School of Nursing
NURSING 416
PSYCHIATRIC MENTAL HEALTH NURSING
Syllabus
Spring 2014
Classroom: AH Room 2108
Tuesdays 4:00pm - 6:40pm
Janet Blenner RN., PHD FAAN
Office: Hardy Tower 11
jblenner@mail.sdsu.edu
office hours prior /after lecture by appt.
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Table of Contents
Course Description and Overview………………………………3-4
Lecture Schedule……………………………………………….5-7
Class/ Clinical Code of Conduct……………………………….5-7
Attendance……………………………………………………....7
Grading & Disability policy…………………………………….9-10
Course Outcomes …....................................................................11-13
Code of Ethics………………………………………………….14-15
Clinical Guidelines……………………………………………..16-20
Assignments (Community, Clinical, Class) …………………...15-18
Clinical Worksheets, Journals………………………………….21-30
Clinical Outcomes and Student Evaluation…………………….31-35
Lecture Schedule……………………………………………….34-36
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COURSE DESCRIPTION
Theory and clinical laboratory experiences will be used in applying nursing process in the care of
patients showing maladaptive responses to psychosocial stressors. Some classes will meet in AH
2108 lecture hall, while some classes will be online only. All classes will have some BB reading
assignments/ prep material. Lectures will include presentation of theories describing and
explaining maladaptive behaviors and application of principles of assessment, planning,
implementation and evaluation of nursing interventions that include multiple and complex of
treatment modalities.
COURSE OVERVIEW
The lecture component of the course addresses mental health and mental illness along a
continuum. Key aspects of psychiatric mental health nursing care include understanding
evolving science, psychiatric diagnoses, psychopharmacology, current approaches to treatment,
special populations and basic California State Mental Health Laws. Nursing students must plan
care based SON psychiatric nursing assessment skills, therapeutic use of the self, increased selfawareness, professional development of therapeutic communication skills and recovery efforts.
The impact of issues related to substance abuse, psychosocial stressors, culture, safety, and
medical disorders is explored in detail.
Practicing mental health nursing in a professional, safe, caring manner is the highest priority for
the patients, students and staff in the clinical component of this course. Under direct and indirect
supervision, the student will maximize opportunities to interact with patients and apply
theoretical concepts to actual patient care situations. Students will provide patient-teaching
whenever appropriate. Students will integrate theory and practice through maximizing
opportunities to understand, support and engage with patients.
Clinical experiences are provided in a variety of settings to enhance the student’s learning
opportunities in psychiatric/mental health nursing along a continuum of patient care.
UNITS:
5
LECTURE:
3 HOURS
CLINICAL:
6 HOURS
CO-REQUISITE:
Concurrent registration in Nursing 414.
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REQUIRED TEXT
Antai-Otong, D. (2007). Psychiatric Nursing: Biological & Behavioral Concepts. (2nd ed.),
Clifton Park, NY: Cengage Delmar Learning
**Required Text: Reading assignments are crucial to understanding lecture content, and
full participation in clinical discussions
HIGHLY RECOMMENDED TEXT
Antai-Otong, D. (2009). Psychiatric Nursing Pocket Guide. (1st Edition), Jones & Bartlett
ISBN: 0763754137 ISBN 13: 9780763754136
** Highly recommended text; helpful in planning care of psychiatric clients in clinical
settings, preparation of Clinical Worksheet
CONTACTING FACULTY
Email:
Dr Blenner : jblenner@mail.sdsu.edu
Office Hours: By appointment and before and after lecture
Contact clinical instructor directly regarding clinical concerns.
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NURSING 416
PSYCHIATRIC MENTAL HEALTH NURSING
Spring 2014 CLASS SCHEDULE
Tuesdays, 1600-1840
Week Date
Topic
1
Psychiatric Mental Health Nursing
1/28
In class
Read/Review each
week before class
Ch. 1, 2, 3, 4, 26, 27,
28, 29
Role of Psychiatric nurse & the inter professional
collaborative team
DSM-Diagnostic Statistical Manual
Therapeutic communication 1
SDS forms need to be completed and signed by Dr.
Blenner on 1st lecture.
2
2/4
In class
3
4
2/11
Culture relevant to diagnosis discussed throughout
course
Assessment & Communication
Therapeutic Communication
Assessing non verbal behavior
Assessing verbal behavior
Therapeutic use of self
Individual Therapy
Psychosis
In class
Schizophrenia and other psychotic disorders
Intro to Psychopharmacology
*1. Student topic: How Schizophrenia is viewed in
other cultures.
2/18
In class
Mood and Affect
Ch. 5, 6, 7, 32, 33, 34
Ch. 8, 14, 19, 20, 21,
31, 33, 34
Ch. 9, 10, 19, 20, 21,
29, 30, 34,
Mood Disorders
Depressive Disorder
Bipolar Disorder
Suicide
ECT
*2. Student topic: ECT and other depression
treatments
*3. Student topic: Post-partum depression and
psychosis
5
2/25
Online
Genetics
Biological mechanisms of the Brain
Pp 77-88, 3
5
6
7
8
3/4
EXAM I (On 1st 5 classes)
In class
Be in class at 3:45 . Exam begins promptly at 4:00
large red scantron form and #2 pencil
3/11
Addiction
Online
Substance related disorders
Withdrawal
Dual Diagnosis
Group Therapy
Personality Disorders
Sexuality & Disorders
 4.Student topic: Domestic violence inc.
personality types of abuser and victim
 5. Woman and madness How woman’s role
and deviations is culturally based
Anxiety Disorders
Panic Disorders
Obsessive Compulsive Disorders
3/18
In class
9
3/25
Online
10
4/1
11
4/8
Online
12
4/15 In
class
Ch. 20, 21, 25, 27,
29, 31, 33, 34
11, 13, 15, 18
Ch. 11, 13
Spring Break
Ch. 12, 22, 23
Somatization Disorder
Eating Disorders
Sleep Disorders
Ch11, 12, 19, 20
PTSD
PTSD specific to various populations
* 6.Student topic: PTSD treatments indepth
description inc. most recent advances.
