Michigan State University. College of Nursing. Spring Prerequisites: NUR 300, NUR 330, NUR 340, NUR 350, PHM 350 Corequisites: NUR 360, NUR 380

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1 Credits: 4 Michigan State University College of Nursing NUR 370: Mental Health and Psychiatric Nursing Lecture/Recitation/Discussion Hours: 2 Lab Hours: 90 Spring 2006 Prerequisites: NUR 300, NUR 330, NUR 340, NUR 350, PHM 350 Corequisites: NUR 360, NUR 380 Faculty Course Coordinators Kathleen Gaskill Bappert Gretchen Gauck Dubes Office Hours by appointment Clinical Instructors U-M Elaine Tetreault (734) (M) eetina2@yahoo.com Page 1 of 41

2 Pine Rest Gretchen Gauck-Dubes (616) (H) (616) (M) St. Lawrence Mary Moretto ((517) (H) (517) (M) Foote Kathleen Bappert (517) (H) (517) (M) Frequently Called Telephone Numbers/People: Media Lab: Life Sciences; College of Nursing; A221 Life Sciences: Class Meeting Day, Time, Location Thursdays, 10:20 12:10, Room A107 The first clinical orientation day will be on January 9, 8 am to 1 pm in room A131. The second clinical day will also be on campus, in B205: on January 18 th 8-2 for students assigned to Wednesday clinicals, and January 23d 8-2 for students assigned to Monday clinicals. Clinical assignments in the hospital will begin on January 25 (Wednesday students) or January 30 (Monday students.) Course Description This course is an extension of foundational social science concepts into nursing therapeutics aimed at mental health and the care of persons with mental illnesses. Medication and non-medication interventions, group interventions, and therapeutic environments will be studied and demonstrated. Page 2 of 41

3 Level II Outcomes and Competencies The CON has defined the following competencies that must be achieved by all students in Level II before progressing onto Level III. At the end of Level II, all students will achieve the objectives and competencies listed below, as well as the bolded indicators specific to this course. All indicators, as well as clinical performance behaviors, clinical assignments and the theory grades must be at 75% to proceed onto the next level. NURSING THERAPEUTICS II Analyzes data in the delivery of targeted nursing care to persons and populations. Competencies 1. Obtains a focused assessment by gathering and using data from a variety of sources to identify and prioritize nursing needs. 2. Apply theoretical and evidence principles to develop, implement, and evaluate an individualized, prioritized plan of care. Indicators 1. Develop and present concept map showing the relationship between patient data and theoretical principles that support the plan of care; include baseline data, interventions, evaluation, and clinical observation that would support Dx and prioritization of DX combined. (Concept map to reflect theories such as Biology, Orem, Family, Pain, Erikson, etc.) credible sources (also EVIDENCE-BASED PRACTICE and CRITICAL THINKING; NUR 360) ILLNESS AND DISEASE MANAGEMENT II Apply understanding of theories and principles in coordinating the care necessary for the management of illness and disease Competencies 1. Based on desired outcomes, determines care management needs of the individual (i.e. clinical pathways). 2. Identify a variety of barriers and resources that affect client outcomes and delivery of care. Indicators 1. Interview a member from a vulnerable population; develop a concept map for a individual/family client from that vulnerable/ethnic population that identifies socio-demographic (age, culture, SES) characteristics that influence the focal health problem, including possible health disparities related to the focal problem, and develop an appropriate risk reduction and/or health promotion diagnoses and intervention plan for the client. Include analysis of issues related to access and barriers to the health care system (Also GLOBAL AND CULTURAL COMPETENCE and HEALTH PROMOTION AND RISK REDUCTION; NUR 360/370) PROFESSIONAL LEADERSHIP II Value the contribution of nursing leadership and roles for the delivery of nursing care to persons and populations in health care settings. Competencies 1. Examine how nursing leadership roles and strategies affect health care quality 2. Collaborate with multiple disciplines in providing client care. Indicators 1. Student led case example from clinical of nurse demonstrating leadership characteristics, the impact and importance (NUR 380) ETHICAL PRACTICE II Apply ethical problem solving in their nursing care. Competencies 1. Accurately identify and characterize ethical problems arising in the care of clients 2. Identify barriers to and resolutions for client self-determination Indicators 1. Scholarly case analysis paper on ethical issue related to a clinical topic with 5 professional (tier 2 writing NUR 380) references using APA format. Successful evaluation will include identification of the components Page 3 of 41

4 of ethics; select appropriate strategies of identification and resolution of the dilemma formulate and defend management (NUR 380) 2. Case problem identification and characterization of an ethical problem within clinical practice (Clinical activity in both NUR 360 and 370) COMMUNICATION II Apply interactive processes in relating to persons, populations, and colleagues. Competencies 1. Demonstrates effective communication skills in nurse-client and professional interactions 2. Demonstrate ability to communicate in writing with a variety of audiences. Indicators 1. Satisfactory completion of two process recordings (NUR 370) HEALTH PROMOTION AND RISK REDUCTION II Apply basic concepts and theories to the development of health promotion plans for persons (individual/family). Competencies 1. Compare and contrast major health indicators in cultural/ethnic groups 2. Assess and address factors that place individuals and families at risk. Indicators 1. Combined with other concepts GLOBAL AND CULTURAL COMPETENCE II Investigate the relevance of global, cultural and socioeconomic factors to health and wellness of persons and populations. Competencies 1. Analyze the importance of global and cultural factors on perception of health and illness 2. Implement nursing interventions that reflect understanding of diversity Indicators 1. Combined with other concepts CRITICAL THINKING II Analyzes critical thinking processes in their nursing practice. Competencies 1. Demonstrates ability to compare and contrast textbook and relevant literature concerning selected patient issue (disease management, risk reduction, health promotion, health teaching) with patient assignment. 2. Takes initiative to plan creatively to meet patient goals. Indicators 1. Combined with other concepts EVIDENCE-BASED PRACTICE II Applies theory and research in planning care that prevents or intervenes in illness and disease. Competencies 1. Formulates and manages nursing interventions that are based on theory and research. Indicators 1. Combined with other concepts Page 4 of 41

