TABLE OF CONTENTS
Course Title ............................................................................................................................... 1
Instructor Information ................................................................................................................. 1
Course Description .................................................................................................................... 1
Credit and Time Allotment ........................................................................................................ 1
Placement ................................................................................................................................. 1
Prerequisites ............................................................................................................................. 1
Course Objectives...................................................................................................................... 1
Responsibilities .......................................................................................................................... 2
Textbooks .................................................................................................................................. 2
Grading ...................................................................................................................................... 2
Clinical Assignments .................................................................................................................. 2
Clinical Grading ......................................................................................................................... 3
Clinical Experience .................................................................................................................... 4
Clinical Objectives...................................................................................................................... 4
Clinical Evaluation Information ................................................................................................... 5
Clinical Evaluation...................................................................................................................... 7
Remediation Plan....................................................................................................................... 9
Interpersonal Process Recording ............................................................................................... 10
Format for Writing an Interpersonal Process Record .................................................................. 11
Example of Interpersonal Process Recording ............................................................................ 12
Interpersonal Relationship Recordings Form ............................................................................. 14
Observations and Interventions.................................................................................................. 16
Psychiatric Nursing Diagnoses................................................................................................... 17
Example Summary of Behavioral Problems Patient Exhibits ...................................................... 18
Summary of Interpersonal Process Recording Form .................................................................. 19
Teaching a Group ...................................................................................................................... 20
Group Presentation Grading Rubric ........................................................................................... 21
Rules and Regulations to be Observed in the Clinical Area ...................................................... 22
Unit 1 ......................................................................................................................................... 24
Unit 2 ......................................................................................................................................... 26
Unit 3 ......................................................................................................................................... 27
ii
Course Title: Nursing 1134 -- Psychiatric Nursing
Course Instructor:
Office Location:
Phone:
E-Mail:
Office Hours:
Jennifer James, RN, BSN
A100 F (Allied Health Wing)
870-391-3528
jjames@northark.edu
Tuesdays from 8:30-3:00
NURS 1134 Psychiatric Nursing
Psychiatric Nursing studies man's adaptive and maladaptive responses to stress throughout the life
cycle. The principal focus of the course is on the utilization of the nursing process with patients in
mental health settings which provide secondary care. Particular emphasis is given to the use of
techniques of communication which are appropriate for one-to-one psychotherapeutic nurse-patient
relationships. The concepts of basic human needs and developmental processes are interwoven in the
structure of the course, and an eclectic view of other relevant contemporary theories is presented,
Guided clinical laboratory experiences are provided. Prerequisite: NURS 1114 and 1124; PSYC 2003.
Credit and Time Allotment: Four semester hours - 3-week course
45 hours of lecture
45 hours of clinical
Placement: First Level (summer semester)
Prerequisites: Nursing 1107, 1114, 1124, and Psychology 2003
Course Outcomes:
Upon successful completion of this course, the student will be able to:
1. Practice in the professional role and behaviors of the Associate Degree nurse as defined by the
Northark School of Nursing, its philosophy, conceptual framework, subconcepts and
competency statement. (Measured by role play and participation in post-conference and
classroom discussion with specific focus on delegation, safety, and conflict management.)
[Professional Identity]
2. Apply safety and quality improvement measures to clients experiencing alterations in mentalhealth health. (Measured by clinical discussions, in class discussions, presentation, quizzes, and
on line activities.) [Nursing Judgment]
3. Utilize evidence-based practice while assisting the client and family to adapt physiologically,
psychologically, and socially to stressors which occur across the lifespan. (Measured by on line
discussion, quizzes, and article summary.) [Nursing Judgment]
4. Apply clinical decision making to assist clients in coping and adaptation that are basic to
human functioning in health and illness across the lifespan. (Measured by clinical post
conference discussions, classroom discussions, quiz, and concept mapping.) [Spirit of Inquiry]
5. Collaborate with the client, family and other health care personnel in planning care and
evaluating outcomes related to mental health alterations. (Measured by clinical evaluation,
group discussions, and online discussions.) [Nursing Judgment]
