Mental Health Mental Health Student Handbook -1- MHV.1.2 Mental Health Table of Contents Focused Exam: Schizophrenia ........................................................................................................................ - 3 Focused Exam: Anxiety .................................................................................................................................. - 5 Focused Exam: Bipolar Disorder ..................................................................................................................... - 7 Focused Exam: Depression............................................................................................................................. - 9 Focused Exam: Alcohol Abuse ...................................................................................................................... - 11 Focused Exam: PTSD .................................................................................................................................... - 13 Self-Reflection ............................................................................................................................................. - 15 - -2- MHV.1.2 Mental Health This assignment provides the opportunity to conduct a focused exam on a patient presenting with schizophrenia. You will assess relevant body systems to evaluate physiological symptoms. You will also interview the patient, including an involuntary movement evaluation, conduct a mental status exam, and provide therapeutic communication. After the patient exam, you will complete an SBAR hand-off. On average, this assignment should take 90 minutes to complete. This assignment includes subjective data collection around sensitive topics such as suicidal ideation and schizophrenic hallucination. Instructions: Perform a focused examination of an adult male patient who has been experiencing auditory hallucinations and paranoid thoughts. Gather the information needed to assess the situation and transfer care to Preceptor Diana. Plan your time: Assignment Time Estimate First Turn In ~90 minutes Allow Reopening ~110 minutes Flexible Turn In ~160 minutes Patient Examination • Review the orders and patient data in the EHR • Interview and examine Eric Ford to gather subjective and objective patient data • Gather HPI and health history, including Mr. Ford’s psychiatric history • Use the Question tab in this Communication Box to gather subjective data from Mr. Ford • Use the Educate tab in the Communication Box to inform and educate Mr. Ford on relevant topics revealed in subjective data collection • Use the Empathize tab in the Communication Box to practice therapeutic communication when opportunities arise during the interview • Maintain respect for the patient’s dignity while broaching sensitive subjects • Conduct the relevant tests to evaluate the patient’s symptoms • Conduct a mental status exam to determine the patient’s mental health and risk factors • Document the findings of the physical examination in the Objective Data Collection tab in the EHR • Document subjective data, using professional terminology, in the Nursing Admitting Note tab in the EHR Patient Hand-Off: • Determine when enough information has been gathered to transfer care to Preceptor Diana • Communicate the patient’s Situation, Background, your Assessment, and your Recommendation in an SBAR hand-off to your preceptor -3- MHV.1.2 Mental Health Tips for Success: You should prepare prior to entering Eric Ford’s room. We suggest taking out your textbook to remind yourself of what doing a mental health assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: Subjective Data: • Chief Complaint • History of Present Illness • Past Medical History • Home Medication • Social History • Review of Systems There are also multiple essential physical exam actions you will need to complete and record accurately in the EHR. Here are the physical exam tasks you will need to complete by using the exam menu to the right of your screen: Objective Data: • Assessed Vitals • Auscultated Breath sounds • Auscultated Heart sounds • Inspect upper extremities for self-harm or abuse • Assessed for involuntary facial or oral movements • Assessed for involuntary movements of upper extremities • Assessed for involuntary movements of lower extremities • Assessed for involuntary movements of torso Remember when you are doing these exams that this simulation is designed to help you improve your assessment skills. Preparing ahead of time will help to set you up for success. Please keep in mind the Focused Exam: Schizophrenia is the only assignment included in the Mental Health Digital Clinical Experience that provides you with a subjective data collection rubric while working the simulation. Please refer to this handbook to help guide you through the additional exams. Technical Support: Contact Shadow Health with any questions or technical issues before contacting your instructor. Support is available at http://support.shadowhealth.com/. -4- MHV.1.2 Mental Health This assignment provides the opportunity to conduct a focused exam on a patient presenting with anxiety from a perceived cardiac event. You will assess relevant body systems to evaluate physiological symptoms. You will also interview the patient, conduct a mental status exam, and provide therapeutic communication. After the patient exam, you will complete an SBAR hand-off. On average, this assignment should