5 Course Objectives At the end of this course the student will: 1. Apply intermediate-level communication skills with people experiencing mental health deviations 2. Critique and value the impact of her/his critical thinking process used in their psychiatric and mental health nursing practice 3. Interpret data in the delivery of targeted nursing care to persons and populations with mental health deviations 4. Analyze the interactions between individual factors and societal forces, and cultural and socioeconomic factors on mental health 5. Analyze and apply theory and data for the care management for mentally ill persons and populations 6. Evaluate the multidisciplinary roles in the care of persons and populations with mental illness 7. Analyze ethical issues related to the care of persons and populations with mentally illness 8. Examine theory and research related to the prevention and treatment of mental illness Required Texts Arnold, EN and Boggs, KU. (2003). Professional Communication Skills for Nurses (4th Edition). W. B. Saunders (ISBN: ). Stuart, G. and Laraia, M. (2005). Principles and Practice of Psychiatric Nursing (8 th Edition). Mosby, Inc. (ISBN: ) Instructional Model NUR 370 is a 4-credit course that includes theoretical, lab and clinical components. This course introduces the beginning nursing student to the concepts and skills related to mental health and psychiatric nursing across the life span. Two hours per week are designated for theory content. Theory content will be presented through lecture, small group discussion, independent viewing of media, and group assignments. The completion of assigned readings and media prior to each class is necessary to facilitate comprehension, understanding and integration of content vital to this course. Six hours a week are designated for lab/clinical study. The lab content of the course will be front loaded with the students utilizing clinical time initially in the simulation lab to expand and evaluate interpersonal skills. The clinical practicum will provide immersion with acutely ill adults and children. Page 5 of 41

6 Evaluation/Grading Scale Standard College of Nursing grading scale will be utilized to report course grades. Percentages will be rounded to the nearest whole number before a grade point is assigned. Points > 0.5 will be rounded up. See Clinical Performance Evaluation form for further clarification of grade determination % % % % % % % 1.0 <64% 0 Fifty percent of the course grade is based on the theory portion of this course and the other 50% of the course grade is based on the clinical portion. The theory grade will be based on quizzes and exams. In addition to the theory quizzes and exams, the students will be responsible for completion of one standardized examination from Educational Resources, Inc. (Mental Health Nursing). A score at or above the national average will result in ½% point added to the course examinations. Students must receive a passing score on the theory examinations to receive the additional points from the ERI examination. Students receiving below national average scores on the exam are be required to complete remediation materials. All documentation and scores for ERI will be maintained by students in their portfolio and monitored by the Integrative Seminar faculty. The specific breakdown of all of the evaluation activities are included below. Theory portion of the course The theory portion of the grading is based on medication quizzes and exams. Medication quizzes are open book and taken on line. Three exams and a cumulative final exam will consist of NCLEX-style questions which test students abilities to apply theory to case situations. Class time will be given for the exams. Evaluation Activities Percent of theory grade Medication quizzes (3) 15 Exam 1 20 Exam 2 20 Exam 3 20 Final Exam 25 Page 6 of 41

7 Clinical Portion of the course The lab/clinical grade will further be divided into assignments and clinical performance. Assignments will include two complete nursing care plans, two process recordings, an ethics presentation, and a vulnerable population presentation. 60% of the clinical grade will be based on these four assignments. The clinical performance portion of the clinical grade is calculated using the clinical performance tool. 40% of the clinical grade will be calculated using the clinical performance tool. Penalties for late assignments will be assessed at 5% per day. University, CON, and Course Policies A. Attendance Page 7 of 41 Assignment Percent of clinical assignment grade 2 Nursing Care Plans 40 2 Process recordings 30 Ethics detective post conference report 10 Vulnerable populations concept map and 20 report 1. Nursing is a professional program and attendance is an expectation ATTENDANCE AT CLINICAL ORIENTATION IS REQUIRED. If you are unable to attend related to an emergency or serious illness, notification of the clinical instructor must be made prior to the clinical experience time. Failure to assume responsibility and accountability for clinical attendance will result in the student being be individually counseled and reported to the Course Chair and Office of Student Affairs. Excessive absence and/or tardiness, or a perceived pattern of absences or tardiness may result in a 0.0 being awarded for the course. If a message is left on voice mail or an answering machine, it is the students responsibility to follow up the recorded message with a personal conversation within 48 hours. 2. Attendance for clinical is required. Make-up clinical hours will be negotiated with the clinical faculty. B. Examinations Examinations will be given during course periods. Students arriving late will have the scheduled time for completion of the exam. All students are expected to take examinations on the date scheduled, unless prior arrangements are made with the course faculty. For emergency situations, students are to contact faculty as soon as possible. If unable to contact faculty, call College of Nursing office and leave a message regarding the reason for absence. It is the student s responsibility to reach faculty as soon as possible following the examination to make arrangements to take an alternate examination. There will be one opportunity for an alternative exam. Alternate exams may use with additional formats (essay, fill in the blank, etc.). Make-up exams are routinely scheduled within one week of the original exam date. Health providers statements may be required. Questions regarding examination grades will be put forward within two weeks of the exam date. Alterations will not be made after this time.

