and will be enforceable in April 2003. The Office of Civil Rights will enforce it. There are civil penalties of $100/violation up to $25,000/year. Criminal penalties are also possible including $50,000 and/or 1 year in prison for wrongful disclosure or $250,000 and/or 10 years in prison for the intent to sell information.
As health care providers, we all have a responsibility to uphold confidentiality for patients. In a busy education or hospital setting it can be difficult. Classroom discussions and clinical conferences and assignments lead to discussions of client's confidential health information. While these oral and written discussions are acceptable in the educational setting, they are not acceptable in common areas such as the cafeteria, or in the written form without preventing the disclosure of the patient's name. The person next to you in line could be a patient's friend, relative, or media member that is not entitled to this privileged information. If clinical/classroom papers are lost or transmitted electronically without safeguards, the general public would have access to confidential patient information.
Confidentiality is the basis of the nurse-patient relationship. If the patient is uneasy about disclosing pertinent and privileged information, the ability of the nurse to provide holistic adequate care is severely compromised. It should be made clear to the patient that this information will not be disclosed unless required by law. The medical record is to be kept private with certain exceptions including:
- Treatment of minors - HIV+ Patients - Abuse of a Child or Adult
- Transportation Safety - Duty to report harm/wound
GEORGIA BAPTIST COLLEGE OF NURSING
Of
Mercer University
NUR 411 Mental Health Nursing
Clinical Component
1. Clinical Experiences: Each student will complete clinical experiences in mental health settings. Students are expected to establish collaborative relationships with members of the health care team and with other professionals in the application of the nursing process in each setting.
2. Clinical Agencies: A variety of mental health settings.
3. Faculty Supervision of Students: The faculty member who is responsible for the student may or may not be present in the same setting as the assigned student. In order to enhance the learning experience of the student and to augment communication between the faculty member and the student, the faculty member will be accessible to the student either by telephone or by beeper during the period of time that is required for the student to complete the clinical assignment. When students complete the clinical assignment, they will notify the faculty member either directly or by voice mail.
4. Uniform Policy: Students are expected to report to all clinical facilities dressed according the policy of the College or the Facility, whichever has been designated by the clinical faculty.
5. Clinical Assignments: There will be several specific assignments relevant to the mental health nursing practice. Successful completion of these assignments by the specified date is necessary for a "Satisfactory" clinical performance rating.
Weekly Worksheet: Mental Health Nursing:
FACULTY: STUDENT: DATE:
Identifying data:
Gender: Age: Marital Status: _____
Ethnicity: ______________
General Appearance:
Unkempt Unclean Well-Groomed Posture
Reason for admission:
________________________________________________________________________________________________________________________________
Current health:__________________________________________________
Significant Health history:_________________________________________
Alterations
Activity:
Sleep:
Appetite/Nutrition/Hydration:
Self-care:
Lab values:
Mental Status Exam: Circle all terms that apply
General Appearance:
Unkempt Unclean Well-Groomed Posture
Motor Activity:
Tremors Tics Hyperactivity Restlessness Boundaries
Agitation Aggressiveness Rigidity Psychomotor retardation
Speech Patterns:
Rate: Normal Slow Rapid Pressure of Speech Stuttering Correct use of words Fluency Quality Volume: ______________
General Attitude:
Cooperative Uncooperative Friendly Hostile
Defensive Disinterested Apathetic Attentive Guarded
Mood:
Sad Depressed Despairing Irritable Anxious Euthymic Dysphoric
Elated Euphoric Fearful Guilty Labile Apathy
Other: ______________
Affect:
Congruent with mood Range: Full Constricted Intensity: Increased Flat Blunted Stability: Normal Labile
Other: ______________
Thought Processes:
Form:
Flight of ideas Associative looseness Circumstantiality Tangentiality Neologisms
Concrete thinking Clang Word salad Preservation Mutism
Poverty of speech Ability to concentrate Attention span Ability to Concentrate Confabulation
Content:
Delusions type Suicidal Obsessions Paranoia Magical thinking
Religiosity Repetition
Abstract Reasoning and comprehension: (Proverbs)
_____________________________________________________________________________
Perceptual Disturbances:
Hallucinations type: Illusions Depersonalization Derealization
Judgment and Insight:
Ability to solve problems
Ability to make decisions
Knowledge about self
Memory
Recent: Impaired Intact Remote: Impaired Intact
Orientation (Time, Place, Person, Situation) Disoriented: Confused
Self Concept:
________________________________________________________________________________________________________________________________________________________________________________________________
Stress and Coping Patterns:
________________________________________________________________________________________________________________________________________________________________________________________________
Risk Assessment:
Suicide: (Thoughts or Ideation/ Plan/ Means/ Means Available)
________________________________________________________________________________________________________________________________________________________________________________________________
Homicide: (Anger behaviors/ history of violence/ history of arrest/ current thoughts of harming others)
________________________________________________________________________________________________________________________________________________________________________________________________
GAF Score: ___________
Family Assessment: (Members/ members available to client/ family participation)
________________________________________________________________________________________________________________________________________________________________________________________________
Sociocultural Assessment: (Cultural group/ cultural group’s perception of mental health and mental illness/ cultural norms relevant to situation)
________________________________________________________________________________________________________________________________________________________________________________________________
Community Resources:
________________________________________________________________________________________________________________________________________________________________________________________________
Spirituality:
________________________________________________________________________________________________________________________________________________________________________________________________
Economic Resources:
________________________________________________________________________________________________________________________________________________________________________________________________
Legal:
________________________________________________________________________________________________________________________________________________________________________________________________
DSM IV-TR Diagnosis:
Axis 1: Axis 2: Axis 3
Axis 4: Axis 5 I
dentify clinical behavior that supports any of the axis diagnoses:
________________________________________________________________________________________________________________________________________________________________________________________________
Nsg. Dx.
Short Term Goal:
Interventions
Long Term Goal:
Interventions:____________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________
Charting ___________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________
MEDICATIONS:
BRAND NAME: GENERIC NAME:
DOSE AND TIME:
PURPOSE:
SIDE EFFECTS:
NSG CONSIDERATIONS/TEACHING: ___________________________________________________________________________________________________________________________________________________________________________________________
OBSERVED EFFECTS:
________________________________________________________________________________________________________________________________________________________________________________________________
BRAND NAME: GENERIC NAME:
DOSE AND TIME:
PURPOSE:
SIDE EFFECTS:
NSG CONSIDERATIONS/TEACHING:
________________________________________________________________________________________________________________________________________________________________________________________________
OBSERVED EFFECTS:
________________________________________________________________________________________________________________________________________________________________________________________________
BRAND NAME: GENERIC NAME:
DOSE AND TIME:
PURPOSE:
SIDE EFFECTS:
NSG CONSIDERATIONS/TEACHING: ____________
OBSERVED EFFECTS:
________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________
Considerations for Drug Interactions:
COMMUNICATION PROJECT
GUIDELINES: GRADING CRITERIA
GUIDELINES:
Each interview will last approximately fifteen (15) minutes. Students will provide their own videotape.
Each pair of students will film two interviews. At the completion of the first interview, the roles will switch. The context of the interview will be a nursing assessment of a consumer who has just arrived to be assessed for admission to an inpatient, outpatient, or emergency treatment facility.
Students will collaborate with their partner to analyze each scenario.
Submit the videotape and one paper per student pair analyzing both scenarios separately.
Each student will add an individual self-analysis (see #5) to the end of the paper.
Each pair will submit a paper with their videotape by the date identified on the syllabus calendar.
Prior to the interview Student A (Consumer) will inform Student B (Nurse) of the diagnosis, age sex, length of illness, medications, and other medical conditions.
INTERVIEW:
STUDENT A: Present symptoms of an identified DSM-IV diagnostic category.
The consumer will include an attempt to:
1. Elicit personal information from the Nurse
2. Ask for advice at least once
3. Ask the nurse for reassurance
4. Disagree with the nurse
5. Make one attempt to challenge therapeutic space boundaries.
STUDENT B: Conduct a therapeutic assessment interview with the consumer. Utilize as many therapeutic communication techniques as possible.
IPR FORM
|Student: Verbal/Nonverbal |Client: Verbal/Nonverbal |Communication Technique/Alternate |Behavior Analysis: Interaction Analysis |
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NUR 411: KEELEY:IPR:S/2003
IPR FORM
|Student: Verbal/Nonverbal |Client: Verbal/Nonverbal |Communication Technique/Alternate |Behavior Analysis: Interaction Analysis |
|Hi My name is _____. I am a student from Mercer|Pt. Nodding off in a chair in the Mileu. | | |
|University. I would like to spend about 15 | | | |
|minutes getting to know you today. | | | |
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|Nonverbal – relaxed posture, eye contact, facing| | | |
|client slightly learning forward. |Coughing | | |
| |Wheezing | | |
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| |Yes, while I am awake. | | |
|How did you arrive at the clinic today? | | | |
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| |I walked. Talked. Squalked. How did you | | |
| |arrive? | | |
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|It is not important how I got here…Let’s focus |Coughing | | |
|on you. | | | |
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| |It is always about me. Everyone wants to | | |
| |sleep with me. My | | |
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|Student: Verbal/Nonverbal |Client: Verbal/Nonverbal |Communication Technique/Alternate |Behavior Analysis: Interaction Analysis |
| |Wife is Janet Jackson and she travels a lot. | | |
| |I am alone and everyone wants to sleep with | | |
| |me when she is gone. | | |
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| |I can hear their thoughts when they look at | | |
|How did you know that everyone wants to sleep |me. | | |
|with you? | | | |
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| |Coughing | | |
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| |Falling asleep. Are you a Nethrerlander? | | |
|When you say “sleep” are you actually referring | | | |
|to falling asleep or sexual implications? | | | |
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|What is a Netherlander? | | | |
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|Student: Verbal/Nonverbal |Client: Verbal/Nonverbal |Communication Technique/Alternate |Behavior Analysis: Interaction Analysis |
|No, I don’t’ think I do. |You don’t know what a Netherlander is? | | |
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| |You would know if you were one. | | |
|Are you a Netherlander? | | | |
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| |Boys cannot be Netherlanders. | | |
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|I wonder where that thought came from? |Where do you live? | | |
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| |Coughing | | |
| |Wheezing | | |
|Remember…I would like to hear about you during | | | |
|this time. Tell me more about being sleepy all | | | |
|of the time. | | | |
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|Student: Verbal/Nonverbal |Client: Verbal/Nonverbal |Communication Technique/Alternate |Behavior Analysis: Interaction Analysis |
|I’ve noticed that you hold your hand in the air.|Coughing | | |
|Is there a reason you need to do this? | | | |
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|There are little men. I wonder where they come | | | |
|from |The little men fall off when I hold my arm | | |
| |high in the air. | | |
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| |I feel them. | | |
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|Are you sleepy often? | | | |
| |They tickle me and make me sleepy. That’s | | |
| |why everybody wants to sleep with me. Yes | | |
| |coughing. | | |
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|Student: Verbal/Nonverbal |Client: Verbal/Nonverbal |Communication Technique/Alternate |Behavior Analysis: Interaction Analysis |
| |Yes, I am very sleepy. I think I will lie | | |
| |down now. | | |
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|I would really like to find out more about you |I don’t have a few more minutes! My wife is | | |
|if you could give me a few more minutes. |coming back! I must get to sleep! | | |
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|SILENCE | | | |
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| |SOB c execution | | |
| |Coughing | | |
| |Wheezing | | |
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|I am sorry to keep you awake… I have 5 more | | | |
|minutes. Do you have 5 more minutes? | | | |
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|Student: Verbal/Nonverbal |Client: Verbal/Nonverbal |Communication Technique/Alternate |Behavior Analysis: Interaction Analysis |
| |Yes, but only 5 min. My arm is tired and I | | |
| |cannot keep the men off any longer. | | |
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| |Janet. | | |
|What is your wife’s name? | | | |
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| |12 years. | | |
|How long have you known her? | | | |
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| |Downtown by the Stadium. | | |
|Where do you and Janet live? | | | |
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| |Coughing | | |
|Were you living there the day you came here? |Wheezing | | |
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|Student: Verbal/Nonverbal |Client: Verbal/Nonverbal |Communication Technique/Alternate |Behavior Analysis: Interaction Analysis |
|Did you come here to get your medicine? |Yes; It was raining. I was out of my | | |
| |medicine. Did I do the right thing? | | |
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| |The police brought me here because I was | | |
| |trying to get into Janet’s concert to be with| | |
| |her. | | |
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| |Do you think we should get a divorce? | | |
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|“Should you get a divorce…” | | | |
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| |Coughing | | |
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| |Am I doing the right thing? You know holding | | |
|I am sorry to keep you awake…I have 5 more |my arm up while my wife is gone? | | |
|minutes. Do you have 5 more minutes? | | | |
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|Student: Verbal/Nonverbal |Client: Verbal/Nonverbal |Communication Technique/Alternate |Behavior Analysis: Interaction Analysis |
|I am not unable to tell you what is right for | | | |
|you. I am sure that is difficult to continue | | | |
|holding your arm that way all of the time. | | | |
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| |I need some rest. | | |
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|Thank you for your time. | | | |
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GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNIVERSITY
NUR 411 MENTAL HEALTH NURSING
Guidelines: You may write a narrative but number each section relating to the
questions. If there is overlapping data, then state: e.g.#4 is discussed in #3. You may
also edit questions to fit your family or include some that are not listed. The paper is
typed. There are no page limits but please aim to be concise and to the point. You
should be able to consolidate important information in an assessment. Try not to include
minute details that are irrelevant.
Family Interview Questions to Consider:
1. Initials of family members/significant others (use only initials-no identifying data for confidentiality).
Initials Age Relationship Type of Residence Members Present at Interview
Does any family member live outside the family home? Does the family member mental illness live with the family or in a group home/apartment or have their own home? Is the family satisfied with this living arrangement? Is the family member with the mental illness living or deceased? If deceased, gear the interview to discussion of care given when the person was living as well as the causes of death and grief experiences within the family.
2. Health Status (list all family members)
Family Member
Disorder and/or self described health status
Current treatment & effectiveness of treatment
Any health/illness patterns that student or family identify?
Any physical health risks related to side effects of psychotropic medication or
lifestyle? i.e smoking, weight gain, liver, kidney problems, and substance abuse… List all physical problems that family members may have.
3. Mental Health Status (list all family members)
Family Member
Disorder and/or self described health status
Current treatment & effectiveness of treatment
Any health/illness patterns that student or family identify?
Any family member has stress, depression, anxiety that the individual identifies
as being related to caregiver burnout?
4. Impact of mental and physical illnesses on family function: Describe the
changes that occur in the family as a result of any family members mental illness
or physical illness. Note: Impact on parents, siblings, and extended family,
significant others, marital status.
5. Family life cycle: Describe the family life cycle stage and any transitions that are occurring.
6. Communication Patterns: Describe the family communication patterns in terms of usual times of communication (morning, dinner, etc.), which family members talk to each other, who communicates the family rules, who is able to set limits. Ask the family about conflicts in communication and how these are handled.
