WEST COAST UNIVERSITY DEPARTMENT OF NURSING. Telephone: (626) FRIDAY: 4:00 PM TO 5:00 PM NURS 204: FRIDAY 5:00 PM 8:30 PM CAMPUS: ROOM 212

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1 WEST COAST UNIVERSITY DEPARTMENT OF NURSING COURSE TITLE & NUMBER: INSTRUCTOR NAME: INSTRUCTOR CONTACT: INSTRUCTOR OFFICE HOURS: COURSE DAY/TIME/ROOM: PSYCHIATRIC / MENTAL HEALTH NURSING: PROMOTING WELLNESS IN THE MENTALLY ILL CLIENT PRACTICUM SOLOMON TAN, MSN/Ed., RN, PHN STAN@WESTCOASTUNIVERSITY.EDU Telephone: (626) WEDNESDAY: 12:00 PM TO 2:00 PM FRIDAY: 4:00 PM TO 5:00 PM NURS 204: FRIDAY 5:00 PM 8:30 PM CAMPUS: ROOM 212 NURS 214L: 1) GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER 2) KAISER MENTAL HEALTH CENTER 3) BROTMAN MEDICAL CENTER 4) AURORA LAS ENCINAS HOSPITAL COURSE PLAN: NURS 204 Week Date: Reading: Topic/Activity: Supplemental Readings: Exams / Assignments: 1 4/16/10 Chapter 1 & 2 Chapter 5 Chapter 12 Chapter 13 1) Introduction to Psychiatric Mental Health Nursing (Roles, and Scope of Practice). 2) Philosophy and Theories for Interdisciplinary Psychiatric Care. 3) Creating a Therapeutic Environment in a Psychiatric Setting and Nursing Care for the Homeless. 4) Legal and Ethical Aspects of Psychiatric/Mental Health Nursing Practice. Bhui, K., Shanahan, L., & Harding, G. (2006). Homelessness and mental Illness: A literature review and a qualitative study of the perception of the adequacy of care. International Journal of Social Psychiatry, 53(2), Forchuk, C., Nelson, G., & Kingston-Macclure, S., Turner, K., & Dill, S. (2006). From psychiatric ward to the streets and shelters. Journal of psychiatric Mental Health Nursing, 13(3), Chapter 10 & 29 5) Therapeutic Communication and Interpersonal Relations National Alliance of Mental Illness (2010). Mental Illnesses, Support and

2 Programs. Retrieved January 14, 2010, from 2 4/23/10 Chapter 11 Chapter 16 Chapter 9 Chapter 30 Chapter 6, 7 & 32 1) Application of the Nursing Process in Psychiatric / Mental Health Nursing 2) Nursing Care for Clients with Schizophrenia and Other Psychotic Disorders 3) Cultural, Ethnic, and Spiritual Consideration 4) Group and Family Intervention 6) Psychobiology and Psychopharmacology Antipsychotics Beebe, L.H. (2007). Beyond the prescription pad: Psychosocial treatments for individuals with schizophrenia. Journal of Psychosocial Nursing and Mental Health Services, 45(3), View: Hartford Institute for Geriatric Nursing (2010). Assessment Tools: Try this and how to try this resource. Issue 3 Mental Status Assessment of Older Adults: the Mini- Cog and video. Retrieved January 14, 2010, from HESI Case Study: Schizophrenia and Psychosis 3 4/30/10 Chapter 17 1) Nursing Care of Mood Disorders: a) Major depressive disorder b) Bipolar disorder Dysthymic disorder, c) Bereavement and d) dysfunctional grieving e) Adjustment disorder Huckshorn, K.A. (2004). Reducing seclusion & restraints use in mental health settings: Core strategies for prevention. Journal of psychosocial nursing and mental health services, 49(9) HESI Case Study: Major Depressive Disorder and Depression Chapter 23 Chapter 24 Chapter 34 Chapter 35 2) Self-injurious Behavior and Suicide Prevention 3) Nursing Care for Elders with Mental Illness and Nursing Interventions for Elder Abuse 4) Crises Intervention 5) Intervening Violence in the Psychiatric Setting View: Hartford Institute for Geriatric Nursing (2010). Assessment Tools: Try this and how to try this resource. Chapter 15 Elder Mistreatment Assessment. Retrieved January 14, 2010, from Chapter 7 & 32 Pharmacology: Mood Disorder 4 5/7/10 Chapter 8 Stress, Anxiety, and Coping Antai-Otong, D. (2006). Anxiety disorders. Nursing Midterm