8 C. Communication & Student Mailboxes: All students are expected to check their and student mailboxes (in the Student Lounge) to retrieve course information. Student paperwork will be returned on a timely basis and placed in the mailboxes or handed back in lecture or clinical setting. is for the sole purpose of conveying constructive, positive course and nursing information ONLY and is a privilege. Any student utilizing this service to convey personal opinion, pass on chain letters, advertising or unauthorized statements will be reported to the Director of the Office of Student Affairs and the Associate Dean for Academic Affairs and dealt with on an individual basis. Inappropriate use may result in the individual being removed from the class list, and any other actions determined necessary by the Course Chairperson and College of Nursing administrators. Student Faculty Relationship It is expected that a professional, courteous, positive demeanor will be exhibited to peers, faculty and College of Nursing staff with each encounter. It is expected that you will be on time to theory and clinical. If for some reason you have to be late or leave early, the course coordinator or your clinical instructor should be notified and plans will be made so you will not disturb the entire class. Talking, reading the newspaper, surfing the net and sleeping are considered disrespectful during lecture. Cell phones are to be turned off during class and clinical time. Asking questions and requesting clarification of information is highly encouraged as student input is valued and worthwhile. Timeliness, honesty and integrity, a positive attitude, assertive communication skills and motivation are some of the personal skills that one should be developing, or refining, during nursing school. These positive skills will be utilized in your three years at the College of Nursing and in your chosen profession. Refer to MSU Spartan Life Handbook and College of Nursing BSN Handbook for Policies regarding: 1. Academic Dishonesty 2. Taping and communication devices 3. Weather 4. Protection of property/computers 5. Protection of Scholarship and grades 6. SIRS 7. Clinical Attire/dress code 8. Disabled Student Page 8 of 41

9 Date 10:20 12:10 January 12 Class Schedule and Theory Assignments Content Faculty Psychopharmacology content, readings and quizzes History of Mental Health Care in the US Asylum video in class Legal/Ethical Issues Bappert Assignments Readings are from Stuart and Laraia, 8 th edition Chapter 1 Chapter 8 Chapter 10 January 19 Theoretical Models: Psychoanalytical Interpersonal (Peplau) Supportive Bappert Chapter 3 January 26 Therapeutic Interventions: Milieu Group Cognitive Behavioral Bappert Take Med Quiz One on line by midnight, February 1 Introduction to meds: Chapter 27 ( ) Chapter 28 ( ) Chapter 30 ( ) Chapter 31 Chapter 32 Chapter 34 ( ) No Class: Voice Over Power Point View on Angel this week February 2 Persons with impaired reality testing Bappert Take Med Quiz Two on line by midnight, February 8 Anti-psychotic medications: Chapter 27 ( ) Chapter 15 Chapter 21 Chapter 35 ( ) February 9 February 16 Persons with disrupted relationships Persons with disrupted mood and suicide Dubes Take Med Quiz Three on line by midnight, Chapter 22 February 15 Anti-anxiety: Chapter 27 ( ) Anti-depressants: Chapter 27 ( ) Mood stabilizers: Chapter 27 ( ) Bappert Chapter 19 Chapter 20 February 23 Exam One Special needs of populations: Elderly Bappert Dubes Cholinesterase inhibitors Chapter 23 (465) Chapter 23 Chapter 38 Page 9 of 41

10 March 2 March 9 Special needs of populations: Children and Adolescents Spring Break Dubes Stimulants used in ADHD Chapter 36 ( ) Chapter 36 Chapter 20 Chapter 25 Chapter 37 March 16 Substance abuse Dubes Chapter 24 March 23 Exam 2 Domestic Violence Dubes Chapter 39 March 30 Persons with Anxiety Bappert Chapter 16 April 6 Family Therapy Tetreault Chapter 11 Chapter 33 April 13 Homelessness Crisis Intervention April 20 Exam Three Bappert Dubes April 27 Review for Final Exam Bappert Dubes Tetreault Chapter 35 Chapter 14 Chapter 15 Finals Week Date TBA Final Exam (Cumulative) Bappert Dubes Page 10 of 41

11 Clinical Calendar All students will participate in lab on Campus the first two dates, January 9 and either January 18 (Wednesday students) or January 23 (Monday students) Participation is required Clinical Day One January 9 Five Hours 8-1 Orientation to the course Introduction to Major Mental Disorders Stuart s Stress Adaptation Model Lecture Mental Status Exam Lecture Psychiatric Focused Care Plans introduction and practice mental status exams Chapter 4 Chapter 16 only fig Chapter 19 only fig Chapter 21 only fig Chapter 7 Bring a copy of the syllabus Bring textbooks Bring copy of psychiatric care plan from syllabus Clinical Day Two January 18 or January 23 Six hours 8-2 Therapeutic Communication Skills Lecture Videos on communication (in class) Process Recordings introduction Meet with clinical faculty From Stuart and Laraia Chapter 2 From Stuart and Laraia Bring textbooks Bring copy of process recording form from syllabus Clinical Days Three through 15 Clinical Assignments in Inpatient Psychiatric Units Page 11 of 41

