Review of Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum 1

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1 Review of Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum 1 May 1, 2007 Rev 5/10/07 Review of the Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum A Joint Project of the ISPN Education Council and SERPN Division, April 2005 Phyllis M. Connolly, Brenda Patzel & Hilarie Price A task force under the APNA Education Council which included, Phyllis M. Connolly, Brenda Patzel and Hilarie Price reviewed the ISPN & SERPN 2005 document with the goal of making recommendations for the support of APNA for use by its members. An extensive review of the documents and literature found on the reference list was completed to determine the congruence with the APNA goals and objectives supporting the most current recommendations and expectations for beginning professional nurses in the area of mental health and psychiatric nursing (P/MHN). Additions have been made to the document as well as some deletions based on the expertise of the reviewers as well as the most recent available literature and documents. In general the Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum (2005) published by ISPN and SERPN provides a very good framework for P/MHN curriculum for undergraduate baccalaureate nursing programs. The table format provides a readable and logical display of the material. The 3 columns are Core Nursing Content, Essential P/MHN Content and Learning Outcomes Defined as Clinical Competencies. It would be most helpful if the Table was revised so those titles appeared on all pages of the Table. There was agreement among the reviewers of this document that the curriculum may not be implemented in just one course or one semester but rather that students will be exposed to the experiences and learning across the entire BSN program. This is specifically the case in which learning outcomes are across the life span and across settings. In addition, there are clear indicators that mental health content and learning outcomes may also span across several semesters. For example, experiences with families and or groups may not occur in P/MHN settings but may occur in pediatric, maternity, and/or community as well as in acute med/surg experiences. Furthermore, patients with psychiatric disorders who have other psychical health problems are in fact treated in acute care med/surg settings which require that students and new BSN/RNs have the requisite skills to provide competent care. The ANA/APNA Standards (2006) address the trends for an increase awareness of physical health problems in the mentally ill living in the community. It is quite clear that the psychiatric/mental health nurse needs to be able to assess the physical component of the patient s health. This is a major issue in the co-morbidity area with issues like diabetes, hypertension and a number of other common disorders (Farnam et al., 1999; Getty & Knab, 1998; Huckshorn, 2007). This is not to suggest that P/MHN content and experiences should be completely integrated or diluted but to acknowledge again that all the experiences would not be possible to acquire in one theory or one psychiatric nursing clinical. Furthermore, there is a belief that psychosocial

2 Review of Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum 2 content is the core for all areas of nursing thus; areas such as therapeutic communication cannot wait until a specific P/MHN course. There is debate regarding the definitions of learning outcomes" and competencies, however this review does not attempt to settle or lay claim to either definition rather that is left to individual academic institutions. McCabe (2000) defines critical clinical competencies as behavioral reflection of the epistemology of psychiatric nursing. They are the specific, measurable behaviors that reflect and represent the standards for practice and identify the nursing action that can be expected of all psychiatric nurses (p. 113). Even though our purpose is to consider competencies that prepare generalist nurses with competencies in mental health nurses that are needed for practice, it is reasonable to consider that these competencies still reflect standards of practice and nursing action required to meet these standards as well. McCabe further asserts that the identified competencies must match practice realities. In determining competencies in psychiatric mental health nursing skills for generalist education at the baccalaureate level, it would seem necessary as well that these competencies match the realities of nursing education today. More recently, Huckshorn (2007) outlined eight core competencies of mental health staff (registered nurses, psychiatric technicians and/or aides) must have in order to improve the quality of care and service delivery in mental health settings (pp ). The proposed revised Psychiatric Mental Health Nursing in the BSN Curriculum does include those core competencies. In addition a manuscript by Hoge, Tondora & Marelli prepared as part of the Annapolis Coalition on Behavioral Health Workforce Education (2001), serves as a comprehensive resource for those wishing to explore and define competency for the purpose of education and job performance. Based on the results of a survey that Patzel, Ellinger, & Hamera (2007) conducted of APNA members who are nurse educators, the mean number of hours for BSN programs represented in the survey was hours. This raises the question of how to have competencies that meet the required education purpose but are still feasible given the limitation of hours for the experience. Thus again, core competencies must be gained through out the nursing program but are not a substitute for the discrete body of psychiatric/mental health nursing. The review of this document did include a number of articles and documents which have used a number of organizing frameworks and we have shared our observations in this preamble. The ISPN & SERPN document does differ from the Quality and Safety Education for Nurses (in press) article in which the organizing framework is Knowledge, Skills and Attitudes. However, Skills is quite similar to Learning Outcomes found in the ISPN & SERPN document. Moreover, the Cronenwett (in press) article is not specific to psychiatric mental health nursing. In the Carter et al. (2006) which is specific to public health nurses has yet another organizing framework, more definitions and suggested teaching-learning strategies. Adding teaching-learning strategies to the ISPN & SERPN document might be something to consider.

