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FIRELANDS REGIONAL MEDICAL CENTER SCHOOL OF NURSING Sandusky, Ohio

COURSE OUTLINE

PSYCHIATRIC NURSING

May 2009

TIME ALLOTMENT:

50 0 83 133 6

Theory Hours Lab Hours Clinical Hours Total Hours Credit Hours

PLACEMENT:

Second Year Summer Semester

TEACHING PERSONNEL:

Katherine Vanderpool, MSN, RN, Course Coordinator Kelly Harmon, MSN, RN Erin Nesbit, BSN, RN

COURSE OBJECTIVES: At the conclusion of the course, the student will be able to: 1. 2. 3. 4. 5. 6. 7. Apply the principles of psychiatric theory in the care of adolescent to geriatric clients with a mental illness diagnosis. (1,2,5,7)* Synthesize psychopathology, health assessment data, and nursing process concepts to plan and care for clients with mental illness. (1,2,3,4,5,6,7)* Refine basic verbal and nonverbal therapeutic communication skills when interacting with clients, families, and members of the health care team. (2,3,5,6)* Demonstrate knowledge of frequently prescribed medications utilized in treating mental illness. (1,4,5,6)* Develop an awareness of community resources and services. (5,6,7)* Demonstrate satisfactory proficiency when using informatics and techniques in the assessment of clients with a mental illness diagnosis. (1,2,3,4,6)* Evaluate self-participation in client care experiences with the focus on ethical, legal, and professional responsibilities. (7)*

COURSE OVERVIEW: This course surveys the common mental disorders, their prevention, treatment and nursing care. A variety of settings from acute in-patient to community agencies are examined. There is emphasis on primary prevention, holistic care, health teaching and therapeutic nursing interventions with the goal of maximizing client self care. Clinical experience is provided at St. Charles Mercy Hospital, Oregon, Ohio in addition to FRMC. The course is offered in the summer semester. This course is taken in the second year. Prerequisite: Nursing Care of Adults I or Medical Surgical Nursing Advanced Concepts.

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TEXTBOOKS: REQUIRED: Assessment Technologies Institute, LLC (2009). Mental Health Nursing: RN ed. th Keltner, N.L., Schwecke, L.H., & Bostrom, C.E. (2007). Psychiatric Nursing (5 ed.). OPTIONAL: Pedersen, Darlene D. (2007). Psych Notes. Clinical pocket guide. Philadelphia, PA: F.A. Davis Company. TEACHING METHODS: Lecture Discussion Films Role playing Power Point presentations Clinical examples Classroom exercises Seminar presentation Guest lecturers Clinical experiences Syllabus handouts METHODS OF STUDENT EVALUATION: Nursing Process Assignments Observation Interaction with Instructor (Pre and Post-conference) Planning, organizing, and executing nursing care Charting entries on Care Plans Interaction with client, staff, family Psychomotor skills required for implementation of nursing care Mid term evaluation Participation in adjunctive therapies (A.A.; Community Health Resource) Unit Exams Final Exam Self-appraisal and completed Clinical Evaluation Tool Seminar Report(s)

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REFERENCES: American Health American Journal of Nursing American Journal of Maternal/Child Nursing Geriatrics, Geriatric Nursing Journal of Gerontological Nursing Journal of Psychosocial Nursing Psychology Today R.N. Supplemental Bibliography ­ (Handout) WEB SITES: http://mentalhealth.samhsa.gov www.nami.org www.nimh.nih.gov www.nmha.org www.nurses.info