3 Chapter 18 Chapter 19 Chapter 7 & /14/10 Chapter 15 Chapter 14 Chapter 31 Nursing Care of Clients with Anxiety Disorders and Dissociative Disorders Nursing Care for Clients with Somatoform and Factitious Disorder Psychopharmacology - Anxiolytics Nursing Care for Clients with Substance Related Disorders Nursing Care for Clients with Cognitive Disorders: Delirium, Dementia, and Amnestic Disorders Cognitive and Behavioral Intervention Pharmacology in Substance Abuse 2006, 36(3), Anxiety Disorders Association of America. (2010). January monthly future: Anxiety and Depression. Retrieved January 2010 from McGuinness, T. (2006). Methamphetamine abuse. American Journal of Nursing, 106(12), Medina, K.L. Shear, Plk., & Schafer, J. (2006) Memory functioning in polysubstance dependent women. Drug and Alcohol Dependence, 84(3), ATI A Practice Internet Paper Due Evolve Case Study: Alzheimer s Disease 6 5/21/10 Chapter 22 Chapter 21 Nursing care of clients with personality disorders: Cluster A, Cluster B and Cluster C Nursing care of clients with eating disorder: Anorexia Nervosa, Bulemia Nervosa and Binge-eating disorder Langley, G.C. & Klopper, H. (2005). Trust as foundation for the therapeutic intervention for patients with borderline personality disorder. Journal of Psychiatric & Mental Health Nursing. 12, Pharm. Exam ATI B Practice Due HESI Case Study: Alcoholism Chapter 7 & 32 Psychopharmacology Osborne, U.L., & McComish, J.L. (2006). Borderline personality disorder: Nursing interventions using dialectical behavioral therapy. Journal of Psychosocial Nursing and Mental Health Nursing, 44, /28/10 Chapter 26 & 27 Chapter 25 Chapter 33 Nursing Care of Children, and Adolescence with Mental Illness Psychiatric / Mental Health Care in Clients with HIV/AIDS Complementary and Alternative Healing in Psychiatric and Autism Society of America. (2010). About Autism. Retrieved January 13, 2010 from HESI Practice Due HESI Case Study: Attention Deficit Hyperactivity Disorder

4 Mental Health Chapter 32 Psychopharmacology in Children and Adolescence 8 6/4/10 Computerized Final Exam Complete Lecture Psychiatric / Mental Health Review 9 6/11/10 Final Exam Evaluation Computerized Exam Final Exam Examination/Evaluations Midterm Exam (section 1) 20% Psychopharmacology Exam 15% Final Exam (section 2) 20% Internet Paper 5% HESI Case Studies 5% HESI practice & ATI (part A & B) unproctored 5% Computerized Final Exam (conversion score) 30% Total 100%

5 Internet Paper Evidence Based Practice CRITERIA POINT STUDENT POINTS Content Introduction: Presentation of research 15 study The paper adequately explains in the 20 studentsʼ own words the authorʼs main points and purpose of the study/research/article Authorʼs argument and reasons for 20 research topic? Terms are clearly defined? How was the research / Study performed? Appropriate for the intended sample? Paper includes how the research study affects or not affect the Nursing Practice Student analysis and critique is organized, 25 well thought out, includes studentsʼ own thoughts and ideas, usefulness in practice and application. Format Correct APA format, grammar and spelling 20 Total Points 100