* 7.Student topic: PTSD specific to Veterans
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4/22
Child and Adolescent Disorders
In class
Ch. 10, 11, 12, 13,
14, 17, 19, 20, 22, 25,
28
Bipolar Disorder
ADHD
Anxiety
Autism
Family therapy
(Gero. and cognitive Disorders are covered in the
Gero. class)
8. Student topic: Student topic: Bullying
describe process and interventions
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4/29
In class
EXAM II
Be in class at 3:45. Exam begins promptly at 4:00
6
15
5/6
Online
Bring small Red Scantron form and #2 pencils
Complementary therapies
* Students are responsible for reviewing lecture material posted on Blackboard and recommended
readings before each class
Code of conduct in class:
Please note that students are not required to attend lectures.
However, all students must attend exams or other faculty designated times.
If you are in class, you are to be an attentive listener and active participant.
Students who wish to audio-tape in class lectures/discussion may do so only with express written
permission of instructor prior to taping. It is for the use of the individual student only and
may not be posted online. The student is responsible for his/her own recorder (See
guidelines for recording).
Students will be respectful of Professor and other students at all times. Issues related to clinical
content, exams etc, are to addressed in a calm, respectful, courteous manner in writing, by
phone or in person with lecturer/instructor.
* Students are responsible for reviewing lecture material posted on Blackboard and recommended
readings before each class
CLASSROOM/CLINICAL CONDUCT
All students have the right to learn without any interference from other students. They have the
right to seek assistance from the lecturer/ clinical instructor if they are having difficulty
understanding material. Faculty will treat all students respectfully and value each student for
his/her contribution.
Students must know and abide by the SDSU SON code for ethical conduct in lecture and clinical
settings. Students are expected to strive for academic success. The faculty supports the effort of
students in striving for excellence.
Conflict resolution: If a conflict arises with another student, the individuals should make every
effort to resolve the conflict between them. If a conflict arises with an instructor (clinical or
class) please address the issue with that individual first before seeking other guidance.
Recording lectures: Students wishing to tape lectures need to obtain approval from the instructor
prior to recording. Permission will be granted to record with the understanding that the
recording will be used for the sole purposes of assisting students with classroom notes and erased
at the end of the semester. Any other use by students will be considered an infraction of this
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policy. Recorded lectures cannot be posted online without express written permission of
instructor.
STUDENTS ARE EXPECTED TO:
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Show a genuine interest in learning the course material.
Develop a positive attitude towards the course and course material.
Demonstrate self-discipline and responsibility for his/her own academic progress.
Attend class regularly, arrive to class on time, stay through the full period, and
bring all necessary materials to class.
Study for tests and exams.
Participate in class.
Ask for help when needed.
Take responsibility for getting notes from a fellow classmate when missing a
class.
Take all tests at the scheduled time and to turn in all assignments at the time it is
due.
HONOR CONDUCT WITH SCHOOLWORK
DEFINITIONS:
Cheating – intentionally using or attempting to use unauthorized materials or
information, sharing information about previously completed tests or assignments or
using others’ work during testing. This includes asking questions from another
student, looking at another student’s test or any talking during the exam (other than
with faculty). In addition, any student who provides answers to the test in any way
such as showing their answers will be equally responsible for the cheating.
Plagiarism – the reproduction of ideas, words or statements of another work without
acknowledgement. This also includes the use of past students’ papers. Students are
responsible for insuring that they properly credit all work and are consistent with
APA manual and guidelines for what constitutes plagiarism.
Falsification and Fabrication – intentional and unauthorized falsification of any
information or citation is not allowed.
Facilitation of Academic Dishonesty – permitting or attempting to help another to
violate the academic conduct.
Academic Misconduct: “…falsely representing a student's academic performance:
cheating, plagiarizing, unauthorized collaborating on coursework, stealing course
examinations or materials, falsifying records or data, or intentionally assisting another
individual in any of the above….” This includes such behaviors as using a prior
students’ paper or clinical material and presenting it as one’s own. In addition,
falsifying clinical data and not giving proper credit to authors in writing papers,
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presentations and other. This holds true for any work submitted to lecture, clinical etc.
(It is at the discretion of the faculty member to document such behavior in student’s
file, or to remove as many points as he/she sees fit).
Non-Academic Misconduct: is defined as the “…disruption of
educational…process…”and includes being rude, distracting, or disrespectful during
class.
Examples:
1. Plagiarism: Students using other students, teachers or authors’ work or parts of
their work as their own is considered an infraction of policy. Buying of papers on
the WEB or other sources to use as one’s own work or using any parts of prior
students’ papers is also considered an infraction. Students should also consult
APA manual for further definitions of plagiarism.
2. Cheating: Students are not to engage in sharing answers to exams, looking at
other students’ exams, showing their answers to other students or cheating in
any other way. In addition, any student leaving the classroom with the exam
is also considered an infraction.
Students who engage in either of the above behaviors are at risk for substantial point
penalties or a zero being given for assignment or exam resulting in possible class
failure.
ATTENDANCE
Students are responsible for material covered in class and online.
Respect of faculty and other students is expected during each class through focused attention and
engagement in information sharing and discussions.
CREDIT
Advanced Standing Competency students can obtain Nursing 416 credits by successfully
completing the NLN test (care of clients with mental disorders) and a clinical assignment.
Students should consult course coordinator as early as possible in the semester for detailed
information.
STUDENT DISABILITY TESTING POLICY
Students are to bring SDS forms for disability testing for both Exam 1 and II to be signed by the
instructor by the first lecture day of class. Both forms need to be handed into the SDS office by
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week 2 of the semester. It is also the responsibility of the student to remind the instructor to email the test to SDS within a couple of days of the exam date.
Any student who needs disability accommodation should provide documentation of their
disability to Student Disability Services at 619-594-6473 (Calpulli Center, Suite 3101), and
receive authorization for academic or clinical accommodations.
GRADING SYSTEM
The final grade is calculated according to the following criteria:
Examination
Examination
#1
#2
35%
35%
Team Presentations in class
(Mental Health Topic)
20%
Medication Presentation
10%
Total
100%
Students MUST bring Red Scranton’s and RED IDs to all examinations.
RED IDs ONLY is to be used on Scantron sheets.
The final examination is not cumulative.
Students must receive a passing grade on all clinical assignments to complete the course.
Students must submit work which reflects understanding and application of the nursing process
in a scholarly manner with use of APA format.