1
6. Demonstrate the ability to use informatics to teach and learn through online library resources.
(Measured by group presentation and discussion board.) [Spirit of Inquiry]
7. Apply effective communication techniques to establish and maintain therapeutic nurse-patient
relationship. Measured by clinical evaluation, role play, quizzes, and case studies. [Human
Flourishing]
8. Explain the legal and ethical aspects specific to psychiatric nursing. (Measured by on line
discussions and quiz). [Professional Identity]
9. Teach management of care to psychiatric patient through education on community resources,
coping mechanisms, and disease process. (Measured by group presentation, case studies,
concept map, quizzes, and clinical evaluation.) [Nursing Judgment]
10. Discuss cultural aspects related to patient center care in the psychiatric patient. Measured by
case scenarios and discussion.[Human Flourishing]
11. Identify assessment techniques used in the psychiatric healthcare setting. Measured by post
conference discussions, classroom discussions, and quizzes. [Nursing Judgment]
12. Employ clinical decision making as it relates to the psychiatric patient. Measured by clinical
evaluations, discussion on line and in class, case studies, and quizzes. [Spirit of Inquiry]
Modes of Teaching-Learning
Teacher:
Lecture
Discussion
Demonstrations
Audiovisual Presentations
Learner:
Discussion (on-line & in class)
Small Group Conference
Role Play
Independent Study Guides
On-Line Research
Textbooks:
Mental Health Nursing, RN Edition 7.0. – ATI Review Series (handed out in class)
2011, Videback, Sheila L. Psychiatric Mental Health Nursing, 5th Ed., Philadelphia, PA:
Lippincott Williams and Wilkins. (purchase in the bookstore)
Syllabus for Psychiatric Nursing 1134 (purchase in the bookstore)
Grading:
ATI Practice Exams 1 & 2
Quizzes
Discussion Board/Movie Media questions
In-Class Teaching Project
Final
20% (a score of 90 or better)
20%
20%
20%
20%
2
*Being late for class will automatically deduct 5 points from your total points possible
Clinical Assignments:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Various clinical assignments range from one-on-one interactions to having meals with
the patients to attending consultations with the physicians and other interdisciplinary
team members.
Participation in all unit activities, as deemed appropriate by the instructor.
Attendance and participation in daily pre- and post-clinical conferences. (Debriefing)
Attendance and participation in post-clinical classes.
Students will teach a group/class to one of the units consisting of children, adolescents,
adults.
Attendance at either Alcoholics Anonymous or Narcotics Anonymous meeting, or other
approved support meeting, meeting dates/time/location to be selected by students from a
list provided by instructor. All meetings must be approved by the instructor
Attendance at family visitation or interdisciplinary staff meeting.
Completion of an Interpersonal Process Recording involving a child, adolescent or adult.
Viewing of the recommended and required videos/CDs as designated by the instructor.
Observe medication pass on all units.
Observe or participate in admission/discharge whenever the opportunity presents itself.
Participate in one-on-one communication whenever time allows.
Assist the unit nurses when appropriate for students level of participation. Request
instruction from instructor and/or staff to enhance one’s further education process.
Actively seek out any activity or experience that will enhance the student’s education.
3
Clinical Experience:
The clinical instructor will:
1.
Provide an appropriate orientation to the facility and staff.
2.
Conduct a brief pre-conference at the beginning of each day to allow interaction between the
instructor and the student concerning the day(s) objectives.
3.
Provide an introduction to the principles and procedures regarding the "Interpersonal Process
Recording".
4.
Make appropriate arrangements for the students to be involved in a variety of therapeutic
interactions such as admissions, groups, one on one, family therapy, administration of
medication, etc.
5.
Will introduce the student to the charting techniques of the specific facility.
6.
Will provide a safe environment for the student and/or provide instruction for the managing of
aggressive people.
7.
Will make every effort to correlate clinical experience with the theory schedule.
8.
Will provide a post-conference daily to allow an appropriate interaction between instructor
and students.
9.
Will assist the students in dealing with such issues as transference, counter-transference and
termination.
Clinical Objectives:
At the completion of the clinical component of Nursing 1134, the student should be able to:
1.
Assess patients for adaptive and maladaptive responses to stress, with particular emphasis
on psychological responses. (Measured through clinical assignments, post conference
discussions, and observation.) [Nursing Judgment]
2.
Analyze assessment data in order to manage care and prioritize long and short term nursing
goals. (Measured through clinical assignments, post conference discussions, and
observation.) [Nursing Judgment]
3.
Apply clinical decision making to arrive at interventions based on stated goals so that
adaptive responses of the client are maximized. (Measured through clinical assignments,
post conference discussions, and observation.) [Spirit of Inquiry]
4.
Implement safety and quality improvement to plan nursing interventions in accord with the
established principles of psychiatric-mental health care. (Measured through clinical
assignments, post conference discussions, and observation) [Nursing Judgment]
5.
Use clinical decision making to evaluate results of nursing interventions implemented and
alter interventions as indicated. (Measured through clinical assignments, post conference
discussions, and observation) [Spirit and Inquiry]
4
North Arkansas College
Department of Nursing
Harrison, Arkansas
NURSING 1134 -- Psychiatric Nursing
CLINICAL EVALUATION
Nursing 1134 is a three-week course with 45 hours of clinical laboratory experience in affiliated
hospital and other psychiatric settings.