6 COURSE PLAN: NURS 214L Week Objective / Activity: Assignments Due: 1 & 2 1. Management of Assualtive Behavior (MAB). Review Crises Intervention 2. Orient to the clinical facility; familiarize self with the unit milieu, physical structure of unit, daily routine of unit, activities/programs, confidentiality, patient documentation, and unit safety/emergency procedures. 3. Review Clinical Syllabus and Objectives. 4. Review hospital policy and procedures. Complete required hospital documentations. 5. Examine personal assumptions and concepts about mental health and illness. 6. Observe the influence of culture, age, sexual orientation, spirituality and family on a client s psychiatric care. 7. Increase awareness of personal feelings, values, beliefs, and fears about mental health and illness, and working in a psychiatric setting. 8. Participate and observe in appropriate unit activities. 9. Apply the nursing process and group dynamics to individuals and groups of clients. 10. Identify the common civil and personal rights retained by psychiatric clients. 11. Locate and read the patient Bill of Rights, and identify how patients are informed of their rights and the accompanying documentation of patient s rights. 12. Identify and interview if possible the roles of various members of the psychiatric care team. 13. Compared and contrast the patient s legal status of hospitalization. Differentiate rationale for 72-hour hold, 14- day hold, 30-day hold, 180-day hold, T-Con, and LPS Conservatorship. 14. Identify qualities of effective psychiatric nurse; observe and analyze therapeutic communication strategies. 15. Initiate a therapeutic interaction with clients in the unit. 16. Identify antipsychotic, mood stabilizers and antidepressants prescribed to your patient and determine side effects, nursing considerations, and rationale for its use. Complete medication list. 17. Identify and contrast nursing assessments for patients with a diagnosis of Schizophrenia, Disorder, and Schizoaffective Disorder. 18. Identify antipsychotic medications: typical vs. atypical. Week 1: Calculation / Dosage examination. Week 2: Complete the following quiz prior to week 2 clinical: 1. HIPPA 2. National Patient Safety Goals 3. Standard Precaution Week 2: Daily Charting Medication Lists Post-Conference Week 3 & 4 1. Discuss the admission and discharge procedures, and the status of civil rights as they pertain to voluntary and involuntary admission of a client to a psychiatric hospital. 2. Identify DSM IV and nursing diagnoses. 3. Define the following terms: Incompetence, confidentiality, Daily Charting Medication Lists Post-Conference

7 Week 5 & 6 privileged communication, impaired nurse and malpractice. 4. State the nature and goal of therapeutic communication in the therapeutic nurse-client relationship. 5. Discuss personal qualities one needs to be an effective helper. Do these differ from leader qualities? 6. Demonstrate therapeutic strategies; include coping mechanisms & identify defense mechanisms. 7. Relate the premises of humanistic interaction and other theories to psychiatric nursing. 8. Initiate a therapeutic interaction with a patient, discuss a common therapeutic goal, clarify the purpose of your assignment, build trust, establish confidentiality, identify duration of the interaction, and identify common ground and boundaries. Document your findings in the daily charting form. 9. Initiate a therapeutic interaction with a patient and formulate a plan of care utilizing the nursing process. Complete Nursing Care Plan. 10. Identify antipsychotic, mood stabilizers, antianxiety, and antidepressants prescribed to your patient and determine side effects, nursing considerations, and rationale for its use. Complete medication list. 11. Complete vital sign and patient care. 12. Attend treatment planning / multidisciplinary team conference. 13. Identify the purpose of patient rounds per hospital policy. 14. Attend and observe unit groups. 15. Identify and contrast nursing assessments for patients with a diagnosis mood disorder, anxiety disorder, dissociative disorder, somatoform and factitious disorder. 16. Identify hospital policy on care of patient on suicidal precautions. 17. Review nursing assessment tool for the elderly 18. Review Elder Mistreatment Assessment tool 19. Identify mood stabilizers, antianxiety, and antidepressants prescribed to your patient and determine side effects, nursing 1. Discuss common transitions for mental health clients specifying challenges and opportunities for change utilizing change theory/problem solving with appropriate nursing actions. 2. Discuss the philosophy and approaches to care used in the hospital or community setting where the student is practicing. 3. Show beginning skill in assessing the mental status and overall health status of selected clients. 4. Describe situational role changes/body image changes as associated with the developmental process. 5. Demonstrate leadership abilities by acting in a leadership role for one clinical day of the rotation with either the charge nurse or the nursing instructor s supervision. 6. Demonstrate ability to establish therapeutic relationship, which progress to the working phase, using therapeutic communication techniques. Document your findings in the Week 3: Nursing Care Plan (1) Week 4: Interpersonal Process Recording (IPA) (1) Week 4: Midterm Daily Charting Medication Lists Post-Conference Week 5: Community Paper Week 6: Nursing Care Plan (2)

