Santa Monica College
Course Outline for
NURSING 25
Course Title:
Nursing 25
Date Submitted: Spring 2002
Updated:
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Units:
1.5
IGETC Area:
CSU GE Area:
Transfer:
CSU
Catalogue Description:
Prerequisite: Nursing 20, 20L, or acceptance into advanced placement and
completion of Nursing 19 with a “C” grade or better.
Corequisite: Nursing 25, Nursing 28
Advisory:
Speech 5, Psychology 19
The focus of this specialty course is to introduce the nursing student to the
principles of psychiatric-mental health nursing as applied to patients across the
life span. Emphasis will be placed on meeting self-care deficits of patients
exhibiting symptoms of common psychiatric disorders and patients experiencing
emotional responses to stress and illness. The course will cover concepts of
mental health, mental illness, stress and coping, assessment of common
psychiatric disorders, biological and psychosocial modes of intervention, and
therapeutic nursing responses.
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Required Text and References:
Fortinash, Katherine M. and Holoday-Worret, Patricia A., Psychiatric Mental
Health Nursing. 3rd Ed. Mosby, Inc., St. Louis, 2004.
Doenges, Marilyn, Nurse’s Pocket Guide: Nursing Diagnoses with Interventions.
7th Ed. Philadephia: F.A. Davis Co., 2000.
Luckenotte, Annette G., Gerontologic Nursing. 2 nd Ed. St. Louis: Mosby, Inc.,
2000.
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Course Objectives:
Upon completion of this course, the student will be able to:
A.
Apply Orem’s Self-Care Model and the nursing process to plan and
implement nursing care in various healthcare settings for actual or
simulated patients who demonstrate symptoms related to ineffective coping
patterns, anxiety, personality disorders, substance abuse disorders, mood
disorders, psychotic disorders, issues of abuse and crisis.
B.
Identify areas of psychosocial dysfunction, which adversely affect a
patient’s health status.
1
C.
D.
E.
F.
G.
Identify and plan nursing interventions to support actual or simulated
patients experiencing emotional responses to medical illness.
Describe sociocultural and lifespan considerations significant to mental
health treatment.
Demonstrate competency in establishing and maintaining a therapeutic
nurse-patient relationship with actual or simulated patients experiencing
mental health problems utilizing effective communication techniques.
Discuss the legal and ethical issues associated with psychiatric nursing
including the rights and restrictions of voluntary and involuntary patients,
confidentiality, the right to the least restrictive treatment alternative and the
right to refuse medication.
Differentiate between normal age-related behavioral changes and
symptoms of mental illness in children, adolescents, and older populations.
Theoretical Objectives:
Upon completion of this course, the student will be able to:
Introduction to Psychiatric Mental Health Nursing
1.
Differentiate between the concepts of mental health and mental illness.
2.
Discuss psychiatric-mental health nursing from a historical perspective.
3.
Explain the influence of culture on the diagnosis, treatment and nursing
interventions for mental illness.
4.
Explain the relevance of Maslow’s Hierarchy of Needs to patient
assessment and planning of nursing interventions.
5.
Describe the roles of neuroanatomy and neurophysiology in the etiological
theories of mental illness.
6.
Identify the major components and relevance to nursing care of the
following developmental theories: psychoanalytical theory, psychosocial
development theory, and behavioral theory.
Stress, Coping Skills and Stress Management
1.
Explain the effect of prolonged stress on physical and mental health.
2.
Identify four diseases of adaptation.
3.
Describe the four levels of anxiety and common behavioral responses of
each.
4.
Identify common coping behaviors used to relieve anxiety.
5.
Discuss the adaptive and maladaptive uses of ego defense mechanisms to
relieve anxiety.
6.
Differentiate between the following ego defense mechanisms:
compensation, denial, displacement, identification, intellectualization,
projection, rationalization, reaction formation, regression, repression,
sublimation and suppression.
7.
Identify various stress management strategies appropriate to reduce stress
in patients and nurses.
2
Legal and Ethical Issues
1.
Identify the criteria for involuntary hospital commitment.
2.
Compare the rights and restrictions of patients committed to voluntary and
involuntary hospital admissions.
3.
Discuss the patient’s right to confidentiality and situations when
confidentiality may be violated.
4.
Discuss the right to the least restrictive treatment setting.
5.
Discuss the patient’s right to refuse treatment.
