School of Nursing NURSING 416 PSYCHIATRIC MENTAL HEALTH NURSING SYLLABUS Fall 2014 Classroom: AH Room Tuesdays 4:00pm - 6:40pm Beverly J. Peterson, PhD, RN, CNS, LMFT Office: Hardy Tower 11 Email: beverlypeterson@cox.net Phone: (760) 632-0740 - Direct Line - Confidential Voicemail Office hours: prior to or after lecture by appointment 1 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 2 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 _______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 self-awareness, 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. 3 REQUIRED TEXT Townsend, M. (2014). Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice. Philadelphia: F. A. Davis Company. **Required Text: Reading assignments are crucial to understanding lecture content, and full participation in clinical discussions FACULTY CONTACT INFORMATION: Personal Email: beverlypeterson@cox.net Phone: (760) 632-0740 - Direct Line - Confidential Voicemail I am easily accessible by email or telephone. My preference is that students use email when communicating with me. I am generally available to take your call between the hours of 8:00 AM and 9:00 PM. If you call and I am not immediately available to speak with you, please leave a clear message indicating the time frame in which I could personally speak with you. Secondly, if you have not heard from me within 6-8 hours, please feel free to call me again....I am quite fine with that! Office Hours: By appointment - Before or After lecture Contact clinical instructor directly regarding clinical concerns. 4 NURSING 416 PSYCHIATRIC MENTAL HEALTH NURSING Fall 2014 CLASS SCHEDULE August 26 through December 9, 2014 Tuesdays, 1600-1840 Date Week 8/26-12/9 Lecture Topics 2014 1 8/26/2014 Welcome to NURSING 416! In class Brief Introductions. SDS forms need to be completed and signed by Dr. Peterson at 1st lecture. Review of Course Syllabus, including assignments, reading, Clinical, etc. Read/Review each week before class Course Textbook: (Lectures: Weeks one and two) Ch. 1: pp. 2 - 13 Ch. 2: pp. 14 - 31 Ch. 5: pp. 77 - 105 1. Brief History of Psychiatric Mental Health Nursing (refer to faculty notes) 2. Role of psychiatric nurse & the interprofessional collaborative team; 3.Therapeutic Relationship / Alliance 4. Effective use of self in working with patients with psychiatric disorders. 5. Transference and counter-transference. 6. Therapeutic communication 1. 7. Importance of cultural considerations in PMH...i.e., relevance of culture to diagnosis. NOTE: Cultural influences in the diagnosing and treatment of individuals with mental illness will be interwoven throughout the course. *Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition - DSM-IV-TR and/or Fifth Edition - DSM-V). Ch. 6: pp. 108 - 129 Faculty Handouts Course Textbook: DSM-V: "Classification: Categories and Codes." Appendix G, pp. 862 - 894. 5 2 Sept. 2 In class Assessment & Communication "Sometimes it's okay to make assumptions!" The process of data collection & evaluation 1. Developing a Therapeutic Alliance 2. Therapeutic Communication 2 3. The nurse & the therapeutic use of self 4. Assessing non verbal behavior 5. Assessing verbal behavior 6. The Nursing Process in PMH 7. Legal and Ethical Issues in PMH 8. Treatment Modalities in PMH (Refer to faculty handout). 3 4 5 Sept. 9 In class Sept. 16 In class Sept. 23 In class 1. Genetics: Refer to handout from faculty Course Textbook: Ch. 4: pp. 58 - 76 Ch. 6: pp.108 - 129 Ch. 7: pp.130 - 155 1. NANDA - Appendix A pp.827-831 2. Nursing Diagnosis & pt. behaviors, Appendix B, pp. 832 and p. 833 2. Mental Status Assessment, Appendix C, pp. 834 - 837. Course Textbook: 2. Biological mechanisms of the Brain: Decade of the brain (1990s) 3. Intro to psychopharmacology: Use of psychopharmacology in the treatment of psychiatric illness / disorders - The "who, what, when, where, why and how " of use of psychotropic medication. Psychosis: 1. Schizophrenia and other psychotic disorders 2. Treatment / Interventions recommended and implemented for patients diagnosed with a psychotic disorder. *1. Student topic: How Schizophrenia is viewed in other cultures. Faculty Handout Mood and Affect: 1. Mood Disorders, Depressive Disorder, Bipolar Disorder, Patients diagnosed as "being a danger to self and others, "Suicide. 2. Legal / ethical issues pertinent to a patient considered "a danger to self and / or others." 3. Treatment / Interventions recommended and implemented for patients diagnosed with a Mood disorder, (see topic 1 above). Will also focus on treatment with ECT Course Textbook: *2. Student topic: ECT and other modalities used to treat depression *3. Student topic: Post-partum Depression and psychosis Ch. 3: pp. 32 - 57; Course Textbook: Ch.15: pp. 335 - 377 Ch. 16: pp. 378 - 427 Ch. 17: pp.428 - 459 SPECIFICALLY: Focus extra attention and emphasis on the data related to "The Suicidal Client" found on pages 414 through 422 of your textbook. 6 6 Sept. 30 In class EXAM I: Exam will focus on data presented in assigned course readings, handouts and data from student presentations for weeks 1 - five. Be in class at 3:45 PM. Exam begins promptly at 4:00 PM. Bring RED IDs to exam. Bring large red Scantron form and #2 pencil! 7 Oct. 7 In class 1. Substance-Related and Addictive Disorders (SRAD): Substance related disorders, withdrawal. Specifically define the terms. 2. Predisposing factors. 