Developing an Innovative Advanced Psychiatric Mental Health Nursing Curriculum: A Journey of Therapeutic Engagement Trish Jones-Bendel, MSN, RN Kelly Bryant, MS, BSN, RN Jeanette Rossetti, EdD, MS, RN Faith Stauserbal, BSN, RN Vision: PMH - A Specialty Practice Impact of Mental Illness on healthcare Co morbidities with other conditions Recognition of the need for nurses to be prepared as PMH Nurses PMH nursing - accidental passion Increased need for highly skilled nurses Model Decision Focus groups held with nursing staff Identified key values, principles, and beliefs held about care for psychiatric patients Various models of caring explored Limited nursing behavioral health models Recovery focus integrating principles of Trauma Informed Care Bendel, Bryant, Rossetti 1
Supporting Evidence for Education Institute of Medicine (IOM) Report President s New Freedom Commission on Mental Health Schools of Nursing modifying curriculum Limited preparation in the specialty of PMH Nursing in behavioral health care settings Discussion within local APNA IL Chapter Tidal Model The Tidal Model: Introduction A mental health recovery model used as the basis for interdisciplinary mental health care Developed by Phil Barker & Poppy Buchanan- Barker of University of Newcastle, UK. Considered a mid-range theory of nursing Focus of model is helping the individual person embark on their own voyage of discovery Bendel, Bryant, Rossetti 2
The Tidal Model: Description The individual is theoretically represented by three personal domains - Self, World, Others Model suggests that mental wellbeing depends on individual life experience Includes sense of self, perceptions, thoughts and actions Incorporates Ten Commitments The Tidal Model: Definition Emphasizes helping people reclaim the personal story of mental distress, by recovering their voice. People use their own language, metaphors and personal stories to begin to express meaning of their lives. This is the first step towards helping recover control over their lives (Barker, 2001) Provides a practice framework for : - exploration of the patient's need for nursing -provision of individually tailored care Barker P. The tidal model: developing a person-centered approach to psychiatric and mental health nursing. Perspectives Psychiatric Care. 2001 Jul-Sep;37(3):79-87 The Tidal Model: Assumptions Belief in the virtue of curiosity - person is the world authority on their life/problems. Recognizes the power of resourcefulness, rather than focus on problems, deficits or weaknesses Respect for the person's wishes, non- paternalistic Acceptance of the paradox of crisis as opportunity Acknowledge all goals must belong to the person Virtue of pursuing elegance - Simplicity Bendel, Bryant, Rossetti 3
Purpose of Curriculum Prepare psychiatric mental health nurses to provide holistic person centered care Foster self-management of person Promote recovery following principles of the Tidal Model Ensure consistent practice and clear articulation of the nurses role on the interdisciplinary team Curriculum Title: Advanced Psychiatric Mental Health Nursing Curriculum: A Journey of Therapeutic Engagement Three-part series: Required attendance A certificate and 18 CEU s were awarded Required attendance for Registered Nurses Practice based concept application Cohort model used Course Objectives Examine the Tidal Model and the nurse s role in assisting the service user to take a more active role in their recovery. Discuss the need for nursing and the craft of psychiatric mental health nursing from a patient (service user) centered, recovery based, model of care. Identify key aspects of nursing assessment following the Tidal Model. Examine the scope of nursing s therapeutic practice. Describe standardized processes of nursing practice. Apply nursing education principles to service user education practices. Distinguish key aspects of the nursing role as leader and advocate following legal, ethical, and evidenced based principles. Examine the Tidal Model s ten commitments and how they offer service users a compass during their journey of recovery. Bendel, Bryant, Rossetti 4
Course Content: Session 1 THE NEED FOR NURSING - Nature of nursing - Getting personal: Being human in mental health care - Craft of psychiatric-mental health nursing practice - Recovery: Person centered perspective (service user) - The Tidal Model: Ten Commitments NURSING ASSESSMENT IN PRACTICE - Assessment: the foundation of practice - Methods of Assessment - Craft of interviewing - Collaborative assessment Course Content: Session 2 SCOPE OF THERAPEUTIC NURSING PRACTICE - The Acute Care Setting - Practice in an Outpatient Setting - Care and Confinement of those with a mental illness - Developing Therapeutic One to One Relationships - Nurse as Milieu Manager STANDARDIZED PROCESSES OF NURSING CARE - Admission to the Psychiatric Unit - Assessing Risk of Suicide and Self-Harm - Observation during Restraint/Seclusion - Trauma Informed Care Course Content: Session 3 NURSE AS EDUCATOR - Group Facilitation - Service User Education - Medication Education - Discharge Planning ORGANIZATION OF NURSING CARE - Nurse as Advocate - Nurse as Leader - Legal and Ethical Issues - Evidence Based Practice in Mental Health Bendel, Bryant, Rossetti 5
Methods of Instruction All Nurse Managers completed curriculum Expert faculty developed novice Adjuncts Facilitator Training Program Conducted Team Teaching Methodology Mentored Teaching Experiences Learning/Teaching Strategies Engaged Learning Instructors & Attendees Variety of teaching strategies utilized: -lecture - group exercises & games - storytelling - role playing - case studies Homework Assignments The Learning Journey Individualized Binders Randomization in Groups Words to Describe PMH Nursing Wordle Development Definitions of PMH Nursing Principles of Flipped Classroom Bendel, Bryant, Rossetti 6
Highlights of the Class - Faculty Highlights of the Class - Students Words to Describe PMH Nursing Bendel, Bryant, Rossetti 7
Methods of Evaluation Course Evaluation - Curriculum evaluation - Instructors evaluation - Content Modification based on feedback Outcome Measurement - Qualitative Research Study - Focus groups of 6-8 nurses Focus Groups: Interview Guide Describe your experience in the Advanced Psychiatric Mental Health Nursing Curriculum at Linden Oaks Hospital. What has been the impact of the Advanced Psychiatric Mental Health Nursing Curriculum on your role as a psychiatric nurse? How has it impacted your knowledge? How has it impacted your confidence level? How has it impacted your self efficacy as a psychiatric nurse? Focus Groups: Interview Guide (Cont) How has your patient care changed since participating in the Advanced Psychiatric Mental Health Nursing Curriculum? Share an example? How would you define the Tidal Model? What are some examples of the Tidal Model in your daily role as a nurse? Describe the barriers you have experienced in trying to implement the Tidal Model in your nursing practice. Bendel, Bryant, Rossetti 8
Outcomes and Evaluation Outcomes included course completion and evidence of provision of holistic care, promoting self-management, recovery and caring with instead of caring for their patients Focus Group Results indicating the experience of and the impact of the curriculum on psychiatric nursing practice Next Steps Development of an Interdisciplinary curriculum All other health care team members will attend Content reflective of Tidal Model principles/ components relevant to their roles Review assessment and care management practices to ensure they reflect a person centered care approach Adapt documentation to reflect new practices Future Implications Philosophy of caring with instead of caring for patients Empowerment and increased self-efficacy of nurses within the organization Integrative approach across the continuum of care embracing Tidal Model principles Collaborative care practices Bendel, Bryant, Rossetti 9
We Embrace our Vision Behavioral Health care with compassion, dignity and excellence Mental Health is a continuum at any point we move along this from wellness to illness We celebrate every day happy to facilitate the journey for patients. Closing Song References Barker, P. & Buchanan-Barker, P. (2010). The Tidal Model of Mental Health Recovery and Reclamation: Application in Acute Care Settings. Issues in Mental Health Nursing, 31, 171-180. Barker, P. (2009). Psychiatric and Mental Health Nursing: The Craft of Caring. London: Hodder Arnold. Barker, P. & Buchanan-Barker, P. (2005). The Tidal Model: A Guide for Mental Health Professionals. New York: Routledge. Barker, P. (2001). The Tidal Model: developing and empowering, person-centred approach to recover within psychiatric and mental health nursing. Journal of Psychiatric and Mental Health Nursing, 3, 233-240. Barker, P. (2001). The Tidal Model: developing a person-centered approach to psychiatric and mental health nursing. Perspectives in Psychiatric Care, Jul-Sept, 37 (3), 79-87. Weston, M.J. (Jan. 31, 2010). Strategies for Enhancing Autonomy and Control Over Nursing Practice. OJIN: The Online Journal of Issues in Nursing, vol 15, No. 1, manuscript 2. Bendel, Bryant, Rossetti 10