LANGARA COLLEGE BSN PROGRAM Course Packet For Nursing 3246 Nursing Practice VI Course Facilitators Fall Term 2006: Barney Hickey, RN, BScN, MScN Nancy Clark, RN, BScN, MScN
Item Table of Contents Page Course Overview, Ends in View, Learning Outcomes... 1 Process... 1 Course Textbook and Required Reading... 1 Overview, Mental Health, Mental Illness... 2 Early Psychosis Intervention, Mental Health Act... 2 Treatment Modalities for Mental Illness... 2 Evaluation and Marking in N 3246... 4 Contacting Your Instructors... 5 Criteria for Class Participation... 6 Professional Responsibilities and Expectations... 7 Criteria for Student Presentation... 8 Nursing Practice VI Weekly Schedule... 9 Learning Activity 1... 10 Learning Activity 2... 12 Learning Activity 3... 14 Learning Activity 4... 15 Learning Activity 5... 17 Learning Activity 6... 19 Learning Activity 7... 21 Learning Activity 8... 23 Learning Activity 9... 25 Learning Activity 10... 26 Learning Activity 11... 28 Learning Activity 12... 29 Student Information Form... 30 Instructor Information Form... 31 Mental Health Common Drugs/Pharmacology... 32 Clinical Placement Data Sheet... 33 Sample Clinical Placement Data Sheet... 34 Student Selection of Projects... 35 Nursing 3246 Nursing Practice VI, Evaluation and Marking... 36
Course Overview Nursing Practice VII: Mental Health Human beings are viewed from a holistic perspective: integration of the body, mind, and the spirit/soul. This course is organized around the comprehensive nursing process, as well as multi-disciplined therapeutic modalities, which assist the individual and family to adapt, recover and grow through their mental health concerns and illnesses. Current relevant research, theory, and the social, legal and ethical implications of providing nursing care to the mentally ill are integrated throughout the content. Ends-In-View (Learning outcomes) This course provides an opportunity for students to learn about the experience of those with mental health concerns. Through this process students will identify and clarify personal values and beliefs related to mental health and mental illness. Students will also analyze the effects of institutionalization on individuals and families mental and the present mental health care delivery in British Columbia and Canada In addition students will recognize the role of nursing within mental health care delivery, understand selected theories and concepts related to the care of clients and their families experiencing mental illness. And finally apply selected theories and concepts to the nursing care of clients and families with mental health concerns. Process Students will explore mental health and mental illness form an epistemological, phenomenological, and ethical perspective through learning activities that include lecture/discussion, guest speakers, mental health consumers, clinical practice, clinical conference, and assigned readings. Students will also present experiences form their clinical practice to gain a better understanding of mental illness and its treatments. Course Textbook and required reading Ministry of Health and Ministry Responsible for Seniors (1998). Revitalizing and Rebalancing British Columbia s Mental Health System. Victoria: Ministry of Health and Minister Responsible for Seniors. Austin, W. & Boyd, M.A. (2008). Psychiatric nursing for Canadian practice. Philadelphia, PA: Lippincott Williams & Wilkins. Note: Readings will be in the form of handouts during class times. As the course is new, you will also be doing literature searches as assigned. 3
Overview The course is organized around the philosophy foundation of the Nursing Program and reflects the following concepts: Mental health Lifestyle management Sleep Diet Exercise Social network/life Support network Recreation, hobbies and interests. Stress management Assertiveness Communication and conflict management. Management of aggressive behavior Mental illness - Schizophrenia - Depression - Mania and hypomania - Schizoaffective disorder - Conversion disorder - Personality disorder - Concurrent disorders (drug and alcohol) - Anxiety disorders General anxiety disorder Obsessive Compulsive Disorder Post Traumatic Stress Disorder Social phobia Specific Phobias Early Psychosis Intervention Mental Health Act Treatment modalities for mental illness 4 Biological Psychological (CBT) Somatic Electro convulsive therapy (ECT) Psychosocial education (individual and family) Life style management
Mental Health Community care Mental health teams Peer support groups Mental health organizations and advocacy groups. 5
EVALUATION This course is worth 100% you must achieve a minimum of 65% to be successful Percentage 1. Quiz 15% 2. Quiz 15% 3. Quiz 15% 4. Quiz 15% 5. Web-ct discussion 15% 6. Student clinical placement presentation 15% 7. Class participation 10% 8. Clinical practice: Pass/Fail Total= 100% 6
CONTACTING YOUR INSTRUCTORS Barney Hickey, RN, BScN, MScN. Office L00B, Office Hours: Afternoons Monday, Tuesday, Wednesday. Langara email: bhickey@langara.bc.ca and office phone is 604-323-5048. Nancy Clark, RN, BScN, MScN. Office B029M, Office Hours: TBA. Langara email: TBA, current email: n.clark@shaw.ca and office phone is 604-323-5754. 7
CRITERIA FOR CLASS PARTICIPATION The value for this activity is 10%. Student self evaluation is 5% and instructor evaluation of student participation is 5%. To achieve the full 10% for this evaluation, the following must be completed: 1. Submit 3-5 goals to your instructor on first day of class. The goals should include the following principles of goal setting: S= Small and specific M= Measurable A= Achievable R= Reasonable T= Time limited 2. Do a written self evaluation of the above goals and give an example of how your goals were met. Award yourself a mark. 3. Attend every class. If you are absent due to illness, you must inform your instructor before the start of class via email or phone message. If you have an advance specific plan, inform your instructor as soon as possible or before the day of class. 8