Plus/minus grading will be used for final grades
A
AB+
B
BC+
C
CD+
D
DF
95 – 100%
90 – 94.9
87 –89.9
83 - 86.9
80 - 82.9
77 – 79.9
73 – 76.9
70 – 72.9
67 – 69.9
63 – 66.9
60 – 62.9
59.9 an below
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COURSE OUTCOMES
Upon completion of this course, the student will:
1.0 Assess increased self-awareness of one’s unique
values as a Professional nurse.
1.1 Analyze the importance of utilizing therapeutic
communication techniques in professional nursing care
1.2 Evaluate one’s ability to listen actively
1.3 Differentiate between social and therapeutic
relationships
1.4 Evaluate one’s own attitudes toward caring for people
with psychiatric disorders.
1.5 Integrate the therapeutic use of self in the
psychiatric setting.
Level IV Outcomes
3, 4, 5, 12
2.0 Integrate knowledge of professional psychiatric
nursing care behaviors
2.1 Implements patient and student safety at all times.
2.2 Support professional psychiatric nursing caring roles
and functions.
2.3 Incorporates ANA standards into psychiatric nursing
practice.
2.4 Manage opportunities for patient teaching
2.5 Manage one’s own learning opportunities in psychiatric
settings.
2.6 Communicate effectively with patients and the health
care team.
2.7 Compare and contrast pertinent evidence-based research
relating to patient outcomes.
2, 4, 7, 8, 10, 11, 12
3.0 Analyze professional psychiatric nursing care based
on nursing diagnosis.
3.1 Incorporate psychological and physical safety into
nursing care.
3.2 Prepare and revise nursing care goals, objectives and
interventions for measurability, specificity and ability to
be attained.
3.3 Collaborate with treatment team and patient to develop
2, 5, 6, 7, 11
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patient diagnoses and treatment goals.
4.0 Discriminate among factors associated with mental
10, 11, 12, 15
health and mental illness
4.1 Formulate an understanding of mental health and mental
illness on a continuum.
5.0 Differentiate among contemporary models in
evidence based mental health nursing care
5.1 Assess the importance of psychological, biological and
genetic theories and evidence-based nursing
interventions in psychiatric disorders.
3, 4, 5, 7, 9, 10, 12, 13
6.0 Analyze symptoms of psychiatric disorders as
documented in DSM-IV-TR.
6.1 Distinguish symptoms and treatments of affective
disorders.
6.2 Distinguish symptoms and treatments of anxiety-related
disorders.
6.3 Distinguish symptoms and treatments of psychotic
disorders.
6.4 Distinguish symptoms and treatments of personality
disorders.
6.5 Distinguish symptoms and treatments of substancerelated disorders.
5, 9, 10, 12, 13
7.0 Analyze the impact of psychosocial stressors,
cultural beliefs, and spiritual needs and sexual
alternatives on psychiatric disorders.
4, 9, 10, 11, &13
7.1 Differentiate behavioral processes requiring professional
nursing care, nursing Interventions, and ongoing
evaluations through the nursing process.
8.0 Evaluate problems associated with substance use.
8.1 Assess the rationale for high rates of nicotine and other
substance dependence in people with psychiatric
disorders.
8.2 Predict the impact of substance use on psychiatric and
medical disorders.
8.3 Compare and contrast evidence-based nursing treatment
modalities for substance use.
3, 4, 9, 10, 11, 12, 13
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9.0 Analyze differences in psychiatric disorders in
various age groups.
9.1 Differentiate skills required to establish therapeutic
relationships with children, adolescents, adults, older
adults and families.
9.2 Differentiate nursing diagnoses and nursing treatment
modalities for specific age groups.
3, 4, 5, 6, 7, 13
10.0 Synthesize psychiatric nursing assessment skills.
2, 5, 6, 7, 13
10.1 Compare subjective and objective perspectives of
presenting problem(s) and need for psychiatric
treatment.
10.2 Analyze assessment data and relating it to theoretical
models
10.3 Write accurate MSE (Mental Status Exam)
10.4 Recognize psychosocial stressors (Axis IV) from DSMIV-TR.
10.5 Evaluate Global Assessment Functioning (GAF-Axis
V) score of current level of functioning on Axis V of
DSM-IV-TR.
10.6 Evaluate adaptive and maladaptive coping methods of
patients and staff members.
10.7 Analyze assessment data and relate it to theoretical
models.
10.8 Differentiate symptoms correlating with psychiatric
diagnosis.
10.9 Evaluate the impact of psychiatric illness (es) on
medical problem(s) and impact of medical problem(s)
on psychiatric illness(es).
11.0 Integrate evidence-based knowledge of
psychopharmacology.
11.1 Examine the mechanisms of action, potential side
effects and rationale for using psychotropic
medications.
11.2 Evaluate the importance of patient-teaching regarding
medications.
11.3 Estimate issues of nonadherence with people with
psychiatric disorders.
8, 9, 11, 13
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Code of Ethics for Nurses
Full text and links available at:
http://www.nursingworld.org/ethics/code/protected_nwcoe303.htm#5.1
PROVISION 1. The nurse, in all professional relationships, practices with compassion and
respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by
considerations of social or economic status, personal attributes, or the nature of health problems.
1.1 Respect for human dignity
1.2 Relationships to patients
1.3 The nature of health problems
1.4 The right to self-determination
1.5 Relationships with colleagues and others
PROVISION 2. The nurse's primary commitment is to the patient, whether an individual,
family, group, or community.
2.1 Primacy of the patient's interests
2.2 Conflict of interest for nurses
2.3 Collaboration
2.4 Professional boundaries
PROVISION 3. The nurse promotes, advocates for, and strives to protect the health, safety, and
rights of the patient.
3.1 Privacy
3.2 Confidentiality
3.3 Protection of participants in research
3.4 Standards and review mechanisms
3.5 Acting on questionable practice
3.6 Addressing impaired practice
PROVISION 4. The nurse is responsible and accountable for individual nursing practice and
determines the appropriate delegation of tasks consistent with the nurse's obligation to provide
optimum patient care.
4.1 Acceptance of accountability and responsibility
4.2 Accountability for nursing judgment and action
4.3 Responsibility for nursing judgment and action
4.4 Delegation of nursing activities
PROVISION 5. The nurse owes the same duties to self as to others, including the responsibility
to preserve integrity and safety, to maintain competence, and to continue personal and
professional growth.