8 narrative form. 7. Demonstrate therapeutic use of self, effective use of empathy, reflection, restatement, general leads, exploration, open-ended questions, and silence. Prepare to complete Process Recording assignment. 8. Identify antipsychotic, mood stabilizers, antianxiety, and antidepressants prescribed to your patient and determine side effects, nursing considerations, and rationale for its use. Complete medication list. 9. Attend treatment planning / multidisciplinary team conference. 10. Assist patient rounds per hospital policy. 11. Complete vital sign and patient care. Attend and observe unit groups. 12. Identify and contrast nursing assessments for patients with a diagnosis of Personality Disorder and Eating Disorder. 13. Identify and contrast nursing assessments for patients with a diagnosis of Substance related disorder, and cognitive disorder. Week 7 & 8 1. Relate the phases of the nurse-client relationship to the nursing process. 2. Demonstrate skill in assessing the mental health and overall health status of an assigned client and prioritize nursing diagnoses. 3. In simulated patient situations, identify a therapeutic and nontherapeutic response by the nurse. 4. Demonstrate the application of the nursing process to psychiatric clients. 5. Demonstrate increase autonomy/accountability in the initiation of a therapeutic 1:1 interaction with client. 6. Describe confusion and disorientation; define and employ psychiatric terms. 7. Identify and discuss general treatment modalities for mental illness. 8. Discuss nurse leader roles and impact on care. 9. Identify developmental states and tasks of individual and family life cycles. 10. Identify and contrast-nursing assessments for children and adolescence diagnosed with mental illness. 11. Identify and contrast nursing assessments for clients with HIV/AIDS. 12. Initiate a therapeutic interaction with a patient, discuss a common therapeutic goal, clarify the purpose of your assignment, build trust, establish confidentiality, identify duration of the interaction, 13. Select another patient and initiate a therapeutic interaction for your Care Plan. 14. Identify antipsychotic, mood stabilizers, antianxiety, and antidepressants prescribed to your patient and determine side effects, nursing considerations, and rationale for its use. Complete medication list. 15. Attend treatment planning / multidisciplinary team conference. Daily Charting Medication Lists Post-Conference Week 7: Interpersonal Process Recording (IPA) (2)

9 16. Complete vital sign and patient care. 17. Attend and observe groups. Week 9 1. Recognize the psychiatric nurse s role in data collection, diagnosis, planning, implementation, evaluation and accountability. 2. Define an ethical dilemma and discuss one that arises in psychiatric nursing practice. 3. Discuss the characteristics of an effective nurse manager in a mental health setting; include decision-making, problem solving, delegation and supervision strategies. 4. Identify ways nurses can serve as leaders in community and hospital mental health settings. 5. Describe various models of community mental health nursing and the process of referrals. 6. Identify the means by which collaboration and conflict resolution occurs and observe roles of multidisciplinary team in psychiatric settings. 7. Identify the trends and challenges facing mental health care today. 8. Utilize information technology in the provision of safe client care data and maintain confidentiality of this data. 9. Describe the responsibility of the psychiatric mental health nurse in regard to incident reporting. 10. Evaluate experience in the psychiatric setting. Daily Charting Medication List Case Presentation Post-conference Clinical Evaluation