The performance of the student will be evaluated by direct observation of clinical performance. The
instructor will collect and record data, which will be shared with the student during evaluation. The
instructor will complete a formal evaluation and discuss it with the student at the end of the course
along with feedback throughout the entire clinical rotation.
The student will:
*be given clinical evaluation(s) during required conference(s) with the clinical instructor,
*have the opportunity to discuss his/her clinical experience with the clinical instructor,
*have the opportunity to write comments on the evaluation form(s),
*be required to sign the clinical evaluation form(s).
The student's signature on the evaluation form signifies that the student has seen the evaluation, but
does not necessarily mean that the student agrees with the evaluation.
The clinical evaluation tool consists of eight major sections. Specific criteria are listed under each
section. If these criteria are not met consistently, an unsatisfactory clinical grade will be considered. In
addition, each criterion deals with accountability and professional conduct. If at any time the student
performance indicates a lack of professional conduct or accountability, the student's standing in the
course will be jeopardized.
For a satisfactory clinical performance, the student must:
1. Meet, in a consistent and progressive manner, the clinical objectives and the criteria related
to each element cited in the clinical evaluation form.
2. Demonstrate active and ongoing preparation for clinical by:
a) arriving on time, which is usually 10 minutes before due on unit
b) being properly dressed for the hospital setting and as mandated in the rules/regulation
c) having the proper tools such as a black pen, small pad, name tag and any necessary supplies
for presentations for IPR
d) being consistently involved with the patients either one-on-one or group participation
e) availing him/herself of all learning opportunities
f) avoiding hanging around the nurses’ station and/or socializing with hospital staff or classmates
g) limiting coffee/smoke breaks to one in the morning and one in the afternoon and meal time to
30 minutes
h) offer assistance to the staff whenever the learning opportunity presents itself. Always ask staff
and/or instructor for help if unsure of what is expected
An unsatisfactory clinical grade will be earned by the student if one or more of the following occurs.
The student:
1.
Demonstrates difficulty in relating theory and principles to clinical situations.
5
2.
Demonstrates a consistent lack of accountability by:
a. failing to prepare for clinical,
b. failing to maintain a safe environment for the client,
c. engaging in unsafe clinical actions,
d. failing to meet evaluation criteria.
3.
Demonstrates unprofessional conduct
4.
Demonstrates difficulty in organizing, making decisions, and carrying out nursing techniques
skillfully.
5.
Fails to complete or completes in an unsatisfactory manner the required interpersonal
process recordings and group class teaching.
The student must achieve a minimum grade of "C" in theory and an overall satisfactory clinical
evaluation in order to pass Nursing 1134. If a student achieves more than one unsatisfactory
evaluation in the clinical component of Nursing 1134, then the theory grade will automatically be
dropped to a "D".
6
CLINICAL EVALUATION
STUDENT NAME:__________________________________________________________________
CLINICAL AFFILIATION:_____________________________________________________________
ORIENTATION DATE:__________CLINICAL DATES:______________________________________
CLINICAL EXPERIENCES:
1. REPORT: Child________________ Adolescent_________________ Adult_________________
2. COMMUNITY: Child______________ Adolescent________________ Adult_________________
3. CHARTS:________________ TIME OUT/SECLUSION:___________________________________
4. SCHOOL: Child___________________________ Adolescent____________________________
5. PLAY: Child___________________ Adolescent_________________ Adult_________________
6. GROUPS: Educational____________________________ Process________________________
7. ONE-ON-ONE: ________________________ OBSERVE MEDS__________________________
8. MEALS: Child________________ Adolescent_________________ Adult__________________
9. STAFFING: Child______________ Adolescent________________ Adult__________________
10. CONSULTATION: Therapist ________________________ Psychiatrist____________________
11.THERAPEUTIC RECREATION: Child___________ Adolescent___________ Adult___________
12. ADMISSION:__________________________ DISCHARGE:_____________________________
TEACHING A GROUP: Project Definition: _______________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
FAMILY VISITATION: ________________________ Attended A.A./N.A.______________________
VIDEO/CDs _________________________________________________________________
_________________________________________________________________________________
POST CLINICAL CONFERENCES:
1. ______________________________________________________________________________
2. ______________________________________________________________________________
3. ______________________________________________________________________________
4. ______________________________________________________________________________
5. ______________________________________________________________________________
6. ______________________________________________________________________________
DEBRIEFINGS: The pre-post-conference provides the opportunity to each student to share his/her clinical
experiences each day, thereby allowing the students to learn from each other. The student is given the
opportunity to discuss both positive and negative experiences.
7
*The clinical instructor and the student will work jointly to seek out and take advantage of any and all
relevant clinical experiences that will provide the best learning opportunities and environment for the
student.