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5.1 Moral self-respect
5.2 Professional growth and maintenance of competence
5.3 Wholeness of character
5.4 Preservation of integrity
PROVISION 6. The nurse participates in establishing, maintaining, and improving health care
environments and conditions of employment conducive to the provision of quality health care
and consistent with the values of the profession through individual and collective action.
6.1 Influence of the environment on moral virtues and values
6.2 Influence of the environment on ethical obligations
6.3 Responsibility for the health care environment
PROVISION 7. The nurse participates in the advancement of the profession through
contributions to practice, education, administration, and knowledge development.
7.1 Advancing the profession through active involvement in nursing and in health care policy
7.2 Advancing the profession by developing, maintaining, and implementing professional
standards in clinical, administrative, and educational practice
7.3 Advancing the profession through knowledge development, dissemination, and
application to practice
PROVISION 8. The nurse collaborates with other health professionals and the public in
promoting community, national, and international efforts to meet health needs.
8.1 Health needs and concerns
8.2 Responsibilities to the public
PROVISION 9. The profession of nursing, as represented by associations and their members, is
responsible for articulating nursing values, for maintaining the integrity of the profession and its
practice, and for shaping social policy.
9.1 Assertion of values
9.2 The profession carries out its collective responsibility through professional associations
9.3 Intraprofessional integrity
9.4 Social reform
American Nurses Association, Code of Ethics for Nurses with Interpretive Statements,
Washington, DC: American Nurses Publishing, 2001.
Reprinted with permission from American Nurses Association, Code of Ethics for Nurses with
Interpretive Statements, ©2001, nursesbooks.org, American Nurses Association,
Washington, DC. www.nursesbooks.org.
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CLINICAL GUIDELINES
Every clinical faculty member is an independent college professor responsible for teaching the
objectives of the course according to the syllabus and his/her professional judgment. Not all
clinical laboratory experiences can or will, have exactly the same requirements. They will differ
by facility, population served, clinical professor, or individual student. The clinical laboratory
component will meet for 12 clinical days. There are 18 additional hours of learning activities
focused on community mental health. These hours include participation in 10 hours of
community based support groups/educational activities and 8 hours spent viewing and analyzing
two psychologically themed films/movies.
It is the responsibility of students to prepare for each clinical experience. Students must arrive on
time at the clinical placement with an understanding of the course, hospital and unit
requirements. The student is expected to practice within his/her individual skill level. It is also a
student’s responsibility to request assistance when unable to perform at the expected level. Safe
and professional practice is required at all times; unsafe clinical practice is grounds for
immediate failure. Again, all students must act in a professional manner at all times in all
interactions whether it is with patients, colleagues, staff or visitors.
Failure to pass the clinical experience of the course will result in a failing grade for lecture and
clinical portions of the class.
DRESS CODE
Students are to be dressed conservatively, appropriately and safely at all times. Most psychiatric
facilities have very specific dress requirements which emphasize safety and maintaining
appropriate boundaries. Students must wear appropriate professional attire or uniforms according
to requirements of the placement.
Dress Restrictions Include:
 Name badges must be worn at all times.
 No tight or seductive clothing including no visible breast cleavage, bare midriff or
visible lower back at any time. ; no bare skin on torso is allowed. School uniforms
are required at some facilities.
 Closed toed, low-heeled shoes are required (that will not impede running if
necessary)
 Jewelry must be minimal and breakaway.
 No dangling earrings.
 No clothing with logos or denim.
 Hair should be pulled back or up.
 No colored nail polish
Other even more specific guidelines may be required by your individual clinical site. Students
who do not to meet dress code requirements may be sent home. They will need to make up that
clinical day. Students who require repeated warning/corrections may have additional penalties.
PROFESSIONAL BOUNDARIES:
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Students must maintain professional boundaries with patients at all times. No student may meet
or socialize with any patient during or after the patient’s hospitalization. Discuss with clinical
instructor methods of managing this important aspect of psychiatric nursing practice.
All mental health assessments will include data collection (subjective and objective when
possible) and a thorough analysis of all information gathered. The nursing care plan will be
planned and implemented upon this information and related to specific theories in psychiatric
nursing and biopsychosocial models. Psychiatric nursing care plans must encompass all patient
needs with regard to medical conditions and psychosocial stressors.
Communication and interviewing skills will build upon previously learned therapeutic
techniques and newly acquired knowledge from lecture and clinical areas. These skills include
active listening, observing, assessing, and interacting with patients and staff in psychiatric
settings. Actual application of these skills will depend upon the student’s clinical setting and
learning opportunities.
CLINICAL ABSENCES:
All illnesses and other absences must be reported directly to the clinical instructor. Clinical absences
must be made up through attending another clinical day or other activities approved by the clinical
instructor.
FIELD TRIP GUIDELINES / LIABILITY:
This course requires students to participate in clinical experiences, support groups and other
experiences and educational opportunities performed off-campus. Should participation in such
activities result in accidents or personal injury, students engaging in such events are deemed to
be aware of the risks, and agree to hold harmless San Diego State University, the State of
California, the Trustees of the California State University and Colleges and its officers,
employees and agents against all claims, demands, suits, judgments, expenses, and costs of any
kind resulting from participation in these activities.
Students using their own vehicles to transport other students to such activities must have proof of
a valid driver’s license and automobile insurance prior to beginning clinical assignments
ASSIGNMENTS
COMMUNITY MENTAL HEALTH CLINICAL HOURS TOTAL OF (18 hours)
18 hours total to include:
10hours participation in community based support groups /Psych-educational meetings or
other psych by permission of clinical faculty
6 hours for analyzing and watching three psychologically themed movies/films
Plus 2 hours for the Doctor and write up
Inpatient acute care treatment of patients with mental health problems represents a small portion
of the mental health care and treatment that is delivered in the US. Changes in political
viewpoints, funding for mental health treatment, and improved pharmacological interventions are
among the factors contributing to the move of much of the care of even the most seriously
mentally ill into the community. Although the majority of mental health focused nursing
education experience will take place in an inpatient setting, an understanding of how acute care
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and community based treatment seeks to work together for the best interest of the
patient/consumer in achieving long term recovery is essential.