12 Guidelines for Clinical Performance and Clinical Assignments Fifty percent (50%) of the grade in NUR 370 is based on clinical performance and clinical assignments. The other fifty percent (50%) is based on scores achieved in the theory portion of the course. The clinical performance portion is worth forty percent (40%) of the clinical grade. It will be calculated using the clinical performance rating form. Clinical instructors will meet with students at midterm to discuss the students performance and then at the end of the term to give students their clinical grades. Students may bring to both sessions their own self evaluation using the clinical performance behavior worksheets and the clinical performance rating form for purposes of discussion. Bolded and starred items on the worksheets indicate items which are most likely to be demonstrated in the psych/mental health setting. CLINICAL PERFORMANCE BEHAVIOR WORKSHEETS 1. DEMONSTRATES CARING TO FACILITATE SPIRITUAL, MENTAL AND PHYSICAL HEALTH: 1) Shows respect, sensitivity, and concern for the welfare of clients, staff, faculty, and peers. * 2) Exhibits caring body language that expresses empathy and a connection with others. 3) Plans & organizes care with sensitivity and compassion to individual client needs. * 4) Fosters strategies for health promotion, disease prevention, and risk reduction. 5) Promotes self-care in clients. * 6) Initiates therapeutic relationships. 7) Fosters spiritual dimensions or addresses spiritual needs of clients or others. * 8) Assists clients with coping mechanisms. 9) Protects the client s safety & privacy, and preserves human dignity while providing care. 10) Adheres to all components of the HIPAA regulations. 11) Assists clients to achieve a peaceful end of life. 3 Expected Category Mean Score at Level II in Psych 2. DEMONSTRATES SELF AWARENESS IN PURSUING LEARNING OPPORTUNITIES TO ENHANCE PROFESSIONAL DEVELOPMENT AND DELIVERY OF NURSING CARE: 1) Exhibits progressive socialization toward professional nurse status, observing and emulating nurse role models and inculcating professional values ( engaged ). * 2) Seeks learning opportunities and resources to develop competence in practice. * 3) Honestly and accurately evaluates personal performance. * 4) Responds professionally to feedback or correction. * 5) Makes changes to improve practice. 3 Expected Category Mean Score at Level II in Psych 3. DEMONSTRATES EFFECTIVE COMMUNICATION: 1) Produces clear, relevant, organized, and thorough writing. 2) Exhibits legally accurate and appropriate documentation. * 3) Recognizes and uses appropriate medical terminology and abbreviations. * 4) Uses various forms of communication in an effort to increase understanding. * 5) Uses clear and open expression in dialogue, and is engaged with person or audience. 6) Elicits preferences and values from clients, and clarifies understanding. * 7) Exhibits professional and therapeutic body language. * 8) Listens attentively & respectfully without interruption or disruption. Page 12 of 41

13 Page 13 of 41 * 9) Maintains self control & dignity, and responds professionally, to situations without blame or aggressive behavior. 4 Expected Category Mean Score in Level II Psych 4. USES PROFESSIONAL COLLABORATION IN THE MANAGEMENT AND DELIVERY OF HEALTH CARE: 1) Distinguishes among the roles, responsibilities, and scope of practice of nursing and other health care team members, for purposes of improving the health of clients. 2) Shares research and experiences at clinical conferences. 3) Contributes insight & helpful information to health care team, and in group conferences. 4) Actively participates in decision-making process with faculty, staff, clients, and peers. * 5) Is sensitive to the learning needs of the group, and contributes accordingly. * 6) Is helpful in group dynamics & team-building, fostering collegiality and encouraging cooperation. * 7) Is respectful, courteous, and approachable in interactions. * 8) Recognizes and accepts diverse thinking. 2 Expected Category Mean Score in Level II Psych 5. EXHIBITS ACCOUNTABILITY, INTEGRITY AND HONESTY & IN NURSING PRACTICE: 1) Follows the ANA Standards of Care for Clinical Practice. 2) Follows policies and procedures of agencies. 3) Reflects awareness of the context and scope of nursing practice, and is mindful of own limitations, demonstrating knowledge of when and how to ask for help. * 4) Adheres to the MSU CON Honor Code. * 5) Assumes responsibility & accountability for own actions & practice. * 6) Follows through on commitments and tasks. * 7) Completes tasks and assignments thoroughly. * 8) Completes tasks and submits assignments on time. 9) Is prepared, flexible, and fair. 10) Corrects wrong or incorrect situations; seeks to remedy errors (by self or others). * 11) Is professional in appearance, manner and conduct. * 12) Is consistently punctual and reliable. 4 Expected Category Mean Score in Level II Psych 6. USES THE TEACHING/LEARNING PROCESS IN PROVIDING HEALTH EDUCATION: * 1) Identifies learning needs of clients and their families through appropriate assessment. 2) Collaborates with clients and their families in achieving the educational goal(s). 3) Considers environmental conditions and the setting in order to optimize learning. 4) Considers developmental and educational level in teaching. 5) Specifies appropriate and reasonable outcome measures. 6) Uses various forms of communication to disseminate information. * 7) Applies theoretical knowledge with rationale when teaching. 8) Provides time for questions. 9) Completes process by validating if learning took place (evaluates outcomes). 10) Provides prompt feedback. 11) Modifies teaching methods if needed. 2 Expected Category Mean Score for Level II Psych 7. ACTS AS AN ADVOCATE FOR THE CLIENT AND HEALTH CARE PROFESSION: * 1) Seeks to assist with the needs of others, especially the vulnerable. 2) Honors and promotes the rights of clients and others. * 3) Provides resources to empower clients, and assist them to make informed choices.

