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GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNIVERSITY
NUR 411
MENTAL HEALTH NURSING
FALL 2004
COURSE COORDINATOR:
Lana Chase, RN, MN, CNS/PMH
GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNIVERSITY
NUR 411 Mental Health Nursing
Course Syllabus
Course Website: faculty.mercer.edu/keeley_ac
Fall 2004
Course Title:
NUR 411 Mental Health Nursing
Course Credits:
6 Semester Hours (4-6-6)
Total Course Hours:
Class: 4 hours/week
Total class hours: 60
Clinical 6 hours/week
Total clinical hours: 90
Course Placement:
Level (4), Fall and Spring semesters, fourth year
Prerequisites:
All Level 1, 2, and 3 courses and PSYC220
Course Description: This course focuses on providing the student with a
theoretical and knowledge foundation for the contemporary practice of mental
health nursing. Concepts taught in nursing and liberal arts courses will be
integrated with current mental health nursing research and theories. Specific
attention will be paid to the integration of prior learning of abnormal psychology
and pharmacology with course emphasis on nursing practice. Utilizing a holistic
view, the course teaches the student mental health nursing skills integrating
perspectives of physical, spiritual, social, intellectual, and emotional needs in the
promotion of health maintenance and the nursing management of life disruptions.
Self-awareness, self-care, empathetic care of others, personal growth and
professional development are vital components of the student experience in
mental health nursing. Therapeutic communication, case management, critical
pathways, psychopharmacology, nursing theories, and psychobiology will be
threads throughout this course. Students will become familiar with standard
assessment tools used in mental health. Opportunities for clinical application of
classroom content will be provided in a variety of mental health settings.
Preparation for class is essential for maximum benefit of the scheduled time.
Prior to each class there will be a quiz on the key points in the assignment. Each
topic has a Study Guide component that is to be completed prior to class.
2
Course Faculty:
Ann Keeley, RN, MN, LMFT (Coordinator)
Assistant Professor
Office 213, Office telephone: 678-547-6749
[email protected]
Kathleen Brewer, RN, PhD, CNS
Associate Professor
Office 236, Office telephone: 678-547-6746
[email protected]
Lana Chase, RN, MN, CNS
Assistant Professor
Office 235, Office telephone: 678-547-6739,
Phone: 770-435-1660, 770-330-3317
[email protected]
Patricia Troyan, RN, CNM, EdD.
Office 265, Office Telephone: 678-547-6762
[email protected]
Course Objectives:
Upon successful completion of NUR 411, the student will be able to:
1.
Function in the role of a mental health nurse in a variety of clinical
settings.
2.
Apply the nursing process to provide mental health nursing care to
individuals, families, groups and communities of diverse cultures in a
variety of settings.
3.
Integrate therapeutic communication skills with the communication skills
acquired thus far in the curriculum.
4.
Adapt principles of teaching-learning to the provision of care within the
realm of mental health nursing.
5.
Integrate a professional code of behavior to the practice of mental health
nursing.
6.
Integrate relevant legal and ethical guidelines in to the practice of mental
health nursing.
7.
Apply nursing theories of evidence-based practice, case management,
and critical pathways to mental health nursing.
8.
Synthesize knowledge from the liberal arts and sciences with current
theories of mental health nursing practice.
9.
Access and utilize print, internet, and community based resources to the
practice of mental health nursing.
Required Textbooks:
Boyd, M.A. (2005). Psychiatric nursing: Contemporary practice (3rd Ed.).
Lippincott Williams & Wilkins: Philadelphia: PA.
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Boyd, M.A., & Foley, M. (2002). Study guide to accompany psychiatric nursing:
Contemporary practice (2nd Ed.). Williams & Wilkins: Philadelphia: PA.
(Will be supplied in class)
Pharmacology Textbook from NUR 312
Abnormal Psychology Textbook from pre-requisite course
Required Readings:
American Nurses Association (1985). Code for nurses with interpretative
statements. Washington, DC: Author (see Student Handbook).
American Nurses Association (1988). Standards of clinical nursing practice (2nd
Ed.). Washington, DC: Author (on Library Reserve).
Evaluation of Student Learning:
1.
Objective Testing
2.
Clinical Performance Evaluation
3.
Drug Calculation Test
4.
Family Project
5.
Communication Project
6.
Class Assignments
Requirements for Successful Completion of Course:
1.
The student must make an average of 75% on objective testing and
written course assignments to successfully complete the course.
2.
The student must pass a drug calculation test with 90% accuracy. Any
student falling below 90% accuracy will have an opportunity for
remediation and two additional opportunities to take the test within 3
weeks after the onset of the course.
3.
Satisfactory clinical performance
4.
Completion of ATI Achievement Examinations
5.
Completion of all clinical and classroom assignments
Course Grading System:
Exam I
Exam II
Exam III
Comprehensive Exam
Communication Project
Family Project
Total
20%
20%
20%
20%
10%
10%
100%
A project with a failing grade will be read by a second faculty member. The
student will receive the highest grade of the two grades.
Make-up exams will follow the policy set forth in the Student Handbook. Please
note* the make-up exam will cover the same content but may be of a
different format and the questions may vary in number.
4
It is the policy of Georgia Baptist College of Nursing of Mercer University to
adhere to all Health Insurance Portability and Accountability Act (H.I.P.A.A)
guidelines. All discussions and/or documents related to confidential
patient/client health information will only be written or electronically
transmitted using the client/patent initials. Furthermore, this information
will only be shared with faculty involved in the student’s education
process. Client/patient discussions will only be held in designated areas of
the university or clinical facility.
NUR 411: Syllabus: Keeley.Chase.11/22/02.Rev. Chase/08/04
5
GEORGIA BAPTIST COLLEGE OF NURSING
OF MERCER UNIVERSITY
INCLEMENT WEATHER CLOSING ACTION PLAN
In cooperation with the overall inclement weather plan of Mercer’s
Cecil B. Day Campus/Atlanta and the off-campus centers in Griffin,
Douglas County, and Covington, the COLLEGE OF NURSING will
follow a predetermined plan to disseminate information to students,
faculty and staff:
1.
The decision to close any one (or all) of the multiple Atlanta
area campuses will be made by Dr. Bartling (School of
Pharmacy) in consultation with Dr. Dattilo (College of Nursing).
Dr. Bartling will consult with designated administrative
individual(s) to determine how each school will respond to the
weather crisis. For example, morning clinical experiences for
nursing may be affected differently from evening business or
education classes.
2.
Dr. Bartling will notify the University Relations and Marketing
Office and a staff member in this office will do the following:
 A message for each school will be recorded on the
University Weather Hot-line telephone number (see below).
 An e-mail broadcast message will be sent to faculty, staff
and students
 A scrolling red message bar will appear on the home page of
Mercer’s web site at www.mercer.edu
 A general message will be given to WSB TV (channel 2) and
WSB radio (AM 750) to put on the air.
IMPORTANT: Faculty, staff, and students should rely on
the phone hot-line message, the web page or their email to get the most accurate information about the
specific plan for our college.
MERCER UNIVERSITY
WEATHER HOT-LINE:
6 547-6111
(678)
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
STUDENT NAME:
COURSE:
DATE:
HONOR SYSTEM CREED
As a member of the Georgia Baptist College of Nursing community, I am bound by honor
to uphold standards of honesty and integrity; to pursue full intellectual, ethical, spiritual,
and moral development; and to accept my personal, academic, professional
responsibilities in the community. To attain these ideals, I embrace this Honor System
as my way of life.
H.I.P.A.A. Statement
It is the policy of Georgia Baptist College of Nursing of Mercer University to adhere to all
Health Insurance Portability and Accountability Act (H.I.P.A.A.) guidelines. All
discussions and/or documents related to confidential patient/client health information
shall be held in strict confidence. Information will only be written or electronically
transmitted using the client/patient initials. Further, this information will only be shared
with faculty involved in the student’s education process. Client/patient discussions will
only be held in designated areas of the university or clinical facility.
Permission for Posting Grades
In accordance with the Buckley Amendment to the Family Educational Rights and
Privacy Act of 1974, we cannot post any exam or course grades without the express
permission of the student. Therefore, we would like to ask each of you to indicate
whether or not you desire to have your grades posted in a public place.
I would like to have grades for the above course posted by an identification
number on a designated bulletin board. YES__________
NO___________
Signature:__________________
Code Number:______________
(Choose a four digit number; which
will be followed by three (3) zeros.)
Statement of Understanding
I have read the Course Outline for the above stated course. I understand the objectives
and requirements of this course and have no questions regarding them. I also have
read the Honor System Creed, the H.I.P.A.A. Statement, and the Permission for Posting
Grades Statement. I understand the purposes and requirements of the above
statements.
Signature:____________________________________
7
GEORGIA BAPTIST COLLEGE OF NURSING OF
MERCER UNIVERSITY
H.I.P.A.A. Background Information
In 1996, Congress enacted the Health Insurance Portability and Accountability
Act, or H.I.P.A.A. The primary purpose was continuity of health insurance
coverage if you change jobs, but it also provided standards for health information
transactions and confidentiality and security of patient data. This confidentiality
portion affects the day-to-day education process of nursing students. Permission
must be received from the patient prior to ANY disclosure.
H.I.P.A.A. Enforcement
The Privacy Rule was published in April 2001 and will be enforceable in April
2003. The Office of Civil Rights will enforce it. There are civil penalties of
$100/violation up to $25,000/year. Criminal penalties are also possible including
$50,000 and/or 1 year in prison for wrongful disclosure or $250,000 and/or 10
years in prison for the intent to sell information.
As health care providers, we all have a responsibility to uphold confidentiality for
patients. In a busy education or hospital setting it can be difficult. Classroom
discussions and clinical conferences and assignments lead to discussions of
client's confidential health information. While these oral and written discussions
are acceptable in the educational setting, they are not acceptable in common
areas such as the cafeteria, or in the written form without preventing the
disclosure of the patient's name. The person next to you in line could be a
patient's friend, relative, or media member that is not entitled to this privileged
information. If clinical/classroom papers are lost or transmitted electronically
without safeguards, the general public would have access to confidential patient
information.
Confidentiality is the basis of the nurse-patient relationship. If the patient is
uneasy about disclosing pertinent and privileged information, the ability of the
nurse to provide holistic adequate care is severely compromised. It should be
made clear to the patient that this information will not be disclosed unless
required by law. The medical record is to be kept private with certain exceptions
including:
- Treatment of minors
- Transportation Safety
- HIV+ Patients
- Abuse of a Child or Adult
- Duty to report harm/wound
8
GEORGIA BAPTIST COLLEGE OF NURSING
Of
Mercer University
NUR 411 Mental Health Nursing
Clinical Component
1.
Clinical Experiences: Each student will complete clinical experiences in
mental health settings. Students are expected to establish collaborative
relationships with members of the health care team and with other
professionals in the application of the nursing process in each setting.
2.
Clinical Agencies: A variety of mental health settings.
3.
Faculty Supervision of Students:
The faculty member who is
responsible for the student may or may not be present in the same setting
as the assigned student. In order to enhance the learning experience of
the student and to augment communication between the faculty member
and the student, the faculty member will be accessible to the student
either by telephone or by beeper during the period of time that is required
for the student to complete the clinical assignment. When students
complete the clinical assignment, they will notify the faculty member either
directly or by voice mail.
4.
Uniform Policy: Students are expected to report to all clinical facilities
dressed according the policy of the College or the Facility, whichever has
been designated by the clinical faculty.
5.
Clinical Assignments: There will be several specific assignments
relevant to the mental health nursing practice. Successful completion of
these assignments by the specified date is necessary for a "Satisfactory"
clinical performance rating.
9
Weekly Worksheet: Mental Health Nursing:
FACULTY:
STUDENT:
DATE:
Identifying data:
Gender:
Age:
Ethnicity: ______________
General Appearance:
Unkempt
Unclean
Marital Status: _____
Well-Groomed
Posture
Reason for admission:
________________________________________________________________
________________________________________________________________
Current health:__________________________________________________
Significant Health history:_________________________________________
Alterations
Activity:
Sleep:
Appetite/Nutrition/Hydration:
Self-care:
Lab values:
10
Mental Status Exam: Circle all terms that apply
General Appearance:
Unkempt
Unclean
Well-Groomed
Posture
Motor Activity:
Tremors
Tics
Hyperactivity Restlessness Boundaries
Agitation
Aggressiveness
Rigidity
Psychomotor retardation
Speech Patterns:
Rate: Normal Slow Rapid
Pressure of Speech
Stuttering
Correct use of words
Fluency
Quality
Volume: ______________
General Attitude:
Cooperative
Uncooperative Friendly
Hostile
Defensive
Disinterested Apathetic
Attentive
Guarded
Mood:
Sad
Depressed
Despairing
Irritable
Anxious
Euthymic Dysphoric
Elated Euphoric
Fearful
Guilty
Labile
Apathy
Other: ______________
Affect:
Congruent with mood Range: Full
Constricted
Intensity: Increased Flat Blunted
Stability: Normal
Labile
Other: ______________
Thought Processes:
Form:
Flight of ideas Associative looseness Circumstantiality
Tangentiality
Neologisms
Concrete thinking
Clang Word salad
Preservation
Mutism
Poverty of speech
Ability to concentrate
Attention span
Ability to Concentrate
Confabulation
Content:
Delusions
type Suicidal
Obsessions
Paranoia
Magical thinking
Religiosity
Repetition
Abstract Reasoning and comprehension: (Proverbs)
_____________________________________________________________________________
Perceptual Disturbances:
Hallucinations type:
Illusions
Depersonalization
Derealization
Judgment and Insight:
Ability to solve problems
Ability to make decisions
Knowledge about self
Memory
Recent: Impaired Intact Remote: Impaired Intact
Orientation (Time, Place, Person, Situation)
Disoriented:
Confused
Self Concept:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Stress and Coping Patterns:
________________________________________________________________
________________________________________________________________
________________________________________________________________
11
Risk Assessment:
Suicide: (Thoughts or Ideation/ Plan/ Means/ Means Available)
________________________________________________________________
________________________________________________________________
________________________________________________________________
Homicide: (Anger behaviors/ history of violence/ history of arrest/ current
thoughts of harming others)
________________________________________________________________
________________________________________________________________
________________________________________________________________
GAF Score: ___________
Family Assessment: (Members/ members available to client/ family
participation)
________________________________________________________________
________________________________________________________________
________________________________________________________________
Sociocultural Assessment: (Cultural group/ cultural group’s perception of
mental health and mental illness/ cultural norms relevant to situation)
________________________________________________________________
________________________________________________________________
________________________________________________________________
Community Resources:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Spirituality:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Economic Resources:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Legal:
________________________________________________________________
________________________________________________________________
________________________________________________________________
DSM IV-TR Diagnosis:
Axis 1:
Axis 2:
Axis 3
Axis 4:
Axis 5
I
dentify clinical behavior that supports any of the axis diagnoses:
________________________________________________________________
________________________________________________________________
________________________________________________________________
12
Nsg. Dx.
Short Term Goal:
Interventions
Long Term Goal:
Interventions:____________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Charting
___________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
MEDICATIONS:
BRAND NAME:
DOSE AND TIME:
PURPOSE:
GENERIC NAME:
SIDE EFFECTS:
NSG CONSIDERATIONS/TEACHING:
___________________________________________________________
________________________________________________________________
________________________________________________________________
OBSERVED EFFECTS:
________________________________________________________________
________________________________________________________________
________________________________________________________________
13
BRAND NAME:
DOSE AND TIME:
PURPOSE:
GENERIC NAME:
SIDE EFFECTS:
NSG CONSIDERATIONS/TEACHING:
________________________________________________________________
________________________________________________________________
________________________________________________________________
OBSERVED EFFECTS:
________________________________________________________________
________________________________________________________________
________________________________________________________________
BRAND NAME:
DOSE AND TIME:
PURPOSE:
GENERIC NAME:
SIDE EFFECTS:
NSG CONSIDERATIONS/TEACHING:
____________
OBSERVED EFFECTS:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Considerations for Drug Interactions:
14
COMMUNICATION PROJECT
GUIDELINES: GRADING CRITERIA
GUIDELINES:
Each interview will last approximately fifteen (15) minutes. Students will provide their own
videotape.
Each pair of students will film two interviews. At the completion of the first interview, the roles will
switch. The context of the interview will be a nursing assessment of a consumer who has just
arrived to be assessed for admission to an inpatient, outpatient, or emergency treatment facility.
Students will collaborate with their partner to analyze each scenario.
Submit the videotape and one paper per student pair analyzing both scenarios separately.
Each student will add an individual self-analysis (see #5) to the end of the paper.
Each pair will submit a paper with their videotape by the date identified on the syllabus calendar.
Prior to the interview Student A (Consumer) will inform Student B (Nurse) of the diagnosis, age
sex, length of illness, medications, and other medical conditions.
INTERVIEW:
STUDENT A:
Present symptoms of an identified DSM-IV diagnostic category.
The consumer will include an attempt to:
1.
Elicit personal information from the Nurse
2.
Ask for advice at least once
3.
Ask the nurse for reassurance
4.
Disagree with the nurse
5.
Make one attempt to challenge therapeutic space boundaries.
STUDENT B: Conduct a therapeutic assessment interview with the consumer. Utilize as many
therapeutic communication techniques as possible.
15
IPR FORM
Student: Verbal/Nonverbal
NUR 411: KEELEY:IPR:S/2003
Client: Verbal/Nonverbal
Communication Technique/Alternate
Behavior Analysis: Interaction Analysis
IPR FORM
Student: Verbal/Nonverbal
Hi My name is _____. I am a
student from Mercer University. I
would like to spend about 15
minutes getting to know you
today.
Client: Verbal/Nonverbal
Pt. Nodding off in a chair in the
Mileu.
Nonverbal – relaxed posture, eye
contact, facing client slightly
learning forward.
Coughing
Wheezing
Communication Technique/Alternate
Yes, while I am awake.
How did you arrive at the clinic
today?
I walked. Talked. Squalked.
How did you arrive?
Coughing
It is not important how I got
here…Let’s focus on you.
It is always about me. Everyone
wants to sleep with me. My
17
Behavior Analysis: Interaction Analysis
Student: Verbal/Nonverbal
Client: Verbal/Nonverbal
Wife is Janet Jackson and she
travels a lot. I am alone and
everyone wants to sleep with
me when she is gone.
How did you know that everyone
wants to sleep with you?
I can hear their thoughts when
they look at me.
Communication Technique/Alternate
Coughing
When you say “sleep” are you
actually referring to falling asleep
or sexual implications?
Falling asleep. Are you a
Nethrerlander?
What is a Netherlander?