Integrating psychiatric concepts of caring into other areas of nursing-medical practice. (2 hours)
1. The Doctor (with William Hurt) every student will view this film. The Write up should
include how caring and good communication changed the nature of his practice. How
might you implement psych principles in your practice as an RN?
SUPPORT /EDUCATION GROUP SUMMARY & REFLECTION
To better understand some of the available resources, you are asked to seek out and participate
in a variety of support groups, educational meetings, family support groups, clubhouses
visitations, etc. Check with your instructor for the appropriateness of groups and activities. The
student should not attend more than one of the same group (i.e. AA meetings)
Guidelines for support group summary & reflection
The following information must be submitted for each community based support or
educational activity/service attended. All hours must be completed by the date indicated by
your clinical instructor. Write ups should be handed in to your clinical instructor after the
meeting and include the following:
1) Name, address, telephone. Place hours and cumulative hours on top of page. (transportation
to and from support groups is not included)
2) Description your activities during the community clinical experience. Explain the impact of
your experience on your personal and professional learning.
3) Two specific detailed examples of interactions (positive or negative) which provided
opportunities for you to learn.
4) Application of your learning experience to the appropriate clinical objectives.
5) Rationale for referring patients and/or families. Indicate how patients could benefit or not
from the site.
Support groups and examples:
The VA Hospital of San Diego, Mesa Vista Hospital and Aurora all have ongoing community
support groups. Check at those facilities, especially if that is where you have your clinical for
dates and times for groups. You may also search on the WEB and in Clubs of San Diego etc, to
find support group meetings. Verify date, time and location by phone if possible. Community
based meetings often move frequently. Some also require permission before you attend. It is
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imperative that you arrive on time (or early), never late (If you are late, skip it!). Do NOT leave
before a meeting is over as it is disruptive.
Examples of Some Support Groups:
Overeaters Anonymous
SMART (Self Management Recovery Training)
Al-ANON
Stressbusters
Empty Cradle (Get permission first)
Tough Love
CHADD (Children & Adults with ADD).
San Diego Phobia Foundation
The Meeting Place
Abuse support groups
MOVIE/FILM ANALYSIS & REFLECTION
Review and analyze four films/movies with psychological themes. Check with instructor before
viewing. Students may be asked to present a film and discuss what was learned from the
experience.
Two mandatory films for all students to watch:
2. The Doctor (with William Hurt) Write up should include how caring and good
communication changed the nature of his practice. How might you implement psych
principles in your practice as an RN?
3. “A Beautiful Mind”,” Sybil” or” As good as it gets” and “Silver lining playbook. “(see
below for write up)
Guidelines for Other movie/film analysis & reflection
Submit 1-2 typed pages (APA) for each movie/film describing:
1) Your emotional response to the movie.
2) Application of psychiatric nursing knowledge to understanding a character’s
behavior, a psychological theme, etc.
3) How consistent or inaccurate is the film in its portrayal of the disorder. Check
your text.
Limit written plot summary to 50 words but be able to discuss in greater detail in
class and clinical lab.
Film/movie examples (2). (Not all-inclusive. Check with your instructor)
Autism: Temple Grandin(savant) (2006), Rain man (savant)
PTSD: Fearless, Reign Over me (2007), Fambul Tok -PTSD healing in Sierra Leone ,
Africa.(2011)Born on the Fourth of July, The Deer Hunter, Sophie’s choice (concentration camp
survivor)
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Schizophrenia:, the Fisher King (1991), Benny and Joon (1993), Kay pak & Revolution #9
(Paranoid Schizophrenic) Shine (Schizoaffective Disorder) Clean and Shaven (auditory
hallucinations), Fisher King (1991), I never promised you a rose garden (1977) and
Alcoholism/Substance Abuse: Flight (2012)The lost Weekend, Days of Wine and Roses,
Leaving Las Vegas, When a man loves a woman, Permanent Midnight (drug abuse), 28 Days,
My name is Bill W.
Mood Disorders: Mr. Jones, Night Mother, The Siler Lining playbook
Anxiety: The Aviator
OCD: As Good As it gets
Personality Disorders: American Psycho (2000),The Night Listener (2006), The Three Faces
of Eve, Taxi Driver
Borderline Personality Disorder: Fatal Attraction, Girl Interrupted (1999), Play Misty for Me
(1971)
Disassociation (aka. multiple personality disorder): Sybil
Family function: Ordinary people, Great Santini, On Golden pond, My Own Private Idaho, The
Squid and the Whale, What is eating Gilbert Grape, The Sum of Us?
Relationships: Harold and Maude, David and Lisa (1978)
Cognitive Disorders: Iris
Psychosexual: Quills (Marquis de Sade life & Sadism), Zoo (Zoophilia), Kissed (necrophilia),
Kinsey (2004), Bliss (1997) (Sexual aversion), The Woodsman (Pedophilia), Lars and the real
girl (2007)
Eating Disorders: The Best Little Girl in the Work, The Karen Carpenter Story
Psych films in general: One Flew over the Cuckoos’ nest, Sling blade, Awakenings, David and
Lisa (1978), Canvas (2006), Manic, Spider
Medication Teaching Presentation (Team)
(Presented in clinical conference)
Pass/Fail 10%
Patient teaching is a critically important part of psychiatric nursing, particularly in relationship to
medications and symptom management. Student teams will present a comprehensive overview of
a specific medication group incorporating principles of adult learning. Both clinical nursing
aspects and significant patient teaching points will be addressed. Each student must present at
least some portion of the presentation. See grading guidelines from your clinical instructor.
Topics:
1. Antipsychotics
2. Anti-depressants
3. Mood Stabilizers
4. Anti-anxiety, sedatives and hypnotics
5. Herbal and nontraditional meds
Psychiatric- Mental Health Topic Presentation (Clinical Group Team)
(Presented in class)
20%
Each clinical group/team will present an in-depth exploration of a preselected topic (with clinical
instructor approval) related to a specific psychiatric issue or concern to the entire class. The
presentation should incorporate principles of adult learning, include an activity to engage the
learners, and encourage questions. See grading guidelines. Presentation dates will be assigned on
first day of class.
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Clinical Worksheets
One (1) worksheet required, due date within clinical groups
Provide verbatim details. Use textbook or other resources to define terms as necessary.