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COURSE OUTLINE UNIT OBJECTIVES CONTENT PSYCHIATRIC NURSING COURSE INTRODUCTION AND OVERVIEW (2 hours) A. B. C. D. Welcome Overview of the Course Outline Course Calendar Course Orientation 1. Assignments 2. Quizzes/tests 3. Grading Scale 4. Attendance 5. Classroom Etiquette 6. Clinical Etiquette E. Review of Student Handbook 1. Plagiarism Statement 2. Attendance Policy and Student Accountability Flowchart 3. Academic Policies 4. Testing Policies 5. Confidentiality F. Documentation 1. Clinical Performance Tool 2. Care Plan 3. Process Recording 4. Satisfactory Teaching Plan 5. Student Presentations G. FRMC and St. Charles Student Orientation 1. Vision Statement 2. Electrical, Fire, Safety 3. Infection Control 4. Emergency Codes 5. Hazardous Material 6. Security, Parking, Smoking, Lost & Found, Telephone Use 7. Confidentiality, Guest Relations 8. Variance Reporting RELATED LEARNING EXPERIENCES Handouts: Orientation Packet: Course Orientation Course Outline Course Calendar Student Accountability Flow Sheet Student Conduct While Providing Nursing Care Student Confidentiality Guidelines Guidelines for Satisfactory Care Plan, Process Recording, Teaching Plan, Medication Posters, Community Resource Paper FRMC and St. Charles Documentation

Integrate expectations and requirements for successful completion of the course.

Orientation to Clinical Sites: FRMC, 1 South or St. Charles, Toledo Handouts

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COURSE OUTLINE UNIT OBJECTIVES CONTENT PSYCHIATRIC MENTAL HEALTH CONCEPTS (6 hours) A. Self-Awareness B. Cultural Competence in Psychiatric Nursing 1. Basic concepts 2. Culture-bound mental health issues 3. Alternative therapies and ethnopharmacology 4. Cultural assessment C. Spirituality 1. Client spirituality and the psychiatric nurse 2. Health care applications D. Historical Overview of Psychiatric Care 1. Benchmarks in psychiatric history 2. Issues that affect the delivery of psychiatric care E. Mental Wellness vs. Mental Illness F. Psychotherapeutic Management in the Continuum of Care 1. Psychotherapeutic management model a. Three interventions b. DSM-IV-TR 2. Continuum of care a. Hospital-based care b. Discharge planning c. Community-based care d. Traditional outpatient services e. Intensive outpatient programs G. Psychiatric Therapy Models 1. Psychoanalytic 2. Interpersonal 3. Developmental 4. Cognitive-Behavioral 5. Stress adaptation 6. Somatic RELATED LEARNING EXPERIENCES

Define self-awareness. (4,7)* Explain the factors that influence how health care providers interact with clients. (1,2,3,5)* Discuss the influence of culture on health beliefs and practice of individuals, families, and mental health care providers. (1,2,3,5)* Discuss benefits and concerns when providing spiritual care to the client with mental health issues. (2,3)*

In Class Activity: Self Awareness Inventory Required reading: Psychiatric Nursing Unit II ­ Ch. 14, pgs. 164-170 ATI Chapter Required reading: Psychiatric Nursing Unit VI ­ Ch. 40, pg. 602 Required reading: Psychiatric Nursing Unit II ­ Ch. 15, pgs. 173-186 ATI Chapter Required reading: Psychiatric Nursing Unit I ­ Ch. 1, pgs. 2-14 ATI Chapter Required reading: Psychiatric Nursing Unit I ­ Ch. 2 & 3, pgs. 15-30 Unit II ­ Ch. 9, pgs. 109-141 Unit V ­ Ch. 27, pgs. 333-335 In Class Activity: DSM-IV-TR case study Required reading: Psychiatric Nursing Unit IV ­ Ch. 23-26, pgs. 285-337 Unit V-Ch. 29 & 34, pgs 385-392; 485-492 ATI Chapter Required reading: Psychiatric Nursing Unit I ­ Ch. 4, pgs. 33-51 ATI Chapter

Identify and discuss the events that affect the delivery of psychiatric care to the individual. (1,2,3)* Discuss the components of psychotherapy throughout the continuum of care in the delivery of psychiatric care to the individual. (1,2,3,4,5,6,7)* Discuss the DSM-IV-TR criteria used to diagnose mental illness. (1,2,4)* Discuss various therapeutic approaches used in the treatment of mental illness. (1,2,4)*