10 Standards for Safety and Professionalism 1. On a locked unit, be very careful when entering and exiting the units. Make sure NO patient is standing beside the door when you leave or enter the units. The unit doors have a window so that you know the patients where-a bouts before you enter the unit. Make sure the door closes completely after entering or exiting the area, and that no patients leave the unit unaccompanied by staff. Psychotic patients can be delusional and paranoid, and elopement attempts are likely. Vigilance is required. 2. Stay away from aggressive patients. At the beginning of each shift, identify which patients are potentially aggressive during report. Always maintain a safe distance. 3. Do not go into patient s rooms without permission from the staff or your instructor. Make sure staff and fellow students are in sight at all times. Keep staff informed of your actions. When in a room with patients, sit or stand close to an exit. Be aware of your surroundings. 4. Smile and make eye contact. Be friendly and professional. Introduce yourself, give your name and role. Be patient and project a caring attitude. Accept patient s feelings, don t judge. Listen attentively. 5. Acknowledge cultural differences. Be sensitive to special needs. Follow language interpretation guidelines. 6. Ask questions whenever you don t understand. Be open to feedback. 7. Introduce yourself to staff and patients when entering the unit. Let staff know when you are leaving the unit. 8. Give report on your patient before leaving the unit. Report any change in your patient, such as increasing suicidality, anxiety, agitation or changes in mental status. 9. Be aware of your patient s medication and any adverse effects. 10. Protect patient s right to confidentiality. Do not discuss patients in hallways and elevators. Do not remove confidential information with patients names from the unit. Do not leave your report sheet in a place where patients or others can pick them up. 11. Stay away from any physical containment procedures on the unit. Observe from a distance only. You may assist other patients to move away from the area if needed or instructed to by your instructor or staff. You can call for a code when instructed by staff. 12. Do not give your telephone number, or personal information to patients or accept theirs. 13. Do not eat in patient care areas. Do not use your cell phones in patient care areas. If you choose to carry your cell phone, it must be on vibrate mode. Conduct your personal business on your break. 14. Dress and conduct yourself professionally. Wear appropriate clothing that displays professionalism: Do not wear scrubs or white uniform. Students are expected to wear appropriate business attire or casual attire Wear a watch with a second hand Cover any tattoos. WCU Nametags must be worn at all times or you cannot enter the units. Hair must be contained or in a bun. Do not wear sandals, backless or high-heeled shoes. Do not wear too much jewelry, dangling earrings or necklaces. Do not wear heavy perfumes or cologne. Do not wear scarves, ties, thick necklaces or lanyards. Don t wear anything that cannot be replaced. If in doubt about an item of clothing, do not wear it.

11 SUPERVISION REQUIREMENTS You may perform the following procedures without supervision once competency is completed in lab: Assess vital signs (T P R BP Pain) and O2 saturation. Provide hygiene Assess input and output Transferring, ambulating, and use of assistive devices (crutches, walkers) Provide teaching, and emotional and physical support Perform non-pharmaceutical pain intervention such as comfort, positioning, distraction, music Assist patient with incentive spirometry You may perform the following procedures only with instructor supervision or the instructor MAY approve the administration with your staff RN. This is required for each individual medication administration! ALL medication administration including oral, ophthalmic, optic, nasal, rectal, topical, subcutaneous, intramuscular, intradermal, transdermal and intravenous. Blood sugar assessment You may NOT perform the following under any circumstances: Take a verbal order from a nurse practitioner, physician, or physician's assistant. Participate in patient containment. take down. You may observe from a safe distant. If a procedure is not on the list, it is your responsibility to ask your clinical instructor before proceeding! If a student does not adhere to these requirements, it will be considered unprofessional conduct and/or unsafe clinical practice.