6.
Discuss nursing responsibilities for care of the patient in restraints or
seclusion including appropriate use of these measures, assessment and
documentation.
Application of the Nursing Process to Psychiatric-Mental Health Nursing
1.
Describe the steps of the nursing process and application of Orem’s SelfCare model as related to psychiatric-mental health nursing practice.
2.
Identify commonly used NANDA nursing diagnoses in psychiatric
nursing.
3.
Identify the six standards of care for psychiatric nursing and describe
nursing actions associated with each.
4.
Discuss the importance of the psychiatric interview process and the stages
of the interview.
5.
Identify the categories of information addressed in a psychiatric history
and assessment.
6.
Discuss the components of the mental status examination.
7.
Describe mental status assessment of the adult and the older adult patient.
8.
Explain the DSM (Diagnostic and Statistical Manual of Mental Disorders)
diagnostic system and the use of the five axes.
9.
Compare and contrast primary, secondary, and tertiary prevention in
community mental health nursing.
Relationship Development and Therapeutic Communication
1.
Identify examples of nonverbal communication exhibited in interactions
between patients and healthcare providers.
2.
Compare and contrast therapeutic and nontherapeutic verbal
communication techniques in simulated nurse-patient interactions.
3.
Describe behaviors of active listening.
4.
Describe therapeutic feedback.
5.
Discuss measures to enhance communication with older adults exhibiting
symptoms of psychiatric disorders.
6.
Discuss the benefits of assertive communication for patients and nurses.
7.
Differentiate between assertive and aggressive communication.
8.
Discuss techniques and rationales for intervening in psychotic
communication.
9.
Discuss the relevance and the dynamics of a therapeutic nurse-client
relationship.
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10.
11.
12.
13.
14.
Identify goals of a therapeutic relationship.
Discuss the essential conditions for a nurse-patient therapeutic relationship
to occur, including trust, empathy, rapport, and respect.
Describe the phases of relationship development and the tasks associated
with each phase.
Discuss the concept of therapeutic use of self.
Define transference and countertransference and their significance in a
therapeutic nurse client relationship.
Treatment and Intervention Modalities
1.
Define milieu therapy.
2.
Discuss conditions that promote a therapeutic community.
3.
Describe the responsibility of the nurse in maintaining a therapeutic
milieu.
4.
Contrast the therapeutic functions of four types of groups.
5.
Discuss curative factors that occur in the group process.
6.
Discuss the role of the nurse in group interventions.
7.
Contrast the advantages and disadvantages of group therapy and
individual therapy.
8.
Discuss the use of behavior therapy as a psychiatric nursing intervention.
9.
Apply principles of behavior therapy to a simulated patient problem.
10.
Define crisis and cite examples of various types of crises.
11.
Discuss the goals of crisis intervention.
12.
Identify the steps of crisis intervention.
13.
Identify the role of the nurse in crisis intervention.
14.
Discuss nursing care of the patient displaying behaviors of anger and
aggression including etiology, situational triggers, signs of escalation, and
nursing interventions to prevent and manage expression of anger and
aggression.
Psychopharmacology
1.
Identify target symptoms, expected side effects and safe administration
guidelines for antipsychotic, antidepressant, mood stabilizing, anxiolytic
and antiparkinsonism medications.
2.
Identify the extrapyramidal symptoms of pseudoparkinsonism, akathisia,
dystonia/dyskinesia and tardive dyskinesia.
3.
Identify symptoms of neuroleptic malignant syndrome.
4.
Discuss nursing implications for psychopharmacological treatment of
older adults and patients with specific medical problems.
5.
Plan nursing interventions to prevent or alleviate side effects of
antipsychotic, antidepressant, mood stabilizing, anxiolytic and
antiparkinsonism medications.
6.
Design teaching plans to instruct patients and their families in the safe use
of antipsychotic, antidepressant, mood stabilizing, anxiolytic and
antiparkinsonism medications.
7.
Identify common reasons for medication non-compliance and nursing
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interventions to promote compliance.
Schizophrenia and Other Psychotic Disorders
1.
Define schizophrenia and describe the subtypes.
2.
Discuss current biological, psychosocial and environmental etiological
theories associated with schizophrenia.
3.
Describe the cognitive, affective, social, and behavioral changes seen in
people with schizophrenia.
4.