INTERPERSONAL REACTION ASSIGNMENT (IPR): ______________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
POINTS ASSIGNED:
POINTS EARNED:
Clinical Experiences
20
_______________
Teaching a Group
15
_______________
Family Visitation or Interdisciplinary Meeting 7
_______________
Substance Abuse Educational Meeting
7
_______________
Videos/CDs
10
_______________
Debriefings
6
_______________
Interpersonal Reaction Paper
35
_______________
Total Points Earned
_______________
Final Evaluation: ___________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Instructor’s Signature______________________________________
Date__________________
Student’s Comments: _______________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Student’s Signature______________________________________
8
Date__________________
NORTH ARKANSAS COLLEGE
Psychiatric Nursing – NURS 1134
REMEDIATION PLAN
Date______________
Student’s Name ____________________________________________________________________
Presenting Problem _________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Student’s Comments ________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Student’s Plan to Correct Problem _____________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Target Date _______________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
______________________________________________
(Student’s Signature)
____________________________
(Date)
______________________________________________
(Instructor’s Signature)
____________________________
(Date)
DISPOSITION _____________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
9
INTERPERSONAL PROCESS RECORDING
The course description emphasizes the use of techniques of communication, which is appropriate for
the one-to-one psychotherapeutic nurse-patient relationship.
The theory part of the course is designed to help the student to understand the principles and concepts
involved in this process. It includes, but is not limited to, the nursing process, therapeutic and nontherapeutic communication techniques, data collection specific to the mental health process, defense
mechanisms, review of various psychological theories, discussion of specifics including anger, anxiety
and suicide, the main clinical diagnosis including schizophrenia and mood disorders, personality
disorders, treatments and interventions, substance disorders, introduction to children and adolescent
disorders, sexual abuse and violence.
The student is also provided with the opportunity to participate, in role play to have a chance to
practice being the patient and the therapeutic individual, in controversial groups to develop a more
tolerant attitude in preparation to learn to accept the patient where they are psychologically and
participation in learning various relaxation techniques that aid the patient to have more self-control over
their behavior.
The “Interpersonal Process Recording” is the main tool the instructor utilizes to evaluate how the
student has learned to transfer his or her knowledge from the theory to the clinical setting. THIS IS
THE CRITICAL THINKING PROCESS:
This process assists the instructor in measuring:
 how the student assesses patients for adaptive and maladaptive responses to stress
 how the student analyses assessment date
 how the student plans intervention
 how the student implements nursing intervention
 how the student utilizes the process of evaluation
Although the instructor is cognizant of the fact that the theory and clinical are presented in a short time
frame, the student should be able to perform the above clinical objectives in a beginning phase of
utilizing the theory and clinical experience in a manner that will demonstrate to the instructor that
he/she understands the basic principles, can present an honest overall evaluation of the interaction,
identify his/her strengths in the therapeutic interpersonal process recording, and identify his/her areas
for improvement and be able to accept critical feedback based on direct observation.
To achieve this objective, the student will be briefly introduced to the IPR (interpersonal Process
Recording) during the theory presentation. The students are then presented with a full hour review on
the first clinical day, where the expectation of the exercise, along with the discussion of previous IPR’s,
is given to help the student to begin to understand by examples, the use of therapeutic and nontherapeutic techniques. The students must identify a patient they may want to conduct their IPR with
on the first or second clinical day.
The students are encouraged to be flexible with their decisions as there are many variables in the
clinical setting such as limited time on units, patients’ mental status, various activities, and possible
discharges. Therefore, the student must be able to interact with any patient and all age groups. At
times the instructor may allow a student to return to a unit to complete their assignment, however, that
accommodation is not always feasible due to the above and other variables.
10
Format for Writing a Process Note
Process note should include approximately a ten-minute interaction.
FORMAT
Brief: Identifying informative statement on patient: physical description, age, sex, where interaction
taking place, if relevant, precipitating event.
Nurse
a. Verbal Comment
ex. "Joe, how have things
been going for you
this week?"
b. Nonverbal
(gestures, feelings,
thoughts)
ex. "Oh, how he has
regressed! That
makes me feel sad."
Patient
a. Verbal Comment
ex. "I'm fine, Florence"
b. Nonverbal
(gestures, feelings,
double messages)
ex. flat inappropriate
smile, pathetic,
glassy eyed, docile
Analysis
1. Do you recognize the
presence of anxiety in
oneself (the nurse)
and/or in the patient?
How is the anxiety
manifested in both the
patient and the nurse?
What behavior is the
patient/nurse utilizing
to mask the anxiety
(defense mechanisms)?
2. How does the patient
see the nurse? What
role is he casting the
nurse into.
3. How does the nurse
perceive the patient?
(What does the patient
mean to you?)
4. What needs does the
patient appear to have?
How do these needs
relate to his level of
growth and
development?
