Specific Core Nursing Content # 10: Concepts of Chronic Illness


Clinical Learning Outcomes

  • Establish & maintain therapeutic relationships with individuals who have a severe persistent psychiatric disorder.
  • Assess common mechanisms of adaptation & coping used by clients experiencing a severe a persistent psychiatric disorder.
  • Plan, implement, & evaluate a relapse prevention plan for clients experiencing a severe persistent psychiatric disorder.
  • Prioritize care strategies for clients experiencing co- morbid health states.


Teaching Strategies


Classroom Teaching Strategies
  • Partner with National Alliance on Mental Illness (NAMI) & Clubhouse Programs-- Invite members or peer specialist to speak to the class [see appendix 9]
  • In Our Own Voices (presentation offered by NAMI)
  • Present Recovery models & practices
    • Tidal Model
    • Psychological Recovery Model (Andresen)
    • Trauma Informed Care - invite consumer as guest speaker
    • Motivational interviewing - use in class role play
    • Self-directed written recovery plans
  • Discuss symptoms & symptom management for serious persistent psychiatric disorders
  • Use of Evolving Case Studies
  • Use of Movies as illustrative case studies:
    • Home (2013). The story of a man who has schizophrenia, moves out of a group home. This film portrays stigma of mental illness.
    • The Soloist (2009). Drama tells the story of a reporter who tries to help a homeless, mentally ill street musician.
    • Canvas (2006). Story of a woman diagnosed with schizophrenia. This film deals with diagnosis and family dynamics.
  • Discussion board on mental illness in the media [See appendix 10]
  • TED Talks is an excellent resource for mini lectures/talks about mental illness, stigma and recovery that can be used in the classroom.
  • The Mental Health Channel is an online network of inspiring documentary videos on mental health topics including: access to care, children, and criminal justice. Free to view, free to share, and commercial free. Available at mentalhealthchannel.tv
  • Acceptance and Commitment Therapy uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. Further information available at https://contextualscience.org/act

Clinical Teaching Strategies
  • Attend support groups such as DBSA (depression bipolar support alliance), NAMI, Double Trouble (support groups for co-occurring disorders)
  • Attend Clubhouse Programs
  • Attend 12 step program support group meeting, have students use buddy system for this
  • Attend Psychosocial Rehabilitation programs
  • Attend a Clozaril Clinic (can search online for local availability)
  • Visit mental health centers to explore treatment options and philosophical approach to treatment
  • Review client records to find evidence of recovery principles in practice
  • Concepts: serious persistent mental illness, co-occurring disorders & co-morbidity
  • Student debate on Psychosocial Rehabilitation vs Recovery Models
  • Assertive Community Treatment & Case Management - invite service providers to speak to class
Reflective Journaling
  • Describe an interaction between nursing staff and a patient that demonstrated empathy, advocacy, or a therapeutic alliance. How does this compare with principles of the Recovery Model?
  • Supplemental Reflection Prompts [see appendix 11]
Resources
  • American Psychiatric Nurses Association Recovery to Practice Program
Simulation
  • Auditory Hallucinations Simulation Exercise [see appendix 12]
  • Interviewing standardized patients (SP) using motivational interviewing
  • Facilitate psychoeducation group (PEG) using psychosocial rehabilitation & recovery principles
Assignments
  • Have students work in pairs to complete an Action Plan for Prevention and Recovery. Can download a self-help guide with instructions from www.mentalhealth.gov/basics/recovery
  • Attend Mental Health support group and write a paper describing their experience [see appendix 13]


Assessment Strategies


Case Assignment with Student Questions

View sample case study.

  • What is your assessment of the situation?
  • Discuss at least 4 strategies to intervene using the principles of recovery.
  • Identify at least 2 community and 2 internet resources available for Jane.
  • How will you evaluate the outcome?
Clinical Skills Checklist
  • Demonstrate ability to partner with clients using recovery model principles & therapeutic communication (Standard 5G. Therapeutic Relationship)
  • Establish a plan of care for clients with serious mental illness (Standard 1. Assessment)
  • Educate client on recovery, relapse, and relapse prevention (Standard 5B. Health Teaching and Health Promotion)
  • Develop a recovery based action plan (Standard 5. Implementation)
The American Psychiatric Nurses Association is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.