18
Behavior Analysis: Interaction Analysis
Student: Verbal/Nonverbal
No, I don’t’ think I do.
Client: Verbal/Nonverbal
You don’t know what a
Netherlander is?
Are you a Netherlander?
You would know if you were
one.
Communication Technique/Alternate
Boys cannot be Netherlanders.
I wonder where that thought came
from?
Where do you live?
Remember…I would like to hear
about you during this time. Tell
me more about being sleepy all of
the time.
Coughing
Wheezing
19
Behavior Analysis: Interaction Analysis
Student: Verbal/Nonverbal
I’ve noticed that you hold your
hand in the air. Is there a reason
you need to do this?
Client: Verbal/Nonverbal
Coughing
There are little men. I wonder
where they come from
The little men fall off when I hold
my arm high in the air.
Communication Technique/Alternate
I feel them.
Are you sleepy often?
They tickle me and make me
sleepy. That’s why everybody
wants to sleep with me. Yes
coughing.
20
Behavior Analysis: Interaction Analysis
Student: Verbal/Nonverbal
Client: Verbal/Nonverbal
Yes, I am very sleepy. I think I
will lie down now.
I would really like to find out more
about you if you could give me a
few more minutes.
I don’t have a few more minutes!
My wife is coming back! I must
get to sleep!
Communication Technique/Alternate
SILENCE
SOB c execution
Coughing
Wheezing
I am sorry to keep you awake… I
have 5 more minutes. Do you
have 5 more minutes?
21
Behavior Analysis: Interaction Analysis
Student: Verbal/Nonverbal
Client: Verbal/Nonverbal
Yes, but only 5 min. My arm is
tired and I cannot keep the men
off any longer.
What is your wife’s name?
Janet.
How long have you known her?
12 years.
Where do you and Janet live?
Downtown by the Stadium.
Were you living there the day you
came here?
Coughing
Wheezing
Communication Technique/Alternate
22
Behavior Analysis: Interaction Analysis
Student: Verbal/Nonverbal
Did you come here to get your
medicine?
Client: Verbal/Nonverbal
Yes; It was raining. I was out of
my medicine. Did I do the right
thing?
Communication Technique/Alternate
.
The police brought me here
because I was trying to get into
Janet’s concert to be with her.
Do you think we should get a
divorce?
“Should you get a divorce…”
Coughing
Coughing
I am sorry to keep you awake…I
have 5 more minutes. Do you
have 5 more minutes?
Am I doing the right thing? You
know holding my arm up while
my wife is gone?
23
Behavior Analysis: Interaction Analysis
Student: Verbal/Nonverbal
I am not unable to tell you what is
right for you. I am sure that is
difficult to continue holding your
arm that way all of the time.
Client: Verbal/Nonverbal
Communication Technique/Alternate
I need some rest.
Thank you for your time.
24
Behavior Analysis: Interaction Analysis
GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNIVERSITY
NUR 411 MENTAL HEALTH NURSING
Guidelines: You may write a narrative but number each section relating to the
questions. If there is overlapping data, then state: e.g.#4 is discussed in #3. You may
also edit questions to fit your family or include some that are not listed. The paper is
typed. There are no page limits but please aim to be concise and to the point. You
should be able to consolidate important information in an assessment. Try not to include
minute details that are irrelevant.
Family Interview Questions to Consider:
1.
Initials of family members/significant others (use only initials-no identifying data
for confidentiality).
Initials Age
Relationship
Type of Residence
Members Present at Interview
Does any family member live outside the family home? Does the family member
mental illness live with the family or in a group home/apartment or have their own
home? Is the family satisfied with this living arrangement? Is the family member
with the mental illness living or deceased? If deceased, gear the interview to
discussion of care given when the person was living as well as the causes of
death and grief experiences within the family.
2.
Health Status (list all family members)
Family Member
Disorder and/or self described health status
Current treatment & effectiveness of treatment
Any health/illness patterns that student or family identify?
Any physical health risks related to side effects of psychotropic medication or
lifestyle? i.e smoking, weight gain, liver, kidney problems, and substance
abuse… List all physical problems that family members may have.
3.
Mental Health Status (list all family members)
Family Member
Disorder and/or self described health status
Current treatment & effectiveness of treatment
Any health/illness patterns that student or family identify?
Any family member has stress, depression, anxiety that the individual identifies
as being related to caregiver burnout?
4.
Impact of mental and physical illnesses on family function: Describe the
changes that occur in the family as a result of any family members mental illness
or physical illness. Note: Impact on parents, siblings, and extended family,
significant others, marital status.
5.
Family life cycle: Describe the family life cycle stage and any transitions that
are occurring.
6.
Communication Patterns: Describe the family communication patterns in terms
of usual times of communication (morning, dinner, etc.), which family members
talk to each other, who communicates the family rules, who is able to set limits.
Ask the family about conflicts in communication and how these are handled.
7.
Stress and coping: Identify any current family stressful events. What coping
strategies do family members use to deal with stress?
8.
Problem solving skills: Determine who solves problems in the family. Do
family members see themselves as good, adequate or poor problem solvers?
9.
Family system: Ask the family to assist you to draw a 3-generatioon family
genogram that identifies the family composition. Identify “relationship patterns”
with the family.
10.
Identify social function patterns with the family: Does the family tend to
interact mostly with the nuclear family, extended family, and/or community
organizations?
Do family members feel isolated or supported?
11.
Financial Issues: Do family members identify any financial issues they are
struggling with? Are these issues related to healthcare or cost of medications?
Are all adults in the family able to financially support themselves?
12.
Legal System: Has the legal system been a benefit to the family or created any
crisis for the family? How?
13.
Network Support: Who does the family seek support from when they have a
crisis? Has the support been adequate? Discuss formal and informal support
networks such as extended family, neighbors, church, NAMI, MH
center/caregivers, police, etc…
Does the family have an advocate who assists them to get their health-care
needs met?
Ask the family members to identify the issues of most concern to them.
What would you and the family include in a multidisciplinary plan of care to address their
healthcare needs?
Have health/mental health caregivers collaborated with family members to develop a
workable plan of care?
Identify any community resources that they have accessed for support.
Have these resources been helpful or not?
In addition to available resources, also discuss a “wish list” of resources that the family
needs but are not currently available to them in their community.
26
Are any of the services on their “wish list” available but not accessible because their
family does not “qualify” for the service under current admission criteria?
Has the family been disappointed in care they received by any facility/hospital/or health
practitioner? What was the nature of their disappointment?
Has the family experienced problems with “stigma” regarding mental illness in their
family?
What role has NAMI played in their lives?
Do family members seek health care in the private or public sector?
Have they received equal care/insurance benefits for mental and physical illnesses?
Have the benefits met the family need?
Do family members have any suggestions for you to become an effective caregiver in
working with families in crisis?
Ask the family members to discuss their feelings/reactions to this interview with you.
Share any self-awareness or insights you gained by interacting with the family.
NUR 411: Family Interview Questions. LC:S03
27
GEORGIA BAPTIST COLLEGE OF NURSING
OF
MERCER UNVIVERSITY
NUR 411 MENTAL HEALTH NURSING
Family Interview Grading
Guidelines: You may write a narrative but number each section relating to the
questions. If there is overlapping data, then state: e.g.#4 is discussed in #3. You may
also edit questions to fit your family or include some that are not listed. The paper is
typed. There are no page limits but please aim to be concise and to the point. You
should be able to consolidate important information in an assessment. Try not to include
minute details that are irrelevant.
35 points Data Gathering: Documented appropriated data related to the family’s
mental, physical, social and spiritual functioning (see questions)
15 points: Family Genogram: List all members in 3 generations. Include age, death,
divorce, biological and stepfamily, and record how the people you interview feel about
this person if anything significant arises.
15 points Interpretation of data: What is your impression of the dynamics of this
family? What conclusions do you draw related to the data you gathered?
15 points Plan of care: List 2 issues that you or a family member identified as a
problem and any solutions that they have sought and alternated solutions you could
suggest. Include community/Internet resources
20 points Self-Awareness: How did you feel going into the home for this interview?
How do you rate your interview skills and what would you do differently in a next
interview? Did you have any attitude changes from this interview and/or throughout the
semester regarding mental illness? How will these changes impact your career in
nursing?
28
SOCIAL CHANGE AND MENTAL HEALTH
LESSON OBJECTIVES:
At the completion of this lesson the student will be able to
1. Identify agents of social change that affect the delivery of mental health care.
2. Relate the concept of social change to the history of psychiatric mental health care.
3. Discuss the history of psychiatric-mental health nursing and its place within nursing
history.
4. Analyze the theoretic arguments that shaped the development of contemporary scientific
thought.
5. Summarize the impact of the current economic and political forces on the delivery of
mental health services.
CONTENT OUTLINE:
1. A Revolutionary Idea: Humane Treatment
2. The 19th and Early 20th Centuries
2.1.1. Horace Mann and the Beginning of Public Responsibility
2.1.2. A Social Reformer: Dorothea Lynde Dix
2.1.3. Life Within Early Institutions
2.1.4. Development of Psychiatric-Mental Health Nursing Thought
2.1.4.1.1. Early Views
2.1.4.1.2. Social Influences
3. Modern Thinking
3.1.1. Evolution of Scientific Thought
3.1.1.1.1. Meyer and Psychiatric Pluralism
3.1.1.1.2. Freud and the Psychoanalytic Theory
3.1.1.1.3. Diagnostic Classifications
3.1.1.1.4. Integration of Biologic Theories Into Psychosocial Treatment
3.1.2. Increased Government Involvement in Mental Health Care
3.1.3. Continued Evolution of Psychiatric-Mental Health Nursing
4. The Late 20th Century
4.1.1. Community Health Movement and Deinstitutionalization
4.1.2. Sanctioning of Holistic Nursing Care
4.1.3. Contemporary Issues
4.1.3.1.1. Changing Demographics
4.1.3.1.2. The Age of Managed Care
4.1.3.1.3. National Mental Health Objectives
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 1: 1-5 pp.
2.
Participation in Classroom critical thinking activities.
3.
Quiz
4.
CRITICAL THINKING FOCUS:
How the concepts of mental health/mental illness are a product of history. What is the history of
professional nursing care in mental health and mental illness.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 2-15). Philadelphia:
Lippincott.
WEB LINKS:
http://www.health.gov/healthypeople This is the Healthy People 2010 website.
http://www.surgeongeneral.com This website of the U.S. Surgeon General contains major mental
health reports.
29
http://www.nlm.nih.gov The National Library of Medicine site offers excellent access to PUBMED
for nursing articles and mental health information. It provides links to the History in Medicine
Library.
http://www.mentalhealth.com This site is an excellent resource on disorders and diagnoses and
provides links to other sites.
http://www.cmhc.com This site provides access to the Mental Health Net, self-help groups,
professional resources, and discussions.
http://www.samhsa.gov/oas/oasftp.htm This Substance Abuse and Mental Health Statistics site
provides national statistics on alcohol, tobacco, and illegal drug use, substance abuse treatment,
and mental health.
http://www.who.int/aboutwho/en/preventing/mental.htm This site of the World Health
Organization has information on mental health disability and programs.
NUR 411: KEELEY/CHASE: 11/22/2002
30
PATIENT RIGHTS AND LEGAL ISSUES
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Discuss the role of informed consent in the delivery of psychiatric-mental health care.
2. Use the concepts of self-determinism and competence in discussing patient treatment
choices.
3. Delineate the differences between voluntary and involuntary treatment.
4. Explain the rationale for providing the least restrictive treatment environment.
5. Discuss the issues of confidentiality and mandates to inform and their implications in
psychiatric mental healthcare.
6. Identify the importance of accurate, descriptive documentation of the biopsychosocial areas.
7. Discuss the issues underlying the insanity plea.
CONTENT OUTLINE:
1. Patient Rights
1.1.
Bill of Rights
1.2.
The Americans With Disabilities Act and Job Discrimination
2. Issues of Consent
2.1.
Self-Determinism
2.2.
Self-Determination Act
2.3.
Advance Care Directives in Mental Health
2.4.
Competency
2.5.
Informed Consent
3. Voluntary and Involuntary Treatment
3.1.
Right to Treatment in the Least Restrictive Environment
4. Issues of Confidentiality
4.1.
Privacy Versus Confidentiality
4.2.
Mandates to Inform
5. Documentation and Legal Issues
6. Criminal Law and Psychiatry
6.1.
Not Guilty by Reason of Insanity (NGRI)
6.2.
Guilty But Mentally Ill (GBMI)
6.3.
Forensic Commitment
6.4.
Misconceptions Regarding the Insanity Plea
7. Public Safety
7.1.
Laws and Systems That Protect Human Rights
7.2.
Internal Rights Protection System
7.3.
External Advocacy Systems
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 4: pp 13-15.
2.
Participation in Classroom Critical Thinking Exercises. CTE # 3. Study Guide Page
16. Critical Thinking Challenge #2. Page 51 Text.
3.
Quiz
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed.,pp.42-52). Philadelphia
Pa.: Lippincott.
WEB LINKS:
http://www.nami.org The National Alliance for the Mentally Ill is a grassroots, self-help support,
and advocacy organization.
http://www.cnps.ca The Canadian Nurses Protective Society (CNPS) is a nonprofit society,
owned and operated by nurses for nurses, offering legal liability protection related to nursing
practice to registered nurses by providing information on education.
31
http://www.nursingnet.org This site provides information on nurses as legal consultants.
NUR 411: KEELEY/CHASE: 11/22/2002
32
COMMUNICATION AND THE THERAPEUTIC RELATIONSHIP
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Identify the importance of self-awareness in nursing practice.
2. Develop a repertoire of verbal and nonverbal communication skills.
3. Develop a process for selecting effective communication techniques.
4. Explain how the nurse can establish a therapeutic relationship with patients by using rapport
and empathy.
5. Explain the physical, emotional, and social boundaries of the nurse-patient relationship.
6. Explain what occurs in each of the three phases of the nurse-patient relationship: orientation,
working, and resolution.
CONTENT OUTLINE:
1. Self-Awareness
1.1.1. The Biopsychosocial Self
1.1.2. Understanding Personal Feelings and Beliefs and Changing Behavior
2. Communication
2.1.1. Using Verbal Communication
2.1.1.1.1. Self-Disclosure
2.1.1.1.2. Verbal Communication Techniques
2.1.2. Using Nonverbal Communication
2.1.3. Selecting Communication Techniques
2.1.4 Applying Communication Concepts
2.1.3.1.1. Rapport
2.1.3.1.2. Empathy
2.1.3.1.3 Biopsychosocial Boundaries and Body Space Zones
2.1.4. Analyzing Interactions
3. The Nurse-Patient Relationship
3.1.1. Orientation Phase
3.1.1.1.1. First Meeting
3.1.1.1.2. Confidentiality in Treatment
3.1.1.1.3. Testing the Relationship
3.1.2. Working Phase
3.1.3. Resolution Phase
LEARNING ACTIVITIES:
1. Study Guide: Chapter 9: Pages 41-43
2. Participation in Case Study Activities. CTE #2. Study Guide. Page 43
3. Quiz
CRITICAL THINKING FOCUS:
Development of self-awareness of individual communication patterns and addition of therapeutic
communication skills utilized in the practice of mental health nursing.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., Pp 178-192).
Philadelphia Pa.: Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
33
CULTURAL ISSUES RELATED TO MENTAL HEALTH CARE
LESSON OBJECTIVES
Upon completion of the lesson, the student will be able to:
1. Identify various cultural and ethnic groups in the United States and Canada.
2. Compare the concepts of prejudice, discrimination, and stereotyping and their relationship to
stigmatization.
3. Define the process of stigmatization as an influence in mental health care delivery.
4. Describe the beliefs about mental health and illness in different cultural groups.
5. Trace the changing view of families from causing mental illness to collaborating in the care.
6. Discuss the changing family structure and the mental health implications.
7. Describe the important role of consumer groups in developing awareness of the special
problems of patients with mental disorders.
CONTENT OUTLINE:
1. Importance of Culture to Psychiatric Nursing
2. Cultural Terms and Issues
2.1.
Acculturation
2.2.
Segregation Versus Integration
2.3.
Prejudice, Discrimination, and Stereotyping
2.4.
Stigmatization
2.5.
Gender and Culture
3. Various Cultural and Religious Views of Mental Illness
3.1.
Religion and Mental Illness
4. Cultural Groups
4.1.
African Americans
4.1.1.
Lives of African Americans Today
4.1.2.
Beliefs About Mental Illness
4.2.
Latino Americans
4.2.1.
Lives of Latino Americans Today
4.2.2.
Access to Mental Health Care
4.3.
Asian Americans, Polynesians, and Pacific Islanders
4.3.1.
Lives of Asian Americans, Polynesians, and Pacific Islanders Today
4.3.2.
Beliefs About Mental Illness
4.4.
Native Americans
5. Socioeconomic Influences on Mental Health Care
5.1.
Poverty and Mental Illness
5.2.
Geographic Location and Access to Mental Health Care
6. Changing Family Structure
6.1.
Family Size
6.2.
Changing Roles
6.3.
Mobility and Relocation
6.4.
Unmarried Couples
6.5.
Single-Parent Families
6.6.
Stepfamilies
6.7.
Childless Families
6.8.
Same-Gender Families
7. Stigma and Mental Illness
7.1.
Effects of Stigma on Patients With Mental Illness
7.2.
Stigmatization and Stress for Family Members
7.3.
Changing Public Attitude: National Alliance for the Mentally Ill
34
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 2: Pages 2-8
2.
Participation in Critical Thinking Exercises in Class : CTE #4, Page 8
3.
Quiz
CRITICAL THINKING FOCUS:
How are the mentally ill a cultural group? What influence do birth cultures have on the definition
of mental health/mental illness? How does the mental health nurse integrate concepts related to
culture to holistic care of her patients?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 16-28).
Philadelphia, Pa. : Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
35
THE MENTAL HEALTH - MENTAL ILLNESS CONTINUUM
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Differentiate the concepts of mental health, mental illness, mental disorder, and mental health
problems.
2. Define epidemiologic terms rate, prevalence, and incidence.
3. Identify categoric and dimensional diagnoses and their relevance to psychiatric nursing.
4. Differentiate the five axes used in the Diagnostic and Statistical Manual for Mental Disorders.
5. Compare Caplan’s conceptualization of prevention with the newer intervention spectrum
recommended by the Committee on Prevention of Mental Disorders.
6. Discuss discipline relationships and the use of nursing care plans and critical pathways.
CONTENT OUTLINE:
1. Epidemiology of Mental Disorders
1.1. Epidemiologic Terms
1.2. Barriers to Psychiatric Epidemiology
1.3. Risk Factors Related to Mental Disorders
2. Diagnoses in Mental Health
2.1. Categoric Versus Dimensional Diagnoses
2.2. Labeling and Its Consequences
2.3. Psychiatric Diagnosis: The Diagnostic and Statistical Manual of Mental Disorders (DSMIV)
3. Interventions in Psychiatric Mental Health
3.1. Caplan’s Model: Primary, Secondary, and Tertiary Prevention
3.2. Interventions Spectrum: Prevention, Treatment, Maintenance
3.3. Clinical Decision Making
3.4. Interdisciplinary Approach and the Nurse’s Role
4. Nursing Care Plans
4.1. Critical Pathways
4.2. Treatment Guidelines in Psychiatric Mental Health Care
5. Nurse as Coordinator
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 3: 9-11pp.
2.
Participation in Class Discussion Case Studies CTE #1,4 Study Guide Page 11,12
3.
Quiz
CRITICAL THINKING FOCUS:
Development of a working definition of mental health that illustrates understanding of the nature
of a continuum of symptoms.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 30-40).
Philadelphia: Lippincott.
WEB LINKS:
http://www.mentalhealth.com This useful site examines many aspects of mental health and
mental illness, including psychiatric diagnosis.
http://www.ahcpr.gov This website of the Agency for Healthcare Research and Quality has a
repository of practice guidelines.
http://www.nursingnet.org This nursing student website includes nursing care plans.
http://www.nursingnet.org This site provides information on nurses as legal consultants.
NUR 411: KEELEY/CHASE: 11/22/2002
36
CONTEMPORARY PSYCHIATRIC NURSING PRACTICE
LESSON OBJECTIVES:
1. Explain the biopsychosocial model as a conceptual framework for understanding and
treating mental health problems
2. Delineate the scope and standards of psychiatric-mental health nursing practice.
3. Discuss selected challenges of in psychiatric-mental health nursing.
4. Identify ethical framework and principles used in the practice of psychiatric nursing.
5. Discuss the impact of psychiatric-mental health nursing professional organizations on
practice.
CONTENT OUTLINE:
1. The Biopsychosocial Model and Psychiatric-Mental Health Nursing
1.1.1. Biologic Domain
1.1.2. Psychological Domain
1.1.3. Social Domain
2. Standards of Care and Professional Practice
2.1.1. Scope of Psychiatric-Mental Health Nursing Areas of Concern
2.1.2. Standards of Care
2.1.3. Standards of Professional Performance
2.1.4. Basic and Advanced Practice Levels
2.1.4.1.1. Basic Level
2.1.4.1.2. Advanced Level
3. Challenges of Psychiatric Nursing
3.1.1. Knowledge Development, Dissemination, and Application
3.1.2. Overcoming the Stigma
3.1.3. Health Care Delivery System Challenges
3.1.4. Impact of Technology
4. Ethical Frameworks
5. Psychiatric-Mental Health Nursing Organizations
LEARNING ACTIVITIES:
4.
Study Guide: Chapter 5: pp 19-22.
5.
Participation in Classroom Critical Thinking Exercises. Critical Thinking Challenge #1.
Page 63 Text.
6.
Quiz
CRITICAL THINKING FOCUS:
How do professional organizations influence the practice of nursing? How is this different from
following doctor's orders? What is the basic philosophy underlying the biopsychosocial model?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 54-63).
Philadelphia: Lippincott.
WEB LINKS:
http://www.nursingworld.org This is the American Nurses Association website.
http://www.ispn-psych.org This is the site of the International Society of Psychiatric-Mental
Health Nurses.
http://www.apna.org This is the American Psychiatric Nurses Association website.
http://www.surgeongeneral.com At the Surgeon General’s website, one can obtain a copy of
Mental Health: Report of the Surgeon General.
http://www.cna-nurses.ca The Canadian Nurses Association.
http://www.cfmhn.org The Canadian Federation of Mental Health Nurses website which has the
Canadian standards of psychiatric nursing practice.
37
THEORETIC BASIS OF PSYCHIATRIC NURSING
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Discuss the need for a theory-based practice and supporting research.
2. Identify the underlying theories that contribute to the understanding of human beings and
behavior.
3. Compare the key elements of each theory that provides a basis for psychiatric-mental health
nursing practice.
4. Identify common nursing theoretical models used in psychiatric-mental health nursing.
CONTENT OUTLINE:
1. Biologic Theories
1.1. General Adaptation Syndrome
1.2. Diathesis-Stress Model
2. Psychological Theories
2.1. Psychodynamic Theories
2.2. Psychoanalytic Theory
2.2.1. Study of the Unconscious
2.3. Personality and Its Development
2.3.1. Psychoanalysis
2.3.2. Neo-Freudian Models
2.3.2.1. Adler’s Foundation for Individual Psychology
2.3.2.2. Jung’s Analytical Psychology: The Existence of Archetypes
2.3.2.3. Horney’s Feminine Psychology
2.3.2.4. Other Neo-Freudian Theories: Birth Trauma and Child’s Play
2.3.3. Departure From Freudianism:
2.3.3.1. Sullivan’s Interpersonal Forces
2.3.3.2. Humanistic Theories
2.3.4. Roger’s Client-Centered Therapy
2.3.5. Gestalt Therapy
2.3.6. Abraham Maslow’s Hierarchy of Needs
2.3.7. Applicability of Psychodynamic Theories to Psychiatric-Mental Health Nursing
Defense Mechanisms
2.3.7.1. Transference and Countertransference
2.3.7.2. Object Relations and Identification
2.3.7.3. Empathy
2.4. Behavioral Theories
2.4.1. Early Stimulus-Response Theories
2.4.2. Reinforcement Theories
2.4.2.1. Edward L. Thorndike
2.4.2.2. B. F. Skinner
2.5. Cognitive Theories
2.5.1. Albert Bandura’s Social Cognitive Theory
2.5.2. Aaron Beck: Thinking and Feeling
2.6. Applicability of Behavioral Theories to Psychiatric-Mental Health Nursing Developmental
Theories
2.7. Erik Erikson: Psychosocial Development
2.7.1. Identity and Adolescents
2.7.2. Research Support for Erikson’s Models
2.8. Jean Piaget: Learning in Children
2.9. Carol Gilligan: Gender Differentiation
2.10.
Jean Baker Miller: A Sense of Connection
2.11.
Applicability of Developmental Theories to Psychiatric-Mental Health Nursing
3. Social Theories
3.1. Family Dynamics
38
4.
5.
6.
7.
8.
3.2. Interactional View
3.3. Problem-Solving Approach
Multigenerational System
4.1. Structural Family Theory
4.2. Applicability of Family Theories to Psychiatric-Mental Health Nursing
4.3. Social Distance
Balance Theory
5.1. Applicability of Balance Theory to Psychiatric-Mental Health Nursing
Role Theories
6.1. Role Theory Perspectives
6.2. Applicability of Role Theories to Psychiatric-Mental Health Nursing
Sociocultural Perspectives
7.1. Margaret Mead: Culture and Gender
7.2. Madeleine Leininger: Transcultural Health Care
7.3. Applicability of Sociocultural Theories to Psychiatric-Mental Health Nursing
Nursing Theories
8.1. Interpersonal Relations Models
8.1.1. Hildegarde Peplau: The Power of Empathy
8.1.2. da Jean Orlando
8.2. Existential and Humanistic Theoretical Perspectives
8.2.1. Joyce Travelbee
8.2.2. Jean Watson
8.3. Systems Models
8.3.1. Imogene M. King
8.3.2. Betty Neuman
8.3.3. Dorothea Orem
8.4. Other Nursing Theories
LEARNING ACTIVITIES:
1. Study Guide: Chapter 6: Pages 23-27
2. Participation in Classroom Critical Thinking Activities CTC #1,7,8. Text Page 90
3. Quiz
CRITICAL THINKING FOCUS:
Integrate theories from the liberal arts into the practice of mental health nursing. Select a nursing
theorist that best fits your understanding of mental health nursing care.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 64-93).
Philadelphia: Lippincott.
WEB LINKS:
http://www.ualberta.ca/~jrnorris/nt/theory.html This site provides a nursing theory page.
http://www.healthsci.clayton.edu/eichelberger/nursing.htm This site provides a nursing theory
link page.
NUR 411: KEELEY/CHASE: 11/22/2002
39
THE BIOLOGIC FOUNDATIONS OF PSYCHIATRIC NURSING
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be ale to:
1. Identify the location of brain structures primarily involved in mental disorders; Describe the
primary functions of these structures in the brain.
2. Describe the various approaches researchers have used to study the central nervous system
and the significance of each approach.
3. Describe the mechanisms of neuronal transmission.
4. Identify the location and function of neurotransmitters significant to hypotheses regarding
major mental disorders.
5. Discuss the basic purpose of new fields of study in psychiatry, including
psychoendocrinology, psychoimmunology, and chronobiology.
6. Compare the application and use of various research methods in biologic psychiatry.
7. Discuss the methods of study related to genetics.
CONTENT OUTLINE:
1. Current Approaches and Technologic Advances
1.1.
Structural Neuroimaging
1.1.1.
Computed Tomography (CT)
1.1.2.
Magnetic Resonance Imaging
1.2.
Functional Neuroimaging
1.2.1.
Positron Emission Tomography (PET)
1.2.2.
Single Photon Emission Computed Tomography (SPECT)
1.3.
Bridging the Gap
2. Neuroanatomy of the Central Nervous System
2.1.
Cerebrum
2.2.
Left and Right Hemispheres
2.3.
Lobes of the Brain
2.3.1.
Frontal Lobes
2.3.2.
Parietal Lobes
2.3.3.
Temporal Lobes
2.3.4.
Occipital Lobes
2.3.5.
Association Cortex
2.4.
Subcortical Structures
2.4.1.
Basal Ganglia
2.4.2.
Limbic System
2.4.3.
Hippocampus
2.4.4.
Thalamus
2.4.5.
Hypothalamus
2.4.6.
Amygdala
2.4.7.
Limbic Midbrain Nuclei
3. Other Important Central Nervous System Structures
3.1.
Neurophysiology of the Central Nervous System
3.1.1.
Neurons and Nerve Impulses
3.1.2.
Synaptic Transmission
3.1.3.
Changing Receptor Sensitivity
3.1.4.
Receptor Subtypes
3.2.
Neurotransmitters
3.2.1.
Cholinergic
3.2.2.
Biogenic Amines
3.2.3.
Dopamine
3.2.4.
Norepinephrine
3.2.5.
Serotonin
3.3.
Histamine
40
3.4.
4.
5.
6.
7.
Amino Acids
3.4.1.
γ-Aminobutyric Acid
3.4.2.
Glutamate
3.5.
Neuropeptides
New Fields of Study
4.1.
Psychoendocrinology
4.2.
Psychoimmunology
4.3.
Chronobiology
Diagnostic Approaches
5.1.
Laboratory Tests
5.2.
Neurophysiologic Procedures
5.2.1.
Electroencephalography
5.2.2.
Polysomnography
5.2.3.
Other Neurophysiologic Methods
Genetics
6.1.
Transmission
6.2.
Risk Factors
Integration of the Biologic, Psychological, and Social Dimensions
LEARNING ACTIVITIES:
1. Study Guide: Chapter 7: Pages 28-31
2. Participation in Case Study Discussion Activities #1 Study Guide Page 31: CTC #6 Text
Page125
3. Quiz
CRITICAL THINKING FOCUS:
Applying information from neuroscience to the practice of mental health nursing.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed.,pp. 94-126).
Philadelphia Pa.: Lippincott.
41
PSYCHOPHARMACOLOGY AND OTHER BIOLOGIC TREATMENTS
LESSON OBJECTIVES:
After studying this chapter, you will be able to:
1. Explain the key role of neurotransmitter chemicals and their receptor sites in the action of
psychopharmacologic medications.
2. Explain the four action sites where current psychotropic medications work: receptors, ion
channels, enzymes, and carrier proteins.
3. Define the three properties that determine the strength and effectiveness of a medication.
4. Describe the hypothesized mechanism of action for each class of psychopharmacologic
medication.
5. Describe the target symptoms and major side effects of various classes of psychotropic
medications.
6. Suggest appropriate nursing methods to administer medications that facilitate efficacy.
7. Implement interventions to minimize side effects of psychopharmacologic medications.
8. Differentiate acute and chronic medication-induced movement disorders.
9. Identify aspects of patient teaching nurses must implement for successful maintenance of
patients using psychotropic medications.
10. Analyze the potential benefits of other forms of somatic treatments including
electroconvulsive therapy, light therapy, and nutrition therapy.
CONTENT OUTLINE:
1. Pharmacodynamics
1.1. Targets of Drug Action: Where Drugs Act
1.2. Receptors
1.3. Ion Channels
1.4. Enzymes
1.5. Carrier Proteins: Uptake Receptors
1.6. Efficacy and Potency: How Drugs Act
1.6.1. Loss of Effect: Biologic Adaptation
2. Target Symptoms and Side Effects
3. Drug Toxicity
4. Pharmacokinetics: How the Body Acts on the Drugs
4.1. Absorption and Routes of Administration
4.2. Bioavailability
4.3. Distribution
4.4. Metabolism
4.5. Elimination
4.6. Individual Variations in Drug Effects
5. Phases of Drug Treatment
5.1. Initiation
5.2. Stabilization
5.3. Maintenance
5.4. Discontinuation
6. Antipsychotic Medications
6.1. Target Symptoms and Mechanism of Action
6.2. Pharmacokinetics
6.3. Depot Preparations
6.4. Side Effects, Adverse Reactions, and Toxicity
6.4.1. Cardiovascular Side Effects
6.4.2. Anticholinergic Side Effects
6.4.3. Weight Gain
6.4.4. Endocrine and Sexual Side Effects
6.4.5. Blood Disorders
6.4.6. Miscellaneous Side Effects
42
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
6.4.7. Medication-Related Movement Disorders
6.4.7.1. Acute Extrapyramidal Syndromes
6.5. Chronic Syndromes
Mood Stabilizers (Antimania Medications)
7.1. Lithium
7.2. Indications and Mechanisms of Action
7.3. Pharmacokinetics
7.4. Side Effects, Adverse Reactions, and Toxicity
Anticonvulsants
8.1. Indications and Mechanisms of Action
8.2. Pharmacokinetics
8.3. Side Effects, Adverse Reactions, and Toxicity
Antidepressant Medications
9.1. Indications
9.2. Pharmacokinetics and Mechanisms of Action
9.3. Side Effects, Adverse Reactions, and Toxicity
Antianxiety And Sedative-Hypnotic Medications
10.1.
Benzodiazepines
10.2.
Indications and Mechanisms of Action
10.3.
Pharmacokinetics
10.4.
Side Effects, Adverse Reactions, and Toxicity
Nonbenzodiazepines
11.1.
Stimulants
11.2.
Indications and Mechanisms of Action
11.3.
Pharmacokinetics
11.4.
Side Effects, Adverse Reactions, and Toxicity
Development Of New Medications
Other Biologic Treatments
Electroconvulsive Therapy
Light Therapy (Phototherapy)
Nutritional Therapies
Psychosocial Issues in the Use of Biologic Treatments
LEARNING ACTIVITIES:
1. Study Guide: Chapter 8: Pages 32-37.
2. Participation in Classroom Critical Thinking Exercises. CTC 5,6,7,8 Text Page 176
3. Quiz
CRITICAL THINKING FOCUS:
Development of a working knowledge of these interventions as they are prescribed in the 21 st
Century. What is the nurse’s responsibility when caring for clients receiving these treatments?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 128-177).
Philadelphia: Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
43
THE ASSESSMENT PROCESS
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Define the assessment process.
2. Differentiate an initial assessment from an ongoing assessment.
3. Discuss the different techniques of data collection.
4. Discuss the synthesis of the biopsychosocial assessment data.
5. Delineate important areas of assessment for the biologic domain in completing the psychiatric
nursing assessment.
6. Delineate important areas of assessment for the psychological domain in completing the
psychiatric nursing assessment.
7. Delineate important areas of assessment for the social domain in completing the psychiatric
nursing assessment.
CONTENT OUTLINE:
1. Assessment as a Process
2. Initial Assessment
3. Ongoing Assessment
4. Techniques of Data Collection
5. Patient Observations
6. Patient and Family Interviews
7. Physical and Mental Examinations
8. Records and Diagnostic Reports
9. Collaboration With Colleagues
10. Biopsychosocial Psychiatric Nursing Assessment
11. Biologic Domain
11.1. Present and Past Health Status
11.2. Physical Examination
11.2.1.
Body Systems Review
11.2.2.
Neurologic Status
11.2.3.
Laboratory Results
11.2.4.
Physical Functions
11.2.4.1.
Elimination
11.2.4.2.
Activity and Exercise
11.2.4.3.
Sleep
11.2.4.4.
Appetite and Nutrition
11.2.4.5.
Hydration
11.2.4.6.
Sexuality
11.2.4.7.
Self-Care
11.3. Pharmacologic Assessment
12. Psychological Domain
12.1. Responses to Mental Health Problems
12.2. Mental Status Examination
12.2.1.
General Observations
12.2.2.
Orientation
12.2.3.
Mood and Affect
12.2.4.
Speech
12.2.5.
Thought Processes
12.2.6.
Cognition and Intellectual Performance
12.2.7.
Attention and Concentration
12.2.8.
Abstract Reasoning and Comprehension
12.2.9.
Memory: Recall, Short-Term, Recent, and Remote
12.2.10.
Insight and Judgment
12.2.11.
Behavior
12.3. Self-Concept
44
12.3.1.
Body Image
12.3.2.
Self-Esteem
12.3.3.
Personal Identity
12.4. Stress and Coping Patterns
12.4.1.
Risk Assessment
12.4.1.1.
Suicidal Ideation
12.4.2.
Assaultive or Homicidal Ideation
13. Social Domain
13.1. Functional Status
13.2. Social Systems
13.2.1.
Family Assessment
13.2.2.
Cultural Assessment
13.2.3.
Community Support and Resources
13.3. Spiritual Assessment
13.4. Occupational Status
13.5. Economic Status
13.6. Legal Status
13.7. Quality of Life
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 10: Pages 44-47.
2.
Participation in Classroom Case Study Activities. CTC # 1, 2. Text Page 212.
3.
Quiz
CRITICAL THINKING FOCUS:
Use of different types of mental health assessment tools in the biopsychosocial assessment of
individuals with mental health problems.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed.,pp. 194-213).
Philadelphia Pa.: Lippincott.
WEB LINKS:
http://www.cybernurse.com/books/nursingassessment.html
books on nursing assessment and diagnosis.
NUR 411: KEELEY/CHASE: 11/22/2002
45
This bookstore website contains
DIAGNOSIS AND OUTCOMES DEVELOPMENT
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Identify the ANA Psychiatric Mental Health Nurse Standards for outcome identification.
2. Define indicators and their use.
3. Describe nurse-sensitive outcomes.
4. Describe the relationship between patient outcomes and indicators.
5. Discuss use of patient outcomes in psychiatric-mental health nursing.
6. Describe measurement of patient outcomes.
7. Write patient outcome statements for psychiatric-mental health nursing.
CONTENT OUTLINE:
1. Deriving Nursing Diagnoses
2. Developing Patient Outcomes
2.1.1. Evolution of Patient Outcomes
2.1.2. Purpose of Patient Outcomes and Indications
2.1.3. Nursing Process and Patient Outcomes
2.1.4. Types of Patient Outcomes
3. Evaluation
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 13: Pages 56-59
2.
In Class Participation in Critical Thinking Exercises. Study Guide. CTE #2. Page 59
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 246-257).
Philadelphia, Pa. : Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
46
PSYCHIATRIC NURSING INTERVENTIONS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Discuss the basis for selection of psychiatric-mental health nursing interventions.
2. Discuss the application of nursing interventions for the biologic domain.
3. Discuss the application of nursing interventions for the psychological domain.
4. Discuss the application of nursing interventions for the social domain.
CONTENT OUTLINE:
1. Nursing Interventions and Psychiatric-Mental Health Nursing
2. Interventions for the Biologic Domain
2.1.
Promotion of Self-Care Activities
2.2.
Activity and Exercise Interventions
2.3.
Sleep Interventions
2.4.
Nutrition Interventions
2.5.
Relaxation Interventions
2.6.
Hydration Interventions
2.7.
Thermoregulation Interventions
2.8.
Pain Management
2.9.
Medication Management
3. Interventions for the Psychological Domain
3.1.
Counseling Interventions
3.2.
Conflict Resolution
3.3.
Conflict Resolution Process
3.4.
Cultural Brokering in Patient-System Conflicts
3.5.
Bibliotherapy
3.6.
Reminiscence
4. Behavior Therapy
4.1.
Behavior Modification
4.2.
Token Economy
5. Cognitive Interventions
6. Psychoeducation
7. Health Teaching
8. Spiritual Interventions
9. Interventions for the Social Domain
10. Social Behavior and Privilege Systems in Inpatient Units
11. Milieu Therapy
11.1. Containment
11.2. Validation
11.3. Structured Interaction
11.4. Open Communication
11.5. Milieu Therapy in Different Settings
12. Promotion of Patient Safety on Psychiatric Units
12.1. Observation
12.2. De-escalation
12.3. Seclusion
12.4. Restraints
13. Home Visits
14. Community Action
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 14: Pages 60-64
2.
Participation in Classroom Critical Thinking Exercises. CTE #1. Study Guide. Page
63.
47
3.
Quiz
CRITICAL THINKING FOCUS:
Incorporating interventions for mental health nursing that are within the legal scope of practice.
Priortizing interventions in mental health nursing practice.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 258-275).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
http://www.hcfa.gov The Health Care Finance Administration website contains the regulations
regarding the use of seclusion and restraint.
http://www.nic.com This Nursing Interventions Classification (NIC) website explains the
development of the NIC and answers questions related to its use.
http://www.apna.org The American Psychiatric Nurses Association site contains conference
information and literature related to nursing.
NUR 411: KEELEY/CHASE: 11/22/2002
48
GROUP INTERVENTIONS
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Discuss group concepts that are useful in leading groups.
2. Compare the roles that group members can assume.
3. Identify important aspects of leading a group such as member selection, leadership skills,
seating arrangements, and ways of dealing with challenging behaviors of group members.
4. Identify four types of groups: psychoeducation, supportive therapy, psychotherapy, and selfhelp.
5. Describe common nursing intervention groups.
CONTENT OUTLINE:
1. Group: Definitions and Concepts
1.1.
Open Versus Closed Groups
1.2.
Group Size
1.3.
Group Development
1.3.1.
Beginning Stage
1.3.2.
Working Stage
1.3.3.
Termination Stage
1.4.
Roles of Group Members
1.5.
Group Communication
1.5.1.
Verbal Communication
1.5.1.1.
Communication Network
1.5.1.2.
Group Themes
1.5.2.
Nonverbal Communication
1.6.
Group Norms and Standards
1.7.
Group Cohesion
1.8.
Groupthink and Decision Making
2. Group Leadership
2.1.
Choosing Leadership Styles
2.2.
Selecting the Members
2.3.
Arranging Seating
2.4.
Dealing With Challenging Group Behaviors
2.4.1.
Monopolizer
2.4.2.
“Yes, but”
2.4.3.
Disliked Member
2.4.4.
Group Conflict
3. Types of Groups
3.1.
Psychoeducation Groups
3.2.
Supportive Therapy Groups
3.3.
Psychotherapy Groups
3.4.
Self-Help Groups
4. Common Nursing Intervention Groups
4.1.
Medication Groups
4.2.
Symptom Management Groups
4.3.
Anger Management Groups
4.4.
Self-Care Groups
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 15: 65-69
2.
Participation in Classroom Critical Thinking Exercises CTE #2. Study Guide Page 68
3.
Quiz
49
CRITICAL THINKING FOCUS:
How the various types of groups are similar and different. What behaviors on the part of the
nurse can positively change the focus and/or dynamics of a group.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 276-289).
Philadelphia: Lippincott.
WEB LINKS:
http://www.mentalhelp.net/selfhelp This website serves as an online self-help resource
containing information on many different self-help groups.
http://www.princeton.edu This site includes an Outdoor Action Guide to Group Dynamics and
Leadership, which reviews how to teach a skill, leadership concepts, and group dynamics.
NUR 411: KEELEY/CHASE: 11/22/2002
50
SCHIZOAFFECTIVE, DELUSIONAL, AND OTHER PSYCHOTIC DISORDERS
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Define schizoaffective disorder and distinguish the major differences among schizophrenia,
schizoaffective, and mood disorders.
2. Discuss the important epidemiologic findings related to schizoaffective disorder.
3. Explain the primary etiologic factors regarding schizoaffective disorder.
4. Explain the primary elements involved in assessment, nursing diagnoses, nursing
interventions, and evaluation for patients with schizoaffective disorder.
5. Define delusional disorder and explain the importance of nonbizarre delusions in diagnosis
and treatment.
6. Explain the important epidemiologic findings regarding delusional disorder.
7. Discuss the primary etiologic factors of delusional disorder.
8. Explain the various subtypes of delusional disorder.
9. Explain the important epidemiologic findings regarding delusional disorder.
10. Discuss the primary etiologic factors of delusional disorder.
11. Explain the various subtypes of delusional disorder.
12. Explain the nursing care of persons with delusional disorder.
CONTENT OUTLINE:
1. Schizoaffective Disorder
1.1. Definition and Clinical Course
1.2. Diagnostic Criteria
1.3. Epidemiology and Risk Factors
1.3.1. Age of Onset
1.3.2. Gender Differences
1.3.3. Ethnic and Cultural Differences
1.3.4. Familial Differences
1.3.5. Comorbidity
1.4. Etiology
1.5. Biologic Theories
1.5.1. Neuropathologic
1.5.2. Genetic
1.5.3. Biochemical
1.6. Psychological and Social Theories
1.6.1.
Interdisciplinary Treatment
1.7. Priority Care Issues
1.8. Nursing Management: Human Response to Disorder
1.8.1.
Biologic Domain
1.8.1.1.
Assessment
1.9. Nursing Diagnoses
1.10. Interventions
1.10.1. Patient Education
1.10.2. Pharmacologic Interventions
1.10.2.1.
Monitoring and Administration of Medications
1.10.2.2.
Side-Effect Management
1.10.2.3.
Drug-Drug Interactions
1.10.2.4.
Teaching Points
1.11. Psychological Domain
1.11.1. Assessment
1.11.2. Nursing Diagnoses
1.11.3. Interventions
1.11.4.
Social Domain
1.11.4.1.
Assessment
51
1.11.5. Nursing Diagnoses
1.11.6. Interventions
1.11.7.
Evaluation and Treatment Outcomes
1.12. Continuum of Care
1.12.1. Inpatient-Focused Care
1.12.2. Emergency Care
1.12.3. Family Intervention
1.12.4. Community Treatment
2. Delusional Disorder
2.1. Definition and Clinical Course
2.2. Diagnostic Criteria
2.3. Subtypes
2.3.1. Erotomanic Delusions
2.3.2. Grandiose Delusions
2.3.3. Jealous Delusions
2.3.4. Somatic Delusions
2.3.5. Unspecified Delusions
2.4. Epidemiology and Risk Factors
2.4.1. Age of Onset
2.4.2. Gender Differences
2.4.3. Familial Differences
2.4.4. Comorbidity
2.5. Etiology
2.5.1. Biologic Theories
2.5.1.1.
Neuropathologic Theories
2.5.1.2.
Genetic and Biochemical Theories
2.6. Interdisciplinary Treatment
2.7. Priority Care Issues
2.8. Nursing Management: Human Response to Disorder
2.8.1.
Biologic Domain
2.8.1.1.
Assessment
2.8.2. Interventions
2.8.3. Somatic Interventions
2.8.4. Pharmacologic Interventions
2.9. Psychological Domain
2.9.1. Assessment
2.9.2. Interventions
2.10. Social Domain
2.10.1. Assessment
2.10.2. Interventions
2.11. Evaluation and Treatment Outcomes
2.12. Continuum of Care
2.12.1. Inpatient-Focused Care
2.12.2. Emergency Care
2.12.3. Family Intervention
2.12.4. Community Treatment
3. Other Psychotic Disorders
3.1. Schizophreniform Disorder
3.2. Brief Psychotic Disorder
3.3. Shared Psychotic Disorder (Folie a Deux)
3.4. Psychotic Disorders Due to Substance Abuse
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 19: Pages 85-88
2.
Participation in Critical Thinking Exercises in Classroom CTC #1, 4. Page 406 Text
3.
Quiz
52
CRITICAL THINKING FOCUS:
Applying the nursing process holistically caring for clients with this diagnosis .
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., Pp. 384-408).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
http://www.surgeongeneral.com Website for Healthy People 2010 and Report of the Surgeon
General.
http://www.nami.org National Alliance for the Mentally Ill advocacy information.
http://www.mentalhealth.com Internet mental health website that provides the American and
European description of schizoaffective disorder and its treatment.
http://www.psycom.net Further defines the DSM-IV criteria for schizoaffective disorder and the
ICD-10 criteria for schizoaffective disorder.
http://www.geocities.com/CollegePark/Classroom/6237 Learn about what psychiatric nurses do
and schizoaffective disorder.
http://www.mhsource.com Questions about schizoaffective and other psychiatric disorders
answered.
NUR 411: KEELEY/CHASE: 11/22/2002
53
NURSING PRACTICE WITHIN A CONTINUUM OF CARE
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Identify the different treatment settings and associated programs along the continuum of
care.
2. Discuss the role of the nurse at different points along the continuum of care.
3. Compare the stages of the nursing process with the phases of coordination of care in the
continuum.
4. Describe current healthcare trends in inpatient and outpatient psychiatric services.
5. Explain how the concept of “the least restrictive environment” influences the assessment
of patients for placement in different treatment settings.
6. Discuss the factors that determine the level of care to be provided to a patient seeking
voluntary or involuntary treatment.
7. Discuss the influence of managed care on services and use of services in the continuum
of care.
CONTENT OUTLINE
1. Defining the Continuum of Care
1.1.
Least Restrictive Environment
1.2.
Coordination of Care and Nursing Process
1.3.
Components of the Continuum of Care
1.3.1.
Inpatient Care
1.3.2.
Long-Term Care
1.3.3.
Short-Term Care
1.3.3.1.
Crisis Stabilization
1.3.3.2.
23-Hour Beds
1.3.3.3.
Crisis Intervention
1.3.4.
Intermediate Care
1.3.5.
Rehabilitation
1.4.
The Role of the Nurse
2. Outpatient Care
2.1.
Partial Hospitalization
2.2.
Outpatient Detoxification
2.3.
Intensive Outpatient Programs
2.4.
In-Home Mental Health Services
2.5.
In-Home Detoxification
2.6.
Case Management Services
2.6.1.
Assertive Community Treatment
2.6.2.
Generalist Case Management Services
2.6.3.
The Nurse as Case Manager
2.7.
Alternative Housing Arrangements
2.7.1.
Personal Care Homes
2.7.2.
Board-and-Care Homes
2.7.3.
Therapeutic Foster Care
2.7.4.
Supervised Apartments
2.7.5.
The Role of the Nurse
2.8.
Clubhouse Model
2.9.
Relapse Prevention After-Care Programs
3. Managed Care
3.1.
Public and Private Collaboration
3.2.
The Role of the Nurse
3.3.
Assessment and Selection of Level of Care
4. Discharge Planning
54
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 17: Pages 73-75
2.
Participation in Critical Thinking Exercises. CTC #2, 6. Text Page 327-8.
3.
Quiz
CRITICAL THINKING FOCUS:
How the mental health nurse's responsibilities may vary within a variety of settings of service for
mental health clients.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., Pp. 308-329).
Philadelphia Pa.: Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
55
CARE OF THE HOMELESS MENTALLY ILL
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Define the meaning of homelessness to the person and family.
2. Describe risk factors for becoming homeless.
3. Identify risk factors for developing mental illness or chemical dependency among people who
are homeless.
4. Differentiate characteristics of various populations who are homeless.
5. Discuss personal and societal attitudes and beliefs about homelessness.
6. Describe assessment of people who are homeless and mentally ill.
7. Formulate some nursing diagnoses relevant to the homeless population.
8. Examine ways in which access to healthcare is limited for people who are homeless and
mentally ill.
9. Summarize interventions for people who are homeless and have psychiatric disorders.
10. Discuss discharge planning needs of people who are homeless and have psychiatric
disorders.
11. List major community resources to which nurses can refer members of the homeless
population.
12. Discuss trends that target improvement of services to people who are homeless and
experiencing psychiatric disorders.
CONTENT OUTLINE:
1. Homelessness
1.1.1. Historical Perspectives
1.1.2. Risk Factors
1.1.3. Homeless Populations
1.1.3.1.1. Incidence
1.1.3.1.2. Diverse Groups in the Homeless Population
1.1.4. Societal Attitudes and Beliefs
2. The Nursing Management of Individuals and Families Who Are Homeless
2.1.1. Assessment
2.1.1.1.1. Biologic Assessment
2.1.1.1.2. Psychological Assessment
2.1.1.1.3. Social and Family Assessment
2.1.1.1.4. Spiritual Assessment
2.1.2. Nursing Diagnoses
2.1.3. Nursing Interventions
2.1.4. Discharge Planning
3. Trends for Improving Services
3.1.1. Emergency Services
3.1.2. Housing Services
3.1.3. Case Management
3.1.4. Rehabilitation and Education
3.1.4.1.1. Day Treatment Programs
3.1.4.1.2. Alcohol and Drug Treatment
3.1.5. Employment Services
3.1.6. Integrated Services
3.1.7. Advocacy
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 32: Pages 144-147
2.
Participation in Classroom Critical Thinking Exercises CTC #1 3. Page 871. Text.
3.
Quiz
56
CRITICAL THINKING FOCUS:
How are nurses professionally responsible for responding the social as well as the human
individual/family mental health ramifications of homelessness.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed.,pp. 858-873).
Philadelphia Pa.: Lippincott.
WEB LINKS:
http://www.nationalhomeless.org The National Coalition for the Homeless. This site represents
a national advocacy network of homeless persons, activists, service providers, and others
committed to ending homelessness through public education, policy advocacy, grassroots
organizing, and technical assistance.
http://www.earthsystems.org/ways Fifty-four ways to help the homeless. This is Rabbi Kroloff’s
website.
http://www.hud.gov/hmless.html United States Housing Authority. This site provides
information for homeless individuals.
http://www.nchv.org National Coalition for Homeless Veterans. This is a website for homeless
veterans.
NUR 411: KEELEY/CHASE: 11/22/2002
57
MOOD DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Describe the global impact of underdiagnosed and untreated mood disorders as a major
public health problem.
2. Distinguish the clinical characteristics and course of depressive disorders and bipolar
disorder.
3. Analyze the prevailing biologic, psychological, and social theories that serve as a basis for
caring for persons with mood disorders.
4. Analyze the human responses to mood disorders with emphasis on concepts of mood, affect,
depressed mood, and manic episode.
5. Formulate nursing diagnoses based on a biopsychosocial assessment of persons with mood
disorders.
6. Formulate nursing interventions that address specific diagnoses based on a continuum of
care.
7. Identify expected outcomes and their evaluation.
8. Analyze special concerns within the nurse-patient relationship common to treating people
with mood disorders.
CONTENT OUTLINE:
1. Depressive Disorders
1.1.
Clinical Course
1.2.
Depressive Disorders in Special Populations
1.2.1.
Children and Adolescents
1.2.2.
Elderly People
1.3.
Epidemiology
1.3.1.
Ethnic and Cultural Differences
1.3.2.
Risk Factors
1.4.
Etiology
1.4.1.
Neurobiologic Theories
1.4.2.
Genetics
1.4.3.
Biologic Hypotheses
1.4.3.1.
Neuroendocrine and Neuropeptide Hypotheses
1.5.
Psychoneuroimmunonology
1.6.
Psychological Theories
1.6.1.
Psychodynamic Factors
1.6.2.
Behavioral Factors
1.6.3.
Cognitive Factors
1.6.4.
Developmental Factors
1.7.
Social Theories
1.7.1.
Family Factors
1.7.2.
Social Factors
2. Interdiscipinary Treatment of Disorder
2.1.
Priority Care Issues
2.2.
Family Response to Disorder
3. Nursing Management: Human Response to Disorder
3.1.
Biologic Domain
3.1.1.
Assessment
3.2.
Nursing Diagnosis for Biologic Domain
3.2.1.
Physical Care Nursing Interventions
3.2.2.
Pharmocologic Interventions
3.2.2.1.
Antidepressant Medication
3.2.2.2.
Monitoring and Administration of Medication
3.2.2.3.
Side-Effect Monitoring and Management
58
3.2.2.4.
First-Generation Antidepressants
3.2.3.
Monoamine Oxidase Inhibitors
3.2.4.
Serotonin Syndrome
3.2.5.
Drug-Drug Interactions
3.2.6.
Teaching Points
3.3.
Other Somatic Therapies
3.3.1.
Electroconvulsive Therapy
3.3.2.
Light Therapy (Phototherapy)
3.4.
Psychological Domain
3.4.1.
Assessment
3.4.1.1.
Mood and Affect
3.4.1.2.
Thought Content
3.4.1.3.
Suicidal Behavior
3.4.1.4.
Cognition and Memory
3.4.2.
Nursing Diagnosis for Psychological Domain
3.4.3.
Interventions for Psychological Domain
3.4.3.1.
Therapeutic Nurse-Patient Relationship
3.4.3.2.
Cognitive Therapy
3.4.3.3.
Behavior Therapy
3.4.3.4.
Interpersonal Therapy
3.4.3.5.
Group Therapy
3.4.3.6.
Patient and Family Education
3.5.
Social Domain
3.5.1.
Assessment
3.5.2.
Nursing Diagnosis for Social Domain
3.5.3.
Interventions for Social Domain
3.5.3.1.
Milieu Therapy
3.5.3.2.
Safety
3.5.3.3.
Other Interventions
3.5.3.4.
Family Interventions
3.6.
Evaluation and Treatment Outcomes
3.7.
Continuum of Care
4. Bipolar Disorders (Manic-Depressive Disorders)
4.1.
Diagnostic Criteria
4.2.
Secondary Mania
4.3.
Rapid Cycling Specifier
4.4.
Clinical Course
4.5.
Bipolar Disorders in Special Populations
4.5.1.
Children and Adolescents
4.5.2.
Elderly People
4.6.
Epidemiology
4.6.1.
Distribution and Age of Onset
4.6.2.
ender and Ethnic and Cultural Differences
4.6.3.
Comorbidity
4.7.
Etiology
4.7.1.
Neurobiologic Theories
4.7.1.1.
Neurotransmitter Hypotheses
4.7.1.2.
Chronobiologic Theories
4.7.1.3.
Sensitization and Kindling Theory
4.7.1.3.1.
Genetic Factors
4.7.2.
Psychological and Social Theories
4.7.3.
Interdisciplinary Treatment of Disorders
4.7.4.
Priority Care Issues
4.7.5.
Family Response to Disorder
4.7.6.
Nursing Management: Human Response to Disorder
4.7.6.1.
Biologic Domain
59
4.7.6.1.1.
Assessment
4.7.6.1.2.
Pharmacologic Assessment
4.7.7.
Nursing Diagnosis for Biologic Domain
4.7.8.
Interventions for Biologic Domain
4.7.8.1.
Pharmacologic Interventions
4.7.8.1.1.
Mood Stabilizers
4.7.8.1.2.
Newer Anticonvulsants
4.7.8.1.3.
Antidepressants
4.7.8.1.4.
Antipsychotics
4.7.8.1.5.
Monitored Administration of Medication
4.7.8.1.6.
Side-Effect Monitoring and Management
4.7.8.1.7.
Drug-Drug Interactions
4.7.8.1.8.
Teaching Points
4.7.8.2.
Other Somatic Interventions: Electroconvulsive Therapy
4.8.
Psychological Domain
4.8.1.
Assessment
4.8.1.1.
Mood
4.8.1.2.
Cognitive
4.8.1.3.
Thought Disturbance
4.8.1.4.
Stress and Coping Factors
4.8.1.5.
Risk Assessment
4.8.2.
Nursing Diagnosis for Psychological Domain
4.8.3.
Interventions for Psychological Domain
4.8.3.1.
Psychoeducation
4.8.3.2.
Psychotherapy
4.9.
Social Domain
4.9.1.
Assessment
4.9.2.
Nursing Diagnosis for Social Domain
4.9.3.
Interventions for Social Domain
4.9.3.1.
Family Interventions
4.9.4.
Evaluation and Treatment Outcomes
4.10. Continuum of Care
4.10.1.
Inpatient Management
4.10.2.
Intensive Outpatient Programs
4.11. Spectrum of Care
4.12. Mental Health Promotion
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 20: Pages 89-92
2.
Participation in Classroom Critical Thinking Exercises CTC #7. Page 449 Text.
3.
Quiz
CRITICAL THINKING FOCUS:
Depression is a world wide epidemic. How can nurses act to prevent depression and or
holistically treat depression when encountered in the health care setting.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 410-451).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
http://www.psycom.net Go to Depression Central. This site is the Internet’s central
clearinghouse for information on all types of depressive disorders and on the most effective
treatments for individuals suffering from major depression, manic-depressive disorder (bipolar
disorder), cyclothymia, dysthymia, and other mood disorders.
60
http://www.mhsource.com/bipolar This site provides an overview of bipolar disorder and
comorbid illnesses.
http://www.nimh.nih.gov/publicat/bipolar.cfm This is a National Institutes of Health publication
providing an overview of bipolar disorder.
http://www.ndmda.org This website of the National Depressive and Manic-Depressive
Association is provided by the organization to educate patients, families, professionals, and the
public concerning the nature of depression and bipolar disorder.
http://www.depression-net.com Depression Net. This website, operated by Organon, provides an
overview of depression and treatment.
http://www.narsad.org The National Alliance for Research on Schizophrenia and Depression is a
national organization that raises and distributes funds to find the causes, cures, and better
treatments of schizophrenia.
NUR 411: KEELEY/CHASE: 11/22/2002
61
CASE-FINDING AND CARE IN SUICIDE: CHILDREN, ADOLESCENTS, AND
ADULTS
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Define suicide, parasuicide, and suicide ideation.
2. Describe population groups that have high rates of suicide.
3. Discuss factors associated with rising rates of suicide in the young.
4. Discuss the civil liberties of patients and other legal issues in care of suicidal patients.
5. Determine factors that affect the nurse’s responsibility in identifying suicidal patients.
6. List screening measures for depression, suicide intent, and psychiatric diagnostic
measures.
7. Describe factors that increase risk for suicide completion.
8. Describe the no-suicide contract.
9. Describe the nurse’s responsibilities in promoting short and long-term recovery in suicidal
adult inpatients.
10. Discuss the patient’s and nurse’s responsibilities in discharging the patient to the
community.
CONTENT OUTLINE:
1. Secondary Trauma
2. Epidemiology of Suicidal Behavior
3. Suicide
3.1.
Age
3.1.1.
Prepubertal Children
3.1.2.
Preadolescents and Adolescents
3.1.3.
Adults
3.1.4.
Older Adults
3.2.
Gender
3.3.
Race
3.4.
Sexual Orientation
4. Parasuicide and Suicide Ideation
4.1.
Etiology of Suicidal Behavior
4.2.
Biologic Theories
4.3.
Psychological Theories
4.4.
Social Theories
5. Effects of Suicide
6. Legal Considerations in Care for Suicidal Patients
6.1.
Confidentiality
6.2.
Informed Consent
6.3.
Competence
6.4.
Beneficence
6.5.
Documentation and Reporting
6.6.
Involuntary Hospitalization
7. Nursing Management: Human Response to Disorder
7.1.
Assessing the Suicidal Patient
7.1.1.
Case Finding
7.1.2.
Determining Risk
7.2.
Nursing Diagnosis and Outcome Identification
7.3.
Planning and Implementing Nursing Interventions
7.3.1.
No-Suicide Contracts
7.3.2.
Inpatient Care and Acute Treatment
7.3.3.
Biologic Interventions
7.3.3.1.
Ensuring Safety
7.3.3.2.
Assisting With Somatic Therapies
62
7.3.3.3.
Assisting With Treatment for Substance Abuse
7.3.3.4.
Psychological Interventions
7.3.3.5.
Social Interventions
7.4.
Discharge Planning and Outpatient Care
7.4.1.
Educating the Patients and Family
7.4.2.
Identifying Continuing Sources of Support
7.4.3.
Establishing an Outpatient Care Plan
7.5.
Evaluation and Treatment Outcomes
7.6.
Avoiding
LEARNING ACTIVITIES:
1
Study Guide: Chapter 38: Pages 173-176.
2
Participation in Classroom Critical Thinking Exercises CTE #2. Page 175 Study
Guide
3
Quiz.
CRITICAL THINKING FOCUS:
If suicide is preventable, why are suicides and suicide attempts on the increase? What is the role
and responsibility of the mental health nurse in case finding and intervention?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd Ed.p.p 1006-1030).
Philadelphia: Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
63
ANXIETY DISORDERS
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Differentiate the concept of anxiety from stress and fear.
2. Discuss the epidemiology, etiology, symptomatology, and treatment of selected anxiety
disorders.
3. Discuss the neurobiologic underpinnings of the anxiety disorders.
4. Discuss biopsychosocial treatment approaches used for patients with anxiety disorders.
5. Identify nursing diagnoses used in providing nursing care for patients with anxiety disorders.
6. Differentiate the concept of anxiety from stress and fear.
7. Discuss the epidemiology, etiology, symptomatology, and treatment of selected anxiety
disorders.
8. Discuss the neurobiologic underpinnings of the anxiety disorders.
9. Discuss biopsychosocial treatment approaches used for patients with anxiety disorders.
10. Identify nursing diagnoses used in providing nursing care for patients with anxiety disorders.
CONTENT OUTLINE:
1. Normal Versus Abnormal Anxiety Response
2. Overview of Anxiety Disorders
2.1.
Panic Disorder
2.1.1.
Clinical Course of Panic Disorder
2.1.2.
Panic Attacks
2.2.
Agoraphobia and Other Phobias
2.2.1.
Diagnostic Criteria
2.2.2.
Disorders in Special Populations
2.2.2.1.
Children
2.2.2.2.
Elderly People
3. Epidemiology
3.1.
Etiology
3.2.
Genetic Theories
3.3.
Neuronatomic Theories
3.4.
Biochemical Theories
3.4.1.
Norepinephrine
3.4.2.
Serotonin
3.4.3.
γ-Aminobutryric Acid
3.4.4.
Corticotropin-Releasing Factor
3.4.5.
Cholecystokinin
3.4.6.
Other Neuropeptides
3.4.7.
Other Panicogenic Substances
3.5.
Psychoanalytic and Psychodynamic Theories
3.6.
Cognitive-Behavioral Theories
4. Risk Factors
5. Comorbidity
6. Interdisciplinary Treatment of Panic Disorder
7. Priority Care Issues
8. Nursing Management: Human Response to Disorder
8.1.
Biologic Domain
8.2.
Assessment of Biologic Domain
8.3.
Substance Use
8.4.
Sleep Patterns
8.5.
Physical Activity
9. Nursing Diagnoses Related to Biologic Domain
9.1.
Biologic Interventions
9.2.
Breathing Control
64
9.3.
9.4.
9.5.
9.6.
10.
11.
12.
13.
Nutritional Planning
Relaxation Techniques
Increased Physical Activity
Psychopharmacologic Treatment
9.6.1.
Selective Serotonin Reuptake Inhibitors
9.6.2.
Tricyclic Antidepressants
9.6.3.
Benzodiazepines
9.6.4.
Monoamine Oxidase Inhibitors
Psychological Domain
10.1. Psychological Assessment
10.2. Rating Scale
10.2.1.
Mental Status Examination
10.2.2.
Assessment of Cognitive Thought Process
10.3. Nursing Diagnoses Related to Psychological Domain
10.4. Psychological Interventions
10.4.1.
Distraction
10.4.2.
Positive Self-Talk
10.4.3.
Panic Control Treatment
10.4.4.
Exposure Therapy
10.4.5.
Systematic Desensitization
10.4.6.
Implosive Therapy
10.4.7.
Cognitive-Beh Therapy
10.4.8.
Psychoeducation
10.5. Social Domain
10.5.1.
Social Assessment
10.5.2.
Cultural Factors
10.5.3.
Social Interventions
10.6. Family Response to Disorder
Evaluation and Treatment Outcomes
Continuum of Care
12.1. Inpatient-Focused Care
12.2. Emergency Care
12.3. Family Interventions
12.4. Community Treatment
Obsessive Compulsive Disorder (OCD)
13.1. Clinical Course of Disorder
13.2. Comorbidity
13.3. Diagnostic Criteria
13.4. OCD in Special Populations
13.4.1.
Children
13.4.2.
Elderly People
13.5. Epidemiology
13.6. Etiology
13.7. Biologic Theories
13.7.1.
Genetic
13.7.2.
Neuropathologic
13.7.3.
Biochemical
13.8. Psychological Theories
13.8.1.
Psychodynamic
13.8.2.
Behavioral
13.9. Risk Factors
13.10. Interdisciplinary Treatment
13.11. Priority Care Issues
13.12. Nursing Diagnoses and Outcome Identification
13.13. Nursing Management: Human Response to Disorder
13.13.1.
Biologic Domain
65
13.13.2.
Biologic Assessment
13.13.3.
Biologic Interventions
13.13.3.1. Electroconvulsive Therapy
13.13.3.2. Psychosurgery
13.13.3.3. Maintaining Skin Integrity
13.13.3.4. Psychopharmacologic Treatment
13.14. Psychological Domain
13.14.1.
Psychological Assessment
13.14.2.
Psychological Interventions
13.14.2.1. Response Prevention
13.14.2.2. Thought Stopping
13.14.2.3. Relaxation Techniques
13.14.2.4. Cognitive Restructuring
13.15. Social Domain
13.15.1.
Social Assessment
13.15.2.
Family Response to Disorder
13.16. Evaluation and Treatment Outcomes
13.17. Continuum of Care
13.17.1.
Inpatient-Focused Care
13.17.2.
Emergency Care
13.17.3.
Family Interventions
13.18. Community Treatment
14. Generalized Anxiety Disorder (GAD)
14.1. Clinical Course of Disorder
14.2. Comorbidity
14.3. Diagnostic Criteria
14.4. GAD in Special Populations
14.5. Epidemiology
14.6. Etiology
14.6.1.
Neurochemical Theories
14.6.2.
Genetic Theories
14.6.3.
Psychological Theories
14.6.4.
Sociologic Theories
14.7. Risk Factors
14.8. Nursing Management: Human Response to Disorder
14.8.1.
Biologic Domain
14.8.1.1.
Biologic Assessment
14.8.1.1.1.
Biologic Interventions: Pharmacologic Treatment
14.8.2.
Psychological and Social Domains
14.9. Evaluation and Treatment Outcomes
14.10. Continuum of Care
15. Other Anxiety and Related Disorders
15.1. Specific Phobia
15.2. Social Phobia
15.3. Posttraumatic Stress Disorder (PTSD)
15.4. Acute Stress Disorder
15.5. Dissociative Disorders
LEARNING ACTIVITIES:
1,
Study Guide: Chapter 21: Pages 93-98
2.
Participation in Classroom Critical Thinking Exercises. CTC #4 , 7 Page 499. Text.
3.
Quiz
CRITICAL THINKING FOCUS:
Development of self-awareness of own anxiety and its manifestations and integrating current
knowledge of disorders and their treatments into nursing practice.
66
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 974-1005).
Philadelphia: Lippincott.
WEB LINKS:
http://www.nimh.nih.gov/anxiety This is the National Institute of Mental Health’s anxiety disorder
website. An anxiety disorders education program available.
http://www.algy.com/anxiety This Anxiety Panic Internet Resource site has self-help resources
for those with panic disorder.
http://www.panicdisorders.com This site provides a guide to more than 700 other sites and also
contains recent articles and resources.
NUR 411: KEELEY/CHASE: 11/22/2002
67
PERSONALITY AND IMPULSE CONTROL DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Identify the common features of personality disorders.
2. Distinguish between the concepts of personality and personality disorder.
3. Analyze the prevailing biologic, psychological, and social theories explaining the development
of personality disorders.
4. Discuss the epidemiology of each personality disorder.
5. Distinguish among the three clusters of personality disorders.
6. Formulate nursing diagnoses and plan interventions for persons with specific personality
disorders.
7. Compare the psychoanalytic explanation of the borderline personality disorder with biosocial
theory.
8. Apply the nursing process to individuals with a diagnosis of borderline personality disorder.
9. Analyze special concerns within the nurse-patient relationship common to treating those with
personality disorders.
10. Compare and contrast the impulse-control disorders.
CONTENT OUTLINE
1. Personality Disorders
2. Personality Disorder Versus Personality Traits
3. Common Features and Diagnostic Criteria
3.1. Maladaptive Cognitive Schema
3.2. Affectivity and Emotional Instability
3.3. Impaired Self-Identity and Interpersonal Functioning
3.4. Impulsivity and Destructive Behavior
4. Cultural Considerations
5. Severity of Disorder
5.1. Cluster A Disorders: Odd-Eccentric
6. Paranoid Personality Disorder: Suspicious Pattern
6.1. Epidemiology
6.2. Etiology
6.3. Nursing Management
7. Schizoid Personality Disorder: Asocial Pattern
7.1. Epidemiology
7.2. Etiology
7.3. Nursing Management
8. Schizotypal Personality Disorder: Eccentric Pattern
8.1. Epidemiology
8.2. Etiology
8.3. Nursing Management
9. Continuum of Care
10. Cluster B Disorders: Dramatic-Emotional
10.1. Borderline Personality Disorder (BPD): Unstable Pattern
10.1.1.
Clinical Course of Disorder
10.1.1.1.
Affective Instability
10.1.1.2.
Identity Disturbances
10.1.1.3.
Unstable Interpersonal Relationships
10.1.1.4.
Cognitive Dysfunctions
10.1.1.5.
Dysfunctional Behaviors
10.1.1.5.1.
Impaired Problem Solving
10.1.1.5.2.
Impulsivity
10.1.1.5.3.
Self-Injurious Behaviors
11. BPD in Special Populations
68
12.
13.
14.
15.
16.
17.
18.
11.1. Epidemiology
11.1.1. Gender
11.1.2. Comorbidty
Risk Factors
12.1. Physical and Sexual Abuse
12.2. Parental Loss or Separation
Etiology
13.1. Biologic Theories
13.2. Psychological Theories
13.3. Psychoanalytic Theories
13.4. Maladaptive Cognitive Processes
13.5. Social Theories: Biosocial Theories
13.5.1. Theodore Millon
13.5.2. Marsha Linehan
13.6. Interdisciplinary Treatment
Dialetic Behavior Therapy
Priority Care Issues
Family Response to Disorder
Nursing Management: Human Response to Borderline Personality Disorder
17.1. Biologic Domain
17.1.1. Assessment of Biologic Domain
17.1.2. Systems Review and Physical Functioning
17.1.3. Physical Indicators of Self-Injurious Behavior
17.1.4. Pharmacologic Assessment
17.1.5. Nursing Diagnoses Related to Biologic Domain
17.1.6. Interventions for the Biologic Domain
17.1.6.1.
Sleep Enhancement
17.1.6.2.
Nutritional Enhancement
17.1.6.3.
Prevention and Treatment of Self-Injury
17.1.6.4.
Pharmacologic Interventions
17.1.7. Controlling Emotional Dysregulation
17.1.7.1.
Reducing Impulsivity
17.1.7.2.
Managing Transient Psychotic Episodes
17.1.7.3.
Reducing Self-Injurous Behavior
17.1.7.4.
Decreasing Anxiety
17.2. Monitoring and Administration of Medications
17.2.1. Side-Effect Monitoring and Management
17.2.2. Drug-Drug Interactions
17.2.3. Teaching Points
17.3. Psychological Domain
17.3.1. Assessment of Psychological Domain
17.3.1.1.
Appearance and Activity Level
17.3.1.2.
Moods
17.3.1.3.
Impulsivity
17.3.1.4.
Cognitive Disturbances
17.3.2. Dissociative and Transient Psychotic Episodes
17.3.2.1.
Interpersonal Skills
17.3.2.2.
Self-Esteem and Coping Skills
17.3.2.3.
Risk Assessment: Suicide or Self-injury
17.3.3. Nursing Diagnoses Related to Psychological Domain
17.3.4. Interventions for the Psychological Domain
Special Issues in the Nurse-Patient Relationship
18.1. Establishing a Trusting Relationship
18.2. Abandonment and Intimacy Fears
18.3. Establishing Personal Boundaries and Limitations
18.4. Management of Dissociative States
69
18.4.1. Behavioral Interventions
18.4.2. Cognitive Interventions
18.4.2.1.
Emotional Regulation
18.4.3. Distraction or Thought Stopping
18.4.4. Challenging Dysfunctional Thinking
18.4.5. Management of Transient Psychotic Episodes
18.4.5.1.
Patient Education
18.5. Social Domain
18.5.1. Assessment of Social Domain
18.5.2. Functional Status
18.5.3. Social Support Systems
18.5.4. Family Assessment
18.6. Interventions for Social Domain
18.6.1. Milieu Management
18.6.2. Group Intervention
18.6.3. Family and Social Support
18.6.4.
Evaluation and Treatment Outcomes
18.7. Continuum of Care
18.8. Mental Health Promotion
19. Antisocial Personality Disorder: Aggrandizing Pattern
19.1. Clinical Course of Disorder
19.2. Epidemiology and Risk Factors
19.2.1. Age of Onset
19.2.2. Gender
19.2.3. Cultural and Ethnic Differences
19.2.4. Comorbidity
19.3. Etiology
19.3.1. Biologic Theories
19.3.1.1.
Genetic
19.3.1.2.
Biochemical
19.3.2. Psychological Theories
19.3.2.1.
Attachment
19.3.2.2.
Temperament
19.3.3. Social Theories
19.3.3.1.
Interdisciplinary Treatment of Disorders
19.4. Priority Care Issues
19.4.1.
Family Response to Disorder
19.5. Nursing Management: Human Response to Disorder
19.5.1.
Assessment of Biopsychosocial Domains
19.5.2.
Nursing Diagnoses and Outcome Identification
19.5.3.
Planning and Implementing Nursing Interventions
19.5.3.1.
Biologic Interventions
19.5.3.2.
Psychological Interventions
19.5.3.3.
Social Interventions
19.5.3.3.1.
Family Interventions
19.5.4.
Evaluation and Treatment Outcomes
19.6. Continuum of Care
20. Histrionic Personality Disorder: Gregarious Pattern
20.1. Epidemiology
20.2. Etiology
20.3. Nursing Management
21. Narcissistic Personality Disorder: Egotistic Pattern
21.1. Epidemiology
21.2. Etiology
21.3. Nursing Management
21.4. Continuum of Care
70
22. Cluster C Disorders: Anxious-Fearful
22.1. Avoidant Personality Disorder: Withdrawn Pattern
22.1.1.
Epidemiology
22.1.1.1.
Etiology
22.1.2.
Nursing Management
23. Dependent Personality Disorder: Submissive Pattern
23.1. Epidemiology
23.2. Etiology
23.3. Nursing Management
24. Obsessive-Compulsive Personality Disorder: Conforming Pattern
24.1. Epidemiology
24.2. Etiology
24.3. Nursing Management
24.4. Continuum of Care
25. Impulse-Control Disorders
25.1. Intermittent Explosive Disorders
25.2. Kleptomania
25.3. Pyromania
25.4. Pathologic Gambling
25.5. Trichotillomania
26. Continuum of Care
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 22: Pages 99-103
2.
Participation in Classroom Critical Thinking Exercise CTC #3, 4 Text Page 550
3.
Quiz
CRITICAL THINKING FOCUS:
How to intervene therapeutically while maintaining a sense of self with individuals diagnosed with
personality/impulse disorders.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., Pp. 502-555).
Philadelphia Pa.: Lippincott.
WEB LINKS:
http://www.mhsanctuary.com/borderline A website for consumers, the Borderline Personality
Sanctuary offers a chat room and books.
http://www.bpdcentral.com This website of Borderline Personality Disorder Central provides
consumer and professional information and resources.
http://www.borderlineresearch.org The Borderline Research Organization is a research
foundation that supports research on borderline personality disorder.
http://www.mentalhealth.com Internet Mental Health is a website for mental health disorders.
NUR 411: KEELEY/CHASE: 11/22/2002
71
SOMATOFORM AND RELATED DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. After studying this chapter, you will be able to:
2. Explain the concept of somatization and its occurrence in people with mental health
problems.
3. Discuss the epidemiologic factors related to somatic problems.
4. Compare the etiologic theories of somatization disorder from a biopsychosocial
perspective.
5. Contrast the major differences between somatoform and factitious disorders.
6. Discuss human responses to somatization disorder.
7. Apply the elements of nursing management to a patient with somatization disorder.
CONTENT OUTLINE:
1. Somatization
1.1.
Cultural Differences in Somatization
1.2.
Gender and Somatization
2. Somatization Disorder
2.1.
Clinical Course
2.2.
Diagnostic Criteria
2.3.
Somatization Disorder in Special Populations
2.3.1.
Children
2.3.2.
Elderly People
2.4.
Epidemiology
2.4.1.
Age of Onset
2.4.2.
Gender, Ethnic and Cultural Differences
2.4.3.
Comorbidity
2.5.
Etiology
2.5.1.
Biologic Factors
2.5.1.1.
Neuropathologic
2.5.1.2.
Genetic
2.5.1.3.
Biochemical Changes
2.5.2.
Psychological Theories
2.5.3.
Social Theories
2.6.
Risk Factors
2.7.
Interdisciplilnary Treatment of Somatization Disorders
2.8.
Nursing Managment: Human Response to Disorder
2.8.1.
Biologic Domain
2.8.1.1.
Review of Systems
2.8.1.2.
Physical Functioning
2.8.1.3.
Pharmacologic Assessment
2.9.
Nursing Diagnoses Related to Biologic Domain
2.10. Biologic Interventions
2.10.1.
Pain Management
2.10.2.
Activity Enhancement
2.10.3.
Nutrition Regulation
2.10.4.
Relaxation
2.11. Psychopharmacologic Interventions
2.11.1.
Monitoring and Administration of Medications
2.11.2.
Side-Effect Monitoring and Management
2.11.3.
Drug-Drug Interaction
2.12. Psychological Domain
2.13. Nursing Diagnoses Related to Psychological Domain
2.14. Psychological Interventions
72
2.14.1.
Development of a Therapeutic Nurse-Patient Relationship
2.14.2.
Counseling
2.14.3.
Health Teaching
2.15. Social Domain
2.15.1.
Nursing Diagnoses Related to Social Domain
2.15.2.
Social Interventions
2.15.2.1.
Group Interventions
2.15.2.2.
Family Interventions
2.15.3.
Evaluation and Treatment Outcomes
2.15.4.
Continuum of Care
2.15.4.1.
Inpatient Care
2.15.4.2.
Emergency Care
2.15.4.3.
Community Treatment
2.16. Mental Health Promotion
3. Other Somatoform Disorders
3.1.
Undifferentiated Somatoform Disorder
3.2.
Conversion Disorder
3.3.
Pain Disorder
3.4.
Hypochondriasis
3.5.
Body Dysmorphic Disorder
3.6.
Factitious Disorders
3.7.
Factitious Disorder
3.8.
Epidemiology
3.9.
Etiology
3.10. Nursing Management: Human Response to Disorder
3.10.1.
Continuum of Care
3.11. Factitious Disorder, Not Otherwise Specified
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 23: Pages 104-108
2.
Participation in Classroom Critical Thinking Exercises CTE #2. Study Guide Page
106
3.
Quiz
CRITICAL THINKING FOCUS:
Integrating the nursing process with the biopsychosocial framework when caring for clients with
somatoform diagnoses.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice. (2nd Ed., Pp. 556-581).
Philadelphia Pa.: Lippincott.
WEB LINKS:
http://www.athealth.com Somatization and somatoform disorders. Friday’s Progress Notes, July
14, 2000, Mental Health Information, Volume 4, Issue 21.
http://www.intelihealth.com InteliHealth provides health information. Somatization disorder can
be found through a search on this website.
NUR 411: KEELEY/CHASE: 11/22/2002
73
SUBSTANCE ABUSE DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Distinguish among the actions, effects and withdrawal symptoms (if any) of alcohol,
marijuana, stimulants, sedatives, hallucinogens, phencyclidine, opiates, nicotine,
solvents, and caffeine.
2. Explain the biologic, psychological, and social theories that attempt to explain substance
abuse, dependence, and addiction.
3. Compare the advantages and disadvantages of several intervention approaches to
substance abuse and chemical dependence.
4. Describe the effects of alcohol and other drug classifications on pregnancy and infants.
5. Describe appropriate nursing diagnoses and treatment interventions for patients who
deny a substance abuse problem.
6. Formulate nursing diagnoses based on a biopsychosocial assessment of persons with
substance use disorders.
7. Formulate nursing interventions that address specific diagnoses related to substance
CONTENT OUTLINE:
1. Definition and Terms
2. Diagnostic Criteria
2.1.
Epidemiology and Cultural Issues
2.1.1.
African Americans
2.1.2.
Latino Americans
2.1.3.
Asians and Pacific Islanders
2.1.4.
Native Americans
2.2.
Gender Differences
2.3.
Comorbidity
2.4.
Etiology
2.4.1.
Genetic Factors
2.4.2.
Neurobiologic Theories
2.4.3.
Psychological Theories
2.4.4.
Behavioral Theories
2.4.5.
Social Theories
2.4.6.
Summary of Etiologic Theories
3. Substances of Abuse
3.1.
Alcohol
3.2.
Definition and Clinical Picture
3.3.
Biologic Responses to Alcohol
3.4.
Alcohol Withdrawal Syndrome
3.5.
Alcohol-Induced Amnestic Disorders
3.6.
Psychopharmacology
3.7.
Adequate Nutrition and Supplemental Vitamins
4. Cocaine
4.1.
Cocaine Intoxication
4.2.
Cocaine Withdrawal
5. Amphetamines and Other Stimulants
5.1.
Cannabis (Marijuana)
5.2.
Hallucinogens
5.3.
Opiates
6. Methadone Maintenance Treatment
6.1.
Naltrexone (Trexan)
6.2.
Opiate Detoxification
7. Sedative-Hypnotics and Anxiolytics
7.1.
Biologic Reactions to Benzodiazepines
7.2.
Benzodiazepine Withdrawal
74
8. Inhalants
8.1.
Neurotoxicity
9. Nicotine
9.1.
Nicotine Withdrawal and Replacement Therapy
10. Caffeine
11. Nursing Management: Human Response to Disorder
11.1. Denial of a Problem
11.2. Enhancing Motivation for Change
11.3. Reality Confrontation
11.4. Countertransference
11.5. Codependence
12. HIV and Substance Abuse
12.1. Harm-Reduction Strategies
13. Pregnancy and Substance Abuse
14. Treatment Modalities
14.1. Twelve-Step Programs
14.2. Cognitive Interventions and Psychoeducation
14.3. Behavioral Interventions
14.4. Group Therapy and Early Recovery
14.5. Individual Therapy
14.6. Family Therapy
15. Planning and Implementing Nursing Interventions
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 25: Pages 112-116
2.
Participation in Classroom Critical Thinking Exercises CTC #1,3,6,9 Text Page 654
3.
Quiz
CRITICAL THINKING FOCUS:
Development of self awareness related to substance abuse and possible personal barriers to
holistic care of patients with these diagnoses. Integration of holistic biopsychosocial framework
into the nursing process and substance abuse.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 616-657).
Philadelphia, Pa. : Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
75
SPECIAL CONCERNS FOR PERSON WITH DUAL DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Define the term dual diagnosis.
2. Discuss the epidemiology of dual diagnosis.
3. Describe the cycle of relapse.
4. Describe the effects of alcohol and other drugs on mental illness.
5. Analyze barriers to the treatment of patients with dual diagnosis.
6. Discuss four etiologies of dual diagnosis.
7. Integrate relapse prevention concepts into the care of a patient with dual diagnosis.
CONTENT OUTLINE:
1. Relationship of Substance Abuse to Mental Illness
2. Manifestations of Dual Diagnosis
2.1.
Epidemiology
2.2.
Psychodynamic Model of Dual Diagnosis
3. Barriers to Treatment
3.1.
Nature of Substance Abuse
3.2.
Countertransference
3.3.
Misunderstandings About and Stigmatization of Mental Illness
4. Health Issues
4.1.
Disorder-Specific Assessment and Interventions
5. Psychotic Illnesses and Substance Abuse
6. Anxiety Disorders and Substance Abuse
7. Mood Disorders and Substance Abuse
8. Organic Mental Disorders and Substance Abuse
9. Cognitive Impairment in Early Stages of Recovery From Substance Abuse
10. Personality Disorders and Substance Abuse
11. General Treatment Elements
11.1. Setting Priorities When Hospitalization Is Necessary
11.2. Crisis Stabilization
11.3. Engagement
11.4. Medication Management
12. Guidelines for Managing Acute Pain in Substance Abusers
12.1. Patient Education
12.2. Self-Help Groups
12.3. Relapse Prevention: Creating a New Lifestyle
13. Continuum of Care and Discharge Planning
14. Case Management
14.1. Family Support and Education
14.2. Comprehensive Concurrent Treatment
15. Planning for Nursing Care
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 33: Pages 145-151
2.
Participation in Classroom Critical Thinking Activities CTE #2. Study Guide Page 150
3.
Quiz
CRITICAL THINKING FOCUS
Development of a working understanding of the interplay of symptoms and treatments when
working with clients with a dual diagnosis.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 874-893).
Philadelphia: Lippincott.
76
WEB LINKS:
http://www.dualdiagnosisfriendly.org
dual diagnosis.
Dual Diagnosis Friendly. This website is for those with
NUR 411: KEELEY/CHASE: 11/22/2002
77
PSYCHOSOCIALLY MEDICALLY COMPROMISED
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Identify medically ill populations at risk for secondary mental illness.
2. Analyze the impact on patients and their families of mental illness associated with
medical illness.
3. Discuss comorbid psychosocial and biologic disorders seen in psychiatric settings and
their treatments.
4. Discuss neurobiologic and psychological disturbances associated with specific medical
illnesses and the medications used to treat them.
5. Develop a plan of care for patients who are experiencing mental illness associated with
medical illness.
6. Discuss biopsychosocial interventions that promote patients’ mental health in physical
illness.
CONTENT OUTLINE:
1. Psychological Illness Related to Specific Physiologic Disorders
2. Psychological Impact of Pain
2.1.
Biologic Basis of the Pain Response
2.2.
Psychological Aspects of the Pain Response
2.3.
Assessment of the Patient With Chronic Pain
2.4.
Sensory and Pharmacologic Modulation of Pain
3. Psychopathologic Complications of AIDS
3.1.
Biologic Basis of Neurologic Manifestations of HIV
3.2.
Psychological Aspects of AIDS
3.3.
Assessment of the AIDS Patient
3.4.
Biopsychosocial Treatment Interventions
4. Psychological Illness Related to Trauma
4.1.
Biologic Basis of the Trauma Response
4.2.
Psychological Aspects of the Trauma Response
4.3.
Assessment of the Trauma Patient
4.4.
Biopsychosocial Treatment Interventions
5. Psychological Illness Related to Central Nervous System Disorders
5.1.
Biologic Basis of Neurologic Impairment
5.2.
Psychological Aspects of Neurologic Impairment
5.3.
Assessment of the Neurologic Patient
5.4.
Biopsychosocial Treatment Interventions
6. Psychological Illness Related to Acute and Chronic Medical Illness
6.1.
Biologic Aspects of Mental Illness Related to Medical Disease
6.2.
Psychological Aspects of Medical Illness
6.3.
Assessment of the Patient With Medical Illness
6.4.
Clinical Features of Special Significance
6.5.
Biopsychosocial Treatment Interventions
7. Recognition of Mental Illness and Biopsychosocial Interventions in Medical Illness
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 34: Pages
2.
Participation in Classroom Critical Thinking Exercises. CTE #2, 4. Study Guide
Page154, 156
3.
Quiz
4.
78
CRITICAL THINKING FOCUS:
Developing an awareness of the presence of mental health issues in patients with physical
diagnoses. Development of interventions that are therapeutic for these phenomena in the
medical setting.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 894-917).
Philadelphia, Pa. : Lippincott.
NUR 411: KEELEY/CHASE: 11/22/2002
79
EATING DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Distinguish the signs and symptoms of anorexia nervosa from bulimia nervosa.
2. Describe two theories of etiology for both anorexia nervosa and bulimia nervosa.
3. Explain the importance of body image, body dissatisfaction, and gender identity in
developmental theories that explain etiology of eating disorders.
4. Explain the impact of sociocultural norms on the development of eating disorders.
5. Describe the risk factors and protective factors associated with the development of eating
disorders.
6. Formulate the nursing diagnoses for individuals with eating disorders.
7. Describe the nursing interventions for individuals with anorexia nervosa and bulimia
nervosa.
8. Differentiate binge eating disorder from bulimia nervosa
9. Analyze special concerns within the nurse-patient relationship for the nursing
management of individuals with eating disorders.
10. Identify strategies for prevention and early detection of eating disorders.
CONTENT OUTLINE:
1. Anorexia Nervosa
1.1. Clinical Course of Disorder
1.2. Diagnostic Criteria
1.3. Epidemiology
1.3.1. Age of Onset
1.3.2. Gender Differences
1.3.3. Ethnic and Cultural Differences
1.3.4. Familial Differences
1.4. Comorbidity
1.5. Etiology
1.6. Biologic Theories
1.6.1. Neuropathologic
1.6.2. Genetic
1.6.3. Biochemical
1.7. Psychological Theories
1.8. Social Theories
1.8.1. Family Responses
1.9. Risk Factors
1.9.1. Biologic
1.9.2. Psychological
1.9.3. Sociocultural
1.9.4. Family
1.10.
Concurrent Disorders
1.10.1. Sexual Abuse
1.11.
Interdisciplinary Treatment
1.12.
Pharmacologic Interventions
1.13.
Priority Care Issues
1.14.
Nursing Management: Human Response to Disorder
1.14.1. Therapeutic Nurse-Patient Relationship
1.14.2. Biologic Domain
1.14.3. Psychological Domain
1.14.3.1.
Patient Education
1.14.4. Social Domain
1.14.5. Evaluation and Treatment Outcomes
1.15.
Continuum of Care
80
1.15.1. Hospitalization
1.15.2. Emergency Care
1.16.
Family Assessment and Intervention
1.17.
Outpatient Treatment
1.18.
Prevention
2. Bulimia Nervosa
2.1. Definition and Clinical Course
2.2. Diagnostic Criteria
2.3. Bulimia Nervosa in Special Populations
2.4. Epidemiology
2.4.1. Age of Onset
2.4.2. Gender Differences
2.4.3. Ethnic and Cultural Differences
2.4.4. Familial Differences
2.4.5. Comorbidity
2.5. Etiology
2.5.1. Biologic Theories
2.5.2. Neuropathologic
2.5.3. Genetic
2.5.4. Biochemical
2.5.5. Psychological and Social Theories
2.6. Cognitive Therapy
2.7. Family
2.8. Risk Factors
2.9. Interdisciplinary Treatment
2.10.
Priority Care Issues
2.11.
Nursing Management: Human Response to Disorder
2.11.1. Therapeutic Nurse-Patient Relationship
2.11.2. Biologic Domain
2.11.2.1.
Pharmacologic Interventions
2.11.3. Psychosocial Domain
2.12.
Treatment Therapies
2.13.
Behavioral Intervention
2.14.
Psychoeducation
2.15.
Evaluation and Treatment Outcomes
3. Continuum of Care
4. Prevention
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 24: Pages 109-111
2.
Participation in Classroom Critical Thinking Activities. CTE #1, 3. Study Guide Page
111.
3.
Quiz
CRITICAL THINKING FOCUS:
Nursing is predominately a female profession and eating disorders are much more likely to occur
in women than men. What can nurses do to help themselves? How can nurses intervene to help
individuals and their families with an identified eating disorder?
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 582-615).
Philadelphia: Lippincott.
81
WEB LINKS:
http://www.anred.com Anorexia Nervosa and Related Eating Disorders (ANRED), P.O. Box
5102, Eugene, OR 97405. The ANRED site has professional and lay information on eating
disorders.
http://www.mirror-mirror.org/eatdis.htm Eating Disorders Shared Awareness. This site gives
information on how to get help with an eating disorder
NUR 411: KEELEY/CHASE: 11/22/2002
82
CHILD AND ADOLESCENT MENTAL HEALTH
LESSON OBJECTIVES:
At the completion of the lesson, the student will be able to:
1. Identify protective factors in the mental health promotion of children and adolescents.
2. Identify risk factors for the development of psychopathology in childhood and
adolescence.
3. Analyze the role of the nurse in mental health promotion with children and families.
4. Identify protective factors in the mental health promotion of children and adolescents.
5. Identify risk factors for the development of psychopathology in childhood and
adolescence.
6. Analyze the role of the nurse in mental health promotion with children and families.
CONTENT OUTLINE:
1. Childhood and Adolescent Mental Health
1.1.
Common Childhood Problems
1.1.1.
Death and Grieving
1.1.2.
Preschool-Aged Children
1.1.3.
School-Aged Children
1.1.4.
Adolescents
1.2.
Separation and Divorce
1.3.
Sibling Relationships
1.4.
Physical Illness
1.5.
Adolescent Risk-Taking Behaviors
2. Risk Factors for Childhood Psychopathology
2.1.
Poverty and Homelessness
2.2.
Child Abuse and Neglect
2.3.
Out-of-Home Placement
2.4.
Children of Alcoholics
3. Intervention Approaches
3.1.
Oppositional Defiant Disorder and Conduct Disorder
3.2.
Nursing Management: Human Response to Disorder
3.2.1.
Biologic Domain
3.2.1.1.
Assessment
3.2.1.2.
Nursing Diagnosis and Outcomes: Biologic Domain
3.2.1.3.
Interventions for the Biologic Domain
3.3.
Psychological Domain
3.3.1.
Assessment
3.3.2.
Nursing Diagnosis and Outcomes: Psychological Domain
3.3.3.
Interventions for the Psychological Domain
3.4.
Social Domain
3.4.1.
Assessment
3.4.2.
Nursing Diagnosis and Outcomes: Social Domain
3.4.3.
Interventions for the Social Domain
4. Evaluation and Treatment Outcomes
5. Continuum of Care
6. Disorders of Mood and Anxiety
6.1.
Anxiety Disorders
6.2.
Separation Anxiety Disorder
6.3.
Epidemiology and Etiology
6.4.
Psychopharmocologic Interventions
6.5.
Nursing Management
6.6.
Obsessive-Compulsive Disorder
6.6.1.
Epidemiology and Etiology
6.6.2.
Psychopharmocologic Interventions
6.6.3.
Nursing Management
83
6.7.
Mood Disorders: Major Depressive Disorder
6.7.1.
Epidemiology
6.7.2.
Nursing Management
6.8.
Tic Disorders and Tourette’s Disorder
6.8.1.
Epidemiology and Etiology
6.8.2.
Psychopharmacologic Interventions
6.8.3.
Nursing Management
7. Childhood Schizophrenia
8. Elimination Disorders
8.1.
Enuresis
8.1.1.
Epidemiology and Etiology
8.1.2.
Nursing Management
8.2.
Encopresis
8.2.1.
Epidemiology and Etiology
8.3.
Nursing Management
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 28, 29: Pages
2.
Participation in Classroom Critical Thinking Activities CTC #8 Page 779 Text. CTE #4
Study Guide Page 134
3.
Quiz
CRITICAL THINKING FOCUS:
Our children are our future. What must mental health nurses do to ensure their mental health?
How can a nurse in a pediatric out-patient practice apply assessment tools for case finding and
provide mental health nursing care for a child and his/her family?
REQUIRED READING
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 724-781).
Philadelphia: Lippincott.
WEB LINKS
http://www.aacap.org/publications/factsfam/index.htm The American Academy of Child and
Adolescent Psychiatry website provides an exhaustive list of links to short articles on many
mental health issues and is geared toward families and consumers.
http://www.chadd.org This site of the Children and Adults with Attention-deficit/Hyperactivity
Disorder (CHADD) organization provides information and resources on ADHD.
http://www.wpi.edu/~trek/aspergers.html This website describes Asperger’s disorder.
http://www.autism-society.org The Autism Society of America advances the understanding of
autism.
http://www.autism.org The website of the Center for Study of Autism contains information and
resources about autism and related disorders.
NUR 411: KEELEY/CHASE: 11/22/2002
84
DELERIUM, DEMENTIA AND OTHER RELATED DISORDERS
LESSON OBJECTIVES:
Upon completion of this lesson, the student will be able to:
1. Distinguish the clinical characteristics, onset, and course of delirium and Alzheimer’s disease.
2. Analyze the prevailing biologic, psychological, and social theories that relate to delirium and
Alzheimer’s disease in elderly people.
3. Integrate biopsychosocial theories into the analysis of human responses to delirium and
dementia, with emphasis on the concepts of impaired cognition and memory.
4. Discuss various etiologies for cognitive impairment in other patients (other than those with
delirium and dementia).
5. Interpret the impact of culture and education on mental status testing.
6. Formulate nursing diagnoses based on a biopsychosocial assessment of patients with
impaired cognitive function.
7. Identify expected outcomes for patients with impaired cognition and their evaluation.
8. Discuss nursing interventions used for patients with impaired cognition.
CONTENT OUTLINE:
1. Delirium
1.1.
Clinical Course of Disorder
1.2.
Diagnostic Criteria
1.3.
Delirium in Special Populations
1.3.1.
Children
1.3.2.
Elderly People
1.4.
Epidemiology and Risk Factors
1.5.
Etiology
1.6.
Interdisciplinary Treatment and Priority Care Issues
1.7.
Nursing Management: Human Response to Disorder
1.7.1.
Biologic Domain
1.7.1.1.
Biologic Assessment
1.7.2.
Past and Present Health Status
1.7.3.
Physical Examination and Review of Systems
1.7.3.1.
Physical Functions
1.7.4.
Pharmacologic Assessment
1.8.
Nursing Diagnoses Related to Biologic Domain
1.9.
Biologic Interventions
1.10. Safety Interventions
1.11. Pharmacologic Interventions
1.12. Psychological Domain
1.12.1.
Psychological Assessment
1.12.2.
Mental Status
1.12.3.
Behavior
1.12.4.
Nursing Diagnoses Related to Psychological Domain
1.12.5.
Psychological Interventions
1.13. Social Domain
1.13.1.
Social Assessment
1.13.2.
Nursing Diagnoses Related to Social Domain
1.13.3.
Social Interventions
2. Evaluations and Treatment Outcomes
3. Continuum of Care
4. Dementia of the Alzheimer’s Type
4.1.
Clinical Course of Disorder
4.2.
Diagnostic Criteria
4.3.
Epidemiology and Risk Factors
4.4.
Etiology
85
4.4.1.
Plaques and Tangles
4.4.2.
Cholinergic Hypothesis
4.5.
Genetic Factors
4.6.
Other Theories
4.7.
Interdisciplinary Treatment
4.8.
Priority Care Issues
4.9.
Family Response to Disorder
4.10. Nursing Management: Human Response to Disorder
4.10.1.
Biologic Domain
4.10.1.1.
Biologic Assessment
4.10.1.2.
Past and Present Health Status
4.10.1.3.
Physical Examination and Review of Body Systems
4.10.1.4.
Physical Functions
4.10.1.4.1.
Self-Care
4.10.1.4.2.
Sleep-Wake Disturbances
4.10.1.4.3.
Activity and Exercise
4.10.1.4.4.
Nutrition
4.10.1.4.5.
Pain
4.11. Nursing Diagnoses Related to Biologic Domain
4.11.1.
Biologic Interventions
4.11.2.
Self-Care Interventions
4.11.3.
Nutritional Interventions
4.11.4.
Interventions Supporting Bowel and Bladder Function
4.11.5.
Sleep Interventions
4.11.6.
Activity and Exercise Interventions
4.11.7.
Pain and Comfort Management
4.11.7.1.
Relaxation
4.11.7.2.
Pharmacologic Interventions
4.11.7.2.1.
Cholinesterase Inhibitors
4.11.7.2.2.
Antipsychotics
4.11.7.2.3.
Antidepressants and Mood Stabilizers
4.11.7.2.4.
Antianxiety Medications (Sedative-Hypnotics)
4.11.7.2.5.
Other Medications
4.11.7.3.
Other Somatic Interventions
4.12. Psychological Domain
4.12.1.
Psychological Assessment
4.12.2.
Responses to Mental Health Problems
4.12.2.1.
Cognitive Status
4.12.2.1.1.
Memory
4.12.2.1.2.
Language
4.12.2.1.3.
Visuopatial Impairment
4.12.2.1.4.
Executive Functioning
4.12.2.2.
Psychotic Symptoms
4.12.2.2.1.
Suspiciousness and Delusion and Illusion Formation
4.12.2.2.2.
Hallucinations
4.12.2.3.
Mood Changes
4.12.2.3.1.
Depression
4.12.2.4.
Anxiety
4.12.2.5.
Catastrophic Reactions
4.12.3.
Behavioral Responses
4.12.3.1.1.
Apathy and Withdrawal
4.12.3.1.2.
Restlessness, Agitation, and Aggression
4.12.3.1.3.
Disinhibition
4.12.3.1.4.
Hypersexuality
4.12.4.
Stress and Coping Skills
4.13. Nursing Diagnoses Related to Psychological Domain
86
5.
6.
7.
8.
9.
10.
4.14. Psychological Interventions
4.14.1.
Interventions for Cognitive Impairment
4.14.1.1.
Validation Therapy
4.14.1.2.
Memory Enhancement
4.14.1.3.
Orientation Interventions
4.14.1.4.
Maintenance of Language Functions
4.14.1.5.
Supporting Visuopatial Functioning
4.14.2.
Interventions for Psychosis
4.14.2.1.
Managing Suspicions, Illusions, and Delusions
4.14.2.2.
Managing Hallucinations
4.14.3.
Interventions for Alterations in Mood
4.14.3.1.
Managing Depression
4.14.3.2.
Managing Anxiety
4.14.3.3.
Managing Catastrophic Reactions
4.14.4.
Interventions for Behavior Problems
4.14.4.1.
Managing Apathy and Withdrawal
4.14.4.2.
Managing Restlessness and Wandering
4.14.4.3.
Managing Aberrant Behavior
4.14.4.4.
Managing Agitated Behavior
4.14.4.5.
Reducing Disinhibition
4.15. Social Domain
4.15.1.
Social Assessment
4.15.2.
Nursing Diagnoses Related to Social Domain
4.15.3.
Social Interventions
4.15.4.
Safety Interventions
4.15.5.
Environmental Interventions
4.15.6.
Socialization Activities
Home Visits
Community Actions
Family Interventions
Evaluation and Treatment Outcomes
Continuum of Care
9.1.
Community Care
9.2.
Inpatient-Focused Care
9.3.
Nursing Home Care
Other Dementias
10.1. Vascular Dementia
10.2. Dementia Caused by Other General Medical Conditions
10.3. Dementia Caused by AIDS
10.4. Dementia Caused by Head Trauma
10.5. Dementia Caused by Parkinson’s Disease
10.6. Dementia Caused by Huntington's Disease
10.7. Dementia Caused by Pick’s Disease
10.8. Dementia Caused by Creutzfeldt-Jakob Disease
10.9. Substance-Induced Persisting Dementia
10.10. Amnestic Disorder
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 31: Pages 139-143
2.
Participation in Class Critical Thinking Exercises CTC #1, 3, Page 855. Text
3.
Quiz
CRITICAL THINKING FOCUS:
How are cognition and memory affected by underlying physical disorders? With a projected
increase in the incidence of these disorders over the next twenty years, what can nurses do to
effectively assist patients and their families in primary prevention and acute care?
87
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 814-857).
Philadelphia: Lippincott.
WEB LINKS:
http://www.alz.org This Alzheimer’s Association website provides information, resources, and
consumer and caregiver support.
http://www.ninds.nih.gov/health_and_medical/disorders/alzheimersdisease_doc.htm The
National Institute of Neurological Disorders and Stroke website provides useful information about
Alzheimer’s disease.
http://www.pdsg.org.uk This website of the Pick’s Disease Support Group provides information
on Pick’s disease, Lewy bodies, and other dementias.
http://www.alzheimer.ca/english/index.htm This site of the Alzheimer’s Association of Canada
provides information and resources related to the disease.
NUR 411: KEELEY/CHASE: 11/22/2002
88
STRESS MANAGEMENT AND CRISIS INTERVENTION
LESSON OBJECTIVES:
Upon completion of this lesson, the student will:
1. Examine person-environment factors that contribute to the stress experience.
2. Relate the cognitive appraisal of the person-environment relationship to stress and
coping.
3. Determine when problem-focused and emotion-focused coping should be used.
4. Define adaptation in terms of health, psychological well-being, and social function.
5. Apply the nursing process to a person who is experiencing stress.
6. Differentiate generalist and specialist psychiatric mental health nursing interventions that
promote successful coping in stressful situations.
7. Define a crisis as an example of severe stress.
8. Differentiate between a crisis due to chronic stress and a psychiatric emergency.
9. Delineate generalist and specialist interventions that promote positive resolution of crises.
CONTENT OUTLINE:
1. Antecedents to Stress
1.1.
Person-Environment Relationship
1.2.
The Person
1.2.1.
Values and Commitment
1.2.2.
Personality Behavior Patterns
1.3.
The Environment
1.3.1.
Social Networks
1.3.2.
Social Support
1.4.
Demands and Constraints
1.5.
Sociocultural Factors
1.5.1.
Life Events
1.6.
Appraisal
2. Stress Responses
2.1.
Physiologic Responses
2.2.
Emotional Responses
2.3.
Coping
2.4.
Adaptation
3. Health and Illness
3.1.
Psychological Well-Being
4. Social Functioning
5. Nursing Management: Human Response to Disorder
5.1.
Assessing Human Responses to Stress
5.1.1.
Biologic Assessment
5.1.1.1.
Review of Systems
5.1.1.2.
Pharmocologic Assessment
5.1.1.3.
Physical Functioning
5.1.2.
Psychological Assessment
5.1.3.
Social Assessment
5.1.3.1.
Recent Life Changes
5.1.3.2.
Social Network and Social Support
5.2.
Nursing Diagnosis and Outcome Identification
5.3.
Planning and Implementing Nursing Interventions
5.3.1.
Biologic Interventions
5.3.2.
Psychological Interventions
5.3.3.
Social Interventions
5.4.
Evaluation and Treatment Outcomes
6. Crisis
6.1.
Developmental Crisis
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6.2.
Situational Crisis
6.2.1.
Death of a Loved One: A Crisis Event
6.2.1.1.
Phases of Bereavement
6.2.1.2.
Shock and Disbelief
6.2.1.3.
Acute Mourning
6.2.1.4.
Resolution
6.2.2.
Dysfunctional Grieving
7. Nursing Management: Human Response to Disorder
7.1.
Assessing Human Responses to Crises
7.1.1.
Biologic Assessment
7.1.2.
Psychological Assessment
7.1.3.
Social Assessment
7.2.
Nursing Diagnosis and Outcome Identification
7.3.
Planning and Implementing Nursing Interventions
7.3.1.1.
Psychopharmacologic Interventions
7.3.2.
Initiation
7.3.3.
Stabilization
7.3.4.
Maintenance
7.3.5.
Medication Cessation
7.3.6.
Biopsychosocial Interventions
8. Crisis Intervention in the Community
8.1.
Telephone Hot Lines
8.2.
Residential Crisis Services
9. Evaluation and Treatment Outcomes
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 35: Pages 159-163
2.
Participation in Classroom Critical Thinking Activities CTE #1 Study Guide Page 161
3.
Quiz
CRITICAL THINKING FOCUS:
Since crisis is inevitable in life, how might the nurse care for patients who are in crisis so that they
may have an optimal outcome.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 920-949).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
http://www.tc.unl.edu/stress This site offers a review of the principles of stress management.
http://www.isma.org.uk This is the home page of the international Stress Management
Association (ISMA) in the United Kingdom. ISMA is a leading professional body for stress
management. Its website has articles from its journal.
http://www.stress-management-isma.org
The International Stress Management Association
seeks to advance the education of professionals and students and to facilitate methodically sound
research in several professional interdisciplinary stress management fields.
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MANAGEMENT OF AGGRESSION
LESSON OBJECTIVES:
Upon completion of the lesson, the student will be able to:
1. Explore feelings about the experience and expression of anger.
2. Discuss the biopsychosocial factors that influence the expression of aggressive and
violent behaviors.
3. Discuss biopsychosocial theories used to explain anger, aggression, and violence.
4. Identify behaviors or actions that escalate and de-escalate violent behavior.
5. Recognize the risk of “nurse abuse” (attacks on nurses).
6. Generate options for responding to the expression of anger and violent behaviors in
clinical nursing practice.
7. Apply the nursing process to the management of anger, aggression, and violence in
patients.
CONTENT OUTLINE:
1. Anger
1.1.
Experience of Anger
1.2.
Expression of Anger
2. Aggression and Violence
3. Models of Anger, Aggression, and Violence
3.1.
Biologic Theories
3.2.
Cognitive Neuroassociation Model
3.3.
Neurostructural Model and the Emotional Circuit
3.4.
Neurochemical Model and Low Serotonin Syndrome
3.5.
Psychological Theories
3.6.
Psychoanalytic Theories
3.7.
Behavioral Theories
3.8.
Drive Theory
3.9.
Social Learning Theory
3.10. Cognitive Theories
3.11. Sociocultural Theories
3.12. Interactional Theory
4. Nursing Management: Human Response to Disorder
4.1.
Assessing the Human Response to Anger, Aggression, and Violence
4.1.1.
Biologic Assessment
4.1.2.
Psychological Assessment
4.1.2.1.
Thought Processing
4.1.2.2.
Perception
4.1.2.3.
Delusion
4.1.2.4.
Sensory Impairment
4.1.3.
Social Assessment
4.2.
Nursing Diagnosis and Outcome Identification
4.3.
Planning and Implementing Nursing Interventions
4.3.1.
Biologic Interventions
4.3.2.
Administering and Monitoring Medications
4.3.3.
Managing Nutrition
4.3.4.
Psychological Interventions
4.3.5.
Affective Interventions
4.3.5.1.
Validating
4.3.5.2.
Listening to the Patient’s Illness Experience
4.3.5.3.
Exploring Beliefs
4.3.6.
Cognitive Interventions
4.3.6.1.
Giving Commendations
4.3.6.2.
Offering Information
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4.3.6.3.
Providing Education
4.3.6.4.
Thought Stopping
4.3.6.5.
Contracting
4.3.7.
Behavioral Interventions
4.3.7.1.
Assigning Behavioral Tasks
4.3.8.
Using Bibliotherapy
4.3.9.
Interrupting Patterns
4.3.10.
Providing Choices
4.4.
Social Interventions
4.4.1.
Reducing Stimulation
4.4.2.
Anticipating Needs
4.5.
Using Seclusion and Restraint
4.6.
Interactional Processes
4.6.1.
Responses to Assault
4.7.
Evaluation and Treatment Outcomes
5. Continuum of Care
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 36: Pages 164-167
2.
Participation in Class Critical Thinking Exercises CTE #2 Study Guide: Page166.
3.
Quiz
CRITICAL THINKING FOCUS:
Integrating current theories of aggression and accepted interventions for the management of
aggression in the clinical environment into a nursing practice model.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 950-974).
Philadelphia: Lippincott.
WEB LINKS:
http://www.journals.wiley.com/0096-140X This site provides a Guide to the Literature on
Aggressive Behavior and information on the Journal of the International Society for Research on
Aggression. The guide provides an extensive list of current publications on aggressive behavior.
http://www.journals.wiley.com/0096-140X This site provides a Guide to the Literature on
Aggressive Behavior and information on the Journal of the International Society for Research on
Aggression. The guide provides an extensive list of current publications on aggressive behavior.
http://www.helping.apa.org/warningsigns The American Psychological Association maintains
this website. This section focuses on teen violence. It includes a personal risk evaluation for
violent behavior, tips on helping when someone you know shows violence warning signs, and a
free brochure.
NUR 411: KEELEY/CHASE: 11/22/2002
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CARING FOR ABUSED PERSONS
LESSON OBJECTIVES:
Upon completion of this lesson the student will be able to:
1. Describe woman, child, and elder abuse.
2. Describe biopsychosocial theories of abuse.
3. Discuss theories explaining why some men become abusive and why some women
remain in violent relationships.
4. Describe biopsychosoical consequences of abuse.
5. Describe the diagnostic criteria for post-traumatic stress disorder (PTSD).
6. Discuss the three major symptom categories found in PTSD and their associated
etiologic factors.
7. Describe the diagnostic criteria for dissociative identity disorder (DID).
8. Integrate biopsychosocial theories into the analysis of human responses to survivors of
abuse.
9. Formulate nursing care plans for survivors of abuse.
CONTENT OUTLINE:
1. Types of Abuse
1.1.
Woman Abuse
1.2.
Battering
1.3.
Rape and Sexual Assault
1.4.
Child Abuse
1.5.
Child Neglect
1.6.
Physical Abuse
1.7.
Sexual Abuse
1.8.
Emotional Abuse
1.9.
Munchausen’s Syndrome by Proxy
1.10. Children of Battered Women
1.11. Elder Abuse
2. Explanatory Theories of Abuse
2.1.
Biologic Theories
2.1.1.
Neurologic Problems
2.1.2.
Links With Substance Abuse
2.2.
Psychological Theories
2.2.1.
Psychopathology Theory
2.2.2.
Social Learning Theory
2.3.
Social Theories
3. Theoretical Dynamics Specific to Woman Abuse
3.1.
Feminist Theories
3.2.
Theory of Borderline Personality Organization
3.3.
Theories Why Women Stay in Violent Relationships
4. Cycle of Violence
4.1.
Traumatic Bonding
4.2.
Survivors of Abuse: Human Responses to Trauma
4.3.
Biologic Responses
4.3.1.
Depression
4.4.
Acute Stress Disorder and Post-Traumatic Stress Disorder
4.4.1.
Hyperarousal
4.4.2.
Intrusion
4.4.3.
Avoidance and Numbing
4.5.
Dissociative Identity Disorder
4.6.
Substance Abuse and Dependence
5. Psychological Responses
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6.
7.
8.
9.
10.
5.1.
Low Self-Esteem
5.2.
Guilt and Shame
5.3.
Anger
5.4.
Social and Interpersonal Responses
5.5.
Problems With Intimacy
5.6.
Revictimization
Nursing Management
6.1.
Assessing for Abuse and Survivors’ Responses
6.1.1.
Biologic Assessment
6.1.2.
Psychological Assessment
6.1.3.
Social Assessment
6.1.4.
Special Assessment Considerations in Sexual Assault
6.2.
Nursing Diagnoses
6.3.
Planning and Implementing Nursing Interventions for Abuse
6.3.1.
Biologic Interventions
6.3.1.1.
Administering and Monitoring Medications
6.4.
Making Referrals for Patients With Comorbid Substance Abuse
6.4.1.
Psychological Interventions
6.4.1.1.
Assisting With Psychotherapy and Counseling
6.4.1.2.
Providing Education
6.4.2.
Using Behavioral Interventions
6.4.3.
Social Interventions
Working With Abusive Families
Working in the Community
Special Intervention Considerations in Sexual Assault
Evaluation and Treatment Outcomes
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 37: Pages 168-172
2.
Participation in Classroom Critical Thinking Exercises CTE #1 Study Guide Page
170.
3.
Quiz
CRITICAL THINKING FOCUS:
How can the mental health nurse holistically intervene in the cycle of abuse. What interventions
are most helpful in the acute care setting for victims of abuse?
REQUIRED READING
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 974-1005).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
http://www.ncadv.org National Coalition Against Domestic Violence. This site serves as a
national information and referral center dedicated to the empowerment of battered women and
their children.
http://www.LetsWRAP.com Women’s Rural Advocacy Programs. This site represents a
cooperative of Domestic Violence and Criminal Justice Intervention programs serving
southwestern Minnesota. It has a section specifically for Native American women.
http://www.breakingthecycleinc.com Breaking the Cycle, Inc. This site is dedicated to ending
violence against women and children through specialized training and awareness programs for
professionals.
http://www.abanet.org/domviol/home.html American Bar Association Domestic Violence. This
site provides links to statistical and informational resources. It includes the Model Code on
Domestic and Family Violence, a general bibliography, and information about legal research and
analysis.
94
http://www.cavnet2.org Communities Against Violence Network. This database of information
also supports a virtual community of more than 900 professionals from the United States, Europe,
Australia, New Zealand, Canada, South Africa, the Middle East, Latin America, and the
Caribbean.
NUR 411: KEELEY/CHASE: 11/22/2002
95
SEXUAL DISORDERS
LEARNING OBJECTIVES:
Upon completion of this lesson, the student will:
1. Distinguish types and etiologies of common sexual dysfunctions and disorders.
2. Analyze biologic, psychological, and social theories that serve as a basis for caring for
persons with sexual disorders, paraphilias, and gender identity disorder.
3. Identify human responses to sexual dysfunctions.
4. Develop a nursing care plan based on a biopsychosocial assessment of persons with a
sexual disorder.
5. Identify nursing intervention strategies common to treating those with sexual disorders.
6. Identify appropriate resources for referring a patient with a sexual dysfunction.
CONTENT OUTLINE:
1. Sexual Development
1.1.
Infancy Through Childhood
1.2.
Childhood Through Adolescence
1.3.
Young Adulthood
1.4.
Adulthood
1.5.
Later Adulthood
1.6.
Old Age
1.7.
The Dying Person
2. Human Sexual Response
2.1.
Sexual Desire
2.2.
Sexual Arousal
2.3.
Orgasm
2.4.
Resolution
3. Sexual Disorders
3.1.
Orgasmic Disorders
3.1.1.
Female Orgasmic Disorder
3.1.2.
Epidemiology
3.1.3.
Etiologic Factors
3.1.3.1.
Biologic Theories
3.1.3.2.
Psychological Theories
3.1.4.
Social Theories
3.2.
Risk Factors
3.3.
Interdisciplinary Treatment
3.4.
Nursing Management
3.4.1.
Biologic Domain
3.4.1.1.
Assessment
3.4.2.
Interventions
3.4.3.
Psychological Domain
3.4.3.1.
Assessment
3.4.3.2.
Interventions
3.4.4.
Social Domain
3.4.4.1.
Assessment
3.4.4.2.
Interventions
3.5.
Evaluation and Treatment Outcomes
4. Premature Ejaculation
4.1.
Epidemiology
4.2.
Etiology
4.3.
Nursing Management
5. Male Orgasmic Disorder
5.1.
Sexual Arousal Disorders
5.2.
Male Erectile Disorder
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6.
7.
8.
9.
10.
11.
5.2.1.
Epidemiology
5.2.2.
Etiology
5.2.2.1.
Biologic Theories
5.2.2.2.
Psychological Theories
5.3.
Nursing Management
5.3.1.
Biologic Domain
5.3.1.1.
Assessment
5.3.1.2.
Interventions
5.3.1.3.
Pharmacologic Interventions
5.3.2.
Psychological Domain
5.3.2.1.
Interventions
5.3.3.
Social Domain
5.3.3.1.
Interventions
5.4.
Evaluation and Treatment Outcomes
Female Sexual Arousal Disorder
6.1.
Other Sexual Disorders
6.2.
Sexual Desire Disorders
6.3.
Hypoactive Sexual Desire Disorder
6.4.
Sexual Aversion Disorder
6.5.
Sexual Pain Disorders
6.5.1.
Dyspareunia
6.5.2.
Vaginismus
6.5.3.
Priapism
Sexual Disorder Caused by a General Medical Condition
Substance-Induced Sexual Dysfunction
Paraphilias
9.1.
Exhibitionism
9.2.
Fetishism
9.3.
Frotteurism
9.4.
Pedophilia
9.5.
Sexual Masochism
9.6.
Sexual Sadism
9.7.
Transvestic Fetishism
9.8.
Voyeurism
9.9.
Paraphilia Not Otherwise Specified
Sexual Disorders Not Otherwise Specified
Gender Identity Disorders
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 27: Pages
2.
Participation in Classroom Critical Thinking Exercises CTE # 1, 2. Study Guide Page
123
3.
Quiz
CRITICAL THINKING FOCUS:
Integrating the theory of sexual disorders into a holistic plan of care for the client. Developing an
awareness of one’s own level of comfort when caring for clients with these diagnoses
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 16-28).
Philadelphia, Pa. : Lippincott.
WEB LINKS:
http://www.dr-bob.org
This site has psychopharmacology tips from
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SLEEP DISORDERS
LESSON OBJECTIVES
1. Describe the major features of sleep.
2. Identify sleep changes in major psychiatric disorders.
3. Distinguish among primary sleep disorders.
4. Discuss biopsychosocial aspects of sleep disorders.
5. Perform a sleep history during a client assessment.
6. Formulate a model nursing care plan for clients with sleep disorders.
CONTENT OUTLINE:
1. Biologic Basis of Sleep
1.1.1. Normal Sleep-Wake Circadian Rhythms
1.1.2. Neurobiologic Basis for Sleep
1.1.3. Stages of Sleep
1.1.3.1.1. Non-rapid-Eye-Movement Sleep
1.1.3.1.2. Rapid-Eye-Movement Sleep
2. Biologic Measurements of Sleep
3. Factors That Affect Sleep
3.1.1. Age
3.1.1.1.1. Newborns and Young Children
3.1.1.1.2. School-Aged Children
3.1.1.1.3. Young Adults
3.1.1.1.4. Middle-Age Adults
3.1.1.1.5. Elderly Adults
3.1.2. Environmental Stimuli
3.1.3. Lifestyle Conditions
4. Comorbidity
4.1.1. Sleep Disorders and Psychoses
4.1.2. Sleep Disorders and Mood Disorders
4.1.3. Sleep Disorders and Alcoholism
5. Primary Sleep Disorders
5.1.1. Dyssomnias
5.1.1.1.1. Primary Insomnia
5.1.1.1.1.1.1. Definition and Course
5.1.1.1.1.1.2. Epidemiology
5.1.1.1.1.1.3. Etiology
5.1.1.1.1.1.4. Biologic Measurements
5.1.1.1.1.1.5. Somatic Interventions
5.1.1.1.2. Primary Hypersomnia
5.1.1.1.2.1.1. Definition and Course
5.1.1.1.2.1.2. Biologic Measurements
5.1.1.1.2.1.3. Psychopharmacologic Interventions
5.1.1.1.3. Narcolepsy
5.1.1.1.3.1.1. Definition and Course
5.1.1.1.3.1.2. Epidemiology
5.1.1.1.3.1.3. Etiology
5.1.1.1.3.1.4. Biologic Measurements
5.1.1.1.3.1.5. Somatic Interventions
5.1.2. Breathing-Related Sleep
5.1.2.1.1. Disorders: Obstructive Sleep Apnea Syndrome
5.1.2.1.1.1.1. Definition and Course
5.1.2.1.1.1.2. Epidemiology
5.1.2.1.1.1.3. Etiology
5.1.2.1.1.1.4. Biologic Measurements
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5.1.2.1.1.1.5
Somatic Interventions
Circadian Rhythm Sleep Disorder
5.1.3.1.1.1.1. Definition and Course
5.1.3.1.1.1.1.1.1.
Delayed Sleep Phase Type
5.1.3.1.1.1.1.1.2.
Jet Lag Type
5.1.3.1.1.1.1.1.3.
Shift Work Type
5.1.3.1.1.1.2. Etiology
5.1.3.1.1.1.3. Epidemiology
5.1.3.1.1.1.4. Somatic Interventions
5.1.4. Parasomnias
5.1.4.1.1. Nightmare Disorder
5.1.4.1.1.1.1. Definition and Course
5.1.4.1.1.1.2. Epidemiology
5.1.4.1.1.1.3. Etiology
5.1.4.1.1.1.4. Biologic Measurements
5.1.4.1.1.1.5. Somatic Interventions
5.1.4.1.2. Sleep Terror Disorder
5.1.4.1.2.1.1. Definition and Course
5.1.4.1.2.1.2. Epidemiology
5.1.4.1.2.1.3. Etiology
5.1.4.1.2.1.4. Biologic Measurements
5.1.4.1.3. Sleepwalking Disorder
5.1.4.1.3.1.1. Definition and Course
5.1.4.1.3.1.2. Epidemiology and Etiology
5.1.4.1.3.1.3. Biologic Measurements
6. Nursing Management: Human Response to Sleep Disorder
6.1.1. Insomnia Assessment
6.1.2. Hypersomnia Assessment
6.1.3. Nursing Diagnoses and Outcome Identification
6.1.4. Planning and Implementing Nursing Interventions
6.1.4.1.1. Biologic Interventions
6.1.4.1.1.1.1. Nutrition
6.1.4.1.2. Psychopharmacologic Interventions
6.1.4.1.3. Psychological Interventions: Patient Education
6.1.4.1.4. Behavioral Interventions
6.1.4.1.4.1.1. Sleep Hygiene
6.1.4.1.4.1.2. Cognitive Therapy
6.1.4.1.5. Social Interventions
6.1.5. Evaluation and Treatment Outcomes
5.1.3.
LEARNING ACTIVITIES:
1.
Study Guide: Chapter 26: Pages
2.
Participation in Classroom Critical Thinking Activities
3.
Quiz
CRITICAL THINKING FOCUS:
Integration of an understanding of the variety of sleep disorders and treatments in to the practice
of mental health nursing.
REQUIRED READING:
Boyd, M. A. (2002). Psychiatric Nursing: Contemporary Practice.(2nd. Ed., pp. 658-685).
Philadelphia: Lippincott.
WEB LINKS:
http://www.users.cloud9.net/~thorpy This is the Sleep Medicine home page.
http://www.sleepfoundation.org This is the website of the National Sleep Foundation.
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http://aasmnet.org This is the site of the American Academy of Sleep Medicine.
http://www.sleepapnea.org This is the American Sleep Apnea Association website.
http://www.narcolepsynetwork.org This is the site of the Narcolepsy Network.
http://www.rls.org This is the website of the Restless Legs Syndrome Foundation.
http://www.med.stanford.edu/school/psychiatry/coe This is the site of the Stanford University
Center of Excellence for the Diagnosis and Treatment of Sleep Disorders.
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100