5. What needs are
operating in the nurse
and how do these needs
affect her/his approach
with the patient?
6. What intervention did the
nurse use? What was
the outcome?
In analyzing one's interview qualitatively, keep in mind the following:
1. Does my response, or lack of it, close off the patient, or does it allow him to move on in greater depth or breadths?
a. Was my response close-ended or open-ended?
b. Was it a general or a specific response?
2. Look for cutoffs, shift in conversation, timing of comments and a probing statement on nurses' part.
3. Is there a theme to the interaction?
a. Who is dictating the theme, the patient or the nurse?
b. Let patient lead, but keep him on the theme.
REFERENCE: Psychotherapeutic Nursing - Claire Fagin
11
EXAMPLE
Interpersonal Process Recordings
Student’s Name___________________________________________________
Patient’s Initials_____________________JS_________________ Age: _22_
Instructor’s Name______________________________________
Race: _W_ Unit: __________Phase of Relationship: _working_
Diagnosis: __Psychosis with drug or poison Intoxication______________________________________________________________________________
Stressors: __Anxiety, Anger____________________________________________________________________________________________________
Nursing Diagnosis: __Anxiety related to inability to express emotions___________________________________________________________________
Goal: __Increase ability to express emotions______________________________________________________________________________________
Nursing Interventions: __1) Encourage recognition of feelings as they occur. 2) Have him pay attention to what his body is experiencing when anxiety
occurs. 3) Give positive feedback when he expresses feelings.
Nurse
Verbal and (non-verbal)
Communication
Patient
Verbal and (non-verbal)
communication
___
Technique
Name of Technique
(Sitting comfortably with relaxed
and expectant expression)
“Could you tell me something
about your father?”
“There’s not much to tell about
him.” (Begins to clinch and
unclench fist)
Broad opening.
Silence
“My father never was around.
He traveled most of the time I
lived at home.” (Clamps teeth
together tightly, hands in a fist)
Silence
Analysis
What you are feeling and thinking and
what you think the patient is feeling,
thinking and saying. Analyze both
verbal and non-verbal information.
Identify application of nursing
interventions, etc.
Uh-oh, this must be one of his
stresses.
I’ll give him time to see if he will go on
and talk about him.
Spoken with disgust. Tenseness noted
in facial expression and clinching fist
indicates to me he is angry now. I
believe he is angry with his father and
doesn’t’ feel like his father gave him
12
Nurse
“Are you saying that your father
wasn’t there when you felt you
needed him?”
Patient
Technique
Verbalizing the implied.
“Yeah, that’s right. He didn’t
have time for me.”
“Does this make you angry?”
Boy, I was right.
Exploring
“No, it doesn’t make me angry.”
(Spoken loudly, teeth clamped,
fists clenched)
“You say that it doesn’t make
you angry, yet you appear angry.
Are you aware that you are
clamping your mouth tight and
your hands are in a fist?”
#1 Encouraging patient to recognize
angry feelings toward his father.
He doesn’t want to admit his anger
and resentment or express his
feelings, but his nonverbal behavior
and tone of voice contradicts what he
is saying.
Restating.
Making Observations
“Yeah, well I guess it does make
me a little angry.”
That’s okay, J.S. It’s okay to feel
anger towards someone. It’s
good that you can admit it.”
enough attention
Analysis
#2 Encouraging him to recognize
what his body is experiencing in
relation to his feelings.
Oh boy, he is expressing his feelings.
Hallelujah!!
Giving reassurance and approval
13
This should be considered nontherapeutic but in this case I see it as
therapeutic.
#3 Giving him positive feedback for
expressing his anger. Letting him
know that it’s okay to have those
feelings and good to let them out.
Interpersonal Process Recordings
Student’s Name___________________________________________________
Patient’s Initials _________________________________________Age: ____
Instructor’s Name______________________________________
Race: ___ Unit: __________Phase of Relationship: __________
Diagnosis: __________________________________ ______________________________________________________________________________
Stressors: _____________ ____________________________________________________________________________________________________
Nursing Diagnosis: _______________________________________ ___________________________________________________________________
Goal: _______________________________ ______________________________________________________________________________________
Nursing Interventions: ________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Nurse
Patient
Technique
14
Analysis
Nurse
Patient
Technique
Analysis
.
15
OBSERVATIONS AND INTERVENTIONS
ASSESSMENT
DIAGNOSIS
PLANNING
DATA COLLECTION
NURSING DIAGNOSIS
GOALS/OUTCOMES
IMPLEMENTATION
NURSING ACTIONS

Subjective & Objective
Low self-esteem related to poor
IPR’s
Short-Term
 Long-Term
Improve IPR’s especially with
family.
Drug abuse related to low selfesteem.
Increase self-esteem.
Anxiety related to inability to
express emotions.
See Daily Plan.
1. Encourage to develop
individuality in order to
separate form parents.
2. Help him identify family
problems and his reaction to
them. Establish alternative
ways of dealing with them.
3. Work to develop open, honest
relationships and establish
goals.
4. Assume responsibility for getting
own needs met.
5. Encourage family therapy.
1. Help identify his positive
qualities and abilities and
encourage these in daily
activities.
2. Encourage him to accept
positive comments about
himself in and in giving himself
positive reinforcement.
3. Give him the message that it’s
alright to have bad thoughts
and to make mistakes and
these do not make him a bad
person.
4. Provide successful experiences.
a. Identify areas of satisfaction
and success in his life
b. Use milieu to encourage his
participation in rewarding
experiences.
16
SCIENTIFIC RATIONALE
EVALUATION
JUDGING EFFECTIVENESS
1.
Drug abuse
8. Delusions
2.
Low self esteem
9. Hallucinations
3.
Poor IPR's
10. Denial
4.
No sense of responsibility
11. Manipulative
5.
Lacks self-control. Impulsivity.
12. Lacks trust-feelings of insecurity
6.
Anxiety
13. Negativistic
7.
Hostility
14. Elation and manic activity
15. Suicidal and homicidal ideations
Nursing Diagnoses:
1.
Drug abuse related to poor sense of identity.
Drug abuse related to low self-esteem.
2.
Low self-esteem related to poor IPR's (friends, parents, brother, authority figures)
Poor IPR's related to low self-esteem.
3.
Poor IPR's related to manipulative behavior.
4.
No sense of responsibility related to lack of self-control.
5.
Impulsiveness related to no sense of responsibility.
Lack of self-control related to inability to accept authority.
6.
Anxiety related to inability to express emotions.
7.
Hostility related to anxiety.
Hostility related to inability to express emotions appropriately.
8.
Delusions of grandeur related to low self-esteem.
Delusions of persecution related to distortions in reality.
9.
Distortions in reality related to poor reality testing.
10. Manipulative behavior related to inability to delay gratification.
Manipulative behavior related to inability to accept responsibility for actions.
17
SUMMARY OF BEHAVIORAL PROBLEMS PATIENT EXHIBITS
(Before admission and now)
Left home in Chicago to live with relative in Oregon and worked as carpenter 2-3 months before
admission. Worked for a month and left abruptly when he became angry with his uncle for
"ripping him off" and not paying enough salary.
Traveled through several Western states-brought drugs and partied with young adults. Smoked
grass and drank large amounts of alcohol. At one party "someone put poison in the punch and
we all flipped out." He began "flashing" and experienced sudden insights of universal nature
and it left him a feeling of magical powers. He became convinced that others were trying to
injure him and take his precious secrets away. This terrified him and he began to run from his
persecutors. "It got so I couldn't trust anyone." He continued to travel and ended up in Mexico,
huddled in the bathroom to hide. He called the police and asked for protection. His father was
notified and he was flown back and transferred here.
Behavior now is inappropriate for the occasion. He is warm, superior and boastful. But is
guarded, suspicious, negativistic and arrogant. Purposeless movement is noted. There are
signs of tension, manic activity and excitement.
Speaks with high-pitched, shouting voice.
He is potentially dangerous to self and others. Unable to care for self and abuses drugs.
18
SUMMARY OF INTERPERSONAL PROCESS RECORDING
(To be submitted to instructor with the original IPR)
Student’s Name_________________________________________ Date________________
Patient's Initials_____________________________________ Client’s Age__________
1.
Student’s strengths related to the IPR.
2.
Student’s areas for improvement related to the IPR.
3.
Instructor’s intervention during the IPR.
4.
Instructor’s feedback after the IPR.
5.
Student’s overall evaluation of the IPR.
6.
Student’s Signature_____________________________________________________
7.
Date Sumbitted ________________________________________________________
(student may add additional comments to the back and initial)
19
TEACHING A GROUP
Purpose:
The student(s) will have the opportunity to conduct a class in a group setting with other
assigned class members. This allows the student(s) to have an opportunity to develop
and present a class in a group setting. This is also an opportunity for the student(s) to
develop critical thinking.
Rationale:
One of the main responsibilities of the psychiatric nurse is to conduct groups. These
groups are sometimes in the form of community meetings, educational groups, support
groups, preventative groups, intervention groups, and re-grouping.
Procedure:
The student will be introduced to the “group teaching” briefly during the theory
presentation of the course. The instructor and staff will determine the amount of time to be
devoted to the “group teaching” during the clinical experience. The instructor will provide
the students with a variety of subjects and ideas that can be utilized. However, it is more
beneficial for both the students and the patients if the student chooses a topic that he or
she is more familiar with.
Student Responsibility:
The student(s) will start thinking about their instructor assigned team on the first clinical
day. The clinical team will consist of three to four students. IT IS THE TEAMS’
RESPONSIBILITY TO PRESENT, IN WRITING, A SPECIFIC OUTLINE OF THE
PROGRAM THAT WILL BE PRESENTED ON THE SECOND CLINICAL DAY. The
purpose for this is to allow the instructor to review the program as to the suitability for the
patient audience, to discuss the program with the team and to check with the head nurse
of the unit as well as the therapists to coordinate the suitability and time of the
presentation.
Time is very limited and must be appropriated carefully, if the above procedure is not met,
it could result in the student not being able to complete his or her class requirement and
loose 15% of their grade.
Time Alloted: The instructor and staff will determine the amount of time to be devoted to the “group
teaching” during the clinical experience.
When the student(s) utilize the group time they are agreeing to present the therapeutic
group for that particular time slot and the full time must be utilized in A THERAPEUTIC
manner. **IF any of the student(s) fails to be prepared for the full time allotted, they will
loose credits from the necessary 15 credits designated for this assignment.
Due to the time constraints and the number of students who need to be observed and
graded, there is no time allowed for a repeat of class.
Patient Audience:
Every effort is made to allow the student(s) to teach to their primary patient unit group to
the age level they are most comfortable with. However, it is not always possible to teach
on that unit. Therefore, the student(s) must be flexible with this assignment.
Supplies:
Generally we can make copies at the facility, however, we are guests and do not want to
take advantage of the hospitality that is offered to us. Therefore, students must ask their
instructor prior to making copies unless requested to do so by the staff. Any additional
supplies must be provided by the student(s).
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In Class Group Presentation Grading Rubric
Textbooks and peer
reviewed journals
Describes disorder
and nursing
interventions,
education, and
safety
Identify treatments,
both
pharmacological and
non-pharm.
Use creativity, and
incorporate NCLEX
questions.
Evidence of
teamwork and
involvement of
classmates
5 Points
4 Points
3 Points
2 Points
Referenced at least
1 textbook and 2
peer reviewed
journals (APA
format)
Described in detail
all four aspects
including rationales.
Referenced at least
1 textbook and 1
journal (APA format)
Referenced at least
1 textbook and 2
journals but did not
use APA format.
Referenced at least
Did not reference
textbook or journal.
textbook or journal.
May or may not have
used APA format.
Described at least 3
aspects including
rationales.
Described at least 3
aspects and did not
include rationales.
Described at least 2
aspects with or
without rationales.
Described 1 aspect
with or without
rationales.
Identified treatments
including pharm,
S/A, dose as well as
detailed information
on non-pharm
treatment.
Identified treatments
including pharm and
non-pharm
treatments, but did
not give specific
information on one
of the two.
Was creative using
skits, role play,
games, etc. but did
not have 3 NCLEX
questions
Identified treatments
both pharm and nonpharm, but only gave
some of the details
about each such as
S/A but not a dose.
Identified both
pharm and nonpharm treatments
but gave minimal
details about both.
Identified either
pharm or non-pharm
treatments, but not
both.
Stood and talked
using a powerpoint
and had 3 NCLEX
questions
Only talked about
subjects without any
audio/visuals, skits,
role play, etc. Did
have 3 NCLEX
questions.
Talked without any
audio/visuals, skits,
role play, games,
and did not have
NCLEX questions.
Work was obviously
not equally divided
among members,
but the class did
participate a lot in
teaching.
Work was divided
equally. Class was
minimally involved in
teaching.
Work was not
equally divided and
class participated
minimally.
Work was not
equally divided and
there was almost no
participation from
class.
Did not just stand
and talk, but utilized
other teaching
strategies, like skits,
role play, games and
had at least 3
NCLEX questions.
Work was divided
equally and all had
parts. Class was
involved and
participated a lot in
teaching.
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1 Point
RULES AND REGULATIONS TO BE OBSERVED IN THE CLINICAL AREA
1.
I understand that we are guests in the host facility and therefore subject to the rules and regulations of that
facility, in addition to the rules and regulations of the psychiatric nursing course and those of my home
school.
2.
I understand that the official hours are provided on the clinical calendar for each clinical group unless
otherwise advised by the clinical instructor. I understand that I must be at the hospital by 6:45 AM for the
morning conference. I understand that if I am late, I will lose five (5) credits from my final grade and I may
be in danger of not being allowed to go into the unit. This can result in an unsatisfactory grade for the clinical
experience. I understand I must have breakfast before I come to the facility.
3.
I understand I may not bring any cell phones, computers, or other electronic equipment into the clinical area.
4.
I have been advised of the 1-800 number that my family can use to reach me in an emergency. I have been
advised that in case of an emergency my family is to call the hospital and ask the receptionist to page the
instructor who will accept and pass on the message to me.
5.
I have been advised that there are no available lockers and therefore can not bring any item of value to the
clinical area. I understand I can only bring my car key (not a large bunch). Students may bring food to eat for
meals and breaks. The food must be in a bag/container that is labeled with the students name and date.
6.
I understand I am to have my name tag with me every day. I also understand that I must block out my last
name on the name tag.
7.
I understand at no time may I give out my last name, phone number or any other personal information to any
patient.
8.
I understand I can not bring any gifts including food, pictures, poems, etc. to any patient. The exception
might be if the students are providing some kind of “treat” for the class or group after the teaching exercise.
This must be discussed with the clinical instructor and head nurse of the unit.
9.
I understand I must have a black pen and a small note pad (select one with no spiral or metal attachments)
with me every day. Ink pens must not have any clips or removable parts. Do not bring paper clips or any
staples to the facility.
10.
I understand the dress code as follows:
a.
neat, clean, casual business attire-students are encouraged to bring a sweater or jacket. No hooded items
or one with tie-strings.
b.
no tee shirts or muscle shirts, no sleeveless shirts, no spaghetti straps, no shirts with any messages on
them and no exposed tattoos.
c.
no shorts, cut-offs, or ¾ length pants, no jeans.
d.
socks or stockings must be worn and only clean sneakers will be allowed. No flip flops.
e.
no dangling earrings, or long necklaces. Rings are limited to wedding and/or engagement rings only.
No excess jewelry.
f.
no low cut blouses, no high slits and no short skirts.
g.
no nail polish, other than clear.
h.
no gum chewing. No food or drink or be taken on the unit. This includes water and coffee. Men must
be clean shaven. If a beard or mustache is worn, it must be neat and trimmed.
11.
I understand if I arrive with any infraction of the above dress code, I will be asked to leave the facility to
make the proper adjustments. I will then be considered late or absent for that day and will be in danger of
losing five credits from my final grade or failing the course due to the loss of a day.
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12.
I have been advised that I cannot leave the facility for any reason.
13.
I have been advised that I can purchase meals at the facility, which are reasonably priced, or I can bring my
lunch. I understand meal time is thirty minutes for lunch or dinner and 15 minutes for a coffee break which is
limited to one in the morning and one in the afternoon.
14.
I understand that clinical sites are smoke-free facilities. I understand I am limited to two breaks and I must
utilize those times only for any smoking breaks. I understand I may not bring cigarettes or a lighter or
matches onto the unit.
15.
I understand I must stay on my assigned unit and follow those patients throughout their schedule for the day.
I can only go to another unit with the instructor’s permission.
16.
I have been advised that sleeping in class or during group or any other activity can result in the loss of credit
from my final grade. Habitual sleeping may result in being asked to leave the clinical area.
17.
I have been advised that any free or quiet time on the units will be utilized interacting with the patients,
reading charts, offering to assist the staff, attending unit activities, preparing for teaching, preparing for the
Interpersonal Process Recording assignment, observing med pass, and/or taking advantage of the other
learning opportunities available that will contribute to my education.
17.
The nurses’ stations have limited space and is needed by the nurses and staff to complete their
responsibilities. Although I have been encouraged to seek out the help and knowledge of the staff, I
understand that I cannot “hang” around the nurses’ station. I may not borrow the staff’s keys.
18.
I understand that if I exhibit any crisis type of behavior physically, mentally, or emotionally, I may be asked
to leave the clinical area. If that occurs, I understand I must consult with the Nursing Director at my school.
The clinical instructor will consult with the Nursing Director of the school as well as the Nursing/Clinical
Director of the facility. I further understand I may not return to the clinical area without permission of the
clinical instructor.
19.
Students will be provided with the location of their primary facility and where to park their cars. Car-pooling
is encouraged due to limited parking.
20.
I have been advised of the following grading system for my clinical experience:
Various clinical experiences .......................................................... 20
Teaching a Class/Group ................................................................ 15
Substance Abuse Educational Meeting ........................................ 7
Family Visitation or Interdisciplinary Meeting ............................. 7
Videos/CDs ................................................................................... 10
Interpersonal Process Recording ................................................... 35
Debriefing(s) ................................................................................. 6
100
I have read all of the above and have had an opportunity to discuss the items and address any questions about the
rules. I further understand any infraction of any of the rules or earning less than 70 points can result in my receiving
an unsatisfactory for the clinical psychiatric nursing clinical experience. I further understand an unsatisfactory
clinical grade can result in an overall grade of D, which is a failing grade for the course.
Student’s PRINTED NAME _________________________________________________
Student’s Signature________________________________________________________
Date_____________________________
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