Specific Core Nursing Content # 5: Clinical Decision Making

Clinical Learning Outcomes

• Apply taxonomy structures to patient specific situations including the development of nursing diagnosis.
• Identify signs and symptoms characteristic of each major disorder.
• Evaluate the degree of evidence-base available to support common psychiatric nursing actions.
• Implement evidenced-based care for patients with psychiatric disorders.
• Plan and implement nursing interventions appropriate to patients’ needs that reflect etiological factors and standards of nursing care.
• Prioritize crisis intervention care practices with patients with psychiatric disorders.
• Assess patient potential for violence including suicide and homicide.
• Develop and implement suicide prevention strategies.

Teaching Strategies

Classroom Teaching Strategies

• Team Based Learning Approach- allows students to discuss and test their views in smaller groups as they hone their decision making skills.
• “Flipped Classroom”; Individual Readiness Assurance Test (IRAT) and Team Readiness Assurance Test (TRAT)
• Voice Recorded PPT to prepare for class content, use of classroom time for application.
• Review the ANA Psychiatric-Mental Health Nursing: Scope and Standards of Practice (2014)
• Evidence-based care principles for psychiatric disorders
  • https://www.researchgate.net/publication/11506852_Evidence-based_psychiatricmental_health_nursing
• Discuss essential Taxonomy systems commonly used in care of psychiatric disorders
  • NANDA-I (2002):Previously termed the North American Nursing Diagnosis Association. This serves as the basis for nursing care plans and decision making.
    •  http://www.nanda.org/
    • https://www.researchgate.net/publication/309494245_New_Update_Psychiatric_Nursing_Diagnosis_List_based_on_the_NANDA-I_Nursing_Diagnoses_NDs
  • DSM-5 and ICD-10: Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States and contains a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system. (DSM-5, 2014)
    • http://www.dsm5.org/Pages/Default.aspx
    • http://www.psychiatry.org/dsm5
    • https://pimsyehr.com/pcc-phc-icd-cdb-for-mental-health-how-do-dsm5-cpt-icd10-codes-interact/
    • WHO Disability Assessment: http://www.who.int/classifications/icf/whodasii/en/
  • The Omaha System: A research-based taxonomy in the public domain that is designed to enhance health care practices and documentation. It is intended for use across the continuum of care for all types of individuals, families, and communities. It is a middle range theory that supports other established health care theories.
    • http://www.omahasystem.org/overview.html
• Videos
  • Animated Minds (2009). This multi-award-winning collection of eight 3- to 6-minute micro-documentaries attempts to communicate the subjective experience of abnormal psychological states by blending edgy animation with narration by people who live each day with debilitating mental conditions. Schizophrenia, Bipolar, Agoraphobia, OCD, Eating Disorders, Autism, and Self Harm. (Can be purchased, or accessed through “Films on Demand”).
  • When the Devil Knocks (2010) – Dissociative Identity Disorder (Films on Demand)
  • Introduction to 12 Step Groups (2006) (Films on Demand)
  • Bipolar Disorder: Shifting Mood Swings (2002)
  • Faces of Drug Addiction Video https://www.rehabs.com/explore/faces-of-addiction/ (A great conversation starter)

Clinical Teaching Strategies

• Nursing Care Plans [see appendix 1]
• Concept Mapping
• Can use Mental Status Exams to evaluate subjects in Nottingham Psychiatric Interview Teaching Videos, available at www.youtube.com

Case Studies 

• Unfolding case study: The Neighborhood © (2011) Pearson Education
• Unfolding case study: man with schizophrenia (2013) – QSEN http://qsen.org/schizophrenia-unfolding-case-study/
• A Case Study of Psychiatric Medication Noncompliance, https://mentalillnesspolicy.org/medical/medication-noncompliance.html

Assessment Tools 

• List of screening tools for many mental illnesses. They indicate which parts of which tools are copyrighted. Some are free to use. https://psychology-tools.com/
• Mental Status Assessment
  • Mini-Mental Status Exam© (MMSE)
  • Montreal Cognitive Assessment (MoCA)
  • Mental Status Exams: Fillable forms available online for use:
    • https://www.pdffiller.com/en/project/56442832.htm?form_id=12113947
    • https://wchsa.org/wp-content/uploads/2017/04/brief_mental_status_exam.pdf
• Suicide Assessment
  • Various tools available at Substance Abuse and Mental Health Services Administration (SAMHSA) http://www.integration.samhsa.gov/clinical-practice/suicide-prevention#tools
  • American Psychiatric Nurses Association (APNA) Suicide Competencies (2015) Retrieved from http://www.apna.org/i4a/pages/index.cfm?pageID=5684
• Suicide Risk Assessment Guide (PDF) from Ontario Hospital Association: https://www.patientsafetyinstitute.ca/en/toolsResources/SuicideRisk/Documents/Suicide%20Risk%20Assessment%20Guide.pdf
• Thought Process and Perceptual Status
• Brief Biosocial Gambling Screen (BBGS)
• CAGE Questionnaires- Alcohol use screening
• Danger Assessment © (2001) Retrieved from http://www.ncdsv.org/images/dangerassessment.pdf

Assessment Strategies

Simulation

• SAMHSA/HRSA screening tools: https://www.integration.samhsa.gov/clinical-practice/screening-tools#suicide
• Assessment Interview & Medication Administration for a Client with Clinical Depression & Alcohol Abuse.Gambel, S. (2013). Retrieved from /files/public/AC2013/1024-Lintner-Handout1.pdf
• Scenario for Alcohol Withdrawal – Clinical Institute Withdrawal Assessment (CIWA)
• Scenario for Opiate withdrawal – Clinical Opiate Withdrawal Scale (COWS)

Clinical Skills Checklist

• Collects health data using appropriate assessment tools (Standard 1. Assessment)
• Uses evidence based assessment tools to determine nursing diagnosis (Standard 2. Diagnosis)
• Identifies expected outcomes (Standard 3. Outcomes Identification)
• Works with client to develop a plan to attain expected outcomes (Standard 4. Planning)