Differentiate among the terms used in the mental status assessment of the
patient with a psychotic disorder including psychosis, delusion,
hallucination, illusion, and magical thinking.
5.
Differentiate between positive and negative symptoms of schizophrenia.
6.
Identify nursing interventions related to counseling, milieu therapy,
psychobiology and health teaching to assist patients with symptoms of
schizophrenia.
7.
Assess symptoms, identify nursing diagnoses, and develop a nursing care
plan for a simulated patient with schizophrenia based on Orem’s Model
and the nursing process.
Mood Disorders
1.
Identify the biological and psychosocial theories regarding the etiology of
mood disorders.
2.
Differentiate between the symptoms and treatment for the following mood
disorders: major depression, bipolar disorder, cyclothymic disorder,
dysthymic disorder and schizoaffective disorder.
3.
Differentiate among terms used in the mental status exam to describe
affect and speech.
4.
Describe assessment of depression in a child, adult and older adult
utilizing a standardized assessment tool.
5.
Identify nursing interventions related to counseling, milieu therapy,
psychobiology and health teaching to assist patients with symptoms of
major depression and bipolar disorder.
6.
Assess symptoms, identify nursing diagnoses, and develop a nursing care
plan for a simulated patient with mood disorder based on Orem’s Model
and the nursing process.
7.
Identify indications, contraindications, side effects and nursing
responsibilities in the use of electroconvulsive therapy (ECT).
8.
Compare and contrast behaviors associated with sadness and the clinical
disorder of major depression.
9.
Describe the prevalence of depression in older adults.
10.
Contrast criteria for differentiating depression from dementia in older
adults.
11.
Explain unique issues regarding assessment, therapeutic interventions, and
psychopharmacological treatment of depression in older adults.
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Suicide
1.
Discuss social, cultural, psychological and physical factors related to the
incidence of suicide.
2.
Identify behavioral changes evident of possible suicide attempt.
3.
Discuss the risk periods and risk factors associated with suicide.
4.
Identify the psychiatric and medical conditions that significantly increase
a patient’s risk of suicide.
5.
Assess the lethality of a suicide plan and the degree of a client’s suicide
risk.
6.
Describe appropriate goals of care and nursing interventions for behaviors
associated with suicide.
7.
Identify the populations that have the highest risk for suicide attempts and
suicide.
8.
Discuss prevalence, risk factors, and behaviors associated with suicide in
older adults.
9.
Identify the elderly group at highest risk for suicide and discuss related
management techniques.
Grief
1.
2.
3.
4.
5.
Discuss the concept of grief as a psychological response to stress.
Describe variables that contribute to the intensity of the grief response.
Discuss anticipatory grief.
Describe the following dysfunctional grief responses: prolonged grief,
delayed or inhibited grief, and distorted grief.
Describe appropriate nursing interventions for behaviors associated with
grief.
Personality Disorders
1.
Contrast the definitions of personality and personality disorder.
2.
Describe the symptoms associated with paranoid, anti-social and
borderline personality disorders.
3.
Assess symptoms, identify nursing diagnoses, and develop a nursing care
plan for a simulated patient with paranoid, borderline and antisocial
personality disorders based on Orem’s Model and the nursing process.
4.
Describe nursing interventions for behaviors associated with personality
disorders including the techniques of limit-setting, confrontation and
time-out.
Substance-Related Disorders
1.
Differentiate between substance abuse, dependence, intoxication, and
withdrawal.
2.
Identify symptoms of intoxication, withdrawal and dependence from:
alcohol, sedative- hypnotics, anxiolytics, CNS stimulants, opioids,
hallucinogens, and cannabis.
3.
Discuss the major biopsychosocial theories explaining the causes of
substance related disorders.
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4.
5.
6.
7.
Explain the dynamics of codependency.
Identify common nursing diagnosis, goals, interventions and outcome
criteria for the care of the patient and family affected by substance-use
disorders and substance-induced disorders.
Identify topics for patient and family teaching relevant to substance-use
disorders and substance-induced disorders
Describe modes of pharmacological and psychosocial treatment for the
patient with substance-related disorders.
Eating Disorders
1.
Compare and contrast the epidemiology and symptoms of the following
eating disorders: anorexia nervosa, bulimia nervosa, and obesity.
2.
Identify etiological implications in the development of eating disorders.
3.
Discuss terms related to family influences in eating disorders:
enmeshment, over protectiveness, rigidity, and conflict avoidance.