take 90 minutes to complete. This assignment includes subjective data collection around sensitive topics such as acute anxiety and panic disorder. Instructions: Perform a focused examination of an adult male patient who has been experiencing anxiety and exhaustion. Gather the information needed to assess the situation and transfer care to Preceptor Diana. Plan your time: Assignment Time Estimate First Turn In ~90 minutes Allow Reopening ~110 minutes Flexible Turn In ~160 minutes Patient Examination: • Review the orders and patient data in the EHR • Interview and examine Mr. Larsen to gather subjective and objective patient data • Gather HPI and health history, including Mr. Larsen psychiatric history • Use the Question tab in the Communication Box to gather subjective data from Mr. Larsen • Use the Educate tab in the Communication Box to inform and educate Mr. Larsen on relevant topics revealed in subjective data collection • Use the Empathize tab in the Communication Box to practice therapeutic communication when opportunities arise during the interview • Conduct the relevant tests to evaluate the patient’s symptoms • Conduct a mental status exam to determine the patient’s mental health and risk factors • Document the findings of the physical examination in the Objective Data Collection tab in the EHR • Document subjective data, using professional terminology, in the Nursing Admitting Note tab in the EHR Patient Hand-Off: • Determine when enough information has been gathered to transfer care to Preceptor Diana • Communicate the patient's Situation, Background, your Assessment, and your Recommendation in an SBAR hand-off to your preceptor -5- MHV.1.2 Mental Health Tips for Success: You should prepare prior to entering John Larsen’s room. We suggest taking out your textbook to remind yourself of what doing a mental health assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: Subjective Data: • Chief Complaint • History of Present Illness • Past Medical History • Home Medications • Social History • Family History • Review of Systems • Anxiety Screening There are also multiple essential physical exam actions you will need to complete and record accurately in the EHR. Here are the physical exam tasks you will need to complete by using the exam menu to the right of your screen: Objective Data: • Assessed Vitals • Inspected Legs • Auscultate Carotid arteries • Auscultated breath sounds • Auscultated heart sounds • Palpated carotid arteries • Palpated radial arteries • Palpated brachial arteries • Palpated femoral arteries • Palpated popliteal arteries • Palpated tibial arteries • Palpated dorsalis pedis arteries • Preformed EKG • Assessed labs Remember when you are doing these exams that this simulation is designed to help you improve your assessment skills. Preparing ahead of time will help to set you up for success. Technical Support: Contact Shadow Health with any questions or technical issues before contacting your instructor. Support is available at http://support.shadowhealth.com/. -6- MHV.1.2 Mental Health This assignment provides the opportunity to conduct a focused exam on a patient with bipolar disorder who is currently experiencing mania. You will assess relevant body systems to evaluate physiological symptoms. You will also interview the patient, conduct a mental status exam, and provide therapeutic communication. After the patient exam, you will complete an SBAR hand-off. On average, this assignment should take 90 minutes to complete. This assignment includes subjective data collection around sensitive topics such as depression, suicide, drug use, and hypersexuality. Instructions: Perform a focused examination of an adult male patient with bipolar disorder who is currently experiencing mania. Gather the information needed to assess the situation and transfer care to Preceptor Diana. Plan your time: Assignment Time Estimate First Turn In ~90 minutes Allow Reopening ~110 minutes Flexible Turn In ~160 minutes Patient Examination: • Review the orders and patient data in the EHR • Interview and examine Lucas Callahan to gather subjective and objective patient data • Gather HPI and health history, including Mr. Callahan’s psychiatric history • Use the Question tab in the Communication Box to gather subjective data from Mr. Callahan • Use the Educate tab in the Communication Box to inform and educate Mr. Callahan on relevant topics revealed in subjective data collection • Use the Empathize tab in the Communication Box to practice therapeutic communication when opportunities arise during the interview • Maintain respect for the patient’s dignity while broaching sensitive subjects • Conduct the relevant tests to evaluate the patient’s symptoms • Conduct a mental status exam to determine the patient’s mental health and risk factors • Document the findings of the physical examination in the Objective Data Collection tab in the EHR • Document subjective data, using professional terminology, in the Nursing Admitting Note tab in the EHR Patient Hand-Off: • Determine when enough information has been gathered to transfer care to Preceptor Diana • Communicate the patient's Situation, Background, your Assessment, and your Recommendation in an SBAR hand-off to your preceptor -7- MHV.1.2 Mental Health Tips for Success: You should prepare prior to entering Lucas Callahan’s room. We suggest taking out your textbook to remind yourself of what doing a mental health assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: Subjective Data: • Chief Complaint • History of Present Illness • Past Medical History • Home Medications • Suicide Screening Questions • Mood Questionnaire Disorder • Social History • Family Medical History • Review of Systems There are also multiple essential physical exam actions you will need to complete and record accurately in the EHR. Here are the physical exam tasks you will need to complete by using the exam menu to the right of your screen. Objective Data: • Assess Vitals • Inspected Eyes • Inspect Nose • Inspect Arms • Inspect Chest • Inspect Legs • Inspect Back • Auscultate Breath Sounds • Auscultate Heart Sounds • Palpate Abdomen • Palpate Radial • Palpate Dorsalis Pedis • Palpate Capillary Refill • Review EKG Results • Review Lab Results Remember when you are doing these exams that this simulation is designed to help you improve your assessment skills. Preparing ahead of time will help to set you up for success. Technical Support: Contact Shadow Health with any questions or technical issues before contacting your instructor. Support is available at http://support.shadowhealth.com/. -8- MHV.1.2 Mental Health This assignment provides the opportunity to conduct a focused exam on a patient presenting with exhaustion and physical weakness. You will assess relevant body systems to evaluate physiological symptoms. You will also interview the patient, conduct a mental status exam, and provide therapeutic communication. After the patient exam, you will complete an SBAR hand-off. On average, this assignment should take 90 minutes to complete. This assignment includes subjective data collection around sensitive topics such as suicidal ideation and depression. Instructions: Perform a focused examination of an older adult female patient who has been experiencing exhaustion and physical weakness related to depression. Gather the information needed to assess the situation and transfer care to Preceptor Diana. Plan your time: Assignment Time Estimate First Turn In ~90 minutes Allow Reopening ~110 minutes Flexible Turn In ~160 minutes Patient Examination: • Review the orders and patient data in the EHR • Interview and examine Abigail Harris to gather subjective and objective patient data • Gather HPI and health history, including Ms. Harris’s psychiatric history • Use the Question tab in the Communication Box to gather subjective data from Ms. Harris • Use the Educate tab in the Communication Box to inform and educate Ms. Harris on relevant topics revealed in subjective data collection • Use the Empathize tab in the Communication Box to practice therapeutic communication when opportunities arise during the interview • Maintain respect for the patient’s dignity while broaching sensitive subjects • Conduct the relevant tests to evaluate the patient’s symptoms • Conduct a mental status exam to determine the patient’s mental health and risk factors • Document the findings of the physical examination in the Objective Data Collection tab in the EHR • Document subjective data, using professional terminology, in the Nursing Admitting Note tab in the EHR Patient Hand-Off: • Determine when enough information has been gathered to transfer care to Preceptor Diana • Communicate the patient's Situation, Background, your Assessment, and your Recommendation in an SBAR hand-off to your preceptor -9- MHV.1.2 Mental Health Tips for Success: You should prepare prior to entering Abigail Harris’s room. We suggest taking out your textbook to remind yourself of what doing a mental health assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: Subjective Data: • Chief Complaint • History of Present Illness • Past Medical History • Home Medications • Social History • Review of Systems • Anxiety Screening There are also multiple essential physical exam actions you will need to complete and record accurately in the EHR. Here are the physical exam tasks you will need to complete by using the exam menu to the right of your screen. Objective Data: • Assessed Vitals • Assess IV Bag • Assess IV Pump • Assess IV Site • Assess Blood Glucose • Assess Urine Quality • Inspected Eyes • Inspect Mouth • Inspect Skin • Inspect Skin Turgor • Auscultate Carotids • Auscultate Breath Sounds • Auscultate Heart Sounds • Palpate Thyroid • Test Gait • Test Fine Motor Skills • Test Grip Strength • Test Capillary Refill Remember when you are doing these exams that this simulation is designed to help you improve your assessment skills. Preparing ahead of time will help to set you up for success. Technical Support: Contact Shadow Health with any questions or technical issues before contacting your instructor. Support is available at http://support.shadowhealth.com/. - 10 - MHV.1.2 Mental Health This assignment provides the opportunity to conduct a focused exam on a patient presenting with alcohol abuse, anxiety, and passive suicidal ideation. You will assess relevant body systems to evaluate physiological symptoms. You will also interview the patient, conduct a mental status exam, and provide therapeutic communication. After the patient exam, you will complete an SBAR hand-off. On average, this assignment should take 90 minutes to complete. This assignment includes subjective data collection around sensitive topics such as suicidal ideation and substance abuse. Instructions: Perform a focused examination of an adult female patient who has been experiencing anxiety, passive suicidal ideation, and alcohol abuse. Gather the information needed to assess the situation and transfer care to Preceptor Diana. Plan your time: Assignment Time Estimate First Turn In ~90 minutes Allow Reopening ~110 minutes Flexible Turn In ~160 minutes Patient Examination: • Review the orders and patient data in the EHR • Interview and examine Rachel Adler to gather subjective and objective patient data • Gather HPI and health history, including Ms. Adler’s psychiatric history • Use the Question tab in this Communication Box to gather subjective data from Ms. Adler • Use the Educate tab in the Communication Box to inform and educate Ms. Adler on relevant topics revealed in subjective data collection • Use the Empathize tab in the Communication Box to practice therapeutic communication when opportunities arise during the interview • Maintain respect for the patient’s dignity while broaching sensitive subjects • Conduct the relevant tests to evaluate the patient’s symptoms • Conduct a mental status exam to determine the patient’s mental health and risk factors • Document the findings of the physical examination in the Objective Data Collection tab in the EHR • Document subjective data, using professional terminology, in the Nursing Admitting Note tab in the EHR Patient Hand-Off: • Determine when enough information has been gathered to transfer care to Preceptor Diana • Communicate the patient’s Situation, Background, your Assessment, and your Recommendation in an SBAR hand-off to your preceptor - 11 - MHV.1.2 Mental Health Tips for Success: You should prepare prior to entering Rachel Adler’s room. We suggest taking out your textbook to remind yourself of what doing a mental health assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: Subjective Data: • Chief Complaint • History of Present Illness • Past Medical History • Home Medications • Social History • CAGE Assessment • Family History • Review of Systems There are also multiple essential physical exam actions you will need to complete and record accurately in the EHR. Here are the physical exam tasks you will need to complete by using the exam menu to the right of your screen: Objective Data: • Assessed Vitals • Inspected eyes • Inspected hands and wrists • Inspected upper extremities for self-harm or abuse • Auscultated breath sounds • Auscultated heart sounds • Palpated radial arteries • Tested capillary refill Remember when you are doing these exams that this simulation is designed to help you improve your assessment skills. Preparing ahead of time will help to set you up for success. Technical Support: Contact Shadow Health with any questions or technical issues before contacting your instructor. Support is available at http://support.shadowhealth.com/. - 12 - MHV.1.2 Mental Health This assignment provides the opportunity to conduct a focused exam on a patient presenting with PostTraumatic Stress Disorder, depression, and anxiety. You will assess relevant body systems to evaluate physiological symptoms. You will also interview the patient, conduct a mental status exam, and provide therapeutic communication. After the patient exam, you will complete an SBAR hand-off. On average, this assignment should take 90 minutes to complete. This assignment includes subjective data collection around sensitive topics such as sexual assault and trauma. Instructions: Perform a focused examination of an adult female patient who has been experiencing sleep problems, anxiety, depression, and Military Sexual Trauma related Post-Traumatic Stress Disorder. Gather the information needed to assess the situation and transfer care to Preceptor Diana. Plan your time: Assignment Time Estimate First Turn In ~90 minutes Allow Reopening ~110 minutes Flexible Turn In ~160 minutes Patient Examination: • Review the orders and patient data in the EHR • Interview and examine Nicole Diaz to gather subjective and objective patient data • Gather HPI and health history, including the patient’s psychiatric history • Use the Question tab in the Communication Box to gather subjective data from Ms. Diaz • Use the Educate tab in the Communication Box to inform and educate Ms. Diaz on relevant topics revealed in subjective data collection • Use the Empathize tab in the Communication Box practice to therapeutic communication when opportunities arise during the interview • Maintain respect for the patient’s dignity while broaching sensitive subjects • Conduct the relevant tests to evaluate the patient’s symptoms • Conduct a mental status exam to determine the patient’s mental health and risk factors • Document the findings of the physical examination in the Objective Data Collection tab in the EHR • Document subjective data, using professional terminology, in the Nursing Admitting Note tab in the EHR Patient Hand-Off: • Determine when enough information has been gathered to transfer care to Preceptor Diana • Communicate the patient’s Situation, Background, your Assessment, and your Recommendation in an SBAR hand-off to your preceptor - 13 - MHV.1.2 Mental Health Tips for Success: You should prepare prior to entering Nicole Diaz’s room. We suggest taking out your textbook to remind yourself of what doing a mental health assessment entails. There are essential sections of patient information that your interview will need to uncover. There are multiple essential questions for each of these topics: Subjective: • Chief Complaint • History of Present Illness • Past Medical History • Home Medications • Social History • Review of Systems There are also multiple essential physical exam actions you will need to complete and record accurately in the EHR. Here are the physical exam tasks you will need to complete by using the exam menu to the right of your screen: Objective: • Assessed vitals • Inspect Upper Extremities • Inspect Legs • Auscultate Carotid Arteries • Auscultate Breath Sounds • Auscultate Heart Sounds Remember when you are doing these exams that this simulation is designed to help you improve your assessment skills. Preparing ahead of time will help to set you up for success. Technical Support: Contact Shadow Health with any questions or technical issues before contacting your instructor. Support is available at http://support.shadowhealth.com/. - 14 - MHV.1.2 Mental Health In all assignments, remember to complete your Self-Reflection, if your instructor has left this activity available for you to complete. What is Self-Reflection? Self-reflection enables us to look at our performance - be it on the job, in the classroom, or out on the field - and critique our practice in a systematic and rigorous way. This process enables us to develop a greater sense of self awareness and to create a plan to improve on areas of weakness in our performance. We gain critical insights from this reflection that help us move from novices to experts in our fields. Self-reflection is proven1 to improve our skills as providers, which leads to better patient outcomes. How do I begin? As you reflect on your practice, thinking about things that have gone well will help you to understand how you can make this happen more often. Conversely, thinking about things that haven’t gone so well helps you to think about how things could be different in the future. Here are some questions to ask yourself: 1. What are you reflecting on? a.) What assignment did you complete? b.) How did you do on the assignment? c.) Did you meet your goal and achieve a score you were happy with? 2. How were you thinking and feeling a.) What were you feeling while completing the assignment? b.) How do you feel about your score? 3. Evaluate a.) What are the highs and lows of your experience? b.) Were there any factors that influenced the outcome? 4. Analyze a.) What could I have done differently? b.) What did I do that was successful that I will continue to do? c.) What did I do that was unsuccessful that I will discontinue? 5. Conclusion a.) How do I feel about the overall experience? b.) What have I learned about my practice? c.) How will this experience change my nursing practice? d.) Are there any factors in a real life scenario that may be different than this virtual environment that may prevent me from reaching my goal that I can anticipate? __________1Gustafsson, C., and Fagerberg, I. (2004), Reflection, the way to professional development? Journal of Clinical Nursing, 13: 271–280. - 15 - MHV.1.2 Mental Health Excerpt from an Excellent Self-Reflection Excerpt from a Satisfactory Self-Reflection I asked Mrs. Smith about her health history and tried to find more information about her low back pain, cough, and frequent urinary tract infections. OLDCARTS helped guide me through the 7 dimensions of her complaints. I assumed that if I went through OLDCARTS I would capture all of the information, and it seems that it really helped me get a very clear picture of the problem. I asked about her self-care related to her frequent urinary tract infections to get a good idea of what education and care she would need to prevent them. I should have addressed Mrs. Smith’s nutrition plan. This would help her manage her obesity, which is probably contributing to her low back pain. I should have asked Mrs. Smith was a very easy patient to interview. I used OLDCARTS to interview her, and it worked well. I think I really did well. I missed a few things about her diet and personal hygiene, but I won’t forget about these things in the future. – While the student identified areas that should improve, he or she does not make a specific and measurable improvement plan or challenge any of his or her assumptions or practices. The reflection is incomplete with limited introspection. Excerpt from an Unsatisfactory SelfReflection I loved this experience! – This is an incomplete reflection. A deep reflection should explain what about the experience was found to be meaningful and how it can help one become a better nurse. Deep reflections involve practitioners examining and questioning their practices and assumptions. Mrs. Smith about the possibility of quitting smoking and about whether she had ever tried to quit (Stead et al., 2008). When I reviewed my transcript, it became apparent that I kept it purely medical and rarely asked any social or cultural questions. I used Jarvis to ask the subjective questions but didn’t think much about finding much else out. This has been really good for me to remember to think of my patients as people with families and lives as well as medical problems. Citation: Stead, L. F., Bergson, G., & Lancaster, T. (2008). Physician advice for smoking cessation. Co- chrane Database Syst Rev, 2 (2). – This reflection describes the experience. It also describes clinical reasoning and supporting citation. It demonstrates analysis of missed items. It recognizes assumptions and failings, and it addresses how these may be addressed in the future. - 16 - MHV.1.2 Mental Health - 17 - MHV.1.2