A) Clinical Objectives for Clinical Day:
List clinical objectives from this syllabus that you will be focusing on for the day.
B) Patient’s Psychiatric History and Reason for Current Admission Including:
Past Psychiatric history including past psychiatric hospitalizations:
“This is 8th known admission to X hospital. Past diagnoses and medications
include...”
“Past suicide attempts include…”
Reason(s) for Current AdmissionObjective data: (from patient’s chart or staff):
“Patient was admitted after police found her wandering in and out of traffic on Route 5,
mumbling incoherently. Placed on 5150, medically cleared and admitted to X. Admits
to A/H S/I” (explain & provide details).
Subjective data: (patients perception or self report)
Patient understands of how and why s/he was admitted.
Includes chief complaint w/significant details
“Cops brought me here. I don’t need to be here.”
“I tried to kill myself.”***
C) Significant Assessment Data:
Include information from patient, staff, medical record and your own
observations.
Patient Initials, Age, Gender, Marital Status, Employment,
Unit to which patient is admitted.
Biological/Medical: Allergies, Past and Current Substance Abuse;
All pertinent laboratory data and information from consults;
All medical conditions and fluctuations in physical problems.
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Compare current vital signs to previous vital signs to identify trends in patient status.
Assess:
Hygiene, dress, food/fluid intake, height, weight, sleep patterns, activity level,
neuromuscular system (gait, movement patterns), skin condition, cardiovascular, pulmonary,
endocrine (diabetes, thyroid), elimination (bowel/bladder, including when last bowel movement
occurred), sexual function (activity, use of birth control).
Psychiatric:
Complete Mental Status Examination. Form to be used is in this Syllabus. May
condense this information into narrative note rather than print form, but all information must be
included. If items listed on form are not in evidence at time of contact with client, please note
this as “Pt. denies”, not N/A.
Conduct and score a mini-mental status examination (MMSE), providing
verbatim responses. The form that must be used, with no amendments, is in this Syllabus.
Psychosocial stressors: (Include in Axis IV of DSM-IV-TR)
Other relevant information includes:
Primary support group (presence or absence of significant others), social environment,
educational, occupational, housing, economic, access to health care, legal system, other.
It is preferable to obtain information after interacting with patient. The quality and quantity of
information you obtain from patient depends on several factors: patient’s ability to trust, insight,
and your ability to build a trusting relationship with patient, and patient’s diagnosis and acuity.
Note any discrepancies between patient’s report and information provided in medical chart.
“Patient has been estranged from family since age 21. She has been homeless since April
of 2005. She was arrested for shoplifting in May, 2005.”
D) Medications:
List ALL psychotropic medications. Tylenol, MOM, etc., does not need to be
included.
For psychotropic medications, & PRNs, include: trade and generic names, classification,
indication for assigned patient, dosage range, times, most common/significant side effects,
especially those reported by patient or staff, adverse reactions, interventions to deal with side
effects, nursing implications and specifics for patient teaching. Dosage range.
Medications may be used for reasons other than those which are FDA-approved (Example: anticonsultants are used for treatment of mania). The question of “why” a patient is on a specific
medication must be addressed.
Indicate whether a patient is experiencing side effects from medications. Indicate specifically
what side effects are occurring, which medications may be responsible for side effects, and
nursing interventions to deal with side effects.
E) Psychiatric Diagnoses According to DSM-IV-TR: (Please note that the DSM V is the
new version but many clinical sites have not adopted it yet).
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Axis I.
Psychiatric Diagnoses
Axis II. Personality Disorders/Mental Retardation
Axis III. Medical Conditions
Axis IV. Psychosocial and Environmental Problems
Psychosocial, environmental, sociocultural and interpersonal stressors.
Axis V. GAF (Global Assessment of Functioning on Admission and Highest for
Past Year)
F) List at least three pertinent nursing diagnoses using PES format (Problem, Etiology,
Symptoms).
1) Risk for danger to self (Problem)
2) Command hallucinations, etc. (Etiology)
3) Admits hearing voices telling her to end her life (Symptoms)
1) Provide three short-term outcomes/goals for each nursing diagnosis. Goals must be
reasonable, specific, and measurable.
Patient will not attempt to harm herself during interactions with nursing student today.
Patient will not attempt to act on command hallucinations.
Reasonable goal…CAN be met, specific-address exact behaviors, measurable-was goal
met?
2) List at least three planned student interventions for each diagnosis.
What did you do to meet goals/interventions? If goals/interventions were not met,
explain.
3) Evaluate interventions and outcomes (were they effective)? Discuss modifications to
interventions as appropriate.
G) Other Pertinent Information:
Patient’s psychosocial stressors (name them), medical problems (new onset diabetes,
recurrent cellulites, recent head injury w/ LOC, with or without medical attention),
substance abuse (be specific about substances, usage, associated problems), affecting
patient by (noncompliance, cellulites, etc.).
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CLINICAL WORKSHEET
A) Clinical Objectives for Clinical Day:
B) Patient’s Psychiatric History and Reason for Current Admission
(SUBJECTIVE and OBJECTIVE)
C) Significant Assessment Data:
Medical/Biological:
Psychiatric:
Psychosocial:
D) Medications:
E) Psychiatric Diagnoses According to DSM-IV-TR IF DSM V is used then use that format)
Axis I.
Psychiatric Diagnoses
Axis II. Personality Disorders
Axis III. Medical Conditions
Axis IV. Psychosocial and Environmental Problems
Axis V. GAF (Global Assessment of Functioning) (On admission and during past year)
F) List at least 3 pertinent nursing diagnoses using PES format (Problem, Etiology, Symptoms).
1) Provide 3 short-term outcomes/goals for each nursing diagnosis. Goals must be reasonable, specific, and
measurable.
2) List at least 3 planned student interventions.
3) Evaluate your interventions and outcomes, and provide modifications to interventions utilized if other
interventions might have been appropriate.
G. Other Pertinent Information:
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MENTAL STATUS EXAMINATION
Student Name __________________________
Use verbatim responses!
