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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. 3 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 89 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. 90 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 91 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 92 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 93 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 96 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 97 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 98 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. 99 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. NUR 411: KEELEY/CHASE: 11/22/2002 100