14 4) Initiates appropriate referrals for clients and/or their families. 5) Identifies economic, legal, and political factors that influence health care delivery. 6) Upholds agendas that enhance high quality and cost effective care. 7) Encourages legislation & policy consistent with advancement of nursing & health care. 8) Recognizes need for change (client/organization), responds by taking appropriate initiative/action. 3 Expected Category Mean Score in Level II Psych 8. DEMONSTRATES AWARENESS OF, AND SENSITIVITY TO THE VALUES & MORES OF CLIENTS IN ETHICAL DECISION MAKING: * 1) Recognizes variations in culture and human diversity. * 2) Identifies and respects differences in values and beliefs. * 3) Provides culturally sensitive and appropriate care. 4) Recognizes differences in ethical beliefs, perspectives, and options in health care. 5) Recognizes the role of nursing in ethical decision making in health care. 6) Upholds the Ethical Code for Nurses. 7) Is non-judgmental 2 Expected Category Mean Score in Level II Psych 9. DEMONSTRATES LEADERSHIP SKILLS IN NURSING PERFORMANCE: 1) Conveys a clear vision of what needs to be done. 2) Takes charge of situations and facilitates solutions. 3) Copes appropriately and in positive ways. 4) Exhibits a high level of competency in knowledge and skill. * 5) Conveys confidence in knowledge and skill, sincerity, and enthusiasm. * 6) Empowers and inspires others to do their best. 2 Expected Category Mean Score in Level II Psych 10. DEMONSTRATES CRITICAL THINKING IN THE PROMOTION OF HOLISTIC HEALTH OF INDIVIDUALS, FAMILIES AND COMMUNITIES: 1) Integrates theory and research-based knowledge from the behavioral, biological and natural sciences to critically analyze and interpret information. * 2) Gathers appropriate data for assessment. * 3) Identifies appropriate nursing diagnoses, goals, and outcome criteria. 4) Recognizes pathological processes and problems when they arise, and intervenes appropriately. 5) Exhibits an accurate understanding of the expected effects, and possible complications that could result from interventions (including medications). 6) Makes appropriate judgments and sound decisions in the management of care, based on a clear and accurate understanding of the rationale. * 7) Evaluates effectiveness of achieving outcomes, and modifies appropriately. 8) Integrates the principles of primary health care in the delivery of care. 9) Uses research findings to enhance and improve clinical practice. 3 Expected Category Mean Score in Level II Psych 11. PERFORMS SKILLS IN A COMPETENT AND EFFICIENT MANNER: 1) Performs nursing skills and therapeutic procedures safely, accurately, and with dexterity. 2) Demonstrates proper use of and care for therapeutic tubes, drains, and devices. 3) Demonstrates an accurate understanding of, and competence in, the use of technical equipment. 4) Calculates medication dosages by all routes accurately. 5) Administers medications by all routes safely. 6) Uses proper safety techniques & precautions (such as call systems, identification procedures, Page 14 of 41

15 restraints, and fire, radiation & hazardous materials protection) when providing care. 7) Recognizes hazards and acts appropriately. 8) Uses the latest information technologies. 9) Manages time efficiently and effectively. 10) Organizes and prioritizes delivery of care and other nursing responsibilities and tasks appropriately. 11) Delegates tasks appropriately, safely and effectively based on experience, education, and licensure status (may be to student peers, nursing team, family members, or lay persons). List the skills you think are important for a psychiatric/mental health nurse: 2 Expected Category Mean Score in Level II Psych Page 15 of 41

16 Page 16 of 41 CLINICAL PERFORMANCE RATING SCALE SELF DIRECTED (4) ALMOST NEVER REQUIRES ALMOST ALWAYS EXHIBITS (10% or < of the time) (90% or > of the time) * direction * a focus on the client or system * guidance * accuracy, safety, and skillfulness * monitoring * assertiveness and initiative * support * efficiency and organization * an eagerness to learn SUPERVISED (3) OCCASIONALLY REQUIRES VERY OFTEN EXHIBITS (25% of the time) (75% of the time) * direction * a focus on the client or system * guidance * accuracy, safety, and skillfulness * monitoring * assertiveness and initiative * support * efficiency and organization * an eagerness to learn ASSISTED (2) OFTEN REQUIRES OFTEN EXHIBITS (50% of the time) (50% of the time) * direction * a focus on the client or system * guidance * accuracy, safety, and skillfulness * monitoring * assertiveness and initiative * support * efficiency and organization * an eagerness to learn NOVICE (1) VERY OFTEN REQUIRES OCCASIONALLY EXHIBITS (75% of the time) (25% of the time) * direction * a focus on the client or system * guidance * accuracy, safety, and skillfulness * monitoring * assertiveness and initiative * support * efficiency and organization * an eagerness to learn DEPENDENT (0) ALMOST ALWAYS REQUIRES ALMOST NEVER EXHIBITS (90% or > of the time) (10% or < of the time) * direction * a focus on the client or system * guidance * accuracy, safety, and skillfulness * monitoring * assertiveness and initiative * support * efficiency and organization * an eagerness to learn Permission required for use, Dr. S. Holaday 08/05