PROFESSIONAL RESPONSIBILITIES AND EXPECTATIONS 1. All students are expected to attend ALL scheduled classes during this term. Attendance will be recorded and hours missed will be considered as part of your final course evaluation. Each student is responsible for signing the attendance sheet for each class. 2. If you are very ill and/or if there is another legitimate reason that prohibits you from attending class, please contact this instructor by voice mail before class hours on the day of the scheduled class. It is essential that you take full responsibility for making up missed content. This instructor will not be responsible for re-teaching the class material that you have missed. If possible, pre-assign another student to obtaining class hand-outs and similar material on your behalf. When you return the class, contact this instructor to discuss theoretical content and strategies for making up the lost time. 3. As a professional courtesy to others and in order to maximize learning, all students will be punctual for classes. Time(s) for break(s) will be negotiated between instructor and students before each class. Each student is responsible for organizing in such a way that he/she arrives on time at the start of each class as well as following break(s). If you are going to be late, please do not disrupt the class when you arrive in class. 4. Preparedness is essential to your success in this course. For the classes to be conducted in an effective, productive and constructive manner, students must prepare adequately. Please ensure that you have completed all required readings and other learning activities listed in the in preparation portion of each class. This instructor may from time to time suggest additional learning activities beyond reading. Such preparation may include researching an issue, retrieving information from various sources, reflecting on it and taking notes, planning to ask questions and/or explore in-depth to generate future discussion in class, etc. 5. During class, each student is expected to participate. Ask questions (and, by the way, there are no stupid or inappropriate questions in any healthy learning environment... so, go for it and ask!). Seek clarification as necessary. Share your personal and professional thoughts, ideas and experiences with others to contribute to a rich learning environment. 6. Interpersonal skills are essential to sound and sensitive nursing practice, especially in mental health practice. Inappropriate language and/or conduct that suggest disrespect towards the instructor and/or other students will not be tolerated. In such cases, a student may be asked by the instructor to leave class in order for others to enjoy a more positive learning environment. Please do not bring newspapers, magazines, knitting or hobby crafts to class. Cellular telephones must be turned off. 7. Your instructor will expect you to access N 3246 on WebCT and it is expected that you will have an email address on the My Langara web portal. You will be provided with a breakdown of the course evaluation with quizzes, a paper, WebCT participation and clinical placements. 9
CRITERIA FOR STUDENT PRESENTATION This presentation will include the following: - Form groups according to your community placements. - On the day of your presentation provide a hard copy of your presentation to your instructor so that he/she can make copies for the rest of the class to keep as future resource. - Your presentation should include the following: Name of agency/placement State whether it is government organization or not What services the agency provides and how do clients access the service(s)? What are the staff s composition and profession? The role of the nurse and your role in the agency How the program began and how is it evaluated? What aspects of health prevention/promotion and client empowerment are present in the agency? Your thoughts of the agency CRITERIA FOR WEB-CT DISCUSSIONS AND EVALUATION This will be handed out on the first day of class. 10
Week 1 Sept 08 Week 2 Sept 15 Week 3 Sept 22 Week 4 Sept 29 Week 5 Oct 06 Week 6 Oct 13 Week 7 Oct 20 Week 8 Oct 27 Week 9 Nov 03 Week 10 Nov 10 Week 11 Nov 17 Nursing Practice VI Weekly Schedule Welcome and Introduction to course Overview of Syllabus and assignments Negotiating group work: Principles of solidarity Review of previous course material related to mental health and mental illness Student personal goals for this course Mental health/mental illness: Historical and Theoretical concepts Foundations for psychiatric/mental health nursing. Ethical and Legal Issues in Psychiatric/Mental Health Nursing The Mental health Act of British Columbia Spirituality and mental health (Guest speakers) Quiz 1 Schizophrenia and Schizoaffective disorder Use of restraints in psychiatric care Mood disorders: Dysthymia; Major Depression; Mania and Hypomania Psychopharmacology (Guest speaker: Pharmacist) Substance related disorders: Drug and Alcohol. Personality Disorders. Quiz 2 Anxiety disorders: GAD, PTSD, OCD, Social phobia Somatoform disorder Guest Speakers (Consumers of Mental Health) The Mood Disorder Association of BC, Canadian Mental Health Association, and Early Psychosis Intervention Program Therapeutic approaches in Psychiatric nursing care: Communication and Therapeutic groups. Students presentation of practice experiences: Reflecting on health promotion and prevention. Quiz 3 11 Week 12 Nov 24 Week 13 Dec 01 Students presentation of practice experiences: Reflecting on health promotion and prevention Students presentation of practice experiences: Reflecting on health promotion and prevention. Course review, courses evaluations, and instructor evaluation Quiz 4
