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.
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.
- Elyn Saks, a professor of law, psychology and psychiatry at USC, shares her experience of living with schizophrenia in a 15 min video.“Elyn Saks: A tale of mental illness-- from the inside” Retrieved from https://www.ted.com/talks/elyn_saks_seeing_mental_illness
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
- 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
- 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]
- American Psychiatric Nurses Association Recovery to Practice Program
- Modules 1 and 2 contain poignant description of consumer experiences and recovery principles. Available free for use at www.apna.org/i4a/pages/index.cfm?pageID=5296
- Auditory Hallucinations Simulation Exercise [see appendix 12]
- Interviewing standardized patients (SP) using motivational interviewing
- Facilitate psychoeducation group (PEG) using psychosocial rehabilitation & recovery principles
- 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]
Case Assignment with Student Questions
- 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?
- 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)