17 1. DEMONSTRATES CARING TO FACILITATE SPIRITUAL, MENTAL & PHYSICAL HEALTH: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) Category Mean Score CLINICAL PERFORMANCE RATING FORM 8. DEMONSTRATES AND HEALTH CARE AWARENESS PROFESSION: OF, AND SENSITIVITY TO VALUES & MORES OF CLIENTS IN ETHICAL DECISION MAKING: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) 2. DEMONSTRATES SELF-AWARENESS IN PURSUING LEARNING OPPORTUNITIES TO ENHANCE PROFESSIONAL DEVELOPMENT AND DELIVERY OF NURSING CARE: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) Category Mean Score 3. DEMONSTRATES EFFECTIVE COMMUNICATION: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) Category Mean Score 4. USES PROFESSIONAL COLLABORATION IN MANAGEMENT & DELIVERY OF HEALTH CARE: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) Category Mean Score 5. EXHIBITS ACCOUNTABILITY, INTEGRITY, AND HONESTY IN NURSING PRACTICE: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) Category Mean Score 6. USES THE TEACHING-LEARNING PROCESS IN PROVIDING HEALTH EDUCATION: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) Category Mean Score 7. ACTS AS AN ADVOCATE FOR THE CLIENT AND HEALTH CARE PROFESSION: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) Category Mean Score 9. DEMONSTRATES LEADERSHIP SKILLS: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) Category Mean Score 10. DEMONSTRATES CRITICAL THINKING TO PROMOTE HOLISTIC HEALTH OF INDIVIDUALS, FAMILIES & COMMUITIES: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) Category Mean Score 11. PERFORMS SKILLS IN A COMPETENT AND EFFICIENT MANNER: Self-Directed (4) Supervised (3) Assisted (2) Novice (1) Dependent (0) Category Mean Score SCORE FOR CLINICAL PERFORMANCE CLINICAL PERFORMANCE GRADE POINT Permission required for use, Dr. S. Holaday 8/05 100% = 30 75% = 22.5 Student Signature Faculty Signature Date Category Mean Score Page 17 of 41

18 Clinical Assignments Clinical assignments will include two complete nursing care plans, two process recordings, an ethics presentation, and a vulnerable population assignment. Sixty (60%) of the clinical grade will be based on these four assignments. Clinical assignments are described below. A. Nursing Care Plans (40%) (2) (pp ) Each day in the clinical setting, students will use the psychiatric nursing care plan template to organize information they learn about their assigned patient and apply the nursing process. Students will turn in portions of the nursing care plan each clinical day to the clinical instructor for review and critique. It is not expected that all parts of the care plan are completed each clinical day. Students will choose a few sections each day to gain competency in those areas. By the end of the semester, students will turn in two complete nursing care plans which will be graded using the clinical synthesis rubric. B. Process Recordings (30%) (2) (pp ) A process recording is a systematic method of collecting, interpreting, analyzing, and synthesizing data collected during a nurse-client interaction. The major purpose of doing a process recording is to critically analyze communication and its effects on behavior to modify subsequent behavior, resulting in improved quality of therapeutic communication and psychiatric nursing care. Each process recording is comprised of five (5) components. Students should prepare process recordings using as a guideline the copy of the form that is provided. By the end of the semester, students will turn in two complete process recordings which will be graded using the process recording rubric. C. Ethics Detective Assignment and Oral Presentation (10%) (1) (p. 36) Students will accurately identify and characterize an ethical problem arising in the care of clients in the psychiatric nursing setting. Students will prepare and deliver an oral presentation to their classmates during clinical time. The assignment will be graded using the ethics presentation rubric. D. Vulnerable Population Assignment and Oral Presentation (20%) (p. 38) Students will identify a member of a vulnerable population group in their clinical settings. They will identify socio-demographic characteristics that influence that client s health problem, including possible health disparities known to affect their population group. Students will then develop nursing strategies that address those issues; interventions may be at the individual, family or community level. They will make an oral presentation to their classmates during clinical time that includes a concept map with nursing diagnosis, all relevant facts and proposed intervention strategies. The assignment will be graded using the health promotion presentation rubric. Page 18 of 41

19 Michigan State University College of Nursing NUR 370 Psychiatric Nursing Care Plan Student Name Unit Date Demographic Data Patients initials Marital Status Gender Current Age Occupation Referral Source Race Place of residence Voluntary Involuntary Chief Complaint (pts statement): Admission date and reason for Admission : Pathophysiology and Relationship to Diagnosis Medical Diagnosis: List DSM Psychiatric Diagnoses Axis I Axis II Axis III Axis IV Axis V Axis I Diagnosis Definition/Pathophysiology Page 19 of 41

20 Etiology: Signs/Symptoms: Medical Treatment: Health History (Including past psychiatric hospitalizations when/where; history of counseling; legal issues; Family History of Mental Illness: Depression, Anxiety, Schizophrenia, Suicide, ADHD, Substance Abuse,Alcohol Abuse) History of Present Illness Page 20 of 41

21 Health Pattern Patient Parameters Client s Description of General Health: Patient Data Health Perception/Health Management Health Practices (physicals, age specific tests, safety in the workplace/home): *Risk Assessment: Previous attempts: Suicide Risk: Plan Self Harming Behaviors: cutting, restricting food Home meds: Compliant/Noncompliant Use of ETOH, tobacco, other substances: cocaine, heroin, over the counter drugs, amphetamines, hallucinogens, prescription drugs Client s perception of hospitalization: Discharge planning: Nutritional/Metabolic Usual dietary pattern (special diet at home, typical daily food/fluid intake): Appetite, N and V: Ability to maintain present weight (recent changes): Diet in hospital: Eating Disorder (anorexia/bulimia) Lab and diagnostics Height/weight: Page 21 of 41

22 Health Pattern Elimination Patient Parameters Normal bowel and bladder patterns (difficulties, incontinence, use of laxatives constipation): Patient Data Usual daily activities/exercise pattern (satisfaction with level of activity,): Hobbies/interests: Activity/Exercise Ability to perform self-care (bathing, grooming, toileting): Mobility aids: Ability to perform home maintenance: Energy Level: (quantify low, moderate, high): Attending groups: Normal pattern of sleep: Sleep/Rest Sleep aids used: Does client feel rested? Difficulty while hospitalized: Page 22 of 41