3. A profile of the substance. Impact / Effects on body. Patterns of use. 4. Treatment modalities specific to substance (pp. 320-325) and non-substance (pp.325 - 327) related disorders and addiction. The exam will be multiple choice, truefalse...anything that DOES NOT REQUIRE A WRITTEN ESSAY! There will be no fewer than 80 and no more than 100 questions! Course Textbook: Ch. 14: pp. 278 - 334 Place attention on the following Tables: *14.1 p. 287 *14.2 p. 291 *14.4 p. 296 *14.5 p. 298 *14-7 pp. 304-305 *14-8 pp. 306-307 *14-9 p. 311 BOX 14-2: pp.308-309 8 Oct. 14 In class Anxiety Disorders Panic Disorders Obsessive Compulsive Disorders Dissociative Disorders 9 Oct. 21 In class 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 10 Oct. 28 11 Nov. 4 In class 12 Nov. 11 Somatization Disorder Eating Disorders Sleep Disorders PTSD: PTSD specific to various populations * 6. Student topic: PTSD treatments; indepth description including most recent advances. * 7. Student topic: PTSD specific to Veterans NO CLASS! Holiday - Veterans Day 7 13 NOV. 18 In class Child and Adolescent Disorders 1. Neuro-developmental disorders: Intellectual Disability (Intellectual Developmental Disorder): Genetic factors, Disruptions in Embryonic Development,, etc.; Autism Spectrum Disorder; Attention Deficit/Hyperactivity Disorder (ADHD); Comorbidity with ADHD; Tourette's Disorder; Disruptive Behavior Disorder: Oppositiional Defiant Disorder (ODD); Conduct Disorder. Conduct Disorders: Separation Anxiety Disorder. Bipolar Disorder; ADD; ADHD; Anxiety. Course Textbook: Ch. 24: pp.646 - 693 Ch. 25 - pp. 694 - 716 2. Survivors of abuse and neglect. 3. General Therapeutic Approaches: a) Behavior Therapy, b) Family Therapy, c) Group Therapy, and d) Complimentary/Alternative Therapy, and e) Psychopharmacology. 14 NOV. 25 In class *8. Student topic: Bullying - describe psychodynamics related to the process and interventions needed. In other words, the "who, what, when, where and why" specific to bullying! Most of the Gero. and cognitive Disorders will be covered in the Gero. class) Survivors of abuse and neglect. 15 DEC. 2 16 DEC. 9 Course Textbook: Ch.26: pp. 717 - 750. Faculty Notes Will discuss some of the issues and signs and Ch. 25: pp. 694 - 716 symptoms related to psychological impact on patients with cognitive disorders; We will include the impact on families. In addition, the psychopharmacological agents used in the treatment of the older adult. Complementary & Psychosocial therapies Course Textbook: *Brief History of medicine *Definitions Ch. 12: pp. 217 - 241 *Classification of Complimentary or alternative medicine or practices (Table 12-1, pp. 219-222) *Table 12-3: Herbal Remedies EXAM II - Exam will cover reading assignments as well as lecture data presented in weeks 7 through 15. Be in class at 3:45. Exam begins promptly at 4:00. Bring RED IDs to exam. Bring large Red Scantron form and #2 pencils 8 The exam will be multiple choice, truefalse...anything that DOES NOT REQUIRE A WRITTEN ESSAY! There will be no fewer than 80 and no more than 100 questions! What to study? Weekly assigned reading, handouts, class notes, "student topic" content. * Before each class, students are responsible for reviewing lecture material posted on Blackboard....i.e., PPT presentations, handouts, etc....as well as the assigned weekly readings. All exam questions will come from these data. 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 the course 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. *To reiterate, students are responsible for reviewing lecture material posted on Blackboard and completing the assigned 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. 9 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. In the event a student colleague is verbally sharing personal data during class discussions, the tape recorder(s) MUST BE TURNED OFF! Any other use by students will be considered an infraction of this policy. Recorded lectures cannot be posted online without express written permission of instructor. STUDENTS ARE EXPECTED TO: 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, 10 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, 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. 11 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 week 2 of the semester. It is also the responsibility of the student to remind the instructor to e-mail 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 D- 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 12 F 59.9 an below 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 patient diagnoses and treatment goals. 2, 5, 6, 7, 11 13 4.0 Discriminate among factors associated with mental health and mental illness 4.1 Formulate an understanding of mental health and mental illness on a continuum. 10, 11, 12, 15 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 evidencebased 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 anxietyrelated 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, and spiritual needs and sexual alternatives on psychiatric disorders. 5, 9, 10, 12, 13 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. 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. 14 10.0 Synthesize psychiatric nursing assessment skills. 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 DSM-V. 10.5 Evaluate Global Assessment Functioning (GAFAxis V) score of current level of functioning on Axis V of DSM-V. 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 non-adherence with people with psychiatric disorders. 2, 5, 6, 7, 13 8, 9, 11, 13 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 15 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. 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 16 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. 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 17 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: 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. 