Patient Initials _______ Date _______
DSM-IV-TR (or V) Diagnoses for Axes I through V:
Axis I______________________________________________________________________
(Psychiatric Clinical Diagnosis/Diagnoses)
Axis II _____________________________________________________________________
(Personality Disorders)
Axis III ____________________________________________________________________
(Medical Problems)
Axis IV ____________________________________________________________________
(Psychosocial Stressors)
Axis V _____________________________________________________________________
(GAF on admission and during past year) Global Assessment of Functioning
Key to Abbreviations to be used for Method of Assessment:
SO=Determination made by direct student observation
PT=Information obtained directly from patient
HX=Information obtained from chart or staff but not directly observed by student
N/A=Data not available
I. IDENTIFYING DATA
PERTINENT DATA
ASSESSMENT
METHOD
Chief Complaint (Pt’s Exact Words)
Circumstances of Referral (How Pt Was
Referred for Help and By Whom)
Orientation (Person, Place, Time
Sex
Age
Race/Ethnicity
Marital Status; Number of Children
Educational Level
Occupational/Financial Status
Living Arrangements
History of Previous Psychiatric Hospitalizations
Religious/Spiritual Preference
Allergies
Other
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2. GENERAL DESCRIPTION
A) APPEARANCE
Grooming, Dress, Hygiene
Height and Weight:
Are they proportional?
Level of Eye Contact
Scars, Tattoos & Other Distinguishing
Skin Marks
Other
B) MOTOR ACTIVITY
Tremors, Tics & Gestures
Psychomotor Retardation or Agitation
Tardive Dyskinesia
Other
C) SPEECH PATTERNS
Slow or pressured speech
Stuttering & Other Impairments
Other
D) GENERAL ATTITUDE
Level of Cooperation:
Friendly/hostile/defensive
Attentive/Distractible
Guarded/Suspicious
Other
3) EMOTIONS
A) MOOD (Sustained feeling tone that prevails over time)
Sad, Depressed
Irritable, Angry
Anxious, Worried
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B) AFFECT (Range of expression of feeling)
Flat (absence of emotional expression)
Appropriate or inappropriate
(congruence of affect w/ situation or
behavior)
Other
4) THOUGHT PROCESSES (How well thoughts are formulated, organized/expressed)
Flight of Ideas
(Rapid Change from 1 Topic to
Another)
Mutism (Refusal to Speak)
Other
5) CONTENT OF THOUGHT
Delusions
Per
(Fixed, False Beliefs)
Persecutory/Paranoid
Grandiose
Somatic
Nihilistic
Erotomanic
B) Suicidal/Homicidal Ideation,
Attempts,
(Plan, Intent, Ability to Carry Out Plan,
Plan, Lethality of Plan, Chance of Being
Rescue, Self-Mutilation)
Id Ideas of Reference (TV, Radio
Broad Broadcasting Information About Pt)
Paranoia/Suspiciousness
Other
6) PERCEPTURAL DISTURBANCES
Hallucinations:
Command
Auditory
Visual
Tactile
Olfactory
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7) SENSORIUM AND COGNITIVE ABILITY
VERBATIM RESPONSES ARE REQUIRED
Memory (Immediate, Recent,
Remote)
Attention Span (Digit Span; World;
Objects to Recall)
Intelligence (Weeks in Year; State
Capitol of California;
Last 3 U. S. Presidents)
Capacity for Abstract Versus
Concrete Thought (Capacity to
Formulate Concepts and Generalize)
Similarities:
(Apples & Oranges; Dogs & Cats;
Chair & Bed)
Proverbs:
(Don’t judge a book by its cover)
(Grass is always greener on the other
side)
(Still waters run deep)
Other
8) IMPULSE CONTROL
Ability to control impulses r/t:
aggression:
Verbal
Physical
9) JUDGMENT AND INSIGHT
Ability to Solve Problems, Make
Decisions
Knowledge About Self:
Awareness of Illness
Other
Additional Comments, if any:
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JOURNAL WRITING (optional)
(Depends on your clinical instructor if required)
Objective: To analyze clinical activities and observations of student through self-reflection and
writing regarding clinical experiences.
Purposes of journaling:







Enhancing problem-solving and critical thinking skills
Reflecting on connections between clinical experiences and classroom theory
Incorporating professional values
Contemplating one’s own perceptions and others’ perceptions
Enhancing skills in the affective, cognitive and behavioral domains
Evaluating one’s listening and communication skills
Observing the change (or lack thereof) in attitude toward psychiatric patients
EXPECTATIONS:
1. Journals are to be written as soon as possible after clinical experience and turned in at the
beginning of pre-assigned clinical dates.
2. Journals are structured to develop your own voice and style through reflection on your personal life
and learning experiences, and professional nursing experiences and theory.
READINGS
PERSONAL/STUDENT NURSE
CLINICAL EXPERIENCES
LIFE EXPERIENCES
3. Journals must show how student identifies and synthesizes the three areas delineated above.
4. Journaling empowers students to apply words to inner dialogues and share significant memories,
reflections, insights and questions with clinical instructor. The supportive dialogue which results
should encourage students to share ideas in classroom and post-conference.
Journal Topics (These are only suggestions):
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A) Discuss significant fears/anxieties AND positive expectations of clinical experiences.
(B) What have you learned about your listening/communication skills? What changes are needed?
(C) What experiences resulted in an increased understanding of psychiatric patients?
(D) Discuss your strengths and weaknesses in the psychiatric setting. What alternative practices can
you adopt for perceived weaknesses?
(E) Describe a significant clinical learning experience. Why did you choose this experience?
(F) Discuss how you will use knowledge from psychiatric nursing in other clinical nursing areas.
Selected References:
Blake, T.K. (2005). Journaling: an active learning technique. International Journal of Nursing Education
Scholarship, 2(1): Article 7.
Rubenfeld, M. G. (2005). Critical thinking TACTICS for nurses: tracking, assessing and cultivating
thinking. Sudbury,
Massachusetts: Jones and Bartlett Publishers.
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San Diego State University School of Nursing
N 416 Psychiatric-Mental Health Nursing
Clinical Outcomes and Evaluation
Clinical Performance:
Medication Presentation: __________
Pass
__________
Unsatisfactory __________
Student Name: ______________________________ Semester/Year: __________________
Clinical Instructor: _________________________
Hospital ________________________
Absences: None ______ Excused (Date) ________ Unexcused (Date) _________________
Satisfactory achievement of the clinical outcomes is necessary for passing N 416.
An overall unsatisfactory rating indicates that the student does not satisfy professional psychiatric nursing
performance standards and will not pass the course.
Evaluation Scale:
2 – Satisfactory: Self-directed with minimal to no supervision
1 -- Needs improvement: Supervision needed
N/O -- Not observed
Student / Instructor Evaluation
1.0 Assess increased self-awareness of one’s own unique values as a
(3, 4, 5, 10, 12)
professional nurse.
1.1 Analyze the importance of utilizing therapeutic communication
techniques in professional nursing care.
______/______
1.2 Evaluate one’s ability to listen actively. ______/______
1.3 Differentiate between social and therapeutic relationships. ______/______
1.4 Evaluate one’s own attitudes toward caring for people with psychiatric disorders. ______/______
1.5 Integrate the therapeutic use of self in the psychiatric setting. ______/______
2.0 Integrate professional psychiatric nursing care behaviors.
(2, 4, 7, 8, 10, 11, 12)
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2.1 Implement patient and student safety at all times. ______/______
2.2 Support professional psychiatric nursing caring roles and functions. ______/______
2.3 Incorporate ANA standards into psychiatric nursing practice. ______/______
2.4 Manage opportunities for patient teaching.
______/______
2.5 Manage one’s own learning opportunities in psychiatric settings. ______/______
2.6 Communicates effectively with patients and the health care team. ______/______
2.7 Compare and contrast pertinent evidence-based research relating to patient outcomes.
______/______
3.0 Analyze professional psychiatric nursing care based on nursing diagnosis.
(2, 5, 6, 7, 11)
3.1 Incorporates psychological and physical safety into nursing care.
______/______
3.2 Prepare and revise nursing care goals, objectives and interventions
for measurability, specificity and ability to be attained. ______/______
3.3 Collaborate with treatment team and patient to develop patient diagnoses
and treatment goals. ______/______
4.0
Discriminate among factors associated with mental health and mental illness. (10, 11, 12, 15)
4.1 Formulate an understanding of mental health and mental illness on a continuum. ____/_______
5.0
Differentiate among contemporary models in evidence-based mental (3, 4, 5, 7, 9, 10, 12, 13)
health nursing care.
5.1 Assess the importance of psychological, biological and genetic theories and
evidence-based nursing interventions in psychiatric disorders. ______/ _______
6.0
Analyze symptoms of psychiatric disorders as documented in DSM-IV-TR. (5, 9, 10, 12, 13)
6.1 Distinguish symptoms and treatments of affective disorders.
______/_______
6.2 Distinguish symptoms and treatments of anxiety-related disorders. ______/______
6.3 Distinguish symptoms and treatments of psychotic disorders. ______/_______
6.4 Distinguish symptoms and treatments of personality disorders. _____/_______
6.5 Distinguish symptoms and treatments of substance-related disorders. ______/_______
7.0
Analyze the impact of psychosocial stressors, cultural beliefs, spiritual needs
(4, 9, 10, 11, 13)
and
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sexual alternatives on psychiatric disorders.
7.1 Differentiate behavioral processes requiring professional nursing care, nursing interventions and
ongoing evaluations through the nursing process. ______/______
8.0
Evaluate problems associated with substance use.
(3, 4, 9, 10, 11, 12, 13)
8.1 Assess the rationale for high rates of nicotine and other substance dependence in
people with psychiatric disorders. ______/______
8.2 Predict the impact of substance use on psychiatric and medical disorders.
______/______
8.3 Compare and contrast evidence-based nursing treatment modalities for
substance use. ______/______
9.0 Analyze differences in psychiatric disorders in various age groups.
(3, 4, 5, 6, 7, 13)
9.1 Differentiate skills required to establish therapeutic relationships with children,
adolescents, adults, older adults and families. ______/______
9.2 Differentiate nursing diagnoses and nursing treatment modalities for specific
age groups. ______/______
10.0 Synthesize psychiatric nursing assessment skills.
(2, 5, 6, 7, 13)
10.1 Compare subjective and objective perspectives of presenting
problem(s) and need for psychiatric treatment. ______/______
10.2 Analyze assessment data and relating it to theoretical models. ______/______
10.3 Write accurate MSE (Mental Status Exam) and Mini-Mental State Examination
(MMSE). ______/______
10.4 Recognize psychosocial stressors (Axis IV) from DSM-IV-TR. ______/______
10.5
Evaluate Global Assessment Functioning (GAF-Axis V) score of
current level of functioning on Axis V of DSM-IV-TR. ______/______
10.6 Evaluate adaptive and maladaptive coping methods of patients and staff. _____/_____
10.7 Analyze assessment data and relates it to theoretical models. ______/______
10.8 Differentiate symptoms correlating with psychiatric diagnosis. ______/_____
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10.9 Evaluate the impact of psychiatric illness on medical problem(s)
and impact of medical problem(s) on psychiatric illness. ______/______
11.0 Integrate evidence-based knowledge of psychopharmacology by:
(8, 9, 11, 13)
11.1 Examine the mechanisms of action, potential side effects and
rationale for using psychotropic medications. ______/______
11.2 Evaluate the importance of patient-teaching regarding medications.
______/______
11.3 Estimate issues of nonadherence with people with psychiatric disorders.
______/______
12.0 Function independently within the defined scope of professional nursing care.
12.1 Adheres to SDSU SON ethical standards at all times.
(6, 7, 10)
______/______
12.2 Dresses appropriately and in accordance with facility and SON policies. ______/______
12.3 Turns assignments in on time.
______/______
12.4 Arrives on time to clinical.
______/______
12.5 Notifies instructor of tardiness or absenteeism in a timely manner. ______/______
12.6 Accepts constructive comments to improve clinical performance. ______/______
12.7 Participates in post-conference discussions.
______/______
STUDENT COMMENTS (Reflect upon personal growth, strengths, and weaknesses)
34
INSTRUCTOR COMMENTS (Particular instances demonstrating strengths, application
of critical thinking skills, progress with clinical worksheets –Instructor make sure you complete this part)
______________________________________________________________________________
STUDENT SIGNATURE
(Actual signature of student required)
DATE
FACULTY SIGNATURE
DATE
8-23-2008
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