23 Health Pattern Cognitive/Perceptual Patient Parameters Psychosocial/developmental level: Level of education achieved: Mental Status Exam: *Appearance and Behavior (dress, grooming, posture,gait, attitude toward interviewer) *Eye contact *Speech *Affect *Mood *Thought Process Content Perceptual Disturbances *Hallucinations (Auditory or Visual) *Delusions (paranoid, delusions of persecution, somatic) Insight (understanding of illness and hospitalization) Patient Data Judgment Client s view of self: Self-Perception/Self-Concept Effects of hospitalization on client s life: Support system: Who relies on you? Anxiety (quantify mild, moderate, or severe): Page 23 of 41

24 Health Pattern Patient Parameters Describe roles/responsibilities (parent, spouse, coworker, etc.): Patient Data Members of household: Dependents: Role/Relationship Children and where they live: Quality of relationships: Safety/abuse (exposure to violence or trauma): Occupational concerns: Concerns about sexual relationship: Sexual Orientation/preference: Sexuality/Reproductive Changes in libido: Last menstrual period: Pregnancies/live births/abortions (spontaneous or surgical); complications: Questions related to health promotion (SBE, Pap, STE, risk for STD): Labs and Diagnostics: Page 24 of 41

25 Health Pattern Coping/Stress Tolerance Stressors identified: Coping mechanisms: Patient Parameters Have family/friends been informed of hospitalization? Patient Data Source of hope and strength: Value/Belief Religious affiliation: Religious/spiritual practices: Cultural influences/belief pattern: Page 25 of 41

26 Primary Nursing Diagnosis: Goals: Expected Outcomes: Nursing Interventions/Rationales 1. Evaluations of Interventions 2. Page 26 of 41

27 3. 4. Impression: (Include whether or not your expected outcome was achieved.) Prioritized Nursing Diagnoses (Include Five Additional Nursing Diagnoses) Page 27 of 41

28 Patient Medication Worksheet (Psychotropics Only) Student Name Date Patient Initials Allergies Generic/Trade Name Normal Dose (Range)/ Patient s Prescrib ed Dose Times and Routes Mechanism of Action (Neurotransmitters involved) Contraindications/ Major Side Effects - Nursing Considerations/Teaching Page 28 of 41

29 Education Focus Nursing Care Plan Worksheet Learner Objectives Information to be Taught Teaching Method and Tools Evaluation of Learning Page 29 of 41

30 Criteria Description of patient, presenting complaint Discussion of Pathophysiology 4 Accomplished Clear and concise descriptions of pertinent demographic data and chief complaint. Presents pathophys in clear, concise manner; demonstrates synthesis of information. Clinical Synthesis Tool 3 Proficient Descriptions adequate but some pertinent data missing or unclear. Most key issues are presented but missing some important factors. 2 Developing Descriptions adequate but poorly differentiates pertinent and non-pertinent Pathophys minimal Poor synthesis of information. 1 Novice Descriptions inadequate limited inclusion of pertinent data. Unable to present concise pathophys related to chief complaint. Comprehensive case presentation History Health Patterns Concept Map Medication Worksheet Nursing Diagnoses Provides all pertinent signs, symptoms and treatment in systematic approach Includes all pertinent history, differentiating history and history of current illness Provides all significant assessment data, including pertinent negatives Concept map contains all appropriately prioritized diagnoses or problems, with relevant supporting data and logical connections/ interactions All medications presented accurately and completely Concise description of most relevant nursing diagnoses. Lists most common signs, symptoms, and treatment. Presents most of pertinent history and history of current illness Provides most significant assessment data,, but does not address pertinent negatives Concept map contains most diagnoses or problems appropriately prioritized, with some relevant supporting data and logical connections/ interactions Most medications presented accurately and completely Concise description of nursing diagnoses but not most relevant. Lists some signs and symptoms but not well organized. Treatment limited. Partial health history and history of current illness Provides some assessment data, few to no pertinent negatives Concept map contains limited diagnoses/problems or inappropriate prioritization, with some relevant supporting data Some medications presented accurately and completely Identifies most obvious nursing diagnoses only. Limited inclusion of signs, symptoms or treatment. Unable to present and differentiate health history and current history Inaccurate or lacking relevant assessment data in most sections. Concept map contains inappropriate diagnoses/problems, with limited relevant supporting data Limited number of medications presented accurately and completely Limited discussion of nursing diagnoses. Nursing Care Plan Well-focused and realistic desired outcomes. Sound rationale for interventions. Focused nursing care but some outcomes not always realistic Rationale adequate.. Limited scope of nursing care plan with limited rationales. Poorly focused nursing care plan. Outcomes or rationales not supported by science. Herrington/Kisting8/05 Page 30 of 41