4.
Identify common nursing diagnoses, goals and interventions for patients
with eating disorders, including nutritional rehabilitation, psychotherapy,
maintenance, and follow-up care.
5.
Describe strategies for safe refeeding of the underweight and
malnourished patient.
6.
Discuss the treatment goals of nutritional care for patients with anorexia
nervosa or bulimia.
Anxiety Disorders
1.
Differentiate between normal anxiety and abnormal anxiety.
2.
Describe the clinical manifestations of the following anxiety disorders
generalized anxiety disorder, panic disorder, phobic disorders, obsessivecompulsive disorder, and post-traumatic stress disorder.
3.
Describe nursing interventions for behaviors associated with anxiety.
4.
Assess symptoms, identify common nursing diagnoses, and develop a
nursing care plan for a simulated patient with an anxiety disorder based on
Orem’s Model and the nursing process.
Anxiety-Related Disorders
1.
Define somatoform disorders
2.
Differentiate between the diagnostic categories of somatoform disorders
and psychological factors affecting physical functioning.
3.
Define conversion disorder, body dysmorphic disorder, pain disorder,
hypochondriasis, and somatization disorder.
4.
Identify physical problems affected by psychological factors.
5.
Identify common nursing diagnoses, goals and interventions for patients
with psychophysiological disorders.
Victims of Abuse
1.
Define sexual, physical and psychological abuse.
2.
Define physical and emotional neglect.
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3.
4.
5.
6.
7.
Identify behaviors and clinical evidence of abuse, neglect and exploitation.
Identify characteristics of persons at risk for becoming abuse victims or
perpetrators.
Discuss nursing care for abuse victims.
Discuss the legal issues of reporting and documentation of abuse.
Describe common feelings among nurses encountering abuse victims and
victimizers in the health care setting and the effect of these reactions on
nursing care.
Psychiatric Disorders First Diagnosed in Infancy, Childhood or Adolescence
1.
Identify symptomotology associated with the following psychiatric
disorders usually first diagnosed in infancy, childhood or adolescence:
Mental Retardation, Autistic Disorder, Attention Deficit
Disorder/Hyperactivity Disorder, Conduct Disorder, Oppositional Defiant
Disorder, Tourette’s Syndrome, Separation Anxiety Disorder.
2.
Identify nursing diagnoses common to clients with the above disorders.
3.
Describe treatment modalities relevant to the above disorders.
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Methods of Presentation:
Lectures, discussions, role play, case studies, small group work, assigned readings
and videos, and computer assisted instruction.
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Course Content:
Coverage
Topic
12.5%
Introduction to Psychiatric-Mental Health Nursing
Concepts of Mental Health and Mental Illness
Ethical and Legal Issues
12.5%
Therapeutic Communication and the Therapeutic Relationship
12.5%
Psychiatric Nursing Process
Treatment and Intervention Modalities
Psychopharmacology
12.5%
Application of the Nursing Process for People with Schizophrenia
and Other Psychotic Disorders
Application of the Nursing Process for People with Mood Disorders
12.5%
Application of the Nursing Process for People with SubstanceRelated Disorders
Understanding Grief and Suicide
12.5%
Application of the Nursing Process for People with Anxiety
Disorders
Application of the Nursing Process for People with AnxietyRelated Disorders
Crisis Intervention
12.5%
Application of the Nursing Process for People with Personality
Disorders
Anger Prevention and Management
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12.5%
Application of the Nursing Process for People with Eating
Disorders
Application of the Nursing Process for People with Psychiatric
Disorders First Diagnosed in Infancy, Childhood or Adolescence
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Methods of Evaluation:
1.
Exams are multiple choice, fill-in, short answer and essay. Other projects (if
assigned) will be graded according to specified guidelines.
Students must pass both Nursing 25 (theory) and Nursing 25 L (clinical) in order
to successfully pass N 25 and progress to the next course.
A passing grade in the nursing program begins at 75% of the total possible course
points. A final score below 75% is considered a failing grade. A failing grade in
Nursing 25 L constitutes a failing grade in Nursing 25 regardless of the
percentage of points earned in the theory course.
2.
3.
Assignments
Exams and quizzes
Final Exam
5%
52%
43 %
A = 92% – 100%
B = 83% – 91%
C = 75% – 82%
D = 70% – 74%
F = 0% – 69%
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