3 Review of Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum 3 Areas to consider to add to the ISPN & SERPN would be using informatics (IOM competency, Long, 2007). This could either be another area to add to the document or under 5. Clinical decision making under the Learning Outcomes j. use informatics to mitigate errors and support decision making. The ANA Standards (2006) also emphasize the need for technology to build an evidence base for practice. This would be an area where telecare, may be included. Telephone crisis services are a common method of delivery of care. Given the need for undergraduates to have the competencies identified by Kaiser et al. (2002) Carter et al. (2006) and Cronenwett (in press) the Omaha System provides students with the competencies in both the management of care and measurement of patient outcomes. Moreover, the use of the Omaha System supports practice and helps students see that their care makes a difference. The Omaha System provides a foundation for understanding the interface of physical and mental health and mental illness. In addition, ANA &APNA (2006) Standard 3, Outcomes Identification, addresses the need to identify and measure outcomes. Furthermore, the Omaha System has well documented applications for persons with psychiatric disorders living in the community (Barrera et al. 2003; Connolly, 1998; Connolly & Elfrink, 2002; Connolly et al. 1998; Connolly et al. 2006). The Omaha System is integrated into the National Library of Medicine s Metathesaurus, CINAHL, Alternative Linked and SNOMED. The System can be used collaboratively with Medicare s Outcome and Assessment Information Set (OASIS) and the ICD. The Omaha System has been linked to the International Classification of Nursing Practice, NANDA-International, Nursing Interventions Classifications, Nursing Outcomes Classification, and other terminologies (Martin, 2005, pp ) Additional suggestions for revisions to the ISPN & SERPN are found and marked within the document itself. Summary The Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum is an important document and should be made available for undergraduate baccalaureate nursing programs with the recommended additions and deletions made by this Task Force. The document would benefit from the addition of an area of use of informatics, use of technology, and the inclusion of the Omaha System in the taxonomy area. There is a need for including competency in physical assessment skills. The document could also be enhanced by adding teaching-learning strategies for each area however this will slow down the dissemination of the document. Caution must be used in expecting that all of the curriculum would be met in one or two psychiatric mental health nursing courses. Rather, all could be met within other BSN nursing courses as well as in multiple settings of care. Thank you for the opportunity to conduct this review and to make our recommendations.

4 Review of Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum 4 References American Association of Colleges of Nursing. (1993). The essentials of baccalaureate nursing education. Washington, DC: Author American Nurses Association, American Psychiatric Nurses Association, & International Society of Psychiatric Nurses. (2007). Psychiatric-Mental Health Nursing: Scope and Standards of Practice. ANA, APNA, ISPN. Washington, DC. American Psychiatric Nurses Association (1998, August). Psychiatric Mental health nurse roles in outcomes evaluation and management (Position Statement). Washington, DC: Author. Barrera, C., Machanga, M., Connolly, P. M., & Yoder, M. (2003). Nursing care makes a difference: Application of the Omaha documentation system. Outcomes Management, 7 (4), Carter Ferren, K., Kaiser Laux, K., O Hare, P. A., & Callister Clark, L. (2006). Use of PHN competencies and ACHNE essentials to develop teaching-learning strategies for generalist C/PHN curricula. Public Health Nursing, 23(2), Connolly, P. M. (1998). Omaha System: Psychiatric home care case. [On line], HYPERLINK Connolly, P. M., & Elfrink, V. (2002). Using information technology in community-based psychiatric nursing education: The SJSU/NT project. Home Health Care Management and Practice, 14 (5), Connolly, P. M., Huynh, M. T., & Gorney-Moreno, M. J. (1999, Winter). On the cutting edge or over the edge? Implementing the Nightingale Tracker. On-Line Journal of Nursing Informatics [On-Line], 3(1), Available:

5 Review of Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum 5 Connolly, P. M., Mao, C., Yoder, M., & Canham, D. (2006).Evaluation of the Omaha System in an academic nurse managed center. Online Journal of Nursing Informatics, 10(3) [online]. Available: Connolly, P. M., & Novak, J. (2000). Teaching collaboration: A demonstration project. Journal of American Psychiatric Nurses Association, 6(6), 1 8. Cronenwett, L.Sherwood, G., Barnsteiner, J.,Disch, J., Johenson, J., Mitchell, P., Sullivan Taylor, & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook. Elfrink, V. L. (1999, Winter). The Omaha System: Bridging nursing education and information technology. On-line Journal of Nursing Informatics [On-line] 3(1)Available: Elfrink, V., & Martin, K. (1996). Educating for nursing practice: Point of care technology. Healthcare Information Management, 10(2), Farnam, C. R., Zipple, A. M.,Tyrell, W., & Chittinanda, P. (1999). Health status risk factors of people with severe and persistent mental illness. Journal of Psychosocial Nursing, 27(6), Getty, C. & Knab, S. (1998). Capacity for self-care of persons with mental illness living in community residence and the ability of their surrogate families to perform health care functions. Issues in Mental Health Nursing, 19(1), Herrick, C A. & Bartlett, R. (2004). Psychiatric nurse case management: Past, present, and future. Issues in Mental Health Nursing, 25,

6 Review of Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum 6 Hoge, M. A., Tondora, J., & Marrelli, A. F. (in press?). The fundamentals of workforce competency: Implications for behavioral health. Huckshorn, K. A. (2007). Buidling a better mental health workforce 8 core elements. Journal of Psychosocial Nursing and Mental Health Services, 45(3), Institute of Medicine. (2005). Improving the quality of health care for mental and substance use conditions: Quality chasm series. Washington, DC: National Academies Press. International Council of Nurses (draft) Nursing continuum framework and competencies. Kaiser Laux, K., Carter Ferren, K., O Hare, P. A., & Callister Clark, L. (2002). Making the connections: Linking generalist and specialist essentials in baccalaureate community/public health nursing education and practice. Journal of Professional Nursing, 18(1), Long, J. (2007). The institute of medicine report health professions education: A bridge to quality. Policy, Politics, & Nursing Practice, 4(4), Mallette, C. (2003). Nursing minimum data sets. In D. M. Doran (Ed.) Nursing-Sensitive outcomes: State of the science. (pp ). Sudbury, MA: Jones & Bartlett. Martin, K.S., (2005). The Omaha System: A key to practice, documentation, and information management(2 nd ed.). St. Louis: Elsevier. McCabe, S. (2000). Bringing psychiatric nursing into the twenty-first century. Archives of psychiatric nursing, 15,

7 Review of Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum 7 McNeil, B. J. Elfrink, V. L. & Bickford, C. J. (2003). Nursing information technology, knowledge, skills, and perceptions of student nurses, nursing faculty, and clinicians: A U. S. survey. Journal of Nursing Education, 42, National Council of State Boards of Nursing. (2006). Frequently asked questions about the 2007 NCLEX-RN Test Plan. Chicago, IL: NCSBN. Patzel, B., Ellinger, P., & Hamera, E. (2007).Tomorrow s psychiatric nurses: Where are we today in providing student s clinical experiences. Journal of the American Psychiatric Nurses Association, 13(1),