12 Clinical Written Assignments GUIDELINES FOR INTERPERSONAL PROCES RECORDING (IPA) Interpersonal Process Recording (IPA) is a way to identify patterns in the student s and the patient s communication. IPA is not an intake assessment nor question and answer session. This is a time to listen and to demonstrate a student s caring and concern. This is also a time to recognize a patient s feeling as they emerge and help them identify feelings they have not expressed. IPA is a written record of a segment of the nurse-patient session that reflects as closely as possible the verbal, non-verbal, coping, and defense mechanisms utilized during the interaction. IPA has some disadvantages because they rely on memory and are subject to distortions. However, IPA can be a useful tool for identifying communication patterns. Please see attached IPA template or the template can be downloaded on a document format. When completing this assignment, you may use additional pages. Specific goals are selected by the student prior to the interaction, and are related to particular behaviors. The goals must be realistic and measurable. Broad goals refer to the ultimate expected goal. Therapeutic Communication: please also demonstrate the use of broad openended questions, clarification, confronting, reflecting, empathy, immediacy, focusing. Your goal is to use therapeutic communication and identify what you used and why and its effect. Your goal is not to solve the client s problem but to explore and use therapeutic communication. Instructions: Select a client to participate with you. Please do not create a script to use for this interaction. Also, do not take notes during the interview. Taking notes may be distracting for both the student and the patient or the patient may resent or misunderstand the student s intent. The interpretation will be completed later. The purpose of this interview is to give you an opportunity to practice specific communication strategies and to correctly use and identify these strategies. Write out and analyze a segment of the nursepatient interaction; you said your patient said. Also identify non-verbal communication (This make take a few pages.) Utilize 3 different strategies from the following list: Communication Strategies Clarifying Giving feedback Rephrasing or restating or paraphrasing Summarizing Structuring Focusing/pinpointing Using empathy Using immediacy Using silence The selected interaction segment will be based upon the parts of the conversation, which were the most meaningful or therapeutic. Allow the selected segment of the interaction

13 flow so the reader can follow the content. Do not take notes during the interaction, but do this immediately. As soon as the interaction is completed, begin to write the conversation verbatim (word for word) to the best of your recollection on the first and second column. Do not forget to document any non-verbal behaviors in the first and second columns. (Student and patient non-verbal communication) During documentation, insert information about any discontinuity, i.e. patient needed to get ready for group therapy; patient used the bathroom; we agreed to meet up directly after group. If the student continue a conversation later and wish to include parts of both conversations, identify the segment. (Always count for how an interaction ended when it is unplanned and abrupt, i.e., client stood up and said he didn t want to talk about this any more ) Complete the third column. Identify the type of communication technique utilized. Then, identify whether the communication technique was therapeutic or non-therapeutic. Evaluate the effectiveness. In this column, identify coping or defense mechanism the client utilized. Identify whether it is adaptive or maladaptive. On the fourth column, identify the student s thoughts and feelings. For example, I was feeling nervous. He had attempted suicide and I didn t know if I could help him. Initially I was feeling somewhat overwhelmed. Once the columns are complete, the student will have gained the insight needed to look back and decide if the technique was therapeutic or non-therapeutic. (Even if the patient responded well to the response and it is nontherapeutic, document what could be more therapeutic. For example, I could have said, You must be very upset or tell me more about what happened. (The ability to look back and analyze possible errors and non-therapeutic response is as valuable as giving the most therapeutic response during the conversation.) Describe the environmental setting where the interaction took place. Document reasons for the environmental setting to be therapeutic or non-therapeutic. In the description of the client, the client should be described in such a way that anyone can identify him or her. Include grooming, affect, posture and environment or setting. Also describe yourself and your feelings prior to the interaction. Never use patient s name in your papers. Use first and last initials instead. Verbal communication is concerned with the spoken word, including inflection and tone of voice. It may also refer to the written word. Note: If the responses are relevant to the goal, did the client initiate the conversation? Did you change the subject being discussed? Non-verbal communication is concerned with gestures, body movements, posture and other unspoken forms of relaying ideas and feelings. Focus is on what is happening to you and the client that has communication value. Assessment. Is there congruency of verbal and nonverbal communication? What communication techniques are you using and reasons? Try to make some interpretation of behavior. Identify your own feelings. When possible, document reasoning behind assessment. Identify the themes discussed, the strategies you used, and your evaluation of these.