31 B. Process Recordings A process recording is a systematic method of collecting, interpreting, analyzing, and synthesizing data collected during a nurse-client interaction. The major purpose of doing a process recording is to critically analyze communication and its effects on behavior to modify subsequent behavior, resulting in improved quality of therapeutic communication and psychiatric nursing care. Each process recording is comprised of five (5) components (described in detail below). Students should prepare process recordings using as a guideline the copy of the form that is provided below. Process recordings should be prepared on the Process Recording Form which follows. 1. Objectives for Interaction with Client. Prior to meeting with a client for whom you will do a process recording, you should have in mind one to three specific objectives for the meeting. You will record your specific objectives at the beginning of your process recording to turn in to your clinical instructor. An objective should indicate a specific, readily measurable change in the client's behavior and function as a guide for your interaction with the client. 2. Context of the Interaction. Describe where the interaction took place, activities involving the client that occurred before the interaction, the client's physical appearance, and how the interaction began; i.e. Did the client approach you, or did you initiate the interaction? Also record any other information which you think could have influenced your interaction with the client; i.e. unusual room temperature, interruptions, noise level, and so forth. 3. Verbatim Nurse-Client Interaction. Record a verbatim account of what was said on the part of the nurse and the client, but also nonverbal cues for both the client and the nurse; such as, tone of voice, rate of speech, body posture, quality of eye contact, and changes in facial expressions. Each time the nurse and client communicate once with each other is referred to as an exchange." Periods of silence are also important to record. Following the record of the conversation should be a brief description of events involving the client that transpired immediately after the interaction. For example, did the client return to his/her previous activity or perhaps choose to isolate him/herself by going outside or to another room? 4. Interpretation of the Interaction and Your Reactions to the Interaction. Use this column to record your thoughts and reactions to the interaction. The emphasis in this part of the process recording is on analyzing that which is not explicit, understanding the probable meaning of the data as recorded in the previous column, and recognizing relevant nursing actions. For example, an analysis might focus on identifying a client's apparent underlying anger, speculating as to the possible causes of the anger, and clarifying why you reacted the way you did, or what prompted you to say or do a particular thing during the interaction. The process of interpretation may well begin during the interaction itself; however, an in-depth interpretation of what occurred during the interaction should take place after the interaction with the client. Your interpretation should reflect knowledge of theoretical concepts and psychiatric nursing care principles for work with clients. Include references here. 5. Nursing Care, Rationale, and Modifications. In the final column you should apply relevant theoretical nursing concepts and psychiatric nursing care principles to stating rationale for why you did what you did in the interaction at each exchange. Alternatively, if there is something that you would have done differently within a given exchange, you should state rationale for why the alternative action would have been better. Rationale stated for each intervention should be drawn from the literature as opposed to documenting your opinion only. Again, cite references. Specific examples of what you could have said or done differently should be included for each exchange. For example, you might explain how anger can adversely affect a client if not dealt with in an Page 31 of 41

32 appropriate fashion by the client as a rationale for reflecting to the client that he/she seems angry (rationale drawn from literature). Finally, you should include a brief summary to evaluate whether or not your initial objectives for the interaction were met. If your objectives were not met, provide a brief analysis of why. Note that this section of the process recording provides you the opportunity to think about how you would rework/modify a conversation when you can devote undivided time to think over what transpired in the interaction with the client; i.e. You have the chance to "do the conversation twice" (once as it occurred, and again as you think it should have occurred). Process recordings are a learning tool. They are not supposed to be perfect; they are supposed to be critical. They are evaluated according to whether the interaction was analyzed critically, corrections were suggested with appropriate rationale, and references were used appropriately. Note: Unless negotiated differently with an individual clinical instructor, all process recordings should be typed. Page 32 of 41

33 Process Recording Form Student Client Initials Age Date / / Time : a.m./p.m. Objectives for the Interaction: Context of the Interaction: Verbatim dialog between client and nurse Interpretation of the Interaction (include citations) Nursing Care, Rationale, and Modifications (include citations) Page 33 of 41

34 Summarize interaction; were your goals met? What did you learn from this experience? What are two or three goals for future interactions with this patient? Page 34 of 41

35 Michigan State University College of Nursing Evaluation Form Process Recording Tool Criteria Objectives for Interaction Context of the Interaction 4 Accomplished Discusses one clear objective for the interaction with the client and gains consent from the client at the beginning of the interaction. Clearly describes the context of the interaction identifying factors which influenced the success or presented barriers to the interaction. 3 Proficient Lists an objective for the interaction but does not discuss it with the client before the interaction starts. Describes most of the factors which influenced the interaction. 2 Developing Lists objectives which are vague and are not discussed with the client before the interaction begins. A few factors identified, but unclear how they influenced the conversation. 1 Novice No objectives are identified. The context of the interaction was not discussed. SCORE Verbatim Nurse- Client Interaction Interpretation of the Interaction Nursing Care, Rationale, and Modifications Demonstrates effective communication skills appropriate to the objectives identified for the interaction. Identifies therapeutic communication skills by name; analyzes underlying themes; interprets non-verbal communication by client and nurse. Includes citations. Applies relevant theoretical nursing concepts to state rationale for each intervention with citations. Critically evaluates statements made by nurse and proposes alternative statements with rationale when improvement is warranted. Analyzes whether or not objectives were met, and if not, why. Most of the interaction is therapeutic, but nurse allows the interaction to get off topic at times. Identifies most therapeutic communication skills; discusses possible underlying themes; offers possible meanings for nonverbal communication for most exchanges. Includes some citations. Applies relevant theoretical nursing concepts to most of the interactions and cites references for some of them. Critically evaluates statements made by the nurse but does not offer many alternative statements. Analyzes whether objectives were met. Some of the interaction is therapeutic, but most of the interaction is superficial and more social in nature. Identifies some therapeutic communication skills correctly; analyzes only some of the underlying themes; does not interpret meanings of nonverbal communication. Does not include citations. Provides some rationale for nursing interventions. Partially evaluates interactions. Proposes a few alternative statements. Mentions whether or not objectives were met but does not offer reasons. Interaction is superficial and does not address objectives. Does not identify therapeutic communication skills by name; does not analyze underlying themes; does not interpret meanings of non-verbal communication. Does not include citations. Inaccurate or lacking relevant theoretical rationale. Does not critically evaluate interactions. Does not propose alternatives. Does not mention whether or not objectives met. Page 35 of 41