Learning Activity 1 Concept: Mental health/mental illness: Historical and Theoretical concepts OVERVIEW Although there is an increasing understanding of mental illness, there is still a myth about its origin and cause. Several theories attempt to define mental health. Maslow s theory emphasizes an individual s motivation in the continuous quest for selfactualization (cited in Townsend, 2003, p. 15). Jahoda (cited in Townsend, 2003) suggested six factors that constitutes/reflects mental health. These are 1) A positive attitude towards self, 2) Growth, development, and the ability to achieve self actualization, 3) Integration, 4) Autonomy, 5) perception of reality, and 6) environmental mastery (p. 15). In my years of experience in psychiatric practice these concepts have been simplified for individuals experiencing mental illness to maintaining a balanced and sustaining life style. This involves nutrition/diet, sleep, exercise, managing stress, changing negative thinking, assertiveness, addressing drug or alcohol problem, and maintaining a balanced social life and support system. Mental illness then can be described as a disturbance in our thoughts, feeling, and behaviors as a result of maladaptive response to stress, which interferes with an individuals, work, relationship, and physical functions, which are influenced by cultural values and beliefs. ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will be able to: - Define mental health and mental illness - Understand the history of psychiatric care. - Identify cultural factors that influence mental health and mental illness - Understand psychological response to stress - Identify correlation of adaptive/maladaptive behaviors to mental health and mental illness. IN PREPARATION Read: Austin, W. & Boyd, M.A. (2008). Psychiatric nursing for Canadian Philadelphia, PA: Lippincott Williams & Wilkins. Chapters 2 & 7 Complete the review questions at the end of the chapters. 12 practice. Stephens, T. (1998). Population Mental Health in Canada: working toward a national plan for promoting mental health. (This is available in the reserve section of the Library).
IN CLASS ACTIVITY - Students will engage in small group and large discussion on the following: - Discuss Perspective of mental health and mental illness. - Discuss their experience with mental illness. - Share understanding of stress and the stress response model, and personal response to stress. - Watch video, within these walls on the history of psychiatric care. - Discuss chapter review questions. IN REFLECTION As you read the required reading for this class, has your understanding of the history of mental illness and mental health changed? Do you view those with mental illness the same way as you did before your reading? How would you feel if you or some one in your family has a mental illness? Have you gained any new knowledge on stress and its response? Would you manage your stress differently? 13
Learning Activity 2 Concept: Foundations for psychiatric health nursing; Ethical and Legal Issues in Psychiatric/Mental Health Nursing and Certification OVERVIEW In order to nurse individual with psychiatric illnesses nurses must have an understanding of the various theories of personality development. Developmental theories identify behaviors that are associated with various stages that individuals pass, and identify deviations form each developmental level. In understanding the various theories of human development, Peplau, the first psychiatric nurse theorist proposed a model for psychiatric nursing practice. In her model of interpersonal theory, she stresses the concept of the nurse client relationship development and thus provided a framework for psychodynamic nursing (Townsend, 2003 p. 44). Nurses are engaged in difficult ethical decisions on a daily basis and in psychiatric nursing practice this becomes more of a challenge because of the application of the Mental Health Act (B C, Canada).Therefore, in order to provide competent and appropriate care nurses must understand the legislation/law about patients rights and the right of health care provider when providing care. Would patients rights be compromised in the event of managing physically or verbal aggressive if mechanical restraints or seclusion room is used? ENDS-IN-VIEW (Learning Outcomes) - At the end of this class students will be able to: - Define personality and understand the relevance of knowledge associated with personality development in psychiatric nursing. - Identify the major components of each developmental theory. - Understand the application of Peplau s theory of interpersonal relationship to nursing practice. - Identify the difference among ethics, morals, values, and rights. - Understand the different ethical theories and ethical dilemma - Understand the application of ethical principles, and an ethical decision model. - Identify ethical issues in psychiatric practice and understand behaviors. - Differentiate among civil and criminal law, statutory law and common law. - Become aware of the BC mental health act and its application to psychiatric practice. IN PREPARATION 14 Read: Austin, W. & Boyd, M.A. (2008). Psychiatric nursing for Canadian Philadelphia, PA: Lippincott Williams & Wilkins. Chapters 5, 6 & 9 practice.
Complete the review questions at the end of the chapter Read the Mental Health Act (BC, Canada, 1998). This is available at http:/www.healthservices.gov.bc.ca/mhd/mhdforms.html IN CLASS ACTIVITY - Students will engage in small group and large discussion on the following: - Discuss their understanding of psychiatric nursing practice - Discuss knowledge of nursing models and compare and contrast with Peplau s model. - Share past knowledge or experience of an ethical dilemma. - Discuss the principles of ethical decision making. - Engage in debate on an ethical decision in psychiatric nursing practice and the application of the mental health act of BC. - Discuss chapters review questions. IN REFLECTION How will your understand of ethics and legal issues prepare you for psychiatric nursing practice. If your values and beliefs were to be compromised because of the decision you have to make in your practice, how would you cope with this? Do you think patients should be admitted to hospital and treated against their wish/permission? Why or Why not? How have you managed aggressive behavior in your practice or have you witnessed the management of this behavior? If so what was the outcome and how did it make you feel? In your nursing practice thus far, have you considered or identified your clients developmental level/task? If so, what was your understanding of their behavior or illness, and how did you respond and plan their care? Would your understanding of their behavior change in the future, or would you do anything different in planning their care? If so what would you do different? 15
Learning Activity 3 Concept: Spirituality and Mental Health OVERVIEW There is increasing recognition of the role of spirituality in health and healing. However, in psychiatric practice this phenomenon is still not explored for its usefulness in managing and recovering from mental illness. From the available research on this subject, they show a positive relationship between spirituality and positive mental health (Rajakumar, 2005 unpublished masters thesis UBC) ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will be able to: - Understand the conceptualization of spirituality and identify how spirituality may assist in promoting mental health and managing mental illness. - Gain knowledge of the role of spirituality in health and healing, specifically in psychiatric care. IN PREPARATION Read: Ameling, A., & Povilonis, M, (2001). Spirituality: Meaning, mental health nursing. Journal of Psychosocial Nursing, 39(4), 15-20. Baldacchino, D. B., & Draper, P. (2001). Spiritual coping strategies: a review of the nursing research literature. Journal of Advanced Nursing, 34(6), 833-841 IN CLASS ACTIVITY Students will engage in discussions about their own spirituality, discuss their experience of spiritual practice with their clients, and on the presentation of guest speakers. IN REFLECTION Are you aware of your spirituality and if so what does it mean for you? Has it helped you in any stressful situation? Have you encountered any patient s experience of spirituality? Have you assessed patient s spirituality and provided any interventions for spiritual distress? and 16
Learning Activity 4 Concept: Schizophrenia and Schizoaffective Disorder and Restraints OVERVIEW Schizophrenia is a serious mental illness that affects mostly the young (late adolescence or early adult years). Its development is characterized by a gradual decline in social/occupational functioning as well as a decline in academic functioning, and the characteristics symptoms of hallucinations and or delusions. During times of acute psychosis, clients may act on their delusions or hallucinations and become aggressive or acutely suicidal and may require restraints. The theories of its cause are biological, psychological and environmental (Townsend, 2003). Early diagnosis and treatment rehabilitation can reduce the severity of the illness and improve overall functioning. Individuals with schizophrenia can also experience a mood disorder such as depression or mania, which compounds their presentation and thus presents as a challenge to manage. Mental status assessment is an important aspect of care for the mentally ill, especially for forming a working diagnosis ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will be able to: - Identify and describe the theories and epidemiological statistics of schizophrenia. - Describe the trajectory of schizophrenia and its treatments - Understand the effects of schizophrenia on the individual and his/her family. - Dispel any myths about schizophrenia - Understand the nursing care for the patient who is experiencing perceptual disturbances. - Describe their understanding of Schizoaffective Disorder. - Understand the rational for mechanical or seclusion room use. - Understand the nursing care of aggressive patients and for patients in restraints or seclusion room that can result in a malpractice action. IN PREPARATION Read Austin, W. & Boyd, M.A. (2008). Psychiatric nursing for Canadian practice. Philadelphia, PA: Lippincott Williams & Wilkins. Chapters 17, 18 and pp. 56-58; 192-195; 682-684; 853-854; and 913 On page 192 start your reading forms the heading: Promotion of Client safety on psychiatric units. Complete the review questions at the end of the chapters 17
IN CLASS ACTIVITY - Students will engage in small group and large discussion on the following: - Discuss the theories of schizophrenia. - Discuss the treatments of and nursing care for the patient, who has schizophrenia. - Practice how to communicate with someone who is experiencing hallucinations and delusions. - Discuss management of aggressive behavior and their experience with the use of mechanical restraints or seclusion room and their understanding for the use of these. - Discuss chapter review questions. IN REFLECTION What is the current societal view of those with the illness of schizophrenia? Are the services available to them adequate? If not, what treatments and or services should be available to this group of patients? What can you and the public do to advocate for them? How would you feel if you or your loved ones were in restraints? 18
Learning Activity 5 Concept: Mood disorders: Dysthymia; Major Depression; Mania and Hypomania OVERVIEW Depression is one of the most common psychiatric illnesses. It affects 15% of the adult population, with one in four female and one in eight male. It has no cultural boundaries and can result in death through suicide or self neglect (Townsend, 2003). However, if treated it is one of the psychiatric illnesses that can fully respond to treatment, where remission can be permanent. There are several theories of how depression is caused but the most common is the biological and life risk factors (Townsend). Bipolar disorder is when there is a mood swing from depression to the opposite end of the mood spectrum called mania or hypomania. In this sate a person s mood is elevated to the point of engaging in unusual high risk behaviors, which often places him/her at risk for self harm or harm to others (Townsend, 2003). ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will be able to: - Describe the theories and epidemiological statistics of mood disorders - Identify the suicide rate from depression in youth and adult population. - Describe the symptoms of depression and mania - Describe the treatments for depression and mania - Identify and describe the National and local organizations, and self help groups for mood disorders. - Describe the function of the community mental health teams. - Understand the nursing care for the depressed and manic patient. IN PREPARATION Read Austin, W. & Boyd, M.A. (2008). Psychiatric nursing for Canadian practice. Philadelphia, PA: Lippincott Williams & Wilkins. Chapter 19 Complete the review questions at the end of the chapters. Read British Columbia s Provincial Depression Strategy: Phase 1 Report (2002). (available in the reserve section in the library). IN CLASS ACTIVITY - Students will engage in small group and large discussion on the following: - Discuss the trajectory of the above illnesses, its treatments, and nursing care. - Identify and discuss the signs and symptoms of depression and mania - Discuss the effects of these illnesses on the individual and his/her family. 19
- Discuss your perspective on the required reading. - Share any past experience of nursing a depressed or manic client. - Watch video on Electro Convulsive therapy (ECT). - Discuss chapter review questions. IN REFLECTION As you read, consider if you know of anyone who has a mood disorder and had received treatment or not received treatment? How did they cope or manage their mood disorder? With the knowledge you now have, does it reflect your experience or your belief of and its treatment? Why do you think depression is so prevalent in our society today? 20
Learning Activity 6 Concept: Psychopharmacology: OVERVIEW Biological treatments for psychiatric illnesses did not begin until the mid 20 th century. Before this time psychiatric patients were treated in isolation and in many cases incarcerated for the fear of having demons. However, with the introduction of major tranquillizers in the mid 20 th century many of these fears were dismissed (Townsend, 2003. p. 291). Despite the effectiveness of these tranquillizers; patients suffer detrimental and irreversible side effects. Many of these side effects can still be seen today in patients who are in long term psychiatric care such as Riverview hospital and psychiatric boarding homes. With the new approach to psychiatric care, and the current advancement in information technology and research; the newer age psychotropic drugs produce less detrimental side effects and patients enjoy a higher quality of life. ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will be able to: - Examine historical perspectives related to psychopharmacology. - Understand the role of neurotransmitters and their role in mental illness. - Describe the signs and symptoms of neuroleptic malignant syndrome, lithium toxicity, extra pyramidal symptoms, and serotonin syndrome. - Discuss the indications, actions, contraindications, precautions and the nursing implications for the following groups of drugs: IN PREPARATION Antidepressants Antipsychotics Antianxiety agents Antiparkinsonian agents Mood-stabilizing agents Sedatives-hypnotics Central nervous system stimulants Read: Austin, W. & Boyd, M.A. (2008). Psychiatric nursing for Canadian practice. Philadelphia, PA: Lippincott Williams & Wilkins. Chapter 13. Complete the review questions at the end of the chapter. IN CLASS ACTIVITY Students will engage in discussion on their understanding of the use of drugs in treating mental illness and their experience in using any of these drugs in their nursing practice. Students will also engage in discussions on cultural practices with mental illnesses and how this may complement or hinder treatment. Discuss chapter review questions. 21
IN REFLECTION What were your thoughts about the treatment of mental illness before the 20 th century? Were you aware that there were no drugs used in treating psychiatric illness? What do you know about the history of Riverview hospital or similar institution? 22
Learning Activity 7 Concept: Substance related disorders: Drug and Alcohol Personality Disorders OVERVIEW As you are aware, drugs or alcohol play a significant role in our lives today. They are taken for various reasons such as medical purpose to manage chronic pain, and socially for recreation. However, with prolong use some can become addictive or we can abuse it. This action can lead to altering behaviors and thought process that interferes with our general functioning. In its worst form, some drug use can lead to death form accidental overdose or acts of suicide. The concept of personality disorder is used when an individual behave in an irrational manner despite the presence of an intact intellect (Townsend 2003). This diagnosing and treating certain type of personality disorders poses multiple challenges for health care providers. Therefore, understanding the trajectory of these illnesses is very important if appropriate care and services are to be provided for these clients. ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will be able to: - Define abuse, dependence, intoxication, and withdrawal - Identify the predisposing factors implicated in the etiology of substance-related disorders. - Understand the signs and symptoms of substance-use disorders and substance induced disorders. - Identify the nursing care requires for substance-use disorders and substance induced disorders. - Identify family and patient education. - Define codependency and identify behavioral characteristics associated with the disorder. - Identify the treatment modalities for substance related disorders. - Understand the issues of substance related disorders within the nursing profession. - Understand the differences between the various personality disorders, the epidemiology of these disorders, and the treatment for these disorders. IN PREPARATION Read Austin, W. & Boyd, M.A. (2008). Psychiatric nursing for Canadian practice. Philadelphia, PA: Lippincott Williams & Wilkins. Chapters 23, 24, and 31. Complete the review questions at the end of the chapters 23
IN CLASS ACTIVITY Students will engage in small group and large discussion on the following: - Abuse, dependence, intoxication, and withdrawal - Predisposing factors implicated in the etiology of substance-related disorders. - Signs and symptoms of substance-use disorders and substance induced disorders - Nursing care requires for substance-use disorders and substance induced disorders. - Family and patient education and codependency - Behavioral characteristics associated with the disorder - Treatment modalities for substance related disorders. - Issues of substance related disorders within the nursing profession - Discuss the differences between the various personality disorders and the challenges in treating these disorders. - Chapter review questions. IN REFLECTION What are some of the issues that health care faces with substance use and abuse? What steps are being taken by the WHO and Governments on this issue? Are you aware of the provincial initiative for dealing with these issues? What experience have you had in caring for a patient with substance induced disorder, substance-use disorder or personality disorder? Did you values and beliefs influence the way you cared for these patient? 24
Learning Activity 8 Concept: Anxiety disorders: GAD, PTSD, OCD, Social phobia Somatoform disorder OVERVIEW Throughout history humans have experienced anxiety. However, in the early ages the understanding of anxiety was from a physiological or biological in nature and was given a medical diagnosis. However, we now know that anxiety is more than a physiological response, and that it also has a psychological nature. In recent years anxiety disorders has become the most common of all psychiatric illnesses and result in considerable functional impairment and distress (Townsend, 2003, p. 514). Somatoform disorder is a challenge to diagnose and treat and therefore the understanding of this disorder is paramount in providing appropriate and effective care and treatment (Hurwitz, 200 ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will be able to: - Differentiate among the terms, stress, anxiety and fear; normal anxiety and psychoneurotic anxiety; conversion disorder and the different anxiety disorders. - Understand the historical aspects and epidemiological statistics related to anxiety disorders. - Identify predisposing factors in the development of anxiety disorders. - Be aware of the various treatment modalities in the treatment of anxiety disorders. - Understand the nursing care for conversion and anxiety disorders IN PREPARATION Read Austin, W. & Boyd, M.A. (2008). Psychiatric nursing for Canadian practice. Philadelphia, PA: Lippincott Williams & Wilkins. Chapters 20 and 21 Complete the review questions at the end of the chapters Hurwitz, TA. (2004). Somatization and Conversion Disorder. Canadian Journal of Psychiatry, 49(3), IN CLASS ACTIVITY Students will engage in small group and large discussion on the following: - The differences among the terms stress, anxiety and fear; normal anxiety and psychoneurotic anxiety; and the different anxiety disorders. - The historical aspects and epidemiological statistics related to anxiety disorders. - The predisposing factors in the development of anxiety disorders and conversion disorder. 25
- The various treatment modalities in the treatment of anxiety disorders and conversion disorder. - The nursing care for anxiety disorders and conversion disorder. - Chapter review questions and discussion on Hurwitz s article. IN REFLECTION Have you ever experience anxiety or know of any one with anxiety problem? If so what was the level of anxiety or was it any of the other anxiety disorders? How did you manage your anxiety? How have others managed their anxiety? Have you very nursed a patient with any of the anxiety disorders or conversion disorder mentioned in your reading? What nursing interventions did you provide and what was it effective? How did you feel nursing this patient? 26
Learning Activity 9 Guest Speakers from consumers of mental health, the Mood Disorder Association of BC, the Canadian Mental Health Association, and Early Psychosis Intervention Program. OVERVIEW Although there is an increase in the recognition of metal illness, there is still a stigma in society today and as such many individuals with mental illness are marginalized. The purpose of these guest speakers is to provide an overview of their organization and the role of these organizations in advocating for and offer support for the mentally ill and their families. The speakers will also share their personal experience with a mental illness. ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will have an opportunity to understand the role of the above mental health organizations and how mental illness affects a person s life. IN PREPARATION Please access the following websites and read the purpose, goals and objectives of the named organizations. 1) The mood disorders association of BC www.mdabc.bc.ca 2) The Canadian Mental Health Association www.cmha.bc.ca IN CLASS ACTIVITY Participate in discussions on the work of these organizations and the experience of the consumer with mental illness. IN REFLECTION Are the services for the mentally ill adequate? If not, what would you suggest? How can we as nurses advocate for the mentally ill and their families? What services have you recommended or accessed for any of your client who has had a mental illness? 27
Learning Activity 10 Concept: Therapeutic approaches in Psychiatric nursing care: Communication and Therapeutic groups. Students presentation of practice experiences: Reflecting on health promotion and prevention and client/community empowerment OVERVIEW Communication is the basis of any relationship and therapeutic communication is the core of all nurse client relationship (Townsend, 2003). In psychiatric nursing practice it is even more important to develop and maintain a therapeutic nurse client relationship because of the nature of psychiatric illnesses. For example, patients who are experiencing psychosis may not trust the nurse and therefore will not be willing to engage in conversation or may not allow the nurse to carry out his or her nursing intervention, which could compromise the client s care. In your health promotion, prevention and empowerment class you have learned about what constitutes these concepts. From this knowledge, the purpose of this class is for you to share your practice experience of health promotion, prevention and client empowerment. ENDS-IN-VIEW (Learning Outcomes) - Describe the relevance of a therapeutic nurse-client relationship. - Describe the dynamics of a nurse client relationship. - Identify and describe the different therapeutic communication techniques. - Identify barriers to therapeutic communication. - Describe the importance of self-awareness in the nurse client relationship. - Identify the goals of the nurse client relationship. - Identify the essential conditions for a therapeutic relationship to occur. - Describe the phases of the nurse client relationship and the tasks associated with each phase. - Describe the different therapeutic groups in psychiatric care. - Gain a broad understanding of the different health promotion. Prevention and empowerment activities that are carried out by individuals and by the community. - Understand the process of program planning, implementation and evaluation. - Be aware of the different services that are available for health promotion and prevention and client s empowerment. IN PREPARATION Read: Austin, W. & Boyd, M.A. (2008). Psychiatric nursing for Canadian practice. Philadelphia, PA: Lippincott Williams & Wilkins. Chapter 8. Complete the review questions at the end of the chapters 28
Use the principles of solidarity for group work and plan your presentation. Prepare a written copy of your presentation. IN CLASS ACTIVITY Students will engage in small group and large discussion on the following: - Discuss their understanding of the relevance of a therapeutic nurse-client relationship - Discuss the importance of the nurse client relationship in psychiatric practice. - Describe therapeutic techniques used in psychiatric practice. - Discuss chapter review questions. - Engage in role plays to practice therapeutic communication with the depressed, psychotic and manic client. - In small groups of 3-4 members, students will present the function of their practice placement. This will be guided by the presentation outline provided for this activity.. IN REFLECTION What therapeutic communication techniques have you used in your past nursing practice to develop a relationship with your client? How did you overcome any communication barriers that you have encountered in your practice? Have you ever had the opportunity to nurse a client who was experiencing hallucinations or delusions, or who was severely anxious, depressed or in a manic state? If so, how was it and would you change your communication technique in future interactions with these of clients? In your practice experience thus far, what health promotion, prevention and client/community empowerment activities have you engaged in or know of? With the new knowledge gained, has your understanding of these concepts changed? What, if any activities are you engaging in that will be considered health promotion, prevention or client and community empowerment? 29
Learning Activity 11 Students presentation of practice experiences: Reflecting on health promotion and prevention and client/community empowerment OVERVIEW In your health promotion, prevention and empowerment class you have learned about what constitutes these concepts. From this knowledge, the purpose of this class is for you to share your practice experience of health promotion, prevention and client empowerment. ENDS-IN-VIEW (Learning Outcomes) At the end of this class students will be able to: - Gain a broad understanding of the different health promotion. Prevention and empowerment activities that are carried out by individuals and by the community. - Understand the process of program planning, implementation and evaluation. - Be aware of the different services that are available for health promotion and prevention and client s empowerment. IN PREPARATION Use the principles of solidarity for group work and plan your presentation. Prepare a written copy of your presentation. IN CLASS ACTIVITY In small groups of 3-4 members, students will present the function of their practice placement. This will be guided by the presentation outline provided for this activity. IN REFLECTION In your practice experience thus far, what health promotion, prevention and client/community empowerment activities have you engaged in or know of? With the new knowledge gained, has your understanding of these concepts changed? What, if any activities are you engaging in that will be considered health promotion, prevention or client and community empowerment 30
Learning Activity 12 Student Presentation Course review, courses evaluations, and instructor evaluation OVERVIEW In this course students have had an opportunity to learn about what constitutes mental health and most common mental illness. It is hope that with these knowledge students will be able to gain a better understanding of the concepts of mental health and mental illness and be able to provide appropriate and competent nursing care to their patients. Also that student s can incorporate some of this understanding into their own lives, those of their friends and families, and their community. ENDS-IN-VIEW (Learning Outcome) At the end of this class students will be able to briefly discuss their understanding of the concepts presented in this course. IN PREPARATION Review all your notes for this course. IN CLASS ACTIVITY Students will engage in small group and large discussion on all the content covered in this course. Complete course evaluation and instructor evaluation. IN REFLECTION Reflect on what you have learned in this class and whether this knowledge has changed your outlook on mental health and mental illness. As well as whether your nursing care for these patients will be different in the future from what they have been in the past. 31
Student Information Name: Email: Ph. # What experience (work or voluntary) have you had in working with others. I expect my community experience to be: How can I be most helpful to you as an instructor? Do have any personal concerns that might affect your performance in the practice area? What has been identified in the last of previous terms that you need to continue to work on? 32
Instructor Information: Name: email: Ph: My expectations of students and of myself: Of students: That you will practice in a respectful and professional manner. That you will be well prepared with knowledge regarding the specific clients you are working with. That you will identify your learning needs and take an active role to seek help to meet those needs. That you will feel comfortable to inform me of any difficulty you are experiencing in your practice. That you will be ambassadors for future Langara nursing students, especially since this is the first time we are offering term VII and using some new placements. Of myself That I will endeavor to do my best and to be cognizant of your learning needs and assist as much as possible. That I will assist as much as possible with your project work. That I will inform you at the earliest opportunity if I have any concern regarding your practice and make plans with you for your learning needs. And finally that we will have a successful and rich learning experience Cheers and good luck to all of us!!!!!!!!! Signature 33
Mental Health - Common Drugs The common drugs that students need to know are the long acting antipsychotics such as: Fluepenthixol deconate, Haloperidol deconate, Zuclopenthixol deconate, Risperidol deconate, which is new), Pipotiazine deconate, and Fluphenazine deconate. There are also the oral drugs such as Seroquel, Clozapone, Olanzapine and the use of Benzotropine for Extrapyramidal Side Effects (EPS). Mood Stabilizers: Lithium, Carbamazapine, Divalproex, Lamotrigine, Topiramate and Gabapentin. Antidepressants: These are mainly the SSRI s. All students should read the chapter on Psychopharamcology in their Psych text. 34
Area: Agency: Project: Special considerations: Area: Agency: Project: Special considerations: CLINICAL PLACEMENT DATA SHEET Instructor: Population: ************* Instructor: Population: 35
CLINICAL PLACEMENT DATA SHEET Area: Grandview Woodland, Vancouver Agency: Vancouver Coastal Health Authority Instructor: Barb Leigh Population: Seniors Project: A complex long-term project that will begin with three goals: (1) in conjunction with CHNs, plan and implement flu immunization clinics in Grandview Towers for 300 residents, (2) in conjunction with Seniors Fall Prevention Initiative during the flue clinics, distribute fall prevention information and offer senior personal assessments to identify areas of risk in their homes and (3) work with a multidisciplinary team to facilitate the development of a health committee in Grandview Towers. The committee will be run by seniors for seniors and will assist the seniors in addressing health issues of concern to them. Special considerations: speaking Chinese or Korean will be an asset. 36
PLANNING FOR TERM 7 Student Selection of Projects On the morning of September 7, 2006, during the Introduction to Term 7: 1. Each clinical instructor will complete a Clinical Placement Data Sheet for each of their placements and submit same to TC one week prior to meeting the students. 2. TC makes copies of this data for each student. 3. On the morning of September 7 during the Introduction to Term 7 the TC will hand out the Clinical Placement Data Sheet. Each instructor will review his/her part of the data sheet with the students. Students have an opportunity to ask questions. 4. TC posts a sign-up list for all placements on the wall in the meeting room. Students sign up for the placement of their choice. This process will take no more than one hour and one or two clinical instructors will circulate through the room to address student s concerns during this process. 5. TC to ensure that each instructor receives the placement request forms for the students who signed up for his/her placements. 6. Clinical Instructors to meet briefly with their clinical group to communicate orientation plans. 37
NURSING 3246 NURSING PRACTICE VI EVALUATION AND MARKING Item Date/Due Date Value (Percentage) 1. Quiz #1 Sep 29, 2006 15% 2. Quiz #2 Oct 27, 2006 15% 3. Quiz #3 Nov 17, 2006 15% 4. Quiz #4 Dec 1, 2006 15% 5. WebCT Discussion Ongoing 15% 6. Student Clinical Placement Presentation Week of Dec 1, 2006 15% 7. Class Participation Ongoing 10% 8. Clinical Practice Pass/Fail Pass/Fail Total: 100% 38