*Course Objectives

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COURSE OUTLINE UNIT OBJECTIVES CONTENT BIOLOGICAL BASIS FOR UNDERSTANDING PSYCHOTROPIC DRUGS (10 hours) A. Psychobiology 1. Study Guide B. Psychopharmacology 1. Intro a. Nursing responsibilities b. Pharmacokinetics c. Blood- brain barrier d. Neurons & neurotransmitters e. Receptors f. Client education 2. Anti-Parkinson Medications a. Parkinson's disease vs parkinsonism b. Extra-pyramidal side effects 1. Treatment 3. Antipsychotic medications a. Overview b. Classification 1. Typical 2. Atypical 3. Novel 4. Antidepressant Medications a. Biochemical theory of depression b. Selective Serotonin Reuptake Inhibitors (SSRs) c. Novel d. Tricyclic e. Monoamine Oxidase Inhibitors (MAOIs) f. Nursing Implications 5. Anti-manic Medications a. Lithium b. Anticonvulsants c. Antipsychotics 6. Anti-anxiety Medications a. Benzodiazepines b. Non-benzodiazepines

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RELATED LEARNING EXPERIENCES

Apply biological theories to the treatment of mental health. (1,2,4,6) Demonstrate knowledge of frequently prescribed medications utilized in treating mental illness. (1,4,5,6,7)* Describe the pharmacokinetics and pharmacodynamics of psychotropic medications. (4)* Describe the nurse's responsibility in administering psychotropic medications. (1,2,4)*

Required Reading: Psychiatric Nursing Unit I-Ch. 6, pg. 66-86 Required Reading: Psychiatric Nursing Unit III-Ch. 16, pg. 187-211 Study Guide In-Class Activity

Required Reading: Psychiatric Nursing Unit III-Ch. 17, pg. 203-211

Required Reading: Psychiatric Nursing Unit II-Ch. 18, pg. 212-231

Required Reading: Psychiatric Nursing Unit III-Ch. 19, pg. 232-251

Required Reading: Psychiatric Nursing Unit III-Ch. 20, pg. 252-263

Required Reading: Psychiatric Nursing Unit III- Ch. 21, pg. 264-277

*Course Objectives

COURSE OUTLINE UNIT OBJECTIVES CONTENT c. SSRIs d. Miscellaneous 7. Anti-dementia Medications a. Treatment b. Prevention C. Psychopathology 1. Mood Disorders a. Major Depression b. Dysthymic bi-polar c. Bi-Polar a. Manic episodes 2. Suicide 3. Cognitive Disorders a. Dementia 1. Alzheimer's disease c. Delirium 4. Mental Health Disorders in Older Adults a.. Psychopathology 1. Depression 2. Manic episodes 3. Psychotic disorders 4. Anxiety disorders 5. Substance abuse b Assessment 1. Psychosocial 2. Physical 3. Psychotherapeutic management c. Nursing Process RELATED LEARNING EXPERIENCES

Required Reading: Psychiatric Nursing Unit III-Ch. 22, pg. 278-284

Utilize the components of psychopathology when providing nursing care for the psychiatric client. (1,2,4,7)* Identify the characteristics of the different mood disorders. (1,2,4)* Differentiate between delirium, dementia, & Alzheimer's disorder. (1,2,4)* Describe the impact of aging in providing care to the older adult. (1,2,5,7)* Describe the role of the nurse when caring for the older adult with a mental disorder. (1,2,4,5)* Apply the nursing process in the care of the older adult with a mental disorder. (1,2,3,4,5,6,7)* Apply the nursing process in the care of selected clients diagnosed with altered thought disorders. (1,2,3,4,5,7)

Required Reading: Psychiatric Nursing Unit V-Ch. 29 & 30, pg. 367-411 ATI Chapter Client assignment Video ?

Required Reading: Psychiatric Nursing Unit V- Ch. 32, pg. 442-468 ATI Chapter Client assignment Required Reading: Psychiatric Nursing Unit VI-Ch. 43, pg. 656-679 ATI Chapter Clinical: 16 hours for Geriatric Assessment

Required Reading: Psychiatric Nursing Unit II-Ch. 9, pg.109-117 ATI Chapter

*Course Objectives

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COURSE OUTLINE UNIT OBJECTIVES CONTENT THERAPEUTIC NURSE-CLIENT RELATIONSHIPS (24 hours) A. Legal Issues 1. Types of Law 2. Civil Law 3. Commitment Issues 4. Client rights 5. Advance Directives B. Ethical Concepts 1. Model for ethical decision making C. Nurse-Client Communication 1. Interpersonal communication 2. Therapeutic communication 3. Process Recording D. Nurse-Client Relationships 1. Developing Nurse-Client relationships a. Phases b. Boundaries 2. Behavior Interventions E. Nursing Process F. Group Therapy 1. Benefits 2. Therapeutic factors 3. Group types 4. Group management issues 5. Types of clients in groups G. Working with the Family 1. Definition of Family a. Contemporary family 2. Family Assessment 3. Effects of mental illness on the family & the Individual 4. Family reactions to psychiatric treatment & Hospitalization 5. Key nursing interventions 6. Family Resources RELATED LEARNING EXPERIENCES

Discuss the legal and ethical issues related to the care of psychiatric clients. (1,2,3,5)

Required reading: Psychiatric Nursing Unit I-Ch. 5, pg. 52-65 ATI Chapter

Lecture notes Required Reading: Psychiatric Nursing Unit II-Ch. 7, pg. 87-95 ATI Chapter In Class Activity Required Reading: Psychiatric Nursing Unit II-Ch. 8, pg. 96-108 ATI Chapter Clinical: Process Recording Required Reading: Psychiatric Nursing Unit I-Ch. 12, pg. 142-151 ATI Chapter

Utilize therapeutic communication techniques when interacting with the mental health client. (1,2,3,4,5)* Demonstrate the components of a therapeutic relationship when working with the clients diagnosed with a mental health disorder. (1,2,5 ,7)*

Describe the benefits of group therapy for the client with a mental illness diagnosis. (1,2,3,7)* Identify specific interventions for management issues that arise in group therapy. (1,2,3,7)* Identify the issues families face when presented with psychiatric intervention of a family member. (1,2,3,5,7)*

Required Reading: Psychiatric Nursing Unit II-Ch. 13, pg. 152-172 ATI Chapter

*Course Objectives

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COURSE OUTLINE UNIT OBJECTIVES CONTENT H. Psychopathology 1. Stress, Anxiety, Coping & Crisis a. Stress & anxiety b. Coping with anxiety c. Relationship between anxiety & stress 2. Crisis 3. The Aggressive Client a. Anger & related concepts b. Aggression etiology c. Aggression variables d. Nursing interventions for aggression & anger e. Victims of assault: Staff members 1. Personality Disorders a. Odd-eccentric behaviors 1. Paranoid 2. Schizoid 3. Schizotypal b. Dramatic, Emotional, Erratic Behaviors 1. Antisocial 2. Borderline 3. Narcissistic 4. Histrionic c. Anxious, & Fearful Behaviors 1. Dependent 2. Avoidant 2. Somatoform, & Dissociative Disorders a. Generalized Anxiety Disorder b. Panic Disorder c. Obsessive-Compulsive Disorder d. Phobic Disorders e. Acute Stress & Post Traumatic Disorders f. Somatization Disorders g. Pain Disorder h. Hypochondrias is i. Conversion Disorder 3. Dissociative Identity Disorders RELATED LEARNING EXPERIENCES Required Reading: Psychiatric Nursing Unit II-Ch. 10, pg. 118-127 ATI Chapter

Identify the long and short term effects of stress. (1,2,3,5)* Identify the relationship between stress and anxiety. (1,2,3,5,)* Describe the differences related to anger, aggression, passive aggression, and assertiveness. (1,2,3,5)* Utilize appropriate nursing interventions when working with the individual exhibiting angry or aggressive behaviors. (1,2,3,5,7)* Discuss concepts of psychopathology and how psychopathology affects mental health. (1,2,4,6)* Identify common characteristics demonstrated by clients diagnosed with a personality disorder. (1,2)*

Required Reading: Psychiatric Nursing Unit II-Ch. 11, pg. 128-141

Required Reading: Psychiatric Nursing Unit V-Ch. 33, pg. 269-284

Required Reading: Psychiatric Nursing Unit V-Ch. 31 pg. 412-441 ATI Chapter Client assignment Video

Discuss the aspects of care for clients diagnosed with dissociative disorder. (1,2,3,4)* *Course Objectives

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COURSE OUTLINE UNIT OBJECTIVES Differentiate between the types of schizophrenia. (1,2,3,4)* CONTENT 4. Schizophrenia a. Etiology b. Management 1. Milieu 2. Therapy c. Other psychotic disorders 1. Schizoaffective 2. Delusional 3. Brief psychotic 4. Schizophreniform 5. Substance related disorders a. CNS depressants 1. Alcohol 2. Barbiturates 3. Benzodiazepines 4. Gamma Hydroxybutyrate 5. Inhalants 6. Opioids b. Stimulants 1. Cocaine 2. Amphetamines 3. Hallucinogens c. Nursing Issues d. Management e Treatment Programs f. Prescription Drug Abuse 6. Dual Diagnosis a. Definition b. Etiology c. Treatment Issues d. Psychotherapeutic Management RELATED LEARNING EXPERIENCES Required Reading: Psychiatric Nursing Unit V-Ch. 28, pg.338-366 ATI Chapter Client Assignment Video

Demonstrate knowledge of objective and subjective symptoms for substance dependence and abuse. (1,2,4,5,7)*

Required Reading: Psychiatric Nursing Unit V-Ch. 35 & 36, pg. 493-543 ATI Chapter Client Assignment

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Describe major perspectives related to the etiologies for dual diagnosis. (1,2,3,4,)*

*Course Objectives

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COURSE OUTLINE UNIT OBJECTIVES CONTENT SPECIAL POPULATIONS AND THERAPIES IN PSYCHIATRIC NURSING. (8 hours) A. Forensic Nursing B. Sexual Disorders 1. Paraphilias 2. Gender identify disorder C. Eating Disorders 1. Anorexia Nervosa 2. Bulimia Nervosa 3. Male eating disorders D. Survivors of Violence & Trauma 1. Violation 2. Terrorism 3. Torture, Ritual Abuse, & Mind Control 4. Rape & Sexual Assault a. Adult survivors of childhood sexual abuse 5. Partner Abuse E. Child & Adolescent Psychiatric Nursing 1. Diagnostic categories of child psychiatric Disorders a. Developmental b. Attention-Deficit & Disruptive Behavior c. Internalizing d. Tic e. Psychotic f. Elimination 2. Psychopharmacology a. Non-stimulants 3. Cognitive-behavioral therapy RELATED LEARNING EXPERIENCES

Describe the forensic nursing care environment. (1,2,3,4,5)* Recognize the importance of the nurse's role in assessing client's sexual concerns and problems. (1,2,3,5)*

Required Reading: Psychiatric Nursing Unit IV-Ch. 26, pg. 323-331 Required Reading: Psychiatric Nursing Unit V-Ch. 34, pg. 485-492 ATI chapter Required Reading: Psychiatric Nursing Unit V-Ch. 37, pg. 544-562 ATI chapter Required Reading: Psychiatric Nursing Unit VI-Ch. 41, pg. 603-631 ATI Chapter

Recognize the dynamics involved in interpersonal violence crimes. (1,2,3,5)*

Describe major categories of child & adolescent psychiatric problems. (1,2,4,5)*

Required Reading: Psychiatric Nursing Unit VI-Ch. 42, pg. 632-655 ATI Chapter

FINAL REVIEW (2 hours) *Course Objectives

2009 Psych Nsg Course Outline.doc KV/ss/2009

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