7. Stress and coping: Identify any current family stressful events. What coping
strategies do family members use to deal with stress?
8. Problem solving skills: Determine who solves problems in the family. Do family members see themselves as good, adequate or poor problem solvers?
9. Family system: Ask the family to assist you to draw a 3-generatioon family genogram that identifies the family composition. Identify “relationship patterns” with the family.
10. Identify social function patterns with the family: Does the family tend to interact mostly with the nuclear family, extended family, and/or community organizations?
Do family members feel isolated or supported?
11. Financial Issues: Do family members identify any financial issues they are struggling with? Are these issues related to healthcare or cost of medications? Are all adults in the family able to financially support themselves?
12. Legal System: Has the legal system been a benefit to the family or created any crisis for the family? How?
13. Network Support: Who does the family seek support from when they have a crisis? Has the support been adequate? Discuss formal and informal support networks such as extended family, neighbors, church, NAMI, MH center/caregivers, police, etc…
Does the family have an advocate who assists them to get their health-care needs met?
Ask the family members to identify the issues of most concern to them.
What would you and the family include in a multidisciplinary plan of care to address their
healthcare needs?
Have health/mental health caregivers collaborated with family members to develop a workable plan of care?
Identify any community resources that they have accessed for support.
Have these resources been helpful or not?
In addition to available resources, also discuss a “wish list” of resources that the family needs but are not currently available to them in their community.
Are any of the services on their “wish list” available but not accessible because their family does not “qualify” for the service under current admission criteria?
Has the family been disappointed in care they received by any facility/hospital/or health
practitioner? What was the nature of their disappointment?
Has the family experienced problems with “stigma” regarding mental illness in their
family?
What role has NAMI played in their lives?
Do family members seek health care in the private or public sector?
Have they received equal care/insurance benefits for mental and physical illnesses? Have the benefits met the family need?
Do family members have any suggestions for you to become an effective caregiver in working with families in crisis?
Ask the family members to discuss their feelings/reactions to this interview with you.
Share any self-awareness or insights you gained by interacting with the family.
NUR 411: Family Interview Questions. LC:S03
GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNVIVERSITY
NUR 411 MENTAL HEALTH NURSING
Family Interview Grading
Guidelines: You may write a narrative but number each section relating to the
questions. If there is overlapping data, then state: e.g.#4 is discussed in #3. You may
also edit questions to fit your family or include some that are not listed. The paper is
typed. There are no page limits but please aim to be concise and to the point. You
should be able to consolidate important information in an assessment. Try not to include
minute details that are irrelevant.
35 points Data Gathering: Documented appropriated data related to the family’s
mental, physical, social and spiritual functioning (see questions)
15 points: Family Genogram: List all members in 3 generations. Include age, death, divorce, biological and stepfamily, and record how the people you interview feel about
this person if anything significant arises.
15 points Interpretation of data: What is your impression of the dynamics of this family? What conclusions do you draw related to the data you gathered?
15 points Plan of care: List 2 issues that you or a family member identified as a problem and any solutions that they have sought and alternated solutions you could suggest. Include community/Internet resources
20 points Self-Awareness: How did you feel going into the home for this interview? How do you rate your interview skills and what would you do differently in a next interview? Did you have any attitude changes from this interview and/or throughout the semester regarding mental illness? How will these changes impact your career in
nursing?
SOCIAL CHANGE AND MENTAL HEALTH
LESSON OBJECTIVES:
At the completion of this lesson the student will be able to
1. Identify agents of social change that affect the delivery of mental health care.
2. Relate the concept of social change to the history of psychiatric mental health care.
3. Discuss the history of psychiatric-mental health nursing and its place within nursing history.
4. Analyze the theoretic arguments that shaped the development of contemporary scientific thought.
5. Summarize the impact of the current economic and political forces on the delivery of mental health services.
CONTENT OUTLINE:
1. A Revolutionary Idea: Humane Treatment
2. The 19th and Early 20th Centuries
1. Horace Mann and the Beginning of Public Responsibility
2. A Social Reformer: Dorothea Lynde Dix
3. Life Within Early Institutions
4. Development of Psychiatric-Mental Health Nursing Thought
1. Early Views
2. Social Influences
3. Modern Thinking
1. Evolution of Scientific Thought
1. Meyer and Psychiatric Pluralism
2. Freud and the Psychoanalytic Theory
3. Diagnostic Classifications
4. Integration of Biologic Theories Into Psychosocial Treatment
2. Increased Government Involvement in Mental Health Care
3. Continued Evolution of Psychiatric-Mental Health Nursing
4. The Late 20th Century
1. Community Health Movement and Deinstitutionalization
2. Sanctioning of Holistic Nursing Care
3. Contemporary Issues
1. Changing Demographics
2. The Age of Managed Care
3. National Mental Health Objectives
LEARNING ACTIVITIES:
1. Study Guide: Chapter 1: 1-5 pp.
2. Participation in Classroom critical thinking activities.
3. Quiz
4.
CRITICAL THINKING FOCUS:
How the concepts of mental health/mental illness are a product of history. What is the history of professional nursing care in mental health and mental illness.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 2-15). Philadelphia:
Lippincott.
WEB LINKS:
This is the Healthy People 2010 website.
This website of the U.S. Surgeon General contains major mental health reports.
The National Library of Medicine site offers excellent access to PUBMED for nursing articles and mental health information. It provides links to the History in Medicine Library.
This site is an excellent resource on disorders and diagnoses and provides links to other sites.
This site provides access to the Mental Health Net, self-help groups, professional resources, and discussions.
This Substance Abuse and Mental Health Statistics site provides national statistics on alcohol, tobacco, and illegal drug use, substance abuse treatment, and mental health.
This site of the World Health Organization has information on mental health disability and programs.
NUR 411: KEELEY/CHASE: 11/22/2002
PATIENT RIGHTS AND LEGAL ISSUES
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Discuss the role of informed consent in the delivery of psychiatric-mental health care.
2. Use the concepts of self-determinism and competence in discussing patient treatment choices.
3. Delineate the differences between voluntary and involuntary treatment.
4. Explain the rationale for providing the least restrictive treatment environment.
5. Discuss the issues of confidentiality and mandates to inform and their implications in psychiatric mental healthcare.
6. Identify the importance of accurate, descriptive documentation of the biopsychosocial areas.
7. Discuss the issues underlying the insanity plea.
CONTENT OUTLINE:
1. Patient Rights
1. Bill of Rights
2. The Americans With Disabilities Act and Job Discrimination
2. Issues of Consent
1. Self-Determinism
2. Self-Determination Act
3. Advance Care Directives in Mental Health
4. Competency
5. Informed Consent
3. Voluntary and Involuntary Treatment
1. Right to Treatment in the Least Restrictive Environment
4. Issues of Confidentiality
1. Privacy Versus Confidentiality
2. Mandates to Inform
5. Documentation and Legal Issues
6. Criminal Law and Psychiatry
1. Not Guilty by Reason of Insanity (NGRI)
2. Guilty But Mentally Ill (GBMI)
3. Forensic Commitment
4. Misconceptions Regarding the Insanity Plea
7. Public Safety
1. Laws and Systems That Protect Human Rights
2. Internal Rights Protection System
3. External Advocacy Systems
LEARNING ACTIVITIES:
1. Study Guide: Chapter 4: pp 13-15.
2. Participation in Classroom Critical Thinking Exercises. CTE # 3. Study Guide Page 16. Critical Thinking Challenge #2. Page 51 Text.
3. Quiz
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed.,pp.42-52). Philadelphia
Pa.: Lippincott.
WEB LINKS:
The National Alliance for the Mentally Ill is a grassroots, self-help support, and advocacy organization.
The Canadian Nurses Protective Society (CNPS) is a nonprofit society, owned and operated by nurses for nurses, offering legal liability protection related to nursing practice to registered nurses by providing information on education.
This site provides information on nurses as legal consultants.
NUR 411: KEELEY/CHASE: 11/22/2002
COMMUNICATION AND THE THERAPEUTIC RELATIONSHIP
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Identify the importance of self-awareness in nursing practice.
2. Develop a repertoire of verbal and nonverbal communication skills.
3. Develop a process for selecting effective communication techniques.
4. Explain how the nurse can establish a therapeutic relationship with patients by using rapport and empathy.
5. Explain the physical, emotional, and social boundaries of the nurse-patient relationship.
6. Explain what occurs in each of the three phases of the nurse-patient relationship: orientation, working, and resolution.
CONTENT OUTLINE:
1. Self-Awareness
1. The Biopsychosocial Self
2. Understanding Personal Feelings and Beliefs and Changing Behavior
2. Communication
1. Using Verbal Communication
1. Self-Disclosure
2. Verbal Communication Techniques
2. Using Nonverbal Communication
3. Selecting Communication Techniques
2.1.4 Applying Communication Concepts
1. Rapport
2. Empathy
2.1.3.1.3 Biopsychosocial Boundaries and Body Space Zones
4. Analyzing Interactions
3. The Nurse-Patient Relationship
1. Orientation Phase
1. First Meeting
2. Confidentiality in Treatment
3. Testing the Relationship
2. Working Phase
3. Resolution Phase
LEARNING ACTIVITIES:
1. Study Guide: Chapter 9: Pages 41-43
2. Participation in Case Study Activities. CTE #2. Study Guide. Page 43
3. Quiz
CRITICAL THINKING FOCUS:
Development of self-awareness of individual communication patterns and addition of therapeutic communication skills utilized in the practice of mental health nursing.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., Pp 178-192).
Philadelphia Pa.: Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
CULTURAL ISSUES RELATED TO MENTAL HEALTH CARE
LESSON OBJECTIVES
Upon completion of the lesson, the student will be able to:
1. Identify various cultural and ethnic groups in the United States and Canada.
2. Compare the concepts of prejudice, discrimination, and stereotyping and their relationship to stigmatization.
3. Define the process of stigmatization as an influence in mental health care delivery.
4. Describe the beliefs about mental health and illness in different cultural groups.
5. Trace the changing view of families from causing mental illness to collaborating in the care.
6. Discuss the changing family structure and the mental health implications.
7. Describe the important role of consumer groups in developing awareness of the special problems of patients with mental disorders.
CONTENT OUTLINE:
1. Importance of Culture to Psychiatric Nursing
2. Cultural Terms and Issues
1. Acculturation
2. Segregation Versus Integration
3. Prejudice, Discrimination, and Stereotyping
4. Stigmatization
5. Gender and Culture
3. Various Cultural and Religious Views of Mental Illness
1. Religion and Mental Illness
4. Cultural Groups
1. African Americans
1. Lives of African Americans Today
2. Beliefs About Mental Illness
2. Latino Americans
1. Lives of Latino Americans Today
2. Access to Mental Health Care
3. Asian Americans, Polynesians, and Pacific Islanders
1. Lives of Asian Americans, Polynesians, and Pacific Islanders Today
2. Beliefs About Mental Illness
4. Native Americans
5. Socioeconomic Influences on Mental Health Care
1. Poverty and Mental Illness
2. Geographic Location and Access to Mental Health Care
6. Changing Family Structure
1. Family Size
2. Changing Roles
3. Mobility and Relocation
4. Unmarried Couples
5. Single-Parent Families
6. Stepfamilies
7. Childless Families
8. Same-Gender Families
7. Stigma and Mental Illness
1. Effects of Stigma on Patients With Mental Illness
2. Stigmatization and Stress for Family Members
3. Changing Public Attitude: National Alliance for the Mentally Ill
LEARNING ACTIVITIES:
1. Study Guide: Chapter 2: Pages 2-8
2. Participation in Critical Thinking Exercises in Class : CTE #4, Page 8
3. Quiz
CRITICAL THINKING FOCUS:
How are the mentally ill a cultural group? What influence do birth cultures have on the definition of mental health/mental illness? How does the mental health nurse integrate concepts related to culture to holistic care of her patients?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 16-28).
Philadelphia, Pa. : Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
THE MENTAL HEALTH - MENTAL ILLNESS CONTINUUM
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Differentiate the concepts of mental health, mental illness, mental disorder, and mental health problems.
2. Define epidemiologic terms rate, prevalence, and incidence.
3. Identify categoric and dimensional diagnoses and their relevance to psychiatric nursing.
4. Differentiate the five axes used in the Diagnostic and Statistical Manual for Mental Disorders.
5. Compare Caplan’s conceptualization of prevention with the newer intervention spectrum recommended by the Committee on Prevention of Mental Disorders.
6. Discuss discipline relationships and the use of nursing care plans and critical pathways.
CONTENT OUTLINE:
1. Epidemiology of Mental Disorders
1. Epidemiologic Terms
2. Barriers to Psychiatric Epidemiology
3. Risk Factors Related to Mental Disorders
2. Diagnoses in Mental Health
1. Categoric Versus Dimensional Diagnoses
2. Labeling and Its Consequences
3. Psychiatric Diagnosis: The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
3. Interventions in Psychiatric Mental Health
1. Caplan’s Model: Primary, Secondary, and Tertiary Prevention
2. Interventions Spectrum: Prevention, Treatment, Maintenance
3. Clinical Decision Making
4. Interdisciplinary Approach and the Nurse’s Role
4. Nursing Care Plans
1. Critical Pathways
2. Treatment Guidelines in Psychiatric Mental Health Care
5. Nurse as Coordinator
LEARNING ACTIVITIES:
1. Study Guide: Chapter 3: 9-11pp.
2. Participation in Class Discussion Case Studies CTE #1,4 Study Guide Page 11,12
3. Quiz
CRITICAL THINKING FOCUS:
Development of a working definition of mental health that illustrates understanding of the nature of a continuum of symptoms.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 30-40).
Philadelphia: Lippincott.
WEB LINKS:
This useful site examines many aspects of mental health and mental illness, including psychiatric diagnosis.
This website of the Agency for Healthcare Research and Quality has a repository of practice guidelines.
This nursing student website includes nursing care plans.
This site provides information on nurses as legal consultants.
NUR 411: KEELEY/CHASE: 11/22/2002
CONTEMPORARY PSYCHIATRIC NURSING PRACTICE
LESSON OBJECTIVES:
1. Explain the biopsychosocial model as a conceptual framework for understanding and treating mental health problems
2. Delineate the scope and standards of psychiatric-mental health nursing practice.
3. Discuss selected challenges of in psychiatric-mental health nursing.
4. Identify ethical framework and principles used in the practice of psychiatric nursing.
5. Discuss the impact of psychiatric-mental health nursing professional organizations on practice.
CONTENT OUTLINE:
1. The Biopsychosocial Model and Psychiatric-Mental Health Nursing
1. Biologic Domain
2. Psychological Domain
3. Social Domain
2. Standards of Care and Professional Practice
1. Scope of Psychiatric-Mental Health Nursing Areas of Concern
2. Standards of Care
3. Standards of Professional Performance
4. Basic and Advanced Practice Levels
1. Basic Level
2. Advanced Level
3. Challenges of Psychiatric Nursing
1. Knowledge Development, Dissemination, and Application
2. Overcoming the Stigma
3. Health Care Delivery System Challenges
4. Impact of Technology
4. Ethical Frameworks
5. Psychiatric-Mental Health Nursing Organizations
LEARNING ACTIVITIES:
4. Study Guide: Chapter 5: pp 19-22.
5. Participation in Classroom Critical Thinking Exercises. Critical Thinking Challenge #1. Page 63 Text.
6. Quiz
CRITICAL THINKING FOCUS:
How do professional organizations influence the practice of nursing? How is this different from following doctor's orders? What is the basic philosophy underlying the biopsychosocial model?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 54-63).
Philadelphia: Lippincott.
WEB LINKS:
This is the American Nurses Association website.
This is the site of the International Society of Psychiatric-Mental Health Nurses.
This is the American Psychiatric Nurses Association website.
At the Surgeon General’s website, one can obtain a copy of Mental Health: Report of the Surgeon General.
The Canadian Nurses Association.
The Canadian Federation of Mental Health Nurses website which has the Canadian standards of psychiatric nursing practice.
THEORETIC BASIS OF PSYCHIATRIC NURSING
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Discuss the need for a theory-based practice and supporting research.
2. Identify the underlying theories that contribute to the understanding of human beings and behavior.
3. Compare the key elements of each theory that provides a basis for psychiatric-mental health nursing practice.
4. Identify common nursing theoretical models used in psychiatric-mental health nursing.
CONTENT OUTLINE:
1. Biologic Theories
1. General Adaptation Syndrome
2. Diathesis-Stress Model
2. Psychological Theories
1. Psychodynamic Theories
2. Psychoanalytic Theory
1. Study of the Unconscious
3. Personality and Its Development
1. Psychoanalysis
2. Neo-Freudian Models
1. Adler’s Foundation for Individual Psychology
2. Jung’s Analytical Psychology: The Existence of Archetypes
3. Horney’s Feminine Psychology
4. Other Neo-Freudian Theories: Birth Trauma and Child’s Play
3. Departure From Freudianism:
1. Sullivan’s Interpersonal Forces
2. Humanistic Theories
4. Roger’s Client-Centered Therapy
5. Gestalt Therapy
6. Abraham Maslow’s Hierarchy of Needs
7. Applicability of Psychodynamic Theories to Psychiatric-Mental Health Nursing Defense Mechanisms
1. Transference and Countertransference
2. Object Relations and Identification
3. Empathy
4. Behavioral Theories
1. Early Stimulus-Response Theories
2. Reinforcement Theories
1. Edward L. Thorndike
2. B. F. Skinner
5. Cognitive Theories
1. Albert Bandura’s Social Cognitive Theory
2. Aaron Beck: Thinking and Feeling
6. Applicability of Behavioral Theories to Psychiatric-Mental Health Nursing Developmental Theories
7. Erik Erikson: Psychosocial Development
1. Identity and Adolescents
2. Research Support for Erikson’s Models
8. Jean Piaget: Learning in Children
9. Carol Gilligan: Gender Differentiation
10. Jean Baker Miller: A Sense of Connection
11. Applicability of Developmental Theories to Psychiatric-Mental Health Nursing
3. Social Theories
1. Family Dynamics
2. Interactional View
3. Problem-Solving Approach
4. Multigenerational System
1. Structural Family Theory
2. Applicability of Family Theories to Psychiatric-Mental Health Nursing
3. Social Distance
5. Balance Theory
1. Applicability of Balance Theory to Psychiatric-Mental Health Nursing
6. Role Theories
1. Role Theory Perspectives
2. Applicability of Role Theories to Psychiatric-Mental Health Nursing
7. Sociocultural Perspectives
1. Margaret Mead: Culture and Gender
2. Madeleine Leininger: Transcultural Health Care
3. Applicability of Sociocultural Theories to Psychiatric-Mental Health Nursing
8. Nursing Theories
1. Interpersonal Relations Models
1. Hildegarde Peplau: The Power of Empathy
2. da Jean Orlando
2. Existential and Humanistic Theoretical Perspectives
1. Joyce Travelbee
2. Jean Watson
3. Systems Models
1. Imogene M. King
2. Betty Neuman
3. Dorothea Orem
4. Other Nursing Theories
LEARNING ACTIVITIES:
1. Study Guide: Chapter 6: Pages 23-27
2. Participation in Classroom Critical Thinking Activities CTC #1,7,8. Text Page 90
3. Quiz
CRITICAL THINKING FOCUS:
Integrate theories from the liberal arts into the practice of mental health nursing. Select a nursing theorist that best fits your understanding of mental health nursing care.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 64-93). Philadelphia: Lippincott.
WEB LINKS:
This site provides a nursing theory page.
This site provides a nursing theory link page.
NUR 411: KEELEY/CHASE: 11/22/2002
THE BIOLOGIC FOUNDATIONS OF PSYCHIATRIC NURSING
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be ale to:
1. Identify the location of brain structures primarily involved in mental disorders; Describe the primary functions of these structures in the brain.
2. Describe the various approaches researchers have used to study the central nervous system and the significance of each approach.
3. Describe the mechanisms of neuronal transmission.
4. Identify the location and function of neurotransmitters significant to hypotheses regarding major mental disorders.
5. Discuss the basic purpose of new fields of study in psychiatry, including psychoendocrinology, psychoimmunology, and chronobiology.
6. Compare the application and use of various research methods in biologic psychiatry.
7. Discuss the methods of study related to genetics.
CONTENT OUTLINE:
1. Current Approaches and Technologic Advances
1. Structural Neuroimaging
1. Computed Tomography (CT)
2. Magnetic Resonance Imaging
2. Functional Neuroimaging
1. Positron Emission Tomography (PET)
2. Single Photon Emission Computed Tomography (SPECT)
3. Bridging the Gap
2. Neuroanatomy of the Central Nervous System
1. Cerebrum
2. Left and Right Hemispheres
3. Lobes of the Brain
1. Frontal Lobes
2. Parietal Lobes
3. Temporal Lobes
4. Occipital Lobes
5. Association Cortex
4. Subcortical Structures
1. Basal Ganglia
2. Limbic System
3. Hippocampus
4. Thalamus
5. Hypothalamus
6. Amygdala
7. Limbic Midbrain Nuclei
3. Other Important Central Nervous System Structures
1. Neurophysiology of the Central Nervous System
1. Neurons and Nerve Impulses
2. Synaptic Transmission
3. Changing Receptor Sensitivity
4. Receptor Subtypes
2. Neurotransmitters
1. Cholinergic
2. Biogenic Amines
3. Dopamine
4. Norepinephrine
5. Serotonin
3. Histamine
4. Amino Acids
1. γ-Aminobutyric Acid
2. Glutamate
5. Neuropeptides
4. New Fields of Study
1. Psychoendocrinology
2. Psychoimmunology
3. Chronobiology
5. Diagnostic Approaches
1. Laboratory Tests
2. Neurophysiologic Procedures
1. Electroencephalography
2. Polysomnography
3. Other Neurophysiologic Methods
6. Genetics
1. Transmission
2. Risk Factors
7. Integration of the Biologic, Psychological, and Social Dimensions
LEARNING ACTIVITIES:
1. Study Guide: Chapter 7: Pages 28-31
2. Participation in Case Study Discussion Activities #1 Study Guide Page 31: CTC #6 Text Page125
3. Quiz
CRITICAL THINKING FOCUS:
Applying information from neuroscience to the practice of mental health nursing.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed.,pp. 94-126).
Philadelphia Pa.: Lippincott.
PSYCHOPHARMACOLOGY AND OTHER BIOLOGIC TREATMENTS
LESSON OBJECTIVES:
After studying this chapter, you will be able to:
1. Explain the key role of neurotransmitter chemicals and their receptor sites in the action of psychopharmacologic medications.
2. Explain the four action sites where current psychotropic medications work: receptors, ion channels, enzymes, and carrier proteins.
3. Define the three properties that determine the strength and effectiveness of a medication.
4. Describe the hypothesized mechanism of action for each class of psychopharmacologic medication.
5. Describe the target symptoms and major side effects of various classes of psychotropic medications.
6. Suggest appropriate nursing methods to administer medications that facilitate efficacy.
7. Implement interventions to minimize side effects of psychopharmacologic medications.
8. Differentiate acute and chronic medication-induced movement disorders.
9. Identify aspects of patient teaching nurses must implement for successful maintenance of patients using psychotropic medications.
10. Analyze the potential benefits of other forms of somatic treatments including electroconvulsive therapy, light therapy, and nutrition therapy.
CONTENT OUTLINE:
1. Pharmacodynamics
1. Targets of Drug Action: Where Drugs Act
2. Receptors
3. Ion Channels
4. Enzymes
5. Carrier Proteins: Uptake Receptors
6. Efficacy and Potency: How Drugs Act
1. Loss of Effect: Biologic Adaptation
2. Target Symptoms and Side Effects
3. Drug Toxicity
4. Pharmacokinetics: How the Body Acts on the Drugs
1. Absorption and Routes of Administration
2. Bioavailability
3. Distribution
4. Metabolism
5. Elimination
6. Individual Variations in Drug Effects
5. Phases of Drug Treatment
1. Initiation
2. Stabilization
3. Maintenance
4. Discontinuation
6. Antipsychotic Medications
1. Target Symptoms and Mechanism of Action
2. Pharmacokinetics
3. Depot Preparations
4. Side Effects, Adverse Reactions, and Toxicity
1. Cardiovascular Side Effects
2. Anticholinergic Side Effects
3. Weight Gain
4. Endocrine and Sexual Side Effects
5. Blood Disorders
6. Miscellaneous Side Effects
7. Medication-Related Movement Disorders
1. Acute Extrapyramidal Syndromes
5. Chronic Syndromes
7. Mood Stabilizers (Antimania Medications)
1. Lithium
2. Indications and Mechanisms of Action
3. Pharmacokinetics
4. Side Effects, Adverse Reactions, and Toxicity
8. Anticonvulsants
1. Indications and Mechanisms of Action
2. Pharmacokinetics
3. Side Effects, Adverse Reactions, and Toxicity
9. Antidepressant Medications
1. Indications
2. Pharmacokinetics and Mechanisms of Action
3. Side Effects, Adverse Reactions, and Toxicity
10. Antianxiety And Sedative-Hypnotic Medications
1. Benzodiazepines
2. Indications and Mechanisms of Action
3. Pharmacokinetics
4. Side Effects, Adverse Reactions, and Toxicity
11. Nonbenzodiazepines
1. Stimulants
2. Indications and Mechanisms of Action
3. Pharmacokinetics
4. Side Effects, Adverse Reactions, and Toxicity
12. Development Of New Medications
13. Other Biologic Treatments
14. Electroconvulsive Therapy
15. Light Therapy (Phototherapy)
16. Nutritional Therapies
17. Psychosocial Issues in the Use of Biologic Treatments
LEARNING ACTIVITIES:
1. Study Guide: Chapter 8: Pages 32-37.
2. Participation in Classroom Critical Thinking Exercises. CTC 5,6,7,8 Text Page 176
3. Quiz
CRITICAL THINKING FOCUS:
Development of a working knowledge of these interventions as they are prescribed in the 21st Century. What is the nurse’s responsibility when caring for clients receiving these treatments?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 128-177).
Philadelphia: Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
THE ASSESSMENT PROCESS
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Define the assessment process.
2. Differentiate an initial assessment from an ongoing assessment.
3. Discuss the different techniques of data collection.
4. Discuss the synthesis of the biopsychosocial assessment data.
5. Delineate important areas of assessment for the biologic domain in completing the psychiatric nursing assessment.
6. Delineate important areas of assessment for the psychological domain in completing the psychiatric nursing assessment.
7. Delineate important areas of assessment for the social domain in completing the psychiatric nursing assessment.
CONTENT OUTLINE:
1. Assessment as a Process
2. Initial Assessment
3. Ongoing Assessment
4. Techniques of Data Collection
5. Patient Observations
6. Patient and Family Interviews
7. Physical and Mental Examinations
8. Records and Diagnostic Reports
9. Collaboration With Colleagues
10. Biopsychosocial Psychiatric Nursing Assessment
11. Biologic Domain
1. Present and Past Health Status
2. Physical Examination
1. Body Systems Review
2. Neurologic Status
3. Laboratory Results
4. Physical Functions
1. Elimination
2. Activity and Exercise
3. Sleep
4. Appetite and Nutrition
5. Hydration
6. Sexuality
7. Self-Care
3. Pharmacologic Assessment
12. Psychological Domain
1. Responses to Mental Health Problems
2. Mental Status Examination
1. General Observations
2. Orientation
3. Mood and Affect
4. Speech
5. Thought Processes
6. Cognition and Intellectual Performance
7. Attention and Concentration
8. Abstract Reasoning and Comprehension
9. Memory: Recall, Short-Term, Recent, and Remote
10. Insight and Judgment
11. Behavior
3. Self-Concept
1. Body Image
2. Self-Esteem
3. Personal Identity
4. Stress and Coping Patterns
1. Risk Assessment
1. Suicidal Ideation
2. Assaultive or Homicidal Ideation
13. Social Domain
1. Functional Status
2. Social Systems
1. Family Assessment
2. Cultural Assessment
3. Community Support and Resources
3. Spiritual Assessment
4. Occupational Status
5. Economic Status
6. Legal Status
7. Quality of Life
LEARNING ACTIVITIES:
1. Study Guide: Chapter 10: Pages 44-47.
2. Participation in Classroom Case Study Activities. CTC # 1, 2. Text Page 212.
3. Quiz
CRITICAL THINKING FOCUS:
Use of different types of mental health assessment tools in the biopsychosocial assessment of individuals with mental health problems.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed.,pp. 194-213).
Philadelphia Pa.: Lippincott.
WEB LINKS:
This bookstore website contains books on nursing assessment and diagnosis.
NUR 411: KEELEY/CHASE: 11/22/2002
DIAGNOSIS AND OUTCOMES DEVELOPMENT
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Identify the ANA Psychiatric Mental Health Nurse Standards for outcome identification.
2. Define indicators and their use.
3. Describe nurse-sensitive outcomes.
4. Describe the relationship between patient outcomes and indicators.
5. Discuss use of patient outcomes in psychiatric-mental health nursing.
6. Describe measurement of patient outcomes.
7. Write patient outcome statements for psychiatric-mental health nursing.
CONTENT OUTLINE:
1. Deriving Nursing Diagnoses
2. Developing Patient Outcomes
1. Evolution of Patient Outcomes
2. Purpose of Patient Outcomes and Indications
3. Nursing Process and Patient Outcomes
4. Types of Patient Outcomes
3. Evaluation
LEARNING ACTIVITIES:
1. Study Guide: Chapter 13: Pages 56-59
2. In Class Participation in Critical Thinking Exercises. Study Guide. CTE #2. Page 59
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 246-257).
Philadelphia, Pa. : Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
PSYCHIATRIC NURSING INTERVENTIONS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Discuss the basis for selection of psychiatric-mental health nursing interventions.
2. Discuss the application of nursing interventions for the biologic domain.
3. Discuss the application of nursing interventions for the psychological domain.
4. Discuss the application of nursing interventions for the social domain.
CONTENT OUTLINE:
1. Nursing Interventions and Psychiatric-Mental Health Nursing
2. Interventions for the Biologic Domain
1. Promotion of Self-Care Activities
2. Activity and Exercise Interventions
3. Sleep Interventions
4. Nutrition Interventions
5. Relaxation Interventions
6. Hydration Interventions
7. Thermoregulation Interventions
8. Pain Management
9. Medication Management
3. Interventions for the Psychological Domain
1. Counseling Interventions
2. Conflict Resolution
3. Conflict Resolution Process
4. Cultural Brokering in Patient-System Conflicts
5. Bibliotherapy
6. Reminiscence
4. Behavior Therapy
1. Behavior Modification
2. Token Economy
5. Cognitive Interventions
6. Psychoeducation
7. Health Teaching
8. Spiritual Interventions
9. Interventions for the Social Domain
10. Social Behavior and Privilege Systems in Inpatient Units
11. Milieu Therapy
1. Containment
2. Validation
3. Structured Interaction
4. Open Communication
5. Milieu Therapy in Different Settings
12. Promotion of Patient Safety on Psychiatric Units
1. Observation
2. De-escalation
3. Seclusion
4. Restraints
13. Home Visits
14. Community Action
LEARNING ACTIVITIES:
1. Study Guide: Chapter 14: Pages 60-64
2. Participation in Classroom Critical Thinking Exercises. CTE #1. Study Guide. Page 63.
3. Quiz
CRITICAL THINKING FOCUS:
Incorporating interventions for mental health nursing that are within the legal scope of practice. Priortizing interventions in mental health nursing practice.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 258-275).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
The Health Care Finance Administration website contains the regulations regarding the use of seclusion and restraint.
This Nursing Interventions Classification (NIC) website explains the development of the NIC and answers questions related to its use.
The American Psychiatric Nurses Association site contains conference information and literature related to nursing.
NUR 411: KEELEY/CHASE: 11/22/2002
GROUP INTERVENTIONS
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Discuss group concepts that are useful in leading groups.
2. Compare the roles that group members can assume.
3. Identify important aspects of leading a group such as member selection, leadership skills, seating arrangements, and ways of dealing with challenging behaviors of group members.
4. Identify four types of groups: psychoeducation, supportive therapy, psychotherapy, and self-help.
5. Describe common nursing intervention groups.
CONTENT OUTLINE:
1. Group: Definitions and Concepts
1. Open Versus Closed Groups
2. Group Size
3. Group Development
1. Beginning Stage
2. Working Stage
3. Termination Stage
4. Roles of Group Members
5. Group Communication
1. Verbal Communication
1. Communication Network
2. Group Themes
2. Nonverbal Communication
6. Group Norms and Standards
7. Group Cohesion
8. Groupthink and Decision Making
2. Group Leadership
1. Choosing Leadership Styles
2. Selecting the Members
3. Arranging Seating
4. Dealing With Challenging Group Behaviors
1. Monopolizer
2. “Yes, but”
3. Disliked Member
4. Group Conflict
3. Types of Groups
1. Psychoeducation Groups
2. Supportive Therapy Groups
3. Psychotherapy Groups
4. Self-Help Groups
4. Common Nursing Intervention Groups
1. Medication Groups
2. Symptom Management Groups
3. Anger Management Groups
4. Self-Care Groups
LEARNING ACTIVITIES:
1. Study Guide: Chapter 15: 65-69
2. Participation in Classroom Critical Thinking Exercises CTE #2. Study Guide Page 68
3. Quiz
CRITICAL THINKING FOCUS:
How the various types of groups are similar and different. What behaviors on the part of the nurse can positively change the focus and/or dynamics of a group.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 276-289).
Philadelphia: Lippincott.
WEB LINKS:
This website serves as an online self-help resource containing information on many different self-help groups.
This site includes an Outdoor Action Guide to Group Dynamics and Leadership, which reviews how to teach a skill, leadership concepts, and group dynamics.
NUR 411: KEELEY/CHASE: 11/22/2002
SCHIZOAFFECTIVE, DELUSIONAL, AND OTHER PSYCHOTIC DISORDERS
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Define schizoaffective disorder and distinguish the major differences among schizophrenia, schizoaffective, and mood disorders.
2. Discuss the important epidemiologic findings related to schizoaffective disorder.
3. Explain the primary etiologic factors regarding schizoaffective disorder.
4. Explain the primary elements involved in assessment, nursing diagnoses, nursing interventions, and evaluation for patients with schizoaffective disorder.
5. Define delusional disorder and explain the importance of nonbizarre delusions in diagnosis and treatment.
6. Explain the important epidemiologic findings regarding delusional disorder.
7. Discuss the primary etiologic factors of delusional disorder.
8. Explain the various subtypes of delusional disorder.
9. Explain the important epidemiologic findings regarding delusional disorder.
10. Discuss the primary etiologic factors of delusional disorder.
11. Explain the various subtypes of delusional disorder.
12. Explain the nursing care of persons with delusional disorder.
CONTENT OUTLINE:
1. Schizoaffective Disorder
1. Definition and Clinical Course
2. Diagnostic Criteria
3. Epidemiology and Risk Factors
1. Age of Onset
2. Gender Differences
3. Ethnic and Cultural Differences
4. Familial Differences
5. Comorbidity
4. Etiology
5. Biologic Theories
1. Neuropathologic
2. Genetic
3. Biochemical
6. Psychological and Social Theories
1. Interdisciplinary Treatment
7. Priority Care Issues
8. Nursing Management: Human Response to Disorder
1. Biologic Domain
1. Assessment
9. Nursing Diagnoses
10. Interventions
1. Patient Education
2. Pharmacologic Interventions
1. Monitoring and Administration of Medications
2. Side-Effect Management
3. Drug-Drug Interactions
4. Teaching Points
11. Psychological Domain
1. Assessment
2. Nursing Diagnoses
3. Interventions
4. Social Domain
1. Assessment
5. Nursing Diagnoses
6. Interventions
7. Evaluation and Treatment Outcomes
12. Continuum of Care
1. Inpatient-Focused Care
2. Emergency Care
3. Family Intervention
4. Community Treatment
2. Delusional Disorder
1. Definition and Clinical Course
2. Diagnostic Criteria
3. Subtypes
1. Erotomanic Delusions
2. Grandiose Delusions
3. Jealous Delusions
4. Somatic Delusions
5. Unspecified Delusions
4. Epidemiology and Risk Factors
1. Age of Onset
2. Gender Differences
3. Familial Differences
4. Comorbidity
5. Etiology
1. Biologic Theories
1. Neuropathologic Theories
2. Genetic and Biochemical Theories
6. Interdisciplinary Treatment
7. Priority Care Issues
8. Nursing Management: Human Response to Disorder
1. Biologic Domain
1. Assessment
2. Interventions
3. Somatic Interventions
4. Pharmacologic Interventions
9. Psychological Domain
1. Assessment
2. Interventions
10. Social Domain
1. Assessment
2. Interventions
11. Evaluation and Treatment Outcomes
12. Continuum of Care
1. Inpatient-Focused Care
2. Emergency Care
3. Family Intervention
4. Community Treatment
3. Other Psychotic Disorders
1. Schizophreniform Disorder
2. Brief Psychotic Disorder
3. Shared Psychotic Disorder (Folie a Deux)
4. Psychotic Disorders Due to Substance Abuse
LEARNING ACTIVITIES:
1. Study Guide: Chapter 19: Pages 85-88
2. Participation in Critical Thinking Exercises in Classroom CTC #1, 4. Page 406 Text
3. Quiz
CRITICAL THINKING FOCUS:
Applying the nursing process holistically caring for clients with this diagnosis .
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., Pp. 384-408).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
Website for Healthy People 2010 and Report of the Surgeon General.
National Alliance for the Mentally Ill advocacy information.
Internet mental health website that provides the American and European description of schizoaffective disorder and its treatment.
Further defines the DSM-IV criteria for schizoaffective disorder and the ICD-10 criteria for schizoaffective disorder.
Learn about what psychiatric nurses do and schizoaffective disorder.
Questions about schizoaffective and other psychiatric disorders answered.
NUR 411: KEELEY/CHASE: 11/22/2002
NURSING PRACTICE WITHIN A CONTINUUM OF CARE
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Identify the different treatment settings and associated programs along the continuum of care.
2. Discuss the role of the nurse at different points along the continuum of care.
3. Compare the stages of the nursing process with the phases of coordination of care in the continuum.
4. Describe current healthcare trends in inpatient and outpatient psychiatric services.
5. Explain how the concept of “the least restrictive environment” influences the assessment of patients for placement in different treatment settings.
6. Discuss the factors that determine the level of care to be provided to a patient seeking voluntary or involuntary treatment.
7. Discuss the influence of managed care on services and use of services in the continuum of care.
CONTENT OUTLINE
1. Defining the Continuum of Care
1. Least Restrictive Environment
2. Coordination of Care and Nursing Process
3. Components of the Continuum of Care
1. Inpatient Care
2. Long-Term Care
3. Short-Term Care
1. Crisis Stabilization
2. 23-Hour Beds
3. Crisis Intervention
4. Intermediate Care
5. Rehabilitation
4. The Role of the Nurse
2. Outpatient Care
1. Partial Hospitalization
2. Outpatient Detoxification
3. Intensive Outpatient Programs
4. In-Home Mental Health Services
5. In-Home Detoxification
6. Case Management Services
1. Assertive Community Treatment
2. Generalist Case Management Services
3. The Nurse as Case Manager
7. Alternative Housing Arrangements
1. Personal Care Homes
2. Board-and-Care Homes
3. Therapeutic Foster Care
4. Supervised Apartments
5. The Role of the Nurse
8. Clubhouse Model
9. Relapse Prevention After-Care Programs
3. Managed Care
1. Public and Private Collaboration
2. The Role of the Nurse
3. Assessment and Selection of Level of Care
4. Discharge Planning
LEARNING ACTIVITIES:
1. Study Guide: Chapter 17: Pages 73-75
2. Participation in Critical Thinking Exercises. CTC #2, 6. Text Page 327-8.
3. Quiz
CRITICAL THINKING FOCUS:
How the mental health nurse's responsibilities may vary within a variety of settings of service for mental health clients.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., Pp. 308-329).
Philadelphia Pa.: Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
CARE OF THE HOMELESS MENTALLY ILL
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Define the meaning of homelessness to the person and family.
2. Describe risk factors for becoming homeless.
3. Identify risk factors for developing mental illness or chemical dependency among people who are homeless.
4. Differentiate characteristics of various populations who are homeless.
5. Discuss personal and societal attitudes and beliefs about homelessness.
6. Describe assessment of people who are homeless and mentally ill.
7. Formulate some nursing diagnoses relevant to the homeless population.
8. Examine ways in which access to healthcare is limited for people who are homeless and mentally ill.
9. Summarize interventions for people who are homeless and have psychiatric disorders.
10. Discuss discharge planning needs of people who are homeless and have psychiatric disorders.
11. List major community resources to which nurses can refer members of the homeless population.
12. Discuss trends that target improvement of services to people who are homeless and experiencing psychiatric disorders.
CONTENT OUTLINE:
1. Homelessness
1. Historical Perspectives
2. Risk Factors
3. Homeless Populations
1. Incidence
2. Diverse Groups in the Homeless Population
4. Societal Attitudes and Beliefs
2. The Nursing Management of Individuals and Families Who Are Homeless
1. Assessment
1. Biologic Assessment
2. Psychological Assessment
3. Social and Family Assessment
4. Spiritual Assessment
2. Nursing Diagnoses
3. Nursing Interventions
4. Discharge Planning
3. Trends for Improving Services
1. Emergency Services
2. Housing Services
3. Case Management
4. Rehabilitation and Education
1. Day Treatment Programs
2. Alcohol and Drug Treatment
5. Employment Services
6. Integrated Services
7. Advocacy
LEARNING ACTIVITIES:
1. Study Guide: Chapter 32: Pages 144-147
2. Participation in Classroom Critical Thinking Exercises CTC #1 3. Page 871. Text.
3. Quiz
CRITICAL THINKING FOCUS:
How are nurses professionally responsible for responding the social as well as the human individual/family mental health ramifications of homelessness.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed.,pp. 858-873). Philadelphia Pa.: Lippincott.
WEB LINKS:
The National Coalition for the Homeless. This site represents a national advocacy network of homeless persons, activists, service providers, and others committed to ending homelessness through public education, policy advocacy, grassroots organizing, and technical assistance.
Fifty-four ways to help the homeless. This is Rabbi Kroloff’s website.
United States Housing Authority. This site provides information for homeless individuals.
National Coalition for Homeless Veterans. This is a website for homeless veterans.
NUR 411: KEELEY/CHASE: 11/22/2002
MOOD DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Describe the global impact of underdiagnosed and untreated mood disorders as a major public health problem.
2. Distinguish the clinical characteristics and course of depressive disorders and bipolar disorder.
3. Analyze the prevailing biologic, psychological, and social theories that serve as a basis for caring for persons with mood disorders.
4. Analyze the human responses to mood disorders with emphasis on concepts of mood, affect, depressed mood, and manic episode.
5. Formulate nursing diagnoses based on a biopsychosocial assessment of persons with mood disorders.
6. Formulate nursing interventions that address specific diagnoses based on a continuum of care.
7. Identify expected outcomes and their evaluation.
8. Analyze special concerns within the nurse-patient relationship common to treating people with mood disorders.
CONTENT OUTLINE:
1. Depressive Disorders
1. Clinical Course
2. Depressive Disorders in Special Populations
1. Children and Adolescents
2. Elderly People
3. Epidemiology
1. Ethnic and Cultural Differences
2. Risk Factors
4. Etiology
1. Neurobiologic Theories
2. Genetics
3. Biologic Hypotheses
1. Neuroendocrine and Neuropeptide Hypotheses
5. Psychoneuroimmunonology
6. Psychological Theories
1. Psychodynamic Factors
2. Behavioral Factors
3. Cognitive Factors
4. Developmental Factors
7. Social Theories
1. Family Factors
2. Social Factors
2. Interdiscipinary Treatment of Disorder
1. Priority Care Issues
2. Family Response to Disorder
3. Nursing Management: Human Response to Disorder
1. Biologic Domain
1. Assessment
2. Nursing Diagnosis for Biologic Domain
1. Physical Care Nursing Interventions
2. Pharmocologic Interventions
1. Antidepressant Medication
2. Monitoring and Administration of Medication
3. Side-Effect Monitoring and Management
4. First-Generation Antidepressants
3. Monoamine Oxidase Inhibitors
4. Serotonin Syndrome
5. Drug-Drug Interactions
6. Teaching Points
3. Other Somatic Therapies
1. Electroconvulsive Therapy
2. Light Therapy (Phototherapy)
4. Psychological Domain
1. Assessment
1. Mood and Affect
2. Thought Content
3. Suicidal Behavior
4. Cognition and Memory
2. Nursing Diagnosis for Psychological Domain
3. Interventions for Psychological Domain
1. Therapeutic Nurse-Patient Relationship
2. Cognitive Therapy
3. Behavior Therapy
4. Interpersonal Therapy
5. Group Therapy
6. Patient and Family Education
5. Social Domain
1. Assessment
2. Nursing Diagnosis for Social Domain
3. Interventions for Social Domain
1. Milieu Therapy
2. Safety
3. Other Interventions
4. Family Interventions
6. Evaluation and Treatment Outcomes
7. Continuum of Care
4. Bipolar Disorders (Manic-Depressive Disorders)
1. Diagnostic Criteria
2. Secondary Mania
3. Rapid Cycling Specifier
4. Clinical Course
5. Bipolar Disorders in Special Populations
1. Children and Adolescents
2. Elderly People
6. Epidemiology
1. Distribution and Age of Onset
2. ender and Ethnic and Cultural Differences
3. Comorbidity
7. Etiology
1. Neurobiologic Theories
1. Neurotransmitter Hypotheses
2. Chronobiologic Theories
3. Sensitization and Kindling Theory
1. Genetic Factors
2. Psychological and Social Theories
3. Interdisciplinary Treatment of Disorders
4. Priority Care Issues
5. Family Response to Disorder
6. Nursing Management: Human Response to Disorder
1. Biologic Domain
1. Assessment
2. Pharmacologic Assessment
7. Nursing Diagnosis for Biologic Domain
8. Interventions for Biologic Domain
1. Pharmacologic Interventions
1. Mood Stabilizers
2. Newer Anticonvulsants
3. Antidepressants
4. Antipsychotics
5. Monitored Administration of Medication
6. Side-Effect Monitoring and Management
7. Drug-Drug Interactions
8. Teaching Points
2. Other Somatic Interventions: Electroconvulsive Therapy
8. Psychological Domain
1. Assessment
1. Mood
2. Cognitive
3. Thought Disturbance
4. Stress and Coping Factors
5. Risk Assessment
2. Nursing Diagnosis for Psychological Domain
3. Interventions for Psychological Domain
1. Psychoeducation
2. Psychotherapy
9. Social Domain
1. Assessment
2. Nursing Diagnosis for Social Domain
3. Interventions for Social Domain
1. Family Interventions
4. Evaluation and Treatment Outcomes
10. Continuum of Care
1. Inpatient Management
2. Intensive Outpatient Programs
11. Spectrum of Care
12. Mental Health Promotion
LEARNING ACTIVITIES:
1. Study Guide: Chapter 20: Pages 89-92
2. Participation in Classroom Critical Thinking Exercises CTC #7. Page 449 Text.
3. Quiz
CRITICAL THINKING FOCUS:
Depression is a world wide epidemic. How can nurses act to prevent depression and or holistically treat depression when encountered in the health care setting.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 410-451).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
Go to Depression Central. This site is the Internet’s central clearinghouse for information on all types of depressive disorders and on the most effective treatments for individuals suffering from major depression, manic-depressive disorder (bipolar disorder), cyclothymia, dysthymia, and other mood disorders.
This site provides an overview of bipolar disorder and comorbid illnesses.
This is a National Institutes of Health publication providing an overview of bipolar disorder.
This website of the National Depressive and Manic-Depressive Association is provided by the organization to educate patients, families, professionals, and the public concerning the nature of depression and bipolar disorder.
Depression Net. This website, operated by Organon, provides an overview of depression and treatment.
The National Alliance for Research on Schizophrenia and Depression is a national organization that raises and distributes funds to find the causes, cures, and better treatments of schizophrenia.
NUR 411: KEELEY/CHASE: 11/22/2002
CASE-FINDING AND CARE IN SUICIDE: CHILDREN, ADOLESCENTS, AND ADULTS
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Define suicide, parasuicide, and suicide ideation.
2. Describe population groups that have high rates of suicide.
3. Discuss factors associated with rising rates of suicide in the young.
4. Discuss the civil liberties of patients and other legal issues in care of suicidal patients.
5. Determine factors that affect the nurse’s responsibility in identifying suicidal patients.
6. List screening measures for depression, suicide intent, and psychiatric diagnostic measures.
7. Describe factors that increase risk for suicide completion.
8. Describe the no-suicide contract.
9. Describe the nurse’s responsibilities in promoting short and long-term recovery in suicidal adult inpatients.
10. Discuss the patient’s and nurse’s responsibilities in discharging the patient to the community.
CONTENT OUTLINE:
1. Secondary Trauma
2. Epidemiology of Suicidal Behavior
3. Suicide
1. Age
1. Prepubertal Children
2. Preadolescents and Adolescents
3. Adults
4. Older Adults
2. Gender
3. Race
4. Sexual Orientation
4. Parasuicide and Suicide Ideation
1. Etiology of Suicidal Behavior
2. Biologic Theories
3. Psychological Theories
4. Social Theories
5. Effects of Suicide
6. Legal Considerations in Care for Suicidal Patients
1. Confidentiality
2. Informed Consent
3. Competence
4. Beneficence
5. Documentation and Reporting
6. Involuntary Hospitalization
7. Nursing Management: Human Response to Disorder
1. Assessing the Suicidal Patient
1. Case Finding
2. Determining Risk
2. Nursing Diagnosis and Outcome Identification
3. Planning and Implementing Nursing Interventions
1. No-Suicide Contracts
2. Inpatient Care and Acute Treatment
3. Biologic Interventions
1. Ensuring Safety
2. Assisting With Somatic Therapies
3. Assisting With Treatment for Substance Abuse
4. Psychological Interventions
5. Social Interventions
4. Discharge Planning and Outpatient Care
1. Educating the Patients and Family
2. Identifying Continuing Sources of Support
3. Establishing an Outpatient Care Plan
5. Evaluation and Treatment Outcomes
6. Avoiding
LEARNING ACTIVITIES:
1. Study Guide: Chapter 38: Pages 173-176.
2. Participation in Classroom Critical Thinking Exercises CTE #2. Page 175 Study Guide
3. Quiz.
CRITICAL THINKING FOCUS:
If suicide is preventable, why are suicides and suicide attempts on the increase? What is the role and responsibility of the mental health nurse in case finding and intervention?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd Ed.p.p 1006-1030).
Philadelphia: Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
ANXIETY DISORDERS
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Differentiate the concept of anxiety from stress and fear.
2. Discuss the epidemiology, etiology, symptomatology, and treatment of selected anxiety disorders.
3. Discuss the neurobiologic underpinnings of the anxiety disorders.
4. Discuss biopsychosocial treatment approaches used for patients with anxiety disorders.
5. Identify nursing diagnoses used in providing nursing care for patients with anxiety disorders.
6. Differentiate the concept of anxiety from stress and fear.
7. Discuss the epidemiology, etiology, symptomatology, and treatment of selected anxiety disorders.
8. Discuss the neurobiologic underpinnings of the anxiety disorders.
9. Discuss biopsychosocial treatment approaches used for patients with anxiety disorders.
10. Identify nursing diagnoses used in providing nursing care for patients with anxiety disorders.
CONTENT OUTLINE:
1. Normal Versus Abnormal Anxiety Response
2. Overview of Anxiety Disorders
1. Panic Disorder
1. Clinical Course of Panic Disorder
2. Panic Attacks
2. Agoraphobia and Other Phobias
1. Diagnostic Criteria
2. Disorders in Special Populations
1. Children
2. Elderly People
3. Epidemiology
1. Etiology
2. Genetic Theories
3. Neuronatomic Theories
4. Biochemical Theories
1. Norepinephrine
2. Serotonin
3. γ-Aminobutryric Acid
4. Corticotropin-Releasing Factor
5. Cholecystokinin
6. Other Neuropeptides
7. Other Panicogenic Substances
5. Psychoanalytic and Psychodynamic Theories
6. Cognitive-Behavioral Theories
4. Risk Factors
5. Comorbidity
6. Interdisciplinary Treatment of Panic Disorder
7. Priority Care Issues
8. Nursing Management: Human Response to Disorder
1. Biologic Domain
2. Assessment of Biologic Domain
3. Substance Use
4. Sleep Patterns
5. Physical Activity
9. Nursing Diagnoses Related to Biologic Domain
1. Biologic Interventions
2. Breathing Control
3. Nutritional Planning
4. Relaxation Techniques
5. Increased Physical Activity
6. Psychopharmacologic Treatment
1. Selective Serotonin Reuptake Inhibitors
2. Tricyclic Antidepressants
3. Benzodiazepines
4. Monoamine Oxidase Inhibitors
10. Psychological Domain
1. Psychological Assessment
2. Rating Scale
1. Mental Status Examination
2. Assessment of Cognitive Thought Process
3. Nursing Diagnoses Related to Psychological Domain
4. Psychological Interventions
1. Distraction
2. Positive Self-Talk
3. Panic Control Treatment
4. Exposure Therapy
5. Systematic Desensitization
6. Implosive Therapy
7. Cognitive-Beh Therapy
8. Psychoeducation
5. Social Domain
1. Social Assessment
2. Cultural Factors
3. Social Interventions
6. Family Response to Disorder
11. Evaluation and Treatment Outcomes
12. Continuum of Care
1. Inpatient-Focused Care
2. Emergency Care
3. Family Interventions
4. Community Treatment
13. Obsessive Compulsive Disorder (OCD)
1. Clinical Course of Disorder
2. Comorbidity
3. Diagnostic Criteria
4. OCD in Special Populations
1. Children
2. Elderly People
5. Epidemiology
6. Etiology
7. Biologic Theories
1. Genetic
2. Neuropathologic
3. Biochemical
8. Psychological Theories
1. Psychodynamic
2. Behavioral
9. Risk Factors
10. Interdisciplinary Treatment
11. Priority Care Issues
12. Nursing Diagnoses and Outcome Identification
13. Nursing Management: Human Response to Disorder
1. Biologic Domain
2. Biologic Assessment
3. Biologic Interventions
1. Electroconvulsive Therapy
2. Psychosurgery
3. Maintaining Skin Integrity
4. Psychopharmacologic Treatment
14. Psychological Domain
1. Psychological Assessment
2. Psychological Interventions
1. Response Prevention
2. Thought Stopping
3. Relaxation Techniques
4. Cognitive Restructuring
15. Social Domain
1. Social Assessment
2. Family Response to Disorder
16. Evaluation and Treatment Outcomes
17. Continuum of Care
1. Inpatient-Focused Care
2. Emergency Care
3. Family Interventions
18. Community Treatment
14. Generalized Anxiety Disorder (GAD)
1. Clinical Course of Disorder
2. Comorbidity
3. Diagnostic Criteria
4. GAD in Special Populations
5. Epidemiology
6. Etiology
1. Neurochemical Theories
2. Genetic Theories
3. Psychological Theories
4. Sociologic Theories
7. Risk Factors
8. Nursing Management: Human Response to Disorder
1. Biologic Domain
1. Biologic Assessment
1. Biologic Interventions: Pharmacologic Treatment
2. Psychological and Social Domains
9. Evaluation and Treatment Outcomes
10. Continuum of Care
15. Other Anxiety and Related Disorders
1. Specific Phobia
2. Social Phobia
3. Posttraumatic Stress Disorder (PTSD)
4. Acute Stress Disorder
5. Dissociative Disorders
LEARNING ACTIVITIES:
1, Study Guide: Chapter 21: Pages 93-98
2. Participation in Classroom Critical Thinking Exercises. CTC #4 , 7 Page 499. Text.
3. Quiz
CRITICAL THINKING FOCUS:
Development of self-awareness of own anxiety and its manifestations and integrating current knowledge of disorders and their treatments into nursing practice.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 974-1005).
Philadelphia: Lippincott.
WEB LINKS:
This is the National Institute of Mental Health’s anxiety disorder website. An anxiety disorders education program available.
This Anxiety Panic Internet Resource site has self-help resources for those with panic disorder.
This site provides a guide to more than 700 other sites and also contains recent articles and resources.
NUR 411: KEELEY/CHASE: 11/22/2002
PERSONALITY AND IMPULSE CONTROL DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Identify the common features of personality disorders.
2. Distinguish between the concepts of personality and personality disorder.
3. Analyze the prevailing biologic, psychological, and social theories explaining the development of personality disorders.
4. Discuss the epidemiology of each personality disorder.
5. Distinguish among the three clusters of personality disorders.
6. Formulate nursing diagnoses and plan interventions for persons with specific personality disorders.
7. Compare the psychoanalytic explanation of the borderline personality disorder with biosocial theory.
8. Apply the nursing process to individuals with a diagnosis of borderline personality disorder.
9. Analyze special concerns within the nurse-patient relationship common to treating those with personality disorders.
10. Compare and contrast the impulse-control disorders.
CONTENT OUTLINE
1. Personality Disorders
2. Personality Disorder Versus Personality Traits
3. Common Features and Diagnostic Criteria
1. Maladaptive Cognitive Schema
2. Affectivity and Emotional Instability
3. Impaired Self-Identity and Interpersonal Functioning
4. Impulsivity and Destructive Behavior
4. Cultural Considerations
5. Severity of Disorder
1. Cluster A Disorders: Odd-Eccentric
6. Paranoid Personality Disorder: Suspicious Pattern
1. Epidemiology
2. Etiology
3. Nursing Management
7. Schizoid Personality Disorder: Asocial Pattern
1. Epidemiology
2. Etiology
3. Nursing Management
8. Schizotypal Personality Disorder: Eccentric Pattern
1. Epidemiology
2. Etiology
3. Nursing Management
9. Continuum of Care
10. Cluster B Disorders: Dramatic-Emotional
1. Borderline Personality Disorder (BPD): Unstable Pattern
1. Clinical Course of Disorder
1. Affective Instability
2. Identity Disturbances
3. Unstable Interpersonal Relationships
4. Cognitive Dysfunctions
5. Dysfunctional Behaviors
1. Impaired Problem Solving
2. Impulsivity
3. Self-Injurious Behaviors
11. BPD in Special Populations
1. Epidemiology
1. Gender
2. Comorbidty
12. Risk Factors
1. Physical and Sexual Abuse
2. Parental Loss or Separation
13. Etiology
1. Biologic Theories
2. Psychological Theories
3. Psychoanalytic Theories
4. Maladaptive Cognitive Processes
5. Social Theories: Biosocial Theories
1. Theodore Millon
2. Marsha Linehan
6. Interdisciplinary Treatment
14. Dialetic Behavior Therapy
15. Priority Care Issues
16. Family Response to Disorder
17. Nursing Management: Human Response to Borderline Personality Disorder
1. Biologic Domain
1. Assessment of Biologic Domain
2. Systems Review and Physical Functioning
3. Physical Indicators of Self-Injurious Behavior
4. Pharmacologic Assessment
5. Nursing Diagnoses Related to Biologic Domain
6. Interventions for the Biologic Domain
1. Sleep Enhancement
2. Nutritional Enhancement
3. Prevention and Treatment of Self-Injury
4. Pharmacologic Interventions
7. Controlling Emotional Dysregulation
1. Reducing Impulsivity
2. Managing Transient Psychotic Episodes
3. Reducing Self-Injurous Behavior
4. Decreasing Anxiety
2. Monitoring and Administration of Medications
1. Side-Effect Monitoring and Management
2. Drug-Drug Interactions
3. Teaching Points
3. Psychological Domain
1. Assessment of Psychological Domain
1. Appearance and Activity Level
2. Moods
3. Impulsivity
4. Cognitive Disturbances
2. Dissociative and Transient Psychotic Episodes
1. Interpersonal Skills
2. Self-Esteem and Coping Skills
3. Risk Assessment: Suicide or Self-injury
3. Nursing Diagnoses Related to Psychological Domain
4. Interventions for the Psychological Domain
18. Special Issues in the Nurse-Patient Relationship
1. Establishing a Trusting Relationship
2. Abandonment and Intimacy Fears
3. Establishing Personal Boundaries and Limitations
4. Management of Dissociative States
1. Behavioral Interventions
2. Cognitive Interventions
1. Emotional Regulation
3. Distraction or Thought Stopping
4. Challenging Dysfunctional Thinking
5. Management of Transient Psychotic Episodes
1. Patient Education
5. Social Domain
1. Assessment of Social Domain
2. Functional Status
3. Social Support Systems
4. Family Assessment
6. Interventions for Social Domain
1. Milieu Management
2. Group Intervention
3. Family and Social Support
4. Evaluation and Treatment Outcomes
7. Continuum of Care
8. Mental Health Promotion
19. Antisocial Personality Disorder: Aggrandizing Pattern
1. Clinical Course of Disorder
2. Epidemiology and Risk Factors
1. Age of Onset
2. Gender
3. Cultural and Ethnic Differences
4. Comorbidity
3. Etiology
1. Biologic Theories
1. Genetic
2. Biochemical
2. Psychological Theories
1. Attachment
2. Temperament
3. Social Theories
1. Interdisciplinary Treatment of Disorders
4. Priority Care Issues
1. Family Response to Disorder
5. Nursing Management: Human Response to Disorder
1. Assessment of Biopsychosocial Domains
2. Nursing Diagnoses and Outcome Identification
3. Planning and Implementing Nursing Interventions
1. Biologic Interventions
2. Psychological Interventions
3. Social Interventions
1. Family Interventions
4. Evaluation and Treatment Outcomes
6. Continuum of Care
20. Histrionic Personality Disorder: Gregarious Pattern
1. Epidemiology
2. Etiology
3. Nursing Management
21. Narcissistic Personality Disorder: Egotistic Pattern
1. Epidemiology
2. Etiology
3. Nursing Management
4. Continuum of Care
22. Cluster C Disorders: Anxious-Fearful
1. Avoidant Personality Disorder: Withdrawn Pattern
1. Epidemiology
1. Etiology
2. Nursing Management
23. Dependent Personality Disorder: Submissive Pattern
1. Epidemiology
2. Etiology
3. Nursing Management
24. Obsessive-Compulsive Personality Disorder: Conforming Pattern
1. Epidemiology
2. Etiology
3. Nursing Management
4. Continuum of Care
25. Impulse-Control Disorders
1. Intermittent Explosive Disorders
2. Kleptomania
3. Pyromania
4. Pathologic Gambling
5. Trichotillomania
26. Continuum of Care
LEARNING ACTIVITIES:
1. Study Guide: Chapter 22: Pages 99-103
2. Participation in Classroom Critical Thinking Exercise CTC #3, 4 Text Page 550
3. Quiz
CRITICAL THINKING FOCUS:
How to intervene therapeutically while maintaining a sense of self with individuals diagnosed with personality/impulse disorders.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., Pp. 502-555). Philadelphia Pa.: Lippincott.
WEB LINKS:
A website for consumers, the Borderline Personality Sanctuary offers a chat room and books.
This website of Borderline Personality Disorder Central provides consumer and professional information and resources.
The Borderline Research Organization is a research foundation that supports research on borderline personality disorder.
Internet Mental Health is a website for mental health disorders.
NUR 411: KEELEY/CHASE: 11/22/2002
SOMATOFORM AND RELATED DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. After studying this chapter, you will be able to:
2. Explain the concept of somatization and its occurrence in people with mental health problems.
3. Discuss the epidemiologic factors related to somatic problems.
4. Compare the etiologic theories of somatization disorder from a biopsychosocial perspective.
5. Contrast the major differences between somatoform and factitious disorders.
6. Discuss human responses to somatization disorder.
7. Apply the elements of nursing management to a patient with somatization disorder.
CONTENT OUTLINE:
1. Somatization
1. Cultural Differences in Somatization
2. Gender and Somatization
2. Somatization Disorder
1. Clinical Course
2. Diagnostic Criteria
3. Somatization Disorder in Special Populations
1. Children
2. Elderly People
4. Epidemiology
1. Age of Onset
2. Gender, Ethnic and Cultural Differences
3. Comorbidity
5. Etiology
1. Biologic Factors
1. Neuropathologic
2. Genetic
3. Biochemical Changes
2. Psychological Theories
3. Social Theories
6. Risk Factors
7. Interdisciplilnary Treatment of Somatization Disorders
8. Nursing Managment: Human Response to Disorder
1. Biologic Domain
1. Review of Systems
2. Physical Functioning
3. Pharmacologic Assessment
9. Nursing Diagnoses Related to Biologic Domain
10. Biologic Interventions
1. Pain Management
2. Activity Enhancement
3. Nutrition Regulation
4. Relaxation
11. Psychopharmacologic Interventions
1. Monitoring and Administration of Medications
2. Side-Effect Monitoring and Management
3. Drug-Drug Interaction
12. Psychological Domain
13. Nursing Diagnoses Related to Psychological Domain
14. Psychological Interventions
1. Development of a Therapeutic Nurse-Patient Relationship
2. Counseling
3. Health Teaching
15. Social Domain
1. Nursing Diagnoses Related to Social Domain
2. Social Interventions
1. Group Interventions
2. Family Interventions
3. Evaluation and Treatment Outcomes
4. Continuum of Care
1. Inpatient Care
2. Emergency Care
3. Community Treatment
16. Mental Health Promotion
3. Other Somatoform Disorders
1. Undifferentiated Somatoform Disorder
2. Conversion Disorder
3. Pain Disorder
4. Hypochondriasis
5. Body Dysmorphic Disorder
6. Factitious Disorders
7. Factitious Disorder
8. Epidemiology
9. Etiology
10. Nursing Management: Human Response to Disorder
1. Continuum of Care
11. Factitious Disorder, Not Otherwise Specified
LEARNING ACTIVITIES:
1. Study Guide: Chapter 23: Pages 104-108
2. Participation in Classroom Critical Thinking Exercises CTE #2. Study Guide Page 106
3. Quiz
CRITICAL THINKING FOCUS:
Integrating the nursing process with the biopsychosocial framework when caring for clients with somatoform diagnoses.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice. (2nd Ed., Pp. 556-581).
Philadelphia Pa.: Lippincott.
WEB LINKS:
Somatization and somatoform disorders. Friday’s Progress Notes, July 14, 2000, Mental Health Information, Volume 4, Issue 21.
InteliHealth provides health information. Somatization disorder can be found through a search on this website.
NUR 411: KEELEY/CHASE: 11/22/2002
SUBSTANCE ABUSE DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Distinguish among the actions, effects and withdrawal symptoms (if any) of alcohol, marijuana, stimulants, sedatives, hallucinogens, phencyclidine, opiates, nicotine, solvents, and caffeine.
2. Explain the biologic, psychological, and social theories that attempt to explain substance abuse, dependence, and addiction.
3. Compare the advantages and disadvantages of several intervention approaches to substance abuse and chemical dependence.
4. Describe the effects of alcohol and other drug classifications on pregnancy and infants.
5. Describe appropriate nursing diagnoses and treatment interventions for patients who deny a substance abuse problem.
6. Formulate nursing diagnoses based on a biopsychosocial assessment of persons with substance use disorders.
7. Formulate nursing interventions that address specific diagnoses related to substance
CONTENT OUTLINE:
1. Definition and Terms
2. Diagnostic Criteria
1. Epidemiology and Cultural Issues
1. African Americans
2. Latino Americans
3. Asians and Pacific Islanders
4. Native Americans
2. Gender Differences
3. Comorbidity
4. Etiology
1. Genetic Factors
2. Neurobiologic Theories
3. Psychological Theories
4. Behavioral Theories
5. Social Theories
6. Summary of Etiologic Theories
3. Substances of Abuse
1. Alcohol
2. Definition and Clinical Picture
3. Biologic Responses to Alcohol
4. Alcohol Withdrawal Syndrome
5. Alcohol-Induced Amnestic Disorders
6. Psychopharmacology
7. Adequate Nutrition and Supplemental Vitamins
4. Cocaine
1. Cocaine Intoxication
2. Cocaine Withdrawal
5. Amphetamines and Other Stimulants
1. Cannabis (Marijuana)
2. Hallucinogens
3. Opiates
6. Methadone Maintenance Treatment
1. Naltrexone (Trexan)
2. Opiate Detoxification
7. Sedative-Hypnotics and Anxiolytics
1. Biologic Reactions to Benzodiazepines
2. Benzodiazepine Withdrawal
8. Inhalants
1. Neurotoxicity
9. Nicotine
1. Nicotine Withdrawal and Replacement Therapy
10. Caffeine
11. Nursing Management: Human Response to Disorder
1. Denial of a Problem
2. Enhancing Motivation for Change
3. Reality Confrontation
4. Countertransference
5. Codependence
12. HIV and Substance Abuse
1. Harm-Reduction Strategies
13. Pregnancy and Substance Abuse
14. Treatment Modalities
1. Twelve-Step Programs
2. Cognitive Interventions and Psychoeducation
3. Behavioral Interventions
4. Group Therapy and Early Recovery
5. Individual Therapy
6. Family Therapy
15. Planning and Implementing Nursing Interventions
LEARNING ACTIVITIES:
1. Study Guide: Chapter 25: Pages 112-116
2. Participation in Classroom Critical Thinking Exercises CTC #1,3,6,9 Text Page 654
3. Quiz
CRITICAL THINKING FOCUS:
Development of self awareness related to substance abuse and possible personal barriers to holistic care of patients with these diagnoses. Integration of holistic biopsychosocial framework into the nursing process and substance abuse.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 616-657).
Philadelphia, Pa. : Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
SPECIAL CONCERNS FOR PERSON WITH DUAL DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Define the term dual diagnosis.
2. Discuss the epidemiology of dual diagnosis.
3. Describe the cycle of relapse.
4. Describe the effects of alcohol and other drugs on mental illness.
5. Analyze barriers to the treatment of patients with dual diagnosis.
6. Discuss four etiologies of dual diagnosis.
7. Integrate relapse prevention concepts into the care of a patient with dual diagnosis.
CONTENT OUTLINE:
1. Relationship of Substance Abuse to Mental Illness
2. Manifestations of Dual Diagnosis
1. Epidemiology
2. Psychodynamic Model of Dual Diagnosis
3. Barriers to Treatment
1. Nature of Substance Abuse
2. Countertransference
3. Misunderstandings About and Stigmatization of Mental Illness
4. Health Issues
1. Disorder-Specific Assessment and Interventions
5. Psychotic Illnesses and Substance Abuse
6. Anxiety Disorders and Substance Abuse
7. Mood Disorders and Substance Abuse
8. Organic Mental Disorders and Substance Abuse
9. Cognitive Impairment in Early Stages of Recovery From Substance Abuse
10. Personality Disorders and Substance Abuse
11. General Treatment Elements
1. Setting Priorities When Hospitalization Is Necessary
2. Crisis Stabilization
3. Engagement
4. Medication Management
12. Guidelines for Managing Acute Pain in Substance Abusers
1. Patient Education
2. Self-Help Groups
3. Relapse Prevention: Creating a New Lifestyle
13. Continuum of Care and Discharge Planning
14. Case Management
1. Family Support and Education
2. Comprehensive Concurrent Treatment
15. Planning for Nursing Care
LEARNING ACTIVITIES:
1. Study Guide: Chapter 33: Pages 145-151
2. Participation in Classroom Critical Thinking Activities CTE #2. Study Guide Page 150
3. Quiz
CRITICAL THINKING FOCUS
Development of a working understanding of the interplay of symptoms and treatments when working with clients with a dual diagnosis.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 874-893).
Philadelphia: Lippincott.
WEB LINKS:
Dual Diagnosis Friendly. This website is for those with dual diagnosis.
NUR 411: KEELEY/CHASE: 11/22/2002
PSYCHOSOCIALLY MEDICALLY COMPROMISED
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Identify medically ill populations at risk for secondary mental illness.
2. Analyze the impact on patients and their families of mental illness associated with medical illness.
3. Discuss comorbid psychosocial and biologic disorders seen in psychiatric settings and their treatments.
4. Discuss neurobiologic and psychological disturbances associated with specific medical illnesses and the medications used to treat them.
5. Develop a plan of care for patients who are experiencing mental illness associated with medical illness.
6. Discuss biopsychosocial interventions that promote patients’ mental health in physical illness.
CONTENT OUTLINE:
1. Psychological Illness Related to Specific Physiologic Disorders
2. Psychological Impact of Pain
1. Biologic Basis of the Pain Response
2. Psychological Aspects of the Pain Response
3. Assessment of the Patient With Chronic Pain
4. Sensory and Pharmacologic Modulation of Pain
3. Psychopathologic Complications of AIDS
1. Biologic Basis of Neurologic Manifestations of HIV
2. Psychological Aspects of AIDS
3. Assessment of the AIDS Patient
4. Biopsychosocial Treatment Interventions
4. Psychological Illness Related to Trauma
1. Biologic Basis of the Trauma Response
2. Psychological Aspects of the Trauma Response
3. Assessment of the Trauma Patient
4. Biopsychosocial Treatment Interventions
5. Psychological Illness Related to Central Nervous System Disorders
1. Biologic Basis of Neurologic Impairment
2. Psychological Aspects of Neurologic Impairment
3. Assessment of the Neurologic Patient
4. Biopsychosocial Treatment Interventions
6. Psychological Illness Related to Acute and Chronic Medical Illness
1. Biologic Aspects of Mental Illness Related to Medical Disease
2. Psychological Aspects of Medical Illness
3. Assessment of the Patient With Medical Illness
4. Clinical Features of Special Significance
5. Biopsychosocial Treatment Interventions
7. Recognition of Mental Illness and Biopsychosocial Interventions in Medical Illness
LEARNING ACTIVITIES:
1. Study Guide: Chapter 34: Pages
2. Participation in Classroom Critical Thinking Exercises. CTE #2, 4. Study Guide Page154, 156
3. Quiz
4.
CRITICAL THINKING FOCUS:
Developing an awareness of the presence of mental health issues in patients with physical diagnoses. Development of interventions that are therapeutic for these phenomena in the medical setting.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 894-917).
Philadelphia, Pa. : Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
EATING DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Distinguish the signs and symptoms of anorexia nervosa from bulimia nervosa.
2. Describe two theories of etiology for both anorexia nervosa and bulimia nervosa.
3. Explain the importance of body image, body dissatisfaction, and gender identity in developmental theories that explain etiology of eating disorders.
4. Explain the impact of sociocultural norms on the development of eating disorders.
5. Describe the risk factors and protective factors associated with the development of eating disorders.
6. Formulate the nursing diagnoses for individuals with eating disorders.
7. Describe the nursing interventions for individuals with anorexia nervosa and bulimia nervosa.
8. Differentiate binge eating disorder from bulimia nervosa
9. Analyze special concerns within the nurse-patient relationship for the nursing management of individuals with eating disorders.
10. Identify strategies for prevention and early detection of eating disorders.
CONTENT OUTLINE:
1. Anorexia Nervosa
1. Clinical Course of Disorder
2. Diagnostic Criteria
3. Epidemiology
1. Age of Onset
2. Gender Differences
3. Ethnic and Cultural Differences
4. Familial Differences
4. Comorbidity
5. Etiology
6. Biologic Theories
1. Neuropathologic
2. Genetic
3. Biochemical
7. Psychological Theories
8. Social Theories
1. Family Responses
9. Risk Factors
1. Biologic
2. Psychological
3. Sociocultural
4. Family
10. Concurrent Disorders
1. Sexual Abuse
11. Interdisciplinary Treatment
12. Pharmacologic Interventions
13. Priority Care Issues
14. Nursing Management: Human Response to Disorder
1. Therapeutic Nurse-Patient Relationship
2. Biologic Domain
3. Psychological Domain
1. Patient Education
4. Social Domain
5. Evaluation and Treatment Outcomes
15. Continuum of Care
1. Hospitalization
2. Emergency Care
16. Family Assessment and Intervention
17. Outpatient Treatment
18. Prevention
2. Bulimia Nervosa
1. Definition and Clinical Course
2. Diagnostic Criteria
3. Bulimia Nervosa in Special Populations
4. Epidemiology
1. Age of Onset
2. Gender Differences
3. Ethnic and Cultural Differences
4. Familial Differences
5. Comorbidity
5. Etiology
1. Biologic Theories
2. Neuropathologic
3. Genetic
4. Biochemical
5. Psychological and Social Theories
6. Cognitive Therapy
7. Family
8. Risk Factors
9. Interdisciplinary Treatment
10. Priority Care Issues
11. Nursing Management: Human Response to Disorder
1. Therapeutic Nurse-Patient Relationship
2. Biologic Domain
1. Pharmacologic Interventions
3. Psychosocial Domain
12. Treatment Therapies
13. Behavioral Intervention
14. Psychoeducation
15. Evaluation and Treatment Outcomes
3. Continuum of Care
4. Prevention
LEARNING ACTIVITIES:
1. Study Guide: Chapter 24: Pages 109-111
2. Participation in Classroom Critical Thinking Activities. CTE #1, 3. Study Guide Page 111.
3. Quiz
CRITICAL THINKING FOCUS:
Nursing is predominately a female profession and eating disorders are much more likely to occur in women than men. What can nurses do to help themselves? How can nurses intervene to help individuals and their families with an identified eating disorder?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 582-615).
Philadelphia: Lippincott.
WEB LINKS:
Anorexia Nervosa and Related Eating Disorders (ANRED), P.O. Box 5102, Eugene, OR 97405. The ANRED site has professional and lay information on eating disorders.
Eating Disorders Shared Awareness. This site gives information on how to get help with an eating disorder
NUR 411: KEELEY/CHASE: 11/22/2002
CHILD AND ADOLESCENT MENTAL HEALTH
LESSON OBJECTIVES:
At the completion of the lesson, the student will be able to:
1. Identify protective factors in the mental health promotion of children and adolescents.
2. Identify risk factors for the development of psychopathology in childhood and adolescence.
3. Analyze the role of the nurse in mental health promotion with children and families.
4. Identify protective factors in the mental health promotion of children and adolescents.
5. Identify risk factors for the development of psychopathology in childhood and adolescence.
6. Analyze the role of the nurse in mental health promotion with children and families.
CONTENT OUTLINE:
1. Childhood and Adolescent Mental Health
1. Common Childhood Problems
1. Death and Grieving
2. Preschool-Aged Children
3. School-Aged Children
4. Adolescents
2. Separation and Divorce
3. Sibling Relationships
4. Physical Illness
5. Adolescent Risk-Taking Behaviors
2. Risk Factors for Childhood Psychopathology
1. Poverty and Homelessness
2. Child Abuse and Neglect
3. Out-of-Home Placement
4. Children of Alcoholics
3. Intervention Approaches
1. Oppositional Defiant Disorder and Conduct Disorder
2. Nursing Management: Human Response to Disorder
1. Biologic Domain
1. Assessment
2. Nursing Diagnosis and Outcomes: Biologic Domain
3. Interventions for the Biologic Domain
3. Psychological Domain
1. Assessment
2. Nursing Diagnosis and Outcomes: Psychological Domain
3. Interventions for the Psychological Domain
4. Social Domain
1. Assessment
2. Nursing Diagnosis and Outcomes: Social Domain
3. Interventions for the Social Domain
4. Evaluation and Treatment Outcomes
5. Continuum of Care
6. Disorders of Mood and Anxiety
1. Anxiety Disorders
2. Separation Anxiety Disorder
3. Epidemiology and Etiology
4. Psychopharmocologic Interventions
5. Nursing Management
6. Obsessive-Compulsive Disorder
1. Epidemiology and Etiology
2. Psychopharmocologic Interventions
3. Nursing Management
7. Mood Disorders: Major Depressive Disorder
1. Epidemiology
2. Nursing Management
8. Tic Disorders and Tourette’s Disorder
1. Epidemiology and Etiology
2. Psychopharmacologic Interventions
3. Nursing Management
7. Childhood Schizophrenia
8. Elimination Disorders
1. Enuresis
1. Epidemiology and Etiology
2. Nursing Management
2. Encopresis
1. Epidemiology and Etiology
3. Nursing Management
LEARNING ACTIVITIES:
1. Study Guide: Chapter 28, 29: Pages
2. Participation in Classroom Critical Thinking Activities CTC #8 Page 779 Text. CTE #4 Study Guide Page 134
3. Quiz
CRITICAL THINKING FOCUS:
Our children are our future. What must mental health nurses do to ensure their mental health? How can a nurse in a pediatric out-patient practice apply assessment tools for case finding and provide mental health nursing care for a child and his/her family?
REQUIRED READING
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 724-781).
Philadelphia: Lippincott.
WEB LINKS
The American Academy of Child and Adolescent Psychiatry website provides an exhaustive list of links to short articles on many mental health issues and is geared toward families and consumers.
This site of the Children and Adults with Attention-deficit/Hyperactivity Disorder (CHADD) organization provides information and resources on ADHD.
This website describes Asperger’s disorder.
The Autism Society of America advances the understanding of autism.
The website of the Center for Study of Autism contains information and resources about autism and related disorders.
NUR 411: KEELEY/CHASE: 11/22/2002
DELERIUM, DEMENTIA AND OTHER RELATED DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Distinguish the clinical characteristics, onset, and course of delirium and Alzheimer’s disease.
2. Analyze the prevailing biologic, psychological, and social theories that relate to delirium and Alzheimer’s disease in elderly people.
3. Integrate biopsychosocial theories into the analysis of human responses to delirium and dementia, with emphasis on the concepts of impaired cognition and memory.
4. Discuss various etiologies for cognitive impairment in other patients (other than those with delirium and dementia).
5. Interpret the impact of culture and education on mental status testing.
6. Formulate nursing diagnoses based on a biopsychosocial assessment of patients with impaired cognitive function.
7. Identify expected outcomes for patients with impaired cognition and their evaluation.
8. Discuss nursing interventions used for patients with impaired cognition.
CONTENT OUTLINE:
1. Delirium
1. Clinical Course of Disorder
2. Diagnostic Criteria
3. Delirium in Special Populations
1. Children
2. Elderly People
4. Epidemiology and Risk Factors
5. Etiology
6. Interdisciplinary Treatment and Priority Care Issues
7. Nursing Management: Human Response to Disorder
1. Biologic Domain
1. Biologic Assessment
2. Past and Present Health Status
3. Physical Examination and Review of Systems
1. Physical Functions
4. Pharmacologic Assessment
8. Nursing Diagnoses Related to Biologic Domain
9. Biologic Interventions
10. Safety Interventions
11. Pharmacologic Interventions
12. Psychological Domain
1. Psychological Assessment
2. Mental Status
3. Behavior
4. Nursing Diagnoses Related to Psychological Domain
5. Psychological Interventions
13. Social Domain
1. Social Assessment
2. Nursing Diagnoses Related to Social Domain
3. Social Interventions
2. Evaluations and Treatment Outcomes
3. Continuum of Care
4. Dementia of the Alzheimer’s Type
1. Clinical Course of Disorder
2. Diagnostic Criteria
3. Epidemiology and Risk Factors
4. Etiology
1. Plaques and Tangles
2. Cholinergic Hypothesis
5. Genetic Factors
6. Other Theories
7. Interdisciplinary Treatment
8. Priority Care Issues
9. Family Response to Disorder
10. Nursing Management: Human Response to Disorder
1. Biologic Domain
1. Biologic Assessment
2. Past and Present Health Status
3. Physical Examination and Review of Body Systems
4. Physical Functions
1. Self-Care
2. Sleep-Wake Disturbances
3. Activity and Exercise
4. Nutrition
5. Pain
11. Nursing Diagnoses Related to Biologic Domain
1. Biologic Interventions
2. Self-Care Interventions
3. Nutritional Interventions
4. Interventions Supporting Bowel and Bladder Function
5. Sleep Interventions
6. Activity and Exercise Interventions
7. Pain and Comfort Management
1. Relaxation
2. Pharmacologic Interventions
1. Cholinesterase Inhibitors
2. Antipsychotics
3. Antidepressants and Mood Stabilizers
4. Antianxiety Medications (Sedative-Hypnotics)
5. Other Medications
3. Other Somatic Interventions
12. Psychological Domain
1. Psychological Assessment
2. Responses to Mental Health Problems
1. Cognitive Status
1. Memory
2. Language
3. Visuopatial Impairment
4. Executive Functioning
2. Psychotic Symptoms
1. Suspiciousness and Delusion and Illusion Formation
2. Hallucinations
3. Mood Changes
1. Depression
4. Anxiety
5. Catastrophic Reactions
3. Behavioral Responses
1. Apathy and Withdrawal
2. Restlessness, Agitation, and Aggression
3. Disinhibition
4. Hypersexuality
4. Stress and Coping Skills
13. Nursing Diagnoses Related to Psychological Domain
14. Psychological Interventions
1. Interventions for Cognitive Impairment
1. Validation Therapy
2. Memory Enhancement
3. Orientation Interventions
4. Maintenance of Language Functions
5. Supporting Visuopatial Functioning
2. Interventions for Psychosis
1. Managing Suspicions, Illusions, and Delusions
2. Managing Hallucinations
3. Interventions for Alterations in Mood
1. Managing Depression
2. Managing Anxiety
3. Managing Catastrophic Reactions
4. Interventions for Behavior Problems
1. Managing Apathy and Withdrawal
2. Managing Restlessness and Wandering
3. Managing Aberrant Behavior
4. Managing Agitated Behavior
5. Reducing Disinhibition
15. Social Domain
1. Social Assessment
2. Nursing Diagnoses Related to Social Domain
3. Social Interventions
4. Safety Interventions
5. Environmental Interventions
6. Socialization Activities
5. Home Visits
6. Community Actions
7. Family Interventions
8. Evaluation and Treatment Outcomes
9. Continuum of Care
1. Community Care
2. Inpatient-Focused Care
3. Nursing Home Care
10. Other Dementias
1. Vascular Dementia
2. Dementia Caused by Other General Medical Conditions
3. Dementia Caused by AIDS
4. Dementia Caused by Head Trauma
5. Dementia Caused by Parkinson’s Disease
6. Dementia Caused by Huntington's Disease
7. Dementia Caused by Pick’s Disease
8. Dementia Caused by Creutzfeldt-Jakob Disease
9. Substance-Induced Persisting Dementia
10. Amnestic Disorder
LEARNING ACTIVITIES:
1. Study Guide: Chapter 31: Pages 139-143
2. Participation in Class Critical Thinking Exercises CTC #1, 3, Page 855. Text
3. Quiz
CRITICAL THINKING FOCUS:
How are cognition and memory affected by underlying physical disorders? With a projected increase in the incidence of these disorders over the next twenty years, what can nurses do to effectively assist patients and their families in primary prevention and acute care?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 814-857).
Philadelphia: Lippincott.
WEB LINKS:
This Alzheimer’s Association website provides information, resources, and consumer and caregiver support.
The National Institute of Neurological Disorders and Stroke website provides useful information about Alzheimer’s disease.
This website of the Pick’s Disease Support Group provides information on Pick’s disease, Lewy bodies, and other dementias.
This site of the Alzheimer’s Association of Canada provides information and resources related to the disease.
NUR 411: KEELEY/CHASE: 11/22/2002
STRESS MANAGEMENT AND CRISIS INTERVENTION
LESSON OBJECTIVES:
Upon completion of this lesson, the student will:
1. Examine person-environment factors that contribute to the stress experience.
2. Relate the cognitive appraisal of the person-environment relationship to stress and coping.
3. Determine when problem-focused and emotion-focused coping should be used.
4. Define adaptation in terms of health, psychological well-being, and social function.
5. Apply the nursing process to a person who is experiencing stress.
6. Differentiate generalist and specialist psychiatric mental health nursing interventions that promote successful coping in stressful situations.
7. Define a crisis as an example of severe stress.
8. Differentiate between a crisis due to chronic stress and a psychiatric emergency.
9. Delineate generalist and specialist interventions that promote positive resolution of crises.
CONTENT OUTLINE:
1. Antecedents to Stress
1. Person-Environment Relationship
2. The Person
1. Values and Commitment
2. Personality Behavior Patterns
3. The Environment
1. Social Networks
2. Social Support
4. Demands and Constraints
5. Sociocultural Factors
1. Life Events
6. Appraisal
2. Stress Responses
1. Physiologic Responses
2. Emotional Responses
3. Coping
4. Adaptation
3. Health and Illness
1. Psychological Well-Being
4. Social Functioning
5. Nursing Management: Human Response to Disorder
1. Assessing Human Responses to Stress
1. Biologic Assessment
1. Review of Systems
2. Pharmocologic Assessment
3. Physical Functioning
2. Psychological Assessment
3. Social Assessment
1. Recent Life Changes
2. Social Network and Social Support
2. Nursing Diagnosis and Outcome Identification
3. Planning and Implementing Nursing Interventions
1. Biologic Interventions
2. Psychological Interventions
3. Social Interventions
4. Evaluation and Treatment Outcomes
6. Crisis
1. Developmental Crisis
2. Situational Crisis
1. Death of a Loved One: A Crisis Event
1. Phases of Bereavement
2. Shock and Disbelief
3. Acute Mourning
4. Resolution
2. Dysfunctional Grieving
7. Nursing Management: Human Response to Disorder
1. Assessing Human Responses to Crises
1. Biologic Assessment
2. Psychological Assessment
3. Social Assessment
2. Nursing Diagnosis and Outcome Identification
3. Planning and Implementing Nursing Interventions
1. Psychopharmacologic Interventions
1. Initiation
2. Stabilization
3. Maintenance
4. Medication Cessation
5. Biopsychosocial Interventions
8. Crisis Intervention in the Community
1. Telephone Hot Lines
2. Residential Crisis Services
9. Evaluation and Treatment Outcomes
LEARNING ACTIVITIES:
1. Study Guide: Chapter 35: Pages 159-163
2. Participation in Classroom Critical Thinking Activities CTE #1 Study Guide Page 161
3. Quiz
CRITICAL THINKING FOCUS:
Since crisis is inevitable in life, how might the nurse care for patients who are in crisis so that they may have an optimal outcome.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 920-949).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
This site offers a review of the principles of stress management.
This is the home page of the international Stress Management Association (ISMA) in the United Kingdom. ISMA is a leading professional body for stress management. Its website has articles from its journal.
The International Stress Management Association seeks to advance the education of professionals and students and to facilitate methodically sound research in several professional interdisciplinary stress management fields.
MANAGEMENT OF AGGRESSION
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Explore feelings about the experience and expression of anger.
2. Discuss the biopsychosocial factors that influence the expression of aggressive and violent behaviors.
3. Discuss biopsychosocial theories used to explain anger, aggression, and violence.
4. Identify behaviors or actions that escalate and de-escalate violent behavior.
5. Recognize the risk of “nurse abuse” (attacks on nurses).
6. Generate options for responding to the expression of anger and violent behaviors in clinical nursing practice.
7. Apply the nursing process to the management of anger, aggression, and violence in patients.
CONTENT OUTLINE:
1. Anger
1. Experience of Anger
2. Expression of Anger
2. Aggression and Violence
3. Models of Anger, Aggression, and Violence
1. Biologic Theories
2. Cognitive Neuroassociation Model
3. Neurostructural Model and the Emotional Circuit
4. Neurochemical Model and Low Serotonin Syndrome
5. Psychological Theories
6. Psychoanalytic Theories
7. Behavioral Theories
8. Drive Theory
9. Social Learning Theory
10. Cognitive Theories
11. Sociocultural Theories
12. Interactional Theory
4. Nursing Management: Human Response to Disorder
1. Assessing the Human Response to Anger, Aggression, and Violence
1. Biologic Assessment
2. Psychological Assessment
1. Thought Processing
2. Perception
3. Delusion
4. Sensory Impairment
3. Social Assessment
2. Nursing Diagnosis and Outcome Identification
3. Planning and Implementing Nursing Interventions
1. Biologic Interventions
2. Administering and Monitoring Medications
3. Managing Nutrition
4. Psychological Interventions
5. Affective Interventions
1. Validating
2. Listening to the Patient’s Illness Experience
3. Exploring Beliefs
6. Cognitive Interventions
1. Giving Commendations
2. Offering Information
3. Providing Education
4. Thought Stopping
5. Contracting
7. Behavioral Interventions
1. Assigning Behavioral Tasks
8. Using Bibliotherapy
9. Interrupting Patterns
10. Providing Choices
4. Social Interventions
1. Reducing Stimulation
2. Anticipating Needs
5. Using Seclusion and Restraint
6. Interactional Processes
1. Responses to Assault
7. Evaluation and Treatment Outcomes
5. Continuum of Care
LEARNING ACTIVITIES:
1. Study Guide: Chapter 36: Pages 164-167
2. Participation in Class Critical Thinking Exercises CTE #2 Study Guide: Page166.
3. Quiz
CRITICAL THINKING FOCUS:
Integrating current theories of aggression and accepted interventions for the management of aggression in the clinical environment into a nursing practice model.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 950-974).
Philadelphia: Lippincott.
WEB LINKS:
This site provides a Guide to the Literature on Aggressive Behavior and information on the Journal of the International Society for Research on Aggression. The guide provides an extensive list of current publications on aggressive behavior.
This site provides a Guide to the Literature on Aggressive Behavior and information on the Journal of the International Society for Research on Aggression. The guide provides an extensive list of current publications on aggressive behavior.
The American Psychological Association maintains this website. This section focuses on teen violence. It includes a personal risk evaluation for violent behavior, tips on helping when someone you know shows violence warning signs, and a free brochure.
NUR 411: KEELEY/CHASE: 11/22/2002
CARING FOR ABUSED PERSONS
LESSON OBJECTIVES:
Upon completion of this lesson the student will be able to:
1. Describe woman, child, and elder abuse.
2. Describe biopsychosocial theories of abuse.
3. Discuss theories explaining why some men become abusive and why some women remain in violent relationships.
4. Describe biopsychosoical consequences of abuse.
5. Describe the diagnostic criteria for post-traumatic stress disorder (PTSD).
6. Discuss the three major symptom categories found in PTSD and their associated etiologic factors.
7. Describe the diagnostic criteria for dissociative identity disorder (DID).
8. Integrate biopsychosocial theories into the analysis of human responses to survivors of abuse.
9. Formulate nursing care plans for survivors of abuse.
CONTENT OUTLINE:
1. Types of Abuse
1 Woman Abuse
2 Battering
3 Rape and Sexual Assault
1. Child Abuse
2. Child Neglect
3. Physical Abuse
4. Sexual Abuse
5. Emotional Abuse
6. Munchausen’s Syndrome by Proxy
7. Children of Battered Women
8. Elder Abuse
Explanatory Theories of Abuse
9. Biologic Theories
1. Neurologic Problems
2. Links With Substance Abuse
10. Psychological Theories
1. Psychopathology Theory
2. Social Learning Theory
11. Social Theories
2. Theoretical Dynamics Specific to Woman Abuse
1. Feminist Theories
2. Theory of Borderline Personality Organization
1 Theories Why Women Stay in Violent Relationships
3. Cycle of Violence
1. Traumatic Bonding
2. Survivors of Abuse: Human Responses to Trauma
3. Biologic Responses
1. Depression
4. Acute Stress Disorder and Post-Traumatic Stress Disorder
1. Hyperarousal
2. Intrusion
3. Avoidance and Numbing
5. Dissociative Identity Disorder
6. Substance Abuse and Dependence
4. Psychological Responses
1. Low Self-Esteem
2. Guilt and Shame
3. Anger
4. Social and Interpersonal Responses
5. Problems With Intimacy
6. Revictimization
5. Nursing Management
1. Assessing for Abuse and Survivors’ Responses
1. Biologic Assessment
2. Psychological Assessment
3. Social Assessment
4. Special Assessment Considerations in Sexual Assault
2. Nursing Diagnoses
3. Planning and Implementing Nursing Interventions for Abuse
1. Biologic Interventions
1. Administering and Monitoring Medications
4. Making Referrals for Patients With Comorbid Substance Abuse
1. Psychological Interventions
1. Assisting With Psychotherapy and Counseling
2. Providing Education
2. Using Behavioral Interventions
3. Social Interventions
6. Working With Abusive Families
7. Working in the Community
8. Special Intervention Considerations in Sexual Assault
9. Evaluation and Treatment Outcomes
LEARNING ACTIVITIES:
1. Study Guide: Chapter 37: Pages 168-172
2. Participation in Classroom Critical Thinking Exercises CTE #1 Study Guide Page 170.
3. Quiz
CRITICAL THINKING FOCUS:
How can the mental health nurse holistically intervene in the cycle of abuse. What interventions are most helpful in the acute care setting for victims of abuse?
REQUIRED READING
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 974-1005).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
National Coalition Against Domestic Violence. This site serves as a national information and referral center dedicated to the empowerment of battered women and their children.
Women’s Rural Advocacy Programs. This site represents a cooperative of Domestic Violence and Criminal Justice Intervention programs serving southwestern Minnesota. It has a section specifically for Native American women.
Breaking the Cycle, Inc. This site is dedicated to ending violence against women and children through specialized training and awareness programs for professionals.
American Bar Association Domestic Violence. This site provides links to statistical and informational resources. It includes the Model Code on Domestic and Family Violence, a general bibliography, and information about legal research and analysis.
Communities Against Violence Network. This database of information also supports a virtual community of more than 900 professionals from the United States, Europe, Australia, New Zealand, Canada, South Africa, the Middle East, Latin America, and the Caribbean.
NUR 411: KEELEY/CHASE: 11/22/2002
SEXUAL DISORDERS
LEARNING OBJECTIVES:
Upon completion of this lesson, the student will:
1. Distinguish types and etiologies of common sexual dysfunctions and disorders.
2. Analyze biologic, psychological, and social theories that serve as a basis for caring for persons with sexual disorders, paraphilias, and gender identity disorder.
3. Identify human responses to sexual dysfunctions.
4. Develop a nursing care plan based on a biopsychosocial assessment of persons with a sexual disorder.
5. Identify nursing intervention strategies common to treating those with sexual disorders.
6. Identify appropriate resources for referring a patient with a sexual dysfunction.
CONTENT OUTLINE:
1. Sexual Development
1. Infancy Through Childhood
2. Childhood Through Adolescence
3. Young Adulthood
4. Adulthood
5. Later Adulthood
6. Old Age
7. The Dying Person
2. Human Sexual Response
1. Sexual Desire
2. Sexual Arousal
3. Orgasm
4. Resolution
3. Sexual Disorders
1. Orgasmic Disorders
1. Female Orgasmic Disorder
2. Epidemiology
3. Etiologic Factors
1. Biologic Theories
2. Psychological Theories
4. Social Theories
2. Risk Factors
3. Interdisciplinary Treatment
4. Nursing Management
1. Biologic Domain
1. Assessment
2. Interventions
3. Psychological Domain
1. Assessment
2. Interventions
4. Social Domain
1. Assessment
2. Interventions
5. Evaluation and Treatment Outcomes
4. Premature Ejaculation
1. Epidemiology
2. Etiology
3. Nursing Management
5. Male Orgasmic Disorder
1. Sexual Arousal Disorders
2. Male Erectile Disorder
1. Epidemiology
2. Etiology
1. Biologic Theories
2. Psychological Theories
3. Nursing Management
1. Biologic Domain
1. Assessment
2. Interventions
3. Pharmacologic Interventions
2. Psychological Domain
1. Interventions
3. Social Domain
1. Interventions
4. Evaluation and Treatment Outcomes
6. Female Sexual Arousal Disorder
1. Other Sexual Disorders
2. Sexual Desire Disorders
3. Hypoactive Sexual Desire Disorder
4. Sexual Aversion Disorder
5. Sexual Pain Disorders
1. Dyspareunia
2. Vaginismus
3. Priapism
7. Sexual Disorder Caused by a General Medical Condition
8. Substance-Induced Sexual Dysfunction
9. Paraphilias
1. Exhibitionism
2. Fetishism
3. Frotteurism
4. Pedophilia
5. Sexual Masochism
6. Sexual Sadism
7. Transvestic Fetishism
8. Voyeurism
9. Paraphilia Not Otherwise Specified
10. Sexual Disorders Not Otherwise Specified
11. Gender Identity Disorders
LEARNING ACTIVITIES:
1. Study Guide: Chapter 27: Pages
2. Participation in Classroom Critical Thinking Exercises CTE # 1, 2. Study Guide Page 123
3. Quiz
CRITICAL THINKING FOCUS:
Integrating the theory of sexual disorders into a holistic plan of care for the client. Developing an awareness of one’s own level of comfort when caring for clients with these diagnoses
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 16-28).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
This site has psychopharmacology tips from
SLEEP DISORDERS
LESSON OBJECTIVES
1. Describe the major features of sleep.
2. Identify sleep changes in major psychiatric disorders.
3. Distinguish among primary sleep disorders.
4. Discuss biopsychosocial aspects of sleep disorders.
5. Perform a sleep history during a client assessment.
6. Formulate a model nursing care plan for clients with sleep disorders.
CONTENT OUTLINE:
1. Biologic Basis of Sleep
1. Normal Sleep-Wake Circadian Rhythms
2. Neurobiologic Basis for Sleep
3. Stages of Sleep
1. Non-rapid-Eye-Movement Sleep
2. Rapid-Eye-Movement Sleep
2. Biologic Measurements of Sleep
3. Factors That Affect Sleep
1. Age
1. Newborns and Young Children
2. School-Aged Children
3. Young Adults
4. Middle-Age Adults
5. Elderly Adults
2. Environmental Stimuli
3. Lifestyle Conditions
4. Comorbidity
1. Sleep Disorders and Psychoses
2. Sleep Disorders and Mood Disorders
3. Sleep Disorders and Alcoholism
5. Primary Sleep Disorders
1. Dyssomnias
1. Primary Insomnia
1. Definition and Course
2. Epidemiology
3. Etiology
4. Biologic Measurements
5. Somatic Interventions
2. Primary Hypersomnia
1. Definition and Course
2. Biologic Measurements
3. Psychopharmacologic Interventions
3. Narcolepsy
1. Definition and Course
2. Epidemiology
3. Etiology
4. Biologic Measurements
5. Somatic Interventions
2. Breathing-Related Sleep
1. Disorders: Obstructive Sleep Apnea Syndrome
1. Definition and Course
2. Epidemiology
3. Etiology
4. Biologic Measurements
5.1.2.1.1.1.5 Somatic Interventions
3. Circadian Rhythm Sleep Disorder
1. Definition and Course
1. Delayed Sleep Phase Type
2. Jet Lag Type
3. Shift Work Type
2. Etiology
3. Epidemiology
4. Somatic Interventions
4. Parasomnias
1. Nightmare Disorder
1. Definition and Course
2. Epidemiology
3. Etiology
4. Biologic Measurements
5. Somatic Interventions
2. Sleep Terror Disorder
1. Definition and Course
2. Epidemiology
3. Etiology
4. Biologic Measurements
3. Sleepwalking Disorder
1. Definition and Course
2. Epidemiology and Etiology
3. Biologic Measurements
6. Nursing Management: Human Response to Sleep Disorder
1. Insomnia Assessment
2. Hypersomnia Assessment
3. Nursing Diagnoses and Outcome Identification
4. Planning and Implementing Nursing Interventions
1. Biologic Interventions
1. Nutrition
2. Psychopharmacologic Interventions
3. Psychological Interventions: Patient Education
4. Behavioral Interventions
1. Sleep Hygiene
2. Cognitive Therapy
5. Social Interventions
5. Evaluation and Treatment Outcomes
LEARNING ACTIVITIES:
1. Study Guide: Chapter 26: Pages
2. Participation in Classroom Critical Thinking Activities
3. Quiz
CRITICAL THINKING FOCUS:
Integration of an understanding of the variety of sleep disorders and treatments in to the practice of mental health nursing.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 658-685).
Philadelphia: Lippincott.
WEB LINKS:
This is the Sleep Medicine home page.
This is the website of the National Sleep Foundation.
This is the site of the American Academy of Sleep Medicine.
This is the American Sleep Apnea Association website.
This is the site of the Narcolepsy Network.
This is the website of the Restless Legs Syndrome Foundation.
This is the site of the Stanford University Center of Excellence for the Diagnosis and Treatment of Sleep Disorders.
NUR 411: KEELEY/CHASE: 11/22/2002
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