14 Interpretation relates to the observer s perception of the meaning behind the communication. Summary includes an evaluation as related to the goal. Was the goal met? What did the communication mean? If you were to redo this interaction, what would you change? Please type your interaction or print legibly, using the headings of the above columns as a guide. Don t forget your summary and evaluation. Read your guidelines for this assignment as well as your chapter on therapeutic communication. Please avoid trying to solve the client s problem. GUIDELINES OF NURSING CARE PLAN: Nursing Care Plan is the framework for all significant action taken by nurses in providing developmentally and culturally relevant psychiatric mental health care to patients. Whenever possible, interventions are supported by research (evidence based). Rationale should be based on texts & current peer-reviewed articles available through the library. These must be published within the past 5 years unless they qualify as a classic. Plan of care must address at least either two actual, or one actual and one potential nursing diagnoses for your assigned patient. Use the plan to organize and direct your patient care. The care plan needs to be legible and understandable. Teaching-learning needs of your patient must be included in the plan of care. MEDICATION ADMINISTRATION: Students will not administer medication in the hospital setting nor in the community health setting, unless the clinical facility and instructor approves for students to pass medications. MEDICATION EXAMINATION: The medication math test will be given in each of the clinical classes throughout the nursing program. In each class, it is required that the students pass the medication math test for that practicum before they can pass medications. The passing grade is 85%. If the student does not pass the test on the first attempt, they may take it again two more times. The first grade achieved is the one counted toward the final grade. If the student does not pass this medication examination, they are considered unsafe and therefore fail the clinical class and must drop it and the corresponding theory class. Because the body of nursing knowledge builds from one class to the next and the practicum is based on knowing the corresponding theory, the student must successfully pass this class before they can move on to the next nursing class. The Board of Registered Nursing requires that the practicum be taken at the same time as the corresponding theory class, i.e. during the same term, as the theory course is given. If the student fails any course, they are given one opportunity to retake it and if they fail the second time, they are dropped from the program. The medication examination demonstrates knowledge and safety with psychiatric medications, dosages and calculations. Clinical Faculty will notify students of the exact date and time of the Nursing Calculations Exam. Students must pass with an 85% or higher. If a life-threatening dose is provided as an answer, the student will automatically fail the exam. A second attempt will be offered during the

15 second week of clinical prior to patient care. The content of the Nursing Calculations exam will encompass information on: 1. Psychiatric medications, classification, brand and generic names 2. Medication Dosage to be administered 3. Insulin volume calculations 4. 5 Rights for patient administration 5. The Joint Commission standards MEDICATION LIST: The medication lists is part of the care planning and should be attached to the Nursing Care Plan and daily charting. They will be checked at the beginning of each clinical day. Medication list should emphasize indications and precautions relevant to your particular psychiatric/mental health patient. Focus of the nursing care plan should be psychiatric issues with a priority on safety of clients and staff. CASE PRESENTATION: Students will present one client case using the attached form to their clinical group and instructor. Student will be able to use evidence-based practice Vs clinical opinion in supporting their interventions. Students are encouraged to use on-line literature searches, and current publications in their presentation. CLINICAL PERFORMANCE: Criteria for clinical performance include: safety, written and oral communication skills, patient teaching, therapeutic skills and professional behavior. Student will complete core clinical competencies as listed in the Clinical Evaluation Tool. Clinical performance is evaluated by the faculty in collaboration with clinical preceptors and with the student thorough formative & summative self-evaluation. Faculty assigns grades. Clinical Documents Clinical documents may be downloaded on a doc format. 1. Nursing Daily Charting 2. Medication List 3. Interpersonal Process Recording 4. Nursing Care Plan