18 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: 10 hours 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 movie "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 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) 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? 19 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 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 20 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: 1. The Doctor (with William Hurt): Write up should include how caring and good psych principles in your practice as an RN? 2. “A Beautiful Mind”, "Sybil” or "As good as it Gets” and “Silver Lining Playbook". (see below for write up) commun 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) 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). 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 Silver Lining playbook Anxiety: The Aviator (cont'd below) OCD: As Good As it gets Personality Disorders: American Psycho (2000),The Night Listener (2006), The Three Faces of Eve, Taxi Driver 21 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. 2. 3. 4. 5. Antipsychotics Anti-depressants Mood Stabilizers Anti-anxiety, sedatives and hypnotics 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. Clinical Worksheets 22 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. 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, 23 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 of contact with client, please note this as “Pt. denies”, not N/A. condens 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-V) 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: anti-consultants 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). Axis I. Psychiatric Diagnoses Axis II. Personality Disorders/Mental Retardation Axis III. Medical Conditions 24 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 Yea 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.). 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: 25 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: MENTAL STATUS EXAMINATION: (Use verbatim responses!) Student Name __________________________ Patient Initials _______ Date _______ DSM-IV-TR (or V) Diagnoses for Axes I through V: Axis I______________________________________________________________________ (Psychiatric Clinical Diagnosis/Diagnoses) Axis II _____________________________________________________________________ 26 (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 ASSESSMENT I. IDENTIFYING DATA METHOD PERTINENT DATA 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 2. GENERAL DESCRIPTION A) APPEARANCE Grooming, Dress, Hygiene 27 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 B) AFFECT (Range of expression of feeling) Flat (absence of emotional expression) Appropriate or 28 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 (Fixed, False Beliefs) Persecutory/Paranoid Grandiose Somatic Nihilistic Erotomanic B) Suicidal/Homicidal Ideation, Attempts, suicide gesture(s) (Plan, Intent, Ability to Carry Out Plan, Lethality of Plan, Chance of being Rescued, Self-Mutilation) Ideas of Reference (TV, Radio road Broadcasting Information about Pt) Paranoia/Suspiciousness Other 6) PERCEPTURAL DISTURBANCES Hallucinations: Command Auditory Visual Tactile 29 Olfactory 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 30 Knowledge About Self: Awareness of Illness Other Additional Comments, if any: 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. 31 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): 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. San Diego State University School of Nursing N 416 Psychiatric-Mental Health Nursing Clinical Outcomes and Evaluation Clinical Performance: Medication Presentation: __________ Pass __________ Unsatisfactory __________ 32 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 professional nurse. (3, 4, 5, 10, 12) 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. 12) 2.1 Implement patient and student safety at all times. (2, 4, 7, 8, 10, 11, ______/______ 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. 11) (2, 5, 6, 7, 33 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 15) Discriminate among factors associated with mental health and mental illness. (10, 11, 12, 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. (3, 4, 5, 7, 9, 10, 12, 13) 5.1 Assess the importance of psychological, biological and genetic theories and evidence-based nursing interventions in psychiatric disorders. ______/ _______ 6.0 13) Analyze symptoms of psychiatric disorders as documented in DSM-IV-TR. (5, 9, 10, 12, 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 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. (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. ______/______ 34 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. 13) (3, 4, 5, 6, 7, 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. ______/_____ 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. ______/______ 35 11.3 Estimate issues of nonadherence with people with psychiatric disorders. ______/______ 12.0 Function independently within the defined scope of professional nursing care. (6, 7, 10) 12.1 Adheres to SDSU SON ethical standards at all times. ______/______ 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) INSTRUCTOR COMMENTS (Particular instances demonstrating strengths, application of critical thinking skills, progress with clinical worksheets –Instructor make sure you complete this part) 36 ______________________________________________________________________________ STUDENT SIGNATURE (Actual signature of student required) DATE ________ FACULTY SIGNATURE DATE ________ 8-23-2008 37