16 Student: NURSING DAILY CHARTING Date: Client History Name (initials only): Age: Gender: Legal Status: Language: Marital Status: Date of Admission: Ethnicity: Occupation: Education: Psychiatric Diagnosis (Axis I): Personality Disorder / Mental Retardation (Axis II): Presenting Problem Reason for hospitalization (Client s own words): Current stressors: Mental Status Examination Appearance: Behavior: Psychotic symptoms: Affect: Mood: Speech: Thought Content: Risk Potential - Suicide Ideation: Homicidal Ideation: Hypersexual: Fall risk: Elopement risk: Thought Process: Cognition:

17 Insight: Judgment: Psychomotor activity: Coordination/gait/notable movement: Cultural Issues and Religious Affiliation: Familial Concerns: Current Health (Axis III) Vital Signs - T: P: R: BP: Pain (Numeric 1-10): Location: Character: How would you describe your health: Excellent Average Good Poor Medical and (or) physical problems: Nutritional Status: Diet: Feeding supplement: Swallowing difficulty: Physical Assessment: Chewing difficulty: Substance Abuse: Substance Amount / Frequency Duration Last Used Signs of withdrawal symptoms: Additional data: Nursing Process Based on the nursing assessment you have just completed, Identify subjective and objective data and list all nursing problems including cultural issues and teaching needs (Prioritize Problems): Nursing Diagnosis (Actual or Potential): Outcomes / Planning (measurable): Interventions: Evaluation (patient response to interventions):

18 STUDENT: MEDICATION LIST DATE: Medication (Generic/Trade) Dose / Route / Frequency / Range / Therapeutic Level Classification Indication Action Side Effects Food and Drug Interaction Nursing Considerations Rationale for the Patient Medication (Generic/Trade) Dose / Route / Frequency / Range / Therapeutic Level Classification Indication Action Side Effects Food and Drug Interaction Nursing Considerations Rationale for the Patient

19 Psychiatric Nursing Care Plan Student: Date: Clinical Instructor: Patient Initials: Age: Gender: Admit Date: Marital Status: Children / Ages: Legal Status: Occupation: Socioeconomic / Cultural Affiliation: History of Psychiatric Illness: Medical History: Previous Psychiatric Admission / Outpatient Mental Health Services: Living Arrangements: Support System: Reason for Hospitalization: Current Stressors: Mental Status Exam: Substance Abuse: Level of Participation in the unit: Teaching Needs: Discharge Plans: Based on the nursing assessment, list identified nursing problems (prioritize the problem):

20 Psychiatric Nursing Care Plan Nursing Diagnosis (NANDA): Axis I: Definition: (Cite APA format) Related to: (Etiology) As Evidence By: (Signs and symptoms) Erikson s Developmental Stage: Psychopathology: (Cite) Axis II: Axis III: Axis IV: Axis V: 1. Subjective Data: 2. Objective Data: A S S E S S M E N T Nursing Outcome Criteria (NOC): Realistic with measurable timeline Planning: The patient will:

21 Interventions (NIC): Rationale: I N T E R V E N T I O N (NIC) What was your patient s response to your interventions? Was the desired outcome achieved? Yes ( ) No ( ) If no, what revisions (either to desired outcomes and/or interventions) would you make? E V A L U A T I O N Additional Re-Assessments: