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APNA Undergraduate Education Toolkit

Defining and Using Psychiatric-Mental Health Nursing Skills in Undergraduate Nursing Education

Our students live and learn in a multimedia environment. Often their most memorable lessons are not from simple reading assignments. College classrooms have become more interactive, with content provided from a variety of sources and experiences. This toolkit is meant to guide the educator toward some new ways to teach the concepts of psychiatric-mental health nursing as set forth in both the Psychiatric-Mental Health Nursing: Scope and Standards of Practice (2014) and the Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum (2008). This toolkit has been a two year journey compiling real ideas and resources that expert educators rely on to supplement their traditional psychiatric-mental health nursing text. We of the APNA Education Council, Undergraduate Branch, hope that these tools can help to make the education process a little easier.

Suggested Citation: American Psychiatric Nurses Association Education Council, Undergraduate Branch. (2016). Crosswalk toolkit: Defining and using psychiatric-mental health nursing skills in undergraduate nursing education. Retrieved from https://www.apna.org/resources/undergraduate-education-toolkit/

Click on each section below to view the toolkit content and resources.

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Rationale

The Undergraduate Branch of the APNA Education Council was given permission by the APNA Board of Directors to conduct a survey, in two parts. First they asked about the placement and content of psychiatric-mental health (PMH) nursing within nursing curricula. They then asked if the faculty responsible for teaching the content was credentialed/specialized in PMH nursing. The results of the two surveys ascertained current trends in PMH education and examined the integration of PMH skills within the nursing curriculum. The first part of the survey collected data from members of the Undergraduate Branch (n=105) identifying the sequence and teaching of PMH nursing content within their curriculum. The second part was a national survey of PMH curricula and faculty, as reported by the academic institutions themselves, using a stratified sampling process to gather a representative sample in each state. The summarized data provided a snap shot of the current situation.

The APNA Board of Director’s charge dovetailed nicely into the ongoing work of the Undergraduate Branch. The results of the national survey made it clear that the PMH skills expected of undergraduate nurses need to be identified and catalogued. A toolkit of PMH teaching strategies would assist all teachers, regardless of specialty preparation, to teach PMH content.  The membership at recent APNA conferences had expressed a need for a skills toolkit to accompany a “checklist” of skills for nursing students, and for there to be some form of national standardization of teaching of PMH content.  The Undergraduate Branch of the Educational Council assumed leadership for developing these resources. With the potential dilution of PMH content in nursing curriculum as identified in the national survey, APNA members were keen to highlight and preserve the PMH skills necessary for undergraduate nursing students and to provide a repository of ideas and resources for teachers on how to provide students with these skills. This project is meant to provide concrete examples and suggestions for educators, rather than a complete curriculum or a theory. It should continue as a living document, with revisions and additions periodically to keep it rich, accurate, and up to date.

Disclaimer: Websites and YouTube video resources do not belong to APNA and are subject to change without warning. They may not continue to be available. APNA does not endorse any specific movie or program over another. The suggested resources were selected by the faculty as useful to teaching the content, but are not an exclusive list. The Appendices were submitted by the faculty and are available for reproduction and/or use.

Crosswalk Table

This table demonstrates how each core nurse content area relates to the Psychiatric-Mental Health Nursing Scope & Standards of Practice (2014) and the Essentials of Psychiatric-Mental Health Nursing in the BSN Curriculum (2008).

Specific Core
Nursing Content
Scope & Standards of Psychiatric-Mental Health Nursing
Essentials for Undergraduate Education in Psychiatric-Mental Health
Growth and Development
Standard 1 Assessment
Standard 2 Diagnosis
Standard 4 Planning
Standard 5 Implementation

Standard 6 Evaluating

Standard 8 Education
Standard 13 Collaboration
  • Principles of cognitive, emotional, and psychological growth with corresponding developmental milestones
  • Recognition of major disorders occurring in childhood/ adolescence
    1. Mood disorders
    2. Eating disorders
    3. Conduct disorders
    4. ADHD
    5. Pervasive developmental disorders
    6. Substance abuse/dependence disorders
  • Recognition of major disorders occurring in adulthood
    1. Mood disorders
    2. Psychotic disorders
    3. Personality disorders
    4. Substance abuse/dependence disorders
    5. Anxiety disorders
  • Recognition of major disorders occurring in older age
    1. Depression
    2. Dementia
    3. Delirium
Neurobiological Basis of Care Practices
Standard 1 Assessment
Standard 2 Diagnosis
Standard 3 Outcomes Identification
Standard 4 Planning
Standard 5 Implementation

Standard 5B Health Teaching & Health Promotion
Standard 5E Pharmacological, Biological, & Integrative Therapies

Standard 6 Evaluation

Standard 9 Evidence Based Practice & Research

  • Neuroanatomical and neurophysiological basis of and relationship to observable patient behaviors and symptoms of psychiatric disorders
  • Neurobiological theories of etiology of common psychiatric health disorders
  • Genetics and psychiatric disorders
Pharmacotherapeutics and basic principles of Pharmacology
Standard 5E Pharmacological, Biological, and Integrative Therapies
Standard 5B Health Teaching
Standard 9 Evidence Based Practice & Research
  • Neurobiological basis of pharmacological and somatic treatments
  • Major psychotropic agents for identified psychiatric disorders that include:
    1. Classification
    2. Action and expected effect
    3. Side effects and toxicity
    4. Potential interactions with other medications and diet
  • Common alternative medicine approaches used in the treatment of psychiatric disorders
    1. Herbals, minerals, and vitamins
    2. Other alternative treatments
Communication Theory and Interpersonal Skills

Standard 4 Planning

Standard 5G Therapeutic Relationship and Counseling

Standard 11 Communication
Standard 12 Leadership

Standard 13 Collaboration

Standard 14 Professional Practice Evaluation

  • Therapeutic interventions for patients, families, and groups experiencing, or at risk for, psychiatric disorders
  • Therapeutic use of self with patients, families and groups experiencing, or at risk for, psychiatric disorders
    1. Appropriate affective and cognitive responses to patients
    2. Concept of professional boundaries with psychiatric patients and appropriate use of self-disclosure
    3. Communication with patients experiencing common psychiatric symptoms such as disorganized speech, hallucinations, delusions, and decreased production of speech
Clinical Decision Making
Standard 2 Diagnosis
Standard 3 Outcomes
Standard 4 Planning
Standard 5 Implement

Standard 6 Evaluation
Standard 10 Quality of Practice

Standard 12 Leadership

Standard 13 Collaboration

Standard 15 Resource Utilization

Standard 16 Environmental Health

  • Taxonomy systems commonly used in care of psychiatric disorders
    1. NANDA
    2. DSM-IVTR and ICD-10 (DSM-5 and ICD-11 updates)
    3. Omaha System
  • Evidence-based care principles for psychiatric disorders
  • Use of outcome measurements to evaluate interventions and care strategies
  • Principles of safety in various treatment settings
  • Concepts of psychiatric crisis and common intervention practices with patients experiencing psychiatric crisis
  • Violence
    1. Anger and aggression
    2. Levels and types of violence expression such as suicide, homicide, domestic violence, child and elder abuse
  • Standard care practices of common psychiatric disorders including:
    1. Psychotic disorders
    2. Mood disorders
    3. Anxiety disorders
    4. Personality disorders
    5. Substance abuse/dependence disorders
    6. Cognitive disorders
    7. Eating disorders
    8. Somatoform disorders
    9. Family and community violence
  • Use of informatics in psychiatric nursing
Patient Care Roles
Standard 5B Health Teaching and Health Promotion
Standard 5F Milieu Therapy
Standard 5G Therapeutic Relationship

Standard 6 Evaluation
Standard 12 Leadership

Standard 13 Collaboration

  • Principles of teaching/learning theories as they relate to patients with psychiatric disorders including psychoeducational approaches
  • Principles of clinical care manager with psychiatric patients
  • Principles of case manager with psychiatric patients
  • Principles of patient advocacy with psychiatric patients
  • Consumer advocacy groups
    1. NAMI
    2. NMHA
    3. Local resource identification groups
Health Care Settings

Standard 4 Planning

Standard 5 Implementation
Standard 5F Pharmacological, Biological and Integrative Therapies

Standard 10 Quality of Practice

Standard 12 Leadership

Standard 13 Collaboration

Standard 15 Resource Utilization

Standard 16 Environmental Health

  • Principles of inpatient care
  • Principles of psychiatric care in emergency department settings
  • Principles of community mental health
  • Principles of psychiatric home care
  • Relationship of acuity of care and patient needs to the setting of care
  • Evolving care settings (e.g. primary care, telecare and web-based)
Cultural, Ethnic and Spiritual Concepts
Standard 1 Assessment
Standard 4 Planning

Standard 5 Implementation
Standard 7 Ethics

Standard 8 Education

Standard 11 Communication

Standard 15 Resource Utilization

  • Diversity/Cultural humility
  • Cultural, religious and spiritual beliefs regarding mental health and illness
  • Cultural issues and spiritual beliefs as they relate to psychiatric symptom expression
  • Cultural/racial/ethnic diversity and its impact on mental health care delivery
  • Resources for culturally/linguistically sensitive PMH care
Health Promotion and Illness Prevention
Standard 1 Assessment
Standards 5B Health Teaching and Health Promotion

Standard 8 Education
Standard 14 Professional Practice Evaluation

  • Concepts of mental health promotion and illness prevention
  • Known risk factors of common psychiatric disorders
  • Screening and referral for common psychiatric disorders
  • International and national indicators on mental health (e.g. World Health Report and Surgeon General’s Report on Mental Illness)
  • Healthy People 2020 goals and objectives
  • Standardized screening and symptom rating instruments
  • IOM Report and National Patient Safety Goal
Concepts of Chronic Illness
Standard 1 Assessment
Standard 2 Diagnosis
Standard 5 Implementation
Standard 5A Coordination of Care
Standard 5B Health Teaching and Health Promotion
Standard 5E Pharmacological Biological, and Integrative Therapies

Standard 5G Therapeutic Relationship

Standard 6 Evaluation

Standard 8 Education

Standard 9 Evidence Based Practice and Research

Standard 10 Quality of Care

Standard 16 Environmental Health

  • Common adaptation & coping techniques used with severe persistent psychiatric disorders
  • Symptom management for serious persistent psychiatric disorders.
  • Concepts of co-morbidity
  • Symptom management for co-occurring chronic conditions
  • Concepts of relapse, relapse prevention, recovery and resilience
Ethical and legal Principles

Standard 7 Ethics

Standard 8 Education

Standard 10 Quality of Care

Standard 12 Leadership

Standard 13 Collaboration

Standard 14 Professional Practice Evaluation

Ability to assess, identify, and intervene regarding:
  • Resolution of Ethical Dilemmas
  • Professional Boundaries
  • Patient Rights
  • Types of admissions and levels of treatment
  • Legal and Professional Standards
Vulnerable Populations
Standard 1 Assessment
Standard 2 Diagnosis
Standard 5A Coordination of Care
Standard 6 Evaluation

Standard 7 EthicsStandard 12 Leadership

Standard 13 Collaboration

  • Principles and concepts of working with vulnerable populations
  • Access to care
  • Health disparities in mental health care and outcomes
    1. developmentally disabled
    2. elders and children
    3. special needs of diverse populations
    4. Marginalized populations i.e. homeless/jailed
Nursing Research

Standard 9 Evidence-Based Practice and Research

Standard 10 Quality of Practice

Standard 14 Professional Practice Evaluation

  • Research related to psychiatric mental health nursing and care delivery concepts
  • Concepts of evidence based practice

 

1. Growth & Development

Clinical Learning Outcomes

  • Demonstrate competent generalist assessment of the developmental needs of patients experiencing psychiatric disorders.
  • Recognize normative versus non-normative behavioral patterns in terms of developmental milestones.
  • Plan, implement and evaluate age appropriate care for patients with psychiatric disorders.
  • Demonstrate promotion of resilience across the lifespan.

Teaching Strategies

Classroom Teaching Strategies

  • Review of Freud Stages of Emotional Development.
  • Review of Piaget Stages of Cognitive Development.
  • Review of Erikson Stages of Psychosocial Development.
  • Review Maslow’s Hierarchy of Needs.
  • Group presentations of major disorders related to a specific age group.
  • Review concept of resilience and give examples across the lifespan.
  • Demonstrate use of age-specific assessment instruments. See Appendix 15 for Geriatric Depression Scale.

Clinical Teaching Strategies

Assessment Tools

Use of Movies as Case Studies

  • Movies can be viewed in class or as an individual assignment. Easily available for rent or purchase. Students are likely familiar with media resources.
    • Back from Madness: The Struggle for Sanity (1996).  Documentary following four patients as they deal with their mental health condition. This is a good introduction to the field of psychiatry.  Full movie is currently available on YouTube.
    • We Need to Talk About Kevin (2011). Drama depicts development of a child with mental illness, who later commits a massacre in his high school.
    • Lars and the Real Girl (2007).  Movie about a community coming to accept the delusional behaviors of one of its residents.  (An updated version of the “Harvey” movie)
    • Iris (2001).  Movie chronicling the struggle of the writer Iris Murdoch and her family as she deals with Alzheimer’s disease
    • Vertigo (1958).  Classic Hitchcock movie not known by modern students.  Complicated study of obsession, depression, delusional behavior, anxiety etc. Great homework exercise.

Simulation Exercises

  • Difficult to use mannequins for simulation in PMH unless it involves reaction to medication, changes in vital signs. Use of a Standardized Patient is recommended due to need for body language, behavior, and expression. Can use actors, faculty, or students for role play. Use of Standardized Scenarios is helpful.

Assessment Strategies

Assignments with Rubrics

  • Construct a case study on non-normative behavioral patterns in a patient/client
  • Devise care plans for patients/clients from three different age groups [see appendix 1]

Reflection on Experience

  • Reflective journal or diary shared with clinical instructor as student progress through the clinical. Instructions and sample prompts [see appendix 2]
    • Example: Focus on the concept of “Self-control”. Students have to reflect each week on instances of self-control, or lack of self-control, they have witnessed in the clinical area that week. This may be from clients, staff members, family or themselves.
  • Use of poetry to express emotional dimension of the learning experience.
  • Group meeting with students during post clinical to discuss 3 Domains of Learning in Blooms taxonomy – cognitive, psychomotor, affective

Clinical Skills Checklist

  • Developmental assessment of newly admitted patient/client. (Standard 1. Assessment)
  • Engages therapeutically with patient using developmentally appropriate verbal and non-verbal communication. (Standard 5. Implementation)
  • Develop teaching care plan based on learning readiness and developmental state of client.

2. Neurological Basis of Psychiatric-Mental Health Practice

Clinical Learning Outcomes

  • Apply knowledge about the structure and function of the brain in PMH practice.
  • Describe neuroimaging techniques use in PMH.
  • Identify the neurotransmitters, their location and function in the brain.
  • Recognize the genetic component of each mental illness.
  • Incorporate knowledge of circadian rhythms and sleep when conducting a psychosocial assessment.
  • Demonstrate competent generalist assessment skills with emphasis on mental status and neurological functioning.
  • Apply neurobiological knowledge to care practices and patient teaching.
  • Identify the purpose of genetic testing for psychiatric disorders.

 

Teaching Strategies

Classroom Teaching Strategies

  • Journal articles to supplement text:
    • Davies, S., Esler, M., & Nutt, D. (2010). Anxiety-Bridging the heart mind divide. Journal of Psychopharmacology, 24(5), 33-638.
    • Phelps, J. (2015). The Neural basis of bipolar illness. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/special-reports/neural-basis-bipolar-disorder
    • Siever, L.J. (2008). Neurobiology of aggression and violence. The American Journal of Psychiatry, 165(4), 429-442.

Clinical Teaching Strategies

  • Discuss the origin of the patients’ symptoms in terms of brain structure and function. While administering psychotropics, discuss the effects of the medication on areas of the brain.
  • Post conference discussion: “If a patient asked you whether they should have genetic testing done or not, what information would you give them to help them decide?”

Case Study:

  • Discuss a patient who is being treated on a psychiatric unit who was stabilized on a medical unit after a gunshot wound to the head including the Broca’s area and the amygdala. Discuss what possible symptoms would be associated with these affected areas of the brain

Boyd, M. A. (2012). Psychiatric Nursing: Contemporary practice (5th ed.), pp. 80-104. Philadelphia, PA: Lippincott Williams &Wilkins.

Assessment Strategies

Test Bank

Which of the following areas of the brain are associated with emotion and addiction?
A) limbic system, B) cerebellum, C) brain stem, D) dopamine
Answer: A

Assignments with Rubrics

  • Compare/contrast medication, neurotransmitter effects, adverse reactions, side effects and their neurobiological origin.

Clinical Skills Checklist

  • As the student is administering meds, given a diagram of the brain, identify the area the medication is affecting/targeting (Standard 5. Implementation)
  • Apply neurobiological knowledge to care practices and patient teaching. Student will teach the patient about the anatomy of the brain and the area of the brain that the medication is affecting (Standard 3. Outcomes Identification, Standard 5B. Health Teaching)
  • Demonstrate competent generalist assessment skills with emphasis on mental status and neurological functioning (Standard 1. Assessment, Standard 2. Diagnosis)
  • Apply neurobiological knowledge to care practices and patient teaching (Standard 4. Planning)

3. Pharmacotherapeutics & Basic Principles of Pharmacology

Clinical Learning Outcomes

  • Articulate knowledge of the neurobiological mechanism for various psychotropic medications.
  • Evaluate effects of medications on patient, including symptom abatement, side effects, toxicity, and potential interactions with other medications/substances.
  • Identify factors contributing to patient non-adherence.
  • Teach patients to manage their own medications including strategies to increase adherence to prescribed therapeutic regimen.
  • Apply pharmacotherapeutic principles to the safe administration of psychotropic medications.

Teaching Strategies

Classroom Teaching Strategies

  • Multi-method approach that encompasses traditional lectures, active learning strategies, collaborative learning, and problem solving to foster critical thinking, learning skills, and knowledge acquisition.
  • Individual or group presentations on pharmacological issues. Assign each person or group a specific medication classification as well as specific medications in the category (i.e. SSRIs, mood stabilizers, 2nd generation antispsychotics, etc)
  • Student groups make up NCLEX type questions on medications used in PMH nursing.
  • Instructor dissects an NCLEX style question with the students; discussing the stem and how it might be tested in reference to basic principles of pharmacology.
  • Construct arguments for and against the use of alternative medical approaches.
  • Discuss research studies about medication treatment issues. How to promote adherence within the Recovery Model of Care (i.e. enhancing self-management.)

 Clinical Teaching Strategies

  • Demonstrate the skills involved in administration of medication and supervision of clients.
    • Review the seven questions with each student: (Drug information the student is expected to know regarding their patient)
    1. Medication names: Trade and Generic
    2. Drug classification
    3. Drug action in your own words
    4. Why is this drug being used for your client?  (What are your patient’s symptoms the drug is treating?)
    5. What is the expected outcome of therapy with the drug?  (How will you know it is working for your patient?)
    6. Is this a safe dose and route?
    7. Common side effects (3-5) and precautions
    8. Nursing implications for administration and client teaching. (i.e., fall precautions, blood pressure, dietary restrictions)
  • Participate in patient education regarding psychotropic medications and possible side effects.
  • Encourage students to verbalize their thinking and engage with clients who are medicated.
  • Assessment of potential side effects and toxicity in clients and initiation of appropriate nursing action.

Curricular Resources

Case Studies

  • Invite consumers to class to describe their experiences. Focus on side effects of medication, adherence issues, cost issues.

Simulation Exercises

  • High fidelity mannequins used to reproduce pharmacological impact on client, especially adverse or toxic reactions. Affords students different opportunities to role-play different parts of the healthcare team, delegate tasks, share information, and further develop communication skills.

Assessment Strategies

Test Banks

Comparative Case Study

  • Students select two clients with very different experiences with psychotropic medications. One client had very successful outcomes and is compared to another patient who has struggled to find the appropriate medication

Clinical Skills Checklist for this Concept

  • Discuss medication needs of the newly admitted patient/client (Standard 5E. Pharmacological, Biological, and Integrative Therapies)
  • Devise care plans for patients/clients who are being treated with three different types of psychiatric medications (Standard 5B. Health Teaching)

4. Communication Theory & Interpersonal Skills

Clinical Learning Outcomes

  • Demonstrate therapeutic use of self with patients, families and groups.
  • Apply therapeutic communication techniques in care practices with patients experiencing common psychiatric symptoms including disorganized speech, hallucinations, delusions, and decreased production of speech.
  • Demonstrate group participation/leadership skills.
  • Develop professional boundaries necessary for professional care giving relationships.
  • Discuss strategies for safe management of crisis situations that occur in various treatment settings incorporating principles of therapeutic communication and patient psychopathology.
  • Incorporate Patient-centered care approaches to therapeutic communication and relationship building.

Teaching Strategies

Classroom Teaching Strategies

  • Defining Therapeutic Communication

“Therapeutic communication is essential to the use of the self as an instrument of healing.  It is the use of verbal and non-verbal messages to establish a professional therapeutic nurse-client relationship that will be the context for meeting the client’s physical and psychological needs.” Williams, C.  (2004). Therapeutic Interaction in Nursing.  New Jersey:  Slack, Inc.

               Elements that characterize therapeutic communication are:

  • Developing an attitude of respect, dignity and empowerment
  • Active listening
  • Being fully present
  • Listening with the whole self
  • Empathy
  • Communicating hope
  • Developing trust
  • Good direction -communicating with intention
    – Teach difference between “Therapeutic Relationship” vs. “Social Relationship.”
    Therapeutic Communication, the verbal and nonverbal exchange which enhances the trusting nurse-patient relationship, is:
    A) Patient/Client Centered, B) Goal Specific, C) Theory Based, and D) Open to Supervision
  • Review helpful and non-helpful verbal techniques used in therapeutic communication
    • Tools for Transforming Language into Therapeutic Strength-based Communication [see appendix 3]
  • Review use of space.
  • Review principles of motivational interviewing and how it reflects patient-centered care.
    Resources found at https://motivationalinterviewing.org/art-teaching-motivational-interviewing-resource-mi-trainers
    Training activities at www.intrinsicchange.com/training-activities.html
    Other descriptions and resources at https://www.integration.samhsa.gov/clinicalpractice/motivational-interviewing
  • Review non-verbal behaviors designed to facilitate active listening:
S – Sit squarely facing the client (unless ethnic/cultural background of client discourages direct eye contact).
O – Observe an open posture.
L – Lean forward toward the client.
E – Establish eye contact (unless ethnic/cultural background of client discourages direct eye contact).
R – Relax
  • Discuss relevant nursing theorists: H. Peplau, J. Watson and J. Travelbee.
  • Understanding anxiety in communication.
    • Listening Exercise “A Thousand Words for One Picture” activity to illustrate the effect of anxiety, and the importance of feedback in effective communication [see appendix 4]

Clinical Teaching Strategies

  • Lifting the Barriers to Therapeutic Communication That May Interfere with the Nurse-Patient Relationship [see appendix 5]
    • Clinical Group Self Awareness Activity
    • Dyads and Triads Group Role Playing Activity
  • Clinical Process Recording & Analysis [see appendix 6]
  • Reflective Narrative Client-Centered Analysis

Curricular Resources

  • Pounds, K.G. (2017) A theoretical and clinical perspective on social relatedness and the patient with serious mental illness. JAPNA 23 (3), 193-199
  • For critique helpful and unhelpful communication techniques
  • Have students watch one of the movies listed, and write a brief analysis paper. [see appendix 7]
    • A Beautiful Mind (2001) Biographical drama depicts the life of math genius John Nash’s life and struggle with mental illness.
    • Wit (2001) Story of a famous professor who is diagnosed with terminal ovarian cancer and comes to terms with death on a personal level.
    • The Soloist (2009) Journalist befriends a homeless musician who turns out to be a virtuoso living with schizophrenia.

Case Studies

  • “My Name is Anne” [see appendix 8]
    This is an unfolding case study of multiple levels of therapeutic communication breakdown in the care of a hospitalized patient.
  • The story of Legion. In Mark 5, 1-20 in the Bible, we read of a man named Legion. What does this account tell us about the experiences of a person suffering from a mental health problem? How is the person treated by society? What are their expectations? How does the fact he was “cured” before a he could conduct a rational conversation inform us about the way we should handle mental health clients?

Simulation Exercise

Setting: A psychiatric adolescent inpatient unit, in an acute hospital setting.
Scenario: A female adolescent has been admitted involuntarily to an acute psychiatric hospital for attempted suicide: acetaminophen overdose.

The listed article describes pre- and post- simulation reflection on communication skills.

Hammer, M., Fox, S., Hampton, M. D. (2014).  Use of a therapeutic communication simulation model in pre-licensure psychiatric mental health nursing: Enhancing strengths and transforming challenges. Nursing and Health 2(1), 1-8. Retrieved from  http://www.hrpub.org   DOI: 10.13189/nh.2014.020101

Assessment Strategies

Clinical Skills Checklist

  • The student will demonstrate interpersonal and personal communication skills as clinical interventions when providing safe, comprehensive and collaborative nursing care to individuals and families suffering from mental illness and when communicating with the health care team.  (Standard 11. Communication)

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

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 

Assessment Tools 

Assessment Strategies

Simulation

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)

6. Patient Care Roles

Clinical Learning Outcomes

  • Demonstrate ability to effectively teach patients experiencing psychiatric disorders and their families.
  • Plan and evaluate for a continuum of care that provides safety, structure, and support for patients with psychiatric disorders.
  • Evaluate the continuum of care for a patient experiencing a psychiatric disorder.
  • Refer patients and families to advocacy organizations.
  • Assist patients to access self-help groups.
  • Discuss significance of role-modeling and identify consequences of healthy nurse self-care vs. avoidance of nurse self-care.

Teaching Strategies

Classroom Teaching Strategies

  • Review H. Peplau (1952) Six sub-roles of the psychiatric nurse which can be assumed at various times during a therapeutic relationship. These are: Nurse teacher, Mother surrogate, Technical nurse, Nurse manager, Socializing agent, Counselor/therapist
  • Principles of case management.
  • Principles of teaching and learning as applied to client education.
  • Devising and using a teaching plan.
  • Assessing the educational needs of clients.
  • The use of role play, simulation.
  • Use a Spiritual Assessment Model to complete a personal spiritual assessment in 3-5 pages
    a. SAS – Spiritual Assessment Scale (O’Brea), 2014
    b. HOPE – Spiritual Assessment Tool – www.aafp.org
    c. FICA – https://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool
    After completing assessment, use the Betty Neuman Systems Model to identify strengths, stressors and nursing diagnoses.
  • Reflection Paper Assignment – Topic: Compassion Fatiuge; Supporting Myself Spiritually
    -Write a personal reflection about Compassion Fatigue. Include 1 scholarly article for support.
  • Students define Environmental Intelligence and describe how it applies to the nurse-client relationships.
  • Teach mindfulness techniques to help students “pause” and be present in situations.
    See Beauvais, N., O’Shea, E. and Griffin, M (2011) Emotional Intelligence and nursing performance among nursing students. Nursing Education Today, 31, 396-401.
  • Heart Math®:
    • Heart Math® is a program designed to build resilience and enhance coping skills in response to stress, challenges, and adversity through self-regulation and the use of biofeedback technology (Institute of Heart Math®, 2014).
    • Resilience is defined as the capacity to prepare for, recover from, and adapt in the face of stress, challenge and adversity(Heart Math®, 2014).
    • Domains of resilience include: emotional, physical ,spiritual, and mental (Heart Math®,2014).
    • Heart Math ® (2014) techniques include: depleting and renewing emotions, worksheet completion, biofeedback, focused breathing and emotional shifting.
  • Journal articles to supplement text:
    • Koivunen, M., Huhtasalo, J., Makkonen, P., Valimaki, M., Hatonen, H. (2012). Nurses’ roles in systematic patient education sessions in psychiatric nursing. Journal of Psychiatric and Mental Health Nursing, 19 (6), 546–554.
    • Herrick, C. A. & Bartlett, R. (2004). Psychiatric nursing case management: past, present, and future. Issues in Mental Health Nursing, 25(6), 589-602.

Clinical Teaching Strategies

  • Discuss the use of patient advocacy groups with clients
  • Devise teaching plans for teaching two clients about their medications
  • Identify local resources for supporting clients with PMH problems
  • Discussion with clinical case managers
  • Shadow a Case Manager or Intensive Case Manager
  • Develop self-care plan to promote area of self-care/self-improvement. (i.e. set goal to increase nutrition, improve sleep, enhance spirituality, increase exercise, etc.)
  • Assign journaling as method to increase emotional intelligence.  Build self-awareness and reflective practice skills.
    See https://www.tru.ca/disciplines/eng309/nursing/nursing.htm
  • Students to explore concepts such as Time management, Forgiveness, Gratitude, Conflict resolution, Stress reduction, Cognitive reframing, mindfulness, Physical health, to overall Health and Well-being.
    See: Hensel, D and Laux (2014). Longitudinal study of stress, self-care and professional identity among nursing students. Nurse Educator, 39, 227-231.
    Regehr, C., Gloney, D. and Pitts, A. (2013). Interventions to reduce stress in university students:  A review of meta-analysis. Journal of Affective Disorders, 148 (1), 1-11.

Case Studies

  • Write report focusing on client issues that are continually raised at treatment team meetings, such as patient requests that their medication be discontinued.

Simulation Exercises

  • Role play or Standardized Patient exercise examining issues related to patient advocacy situations
  • Plan workload for nurse with a defined case load.

Assessment Strategies

Assignments with Rubrics

  • Devise teaching plan about medications for two clients
  • Report on issues raised by clients during treatment team meetings

Clinical Skills Checklist

  • Workload planning for case load management (Standard 4. Planning)
  • Develop and deliver teaching plan for client (Standard 5B. Health Teaching and Health Promotion)

7. Health Care Settings

Clinical Learning Outcomes

  • Describe available treatment options and community based resources.
  • Plan and implement care in diverse settings including acute inpatient and community based settings of care.
  • Analyze adequacy of care settings related to patient acuity and needs.
  • Describe continuum of care and list at least 7 care settings within the continuum.

Teaching Strategies

Classroom Teaching Strategies
  • Review of history of care of the mentally ill.
  • National and state issues in providing care.
  • Challenges in providing care in the community and in rural areas.
  • Issues and challenges in providing in-patient care.
  • Mental health care examined in relation to access, cost and quality of care issues
Clinical Teaching Strategies
  • Organization and delivery of care within the clinical location.
  • Examination of the prognosis for client, plan for discharge, and issues in their future care in a community setting.
  • Have students develop pt discharge plan to include information about resources including location, cost, services, access/public transportation, waiting list, requirements, languages, etc.
Curricular Resources
  • The Willard Suitcase Exhibit: This site offers a historical perspective on a state mental institution, with firsthand accounts provided by people who lived and worked there in the early 1900’s. Many photographs are used with description of some people who were committed to the Willard Asylum in 1869 – Willard Psychiatric Center in 1995, New York State.  www.suitcaseexhibit.org/
  • Centers for Medicare & Medicaid Services.(2015a). The mental health parity and addiction
    equity act. Retrieved from https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/MHPAEA
  • Corbiere, M., Samson, E., Vilotti, P., & Pellitier,J.F. (2012). Strategies to fight stigma toward people with mental health disorders: Perspectives from different stakeholders. The Scientific World Journal 2012(3), 1-10. doi:10.1100/2012/516358
  • National Alliance on Mental Illness. (2016). Psychosocial treatments: Assertive community treatment. Retrieved from https://nami.org/Learn-More/Treatment/Psychosocial-Treatments
  • Ng, P., Chun, W.K., & Tsun, A (2012). Recovering from hallucinations: A qualitative study of coping with voices hearing of people in Hong Kong. The Scientific World Journal 2012(5), 1-8. doi:10.1100/2012/232619
Case Studies
  • Developed during clinical practice to examine why client is in care, what the treatment plan is and what is their prognosis is.
  • Linked to issues related to accessing care for the duration of their problem.
Simulation Exercises
  • Role play or Standardized Patient examining issues related to moving patient with chronic mental health problems into a community care facility.

Assessment Strategies

Clinical Skills Checklist for this Concept
  • Care planning for client discharge into the community. (Standard 4. Planning)
  • Ability to assess correct placement of client in appropriate care facility. (Standard 5. Implementation)

8. Cultural, Ethnic, & Spiritual Concepts

Clinical Learning Outcomes

  • Demonstrate competent generalist cultural and spiritual assessment
  • Expresses sensitivity and acceptance of others beliefs, attitudes and cultural needs
  • Demonstrate ability to create a culturally sensitive care plan.
  • Provide culturally and spiritually competent care within the scope of nursing that meets the needs of patients from diverse cultural, racial and ethnic backgrounds.

Teaching Strategies

Classroom Strategies
  • Lecture with focus on cultural issues and their effects on health and illness
  • Journal articles to supplement text:
    • Luhrmann, T.M., Padmavati, R., Tharoor, H., Osei, A. (2015). Differences in voice-hearing experiences of people with psychosis in the U.S.A., India and Ghana: interview based study. British Journal of Psychiatry 206(1), 41-44.
    • Adebimpe, V. (1981). Overview: White norms and psychiatric diagnosis of black patients. The American Journal of Psychiatry, 138(3), 279-285.
    • Cochran, et al. (2007). Mental health and substance use disorders among Latino and Asian American lesbian, gay and bisexual adults. Journal of Consulting and Clinical Psychology, 75(5), 785-794.
    • Elliott, R. (2011). Spirituality, mental health nursing and assessment. Journal of Community Nursing, 25(3), 4-10.
    • MacNeela, P., et al. (2012). A risk to himself: attitudes toward psychiatric patients and choice of psychosocial strategies among nurses in medical-surgical units. Research in Nursing and Health, 35, 200-213.
    • Neighbors, H., et al. (2008). Mental health service use among older African Americans: The national survey of American life. American Journal of Geriatric Psychiatry, 16(12), 948-956.
    • Rowland, M., et al. (2015). Cultural competency in the trenches. Journal of the Health Care for the Poor and Underserved, 24, 6-10.
    • Sethabouppha, H., Kane, C. (2005). Caring for the seriously mentally ill in Thailand: Buddhist family caregiving.Archives of Psychiatric Nursing, 1(2), 44-57.
Curricular Resources
Clinical Strategies
  • Have students complete a spiritual assessment.
  • Reflective journaling that addresses cultural differences [See appendix 2]
Case Studies
  • Focus on cultural influences on care and attitudes, i.e. stigma

Assessment Strategies

Spiritual Assessment – FICA, Retrieved from https://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool

  • F- Faith and Belief
    “Do you consider yourself spiritual or religious?” or “Do you have spiritual beliefs that help you cope with stress?”  If the patient responds “NO” the healthcare provider might ask “What gives your life meaning?”
  • I – Importance
    “What importance does your faith or belief have in your life?” “Have your beliefs influenced how you take care of yourself in this illness?” “What role do your beliefs play regarding your health?”
  • C – Community
    “Are you part of a spiritual or religious community? Is this of support to you and how? Is there a group of people you really love or who are important to you?”
  • A – Address in Care
    “How would you like me, your healthcare provider, to address these issues in your healthcare?”

HOPE Approach to Spiritual Assessment, Anadarajah, G., & Hight, E. (2000). Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. Retrieved from www.aafp.org/.

  • H – What are your sources of hope or Spiritual Resources comfort? What helps you during difficult times?
  • O – Are you a member of an Organized Religion? What religious practices are important to you?
  • P – Do you have personal spiritual beliefs that are separate from organized religion? What spiritual practices are most helpful to you?
  • E – Effects on Care:Is there any conflict between your beliefs and the care you will be receiving? Do you hold beliefs or follow practices that you believe may affect your care? Do you wish to consult with a religious or spiritual leader when you are ill or making decisions about your healthcare?

Case Assignment with Student Questions
Case Assignment

 

  • How would the RN discuss the need for hospitalization with this client?
  • Are there alternatives to a hospitalization in this case?
  • How would the RN begin to forge an alliance with the family in order to help this client?
  • What are the most pressing clinical issues that the RN needs to address?
Clinical Skills Checklist
  • Student completes a spiritual assessment of their own belief system. (Standard 1. Assessment)

9. Health Promotion & Illness Prevention

Clinical Learning Outcomes

  • Identify individuals, groups, and populations at risk for mental health problems.
  • Display competent mental health assessment skills using evidence-based strategies and tools (mental status exam, use of psychometric rating scales such as PHQ-9, GAD-7, etc.).
  • Demonstrate effective health promotion skills using teaching and counseling abilities grounded in supporting motivation and self-efficacy for seeking healthy behaviors.
  • Show ability to plan, implement, and evaluate preventive care on primary, secondary, and tertiary levels.
  • Display best practices for patients at risk for, or experiencing psychiatric disorders.

Teaching Strategies

Classroom Teaching Strategies
  • Lecture with focus on health promotion concepts and health teaching
  • Present and demonstrate theoretical principles associated with cognitive behavioral therapy and motivational interviewing for psychiatric nurses assuming the counseling and teaching roles (re: standards of practice)
  • Journal articles to supplement text:
    • Rubak, S., Sandbæk, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: a systematic review and meta-analysis. Br J Gen Practice, 55(513), 305-312.
    • Velligan, D. I., Weiden, P. J., Sajatovic, M., Scott, J., Carpenter, D., Ross, R., & Docherty, J. P. (2010). Strategies for addressing adherence problems in patients with serious and persistent mental illness: recommendations from the expert consensus guidelines. Journal of Psychiatric Practice®, 16(5), 306-324.
    • Turkington, D., Kingdon, D., Rathod, S., Hammond, K., Pelton, J., & Mehta, R. (2006). Outcomes of an effectiveness trial of cognitive-behavioral intervention by mental health nurses in schizophrenia. The British Journal of Psychiatry, 189(1), 36-40.
    • Davidson, K., Norrie, J., Tyrer, P., Gumley, A., Tata, P., Murray, H., & Palmer, S. (2006). The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. Journal of personality disorders, 20(5), 450.
    • Brown, S., & Chan, K. (2006). A randomized controlled trial of a brief health promotion intervention in a population with serious mental illness. Journal of Mental Health, 15(5), 543-549.
    • Fetter, M. (2009). Promoting health literacy with vulnerable behavioral health clients. Issues in Mental Health Nursing, 30(12), 798-802. doi:10.3109/01612840902887725
  • Demonstrate range and use of psychometric assessment tools
  • Documentary “Out of the Shadow” (2004).
    • Depicts resilience with an individual working ultimately to adopt a healthier lifestyle and maintain recovery. Per the author, “helps dispel the stigmas and misconceptions surrounding” schizophrenia. Available at http://outoftheshadow.com
Clinical Teaching Strategies
  • Students focus on stress management, healthy diet, exercise, tobacco cessation, and treatment/medication adherence using best practices.
  • Focus on behavior change and resource supports, incorporating beginning motivational interviewing skills along with therapeutic communication and relationship building skills
Simulation
  • Scenarios characterizing individual and group mental health disparities influenced by primary and secondary prevention strategies
  • Example Simulation using Standardized Patient: Assessment Interview & Medication Administration for a Client with Clinical Depression & Alcohol Abuse
    • This simulation is appropriate for undergraduate psychiatric mental health students. It should be placed after students have had theoretical introduction to clinical depression, Suicidal Ideation assessment, and treatment of acute alcohol withdrawal using substitution therapy.

Case Assignment with Student Questions

Case Study Example

  • Where would she seek accurate epidemiological and evidence-based information?
  • What are critical stressors in the family, peer group, and community which influence adolescent suicide?
  • How does the nurse provide primary prevention relative to suicide?
Clinical Skills Checklist
  • Exhibit effective administration of screening tools for identifying patterns of psychiatric symptoms in mental health clients (Standard 1. Assessment)
  • Demonstrate ability to teach clients with mental illness strategies to manage acute symptom exacerbations in support of sustaining recovery and preventing relapse (Standard 5B. Health Teaching)
  • Identify and establish a plan of care for clients with mental illness supporting education in self-care themes such as attention to diet, exercise, and sleep hygiene (Standard 5B. Health Teaching, Standard 8. Education)
  • Display skill in counseling clients regarding ways to modify behavioral patterns to those embracing health promotion. Relevant behavior modification should include teaching and motivating clients in use of relaxation skills and mindfulness meditation to maintain a grounded posture. (Standard 5B. Health Teaching)
  • Effectively educate client on implementing treatment adherence plans including medication compliance and ongoing talk or group therapies in addition to wellness program participation for health maintenance (Standard 5B. Health Teaching, Standard 8. Education)

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.
  • Identify core components of the Recovery Model of Mental health care.

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]
  • Have each student discuss a key factor from www.mentalhealth.gov/gasics
  • 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: various diagnoses, children and wellness. Free to view, free to share, and commercial free. Available at http://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. Consider AA, OA, NA, AL-ANON, Celebrate Recovery, See https://www.recoveryanswers.org/resources/peer-based-recovery-support/
  • 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

Case Study Example

  • 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?
  • What are at least 3 Recovery-based principles you can communicate to Jane?
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)

11. Ethical & Legal Principles

Clinical Learning Outcomes

  • Clarify personal values concerning working with patients experiencing psychiatric disorders.
  • Demonstrate ethical professional boundaries.
  • Apply ethical principles to treatment dilemmas.
  • Advocate for patients and families with legal and ethical concerns.
  • Develop plan of care to address ethical and/or legal concerns that promote individual integrity.

Teaching Strategies

Classroom Teaching Strategies
  • Review concepts of ethical principles. (Autonomy, Justice, Non-Maleficence, etc.)
    See: http://samples.ibpub.com/9781449665357/Chaper2.pdf
  • Discuss patient rights specific to psychiatric patients.
  • Discuss laws related to involuntary holds/commitment.
  • Review Psychiatric Advanced Directives available at http://www.nrc-pad.org/
  • Debate- Two teams discuss resolution of ethical dilemma applying different theories.
  • Have students debate pro and then con of same issue using discussion board postings.
  • Ethical Issues: The Patient’s Capacity to Make Medical Decisions
    Review and discuss
    http://www.psychiatrictimes.com/special-reports/ethical-issues-patients-capacity-make-medical-decisions

    • Discuss client perception of this event.
    • Ability to communicate a choice
    • Ability to understand information necessary for the specific decision at hand
    • Ability to appreciate the implications and significance of the provided information or the choice being made
    • Ability to reason by weighing and comparing options as well as consequences of the potential decision
    • Provides case study
Clinical Teaching Strategies
  • Post-conference discussion of how patient rights are being upheld (or not).
  • Attend court hearing for Temporary Detention Order or Involuntary Commitment.
    • Discuss client perception of this event.
Role Play
  • “How would you respond if a patient said (or did)…….?” Maintaining professional boundaries.
Simulation
  • ED psychotic patient. Process of obtaining involuntary admission.
  • Consider state laws

Assessment Strategies

Assignment

  • Assign pairs of students to make a short video portraying how a nurse responds to a patient (played by a student) to protect the patient’s rights and to violate a patient’s rights. Show all videos to the class and discuss.
Nurses’ Guide to Professional Boundaries:
Clinical Skills Checklist
  • Maintains professional boundaries with patients and staff. (Standard 7. Ethics, Standard 14. Professional Practice Evaluation)
  • Able to identify components of ethical dilemma and possible resolutions. (Standard 7: Ethics & Standard 2: Diagnosis)
  • Identifies type of admission of each primary patient and correct implications for nursing actions. (Standard 7: Ethics & Standard 10: Quality of Practice)
  • Clarify personal values concerning working with patients experiencing psychiatric disorders. (Standard 7: Ethics & Standard 14: Professional Practice Evaluation)
  • Correctly define and give example of Duty to Warn, Duty to Protect, Duty to Report. (Standard 7: Ethics)

12. Vulnerable Populations

Clinical Learning Outcomes

  • Define vulnerable populations by identifying the variables that put groups of patients at risk of being marginalized in psychiatric mental health treatment.
  • Recognize the multiple and complex care needs of the vulnerable populations.
  • Plan, implement, and evaluate care strategies that protect the rights and dignity of vulnerable populations.

Teaching Strategies

Classroom Teaching Strategies
  • Group exercise to define vulnerable populations: critical thinking about the term
  • Use of the Gelberg and Andersen Behavioral Model for Vulnerable Populations (Stein, Andersen, & Gelberg, 2007).
    • understanding of the variables related to high riskfor unmet mental health needs and health care utilization among vulnerable populations
  • Discussion of the relationship between stigma and access to mental health
    • Video – (2005). Shadow voices: Finding hope in mental illness [Documentary]. United States: Mennonite Media.
  • Prioritizing the care of vulnerable populations and unmet mental health needs.
    • Incorporating care of the vulnerable populations under each module or component of the syllabus.
  • Student group presentations – focus is on care of a specialized group of patients e.g. care of the homeless patient with severe mental illness.
    • Presentations must include a case study and NCLEX questions
  • Flipped classroom strategies to promote student discussion and active learning/critical thinking.
  • Journal articles to supplement text:
    • Lewis, V., Larson, BK, McClurg, A., Goldman, R., & Fisher, B. (2012) The promise and peril of accountable care for vulnerable populations: a framework for overcoming obstacles. Health Affairs, 31(8), 1777-85.
    • Stein, J, Andersen, R., & Gelberg, L. (2007). Applying the Gelberg- Andersen Behavioral Model for Vulnerable Populations to health service utilization in homeless women. Journal of Health Psychology, 12(5), 791-804. Doi: 10.1177/1359105307080612
    • Teaching About Vulnerable Populations: Nursing Students’ Experience in a Homeless Center. Journal of Nursing Education. Mary Jo Stanley, PhD, RN, CNS, 2013; 52(10): 585-588
    • https://doi.org/10.3928/01484834-20130913-03
  • Assign students to answer questions from “A Starter Kit to Teaching Mental Health” focused on older adults. Found at http://www.nln.org/docs/default-source/professional-development-programs/ace-series/acexpress-mental-health-starter-kit.pdf?sfvrsn=2
Clinical Teaching Strategies
  • Students will present cases from their clinical day re: focus on unmet mental health needs of vulnerable populations i.e. children with history of trauma, homeless with major mental illness, elders
  • When reviewing the history of mental health care, review the history and current practice of incarcerating those with mental illnesses. Discuss treatment for the inmate population.
  • Assessment of a patient with the Behavioral Model for Vulnerable Populations to help the student identify risk factors, enabling factors that contribute to homelessness and underutilization of mental health system
  • Nursing care planning with focus on community resources
  • Interdisciplinary experience in the community (community health van or other experiences offered by community/public health faculty) that can focus on holistic nursing e.g. homeless,prison population
  • Conduct a brief interview with a member of another discipline (MSW, OTR/L, spiritual care, MD, or member of police department in the community). Submit as a written assignment. Strategies other disciplines use to engage with vulnerable populations.
  • Post conference discussion re: the unique challenges of caring and finding appropriate services for this population i.e. homeless clients can get meds and have them filled.
  • Discussion of the legal and ethical issues around these cases
  • Compile a list of local resources for homeless individuals or low socio-economic families and mental health services available to them.
  • Students define and give examples of concepts from The Stress Vulnerability Model.  See www.bhevolution.org/public/stress-vulnerability.page
  • From Hazeldon: provide students with interactive activities to understand key characteristics of mental illness and stigma.  See https://walkinourshoes.org/content/classroom_Lessons_Plans.pdf
Case Studies – examples
  • A 48 yr. old woman with Down Syndrome, residing in a group home, struggles with symptoms of OCD and cognitive decline
  • b. A 38 yr. old male, residing alone in a single room, struggles with auditory hallucinations and paranoid delusions associated with schizophrenia
Assignment: with Rubric
  • Attend MH support group and complete 1 page reflection paper about the experience [see appendix 13]
Simulation
  • Patient with schizophrenia
  • Standardized patient is used, scripted case scenarios
  • Students are responsible for pre-simulation work with an interdisciplinary focus for the patient who is in the ED, is acutely psychotic, and is homeless
  • Simulation exercise day – student is responsible for assessment of the patient, including resources available for discharge planning. The faculty emphasize the interdisciplinary nature of the simulation.
Clinical Skills Checklist
  • Conduct a mental health assessment of elderly clients (Standard 1. Assessment)
  • Outline diagnostic criteria for specific mental health problems encountered in childhood (Standard 2. Diagnosis)
  • Devise a plan to help maintain mental health for a homeless person (Standard 5A. Coordination of care)
  • Evaluate effectiveness of care delivery for specific vulnerable clients encountered in clinical practice (Standard 6. Evaluation)
  • Discuss the challenges in promoting mental health in incarcerated populations (Standard 7. Ethics)

13. Nursing Research

Clinical Learning Outcomes

  • Critically appraise research studies.
  • Utilize research findings in planning and evaluating nursing care.
  • Disseminate research findings to colleagues, patients and families.
  • Utilize research findings to evaluate clinical policies and procedures.

Teaching Strategies

Classroom Teaching Strategies
  • Relate the ANA (2015) Code of Ethics to research with vulnerable populations.
  • Discuss research procedure in relation to psychiatric-mental health nursing.
    • Qualitative vs Quantitative
    • Institutional Review Board
    • Informed Consent
  • Discuss evidence-based practice in psychiatric-mental health nursing.
  • Value the mental health organizations supporting nursing research.
  • Research Study Critique
  • Literature Review of a Mental Health Topic (peer reviewed journals)
  • Review of Measurement Tools
  • Concept Mapping of a Research Article
  • Group Activity: Develop Mini Research Proposal
  • Meet a Psychiatric Mental Health Nurse Scientist (virtual)
  • Identify mental health data bases for literature search
Clinical Teaching Strategies
  • Grand Rounds: Pose a research question in relation to a clinical situation
  • Pre/Post PMH Conference Topics : Informed Consents, Involuntary commitments, Mental health parity
Journal Club
  • Ted Talks club
  • Research article review – Students can choose from listed PMH journals

Assessment Strategies


Classroom Strategies
  • ATI & HESI Assessment
  • Research Presentation
  • Poster Presentation of Research Findings- Assignment with rubric [see appendix 14]
Reflective Journal Prompts – Can also be used for online discussion board
  • Pose a research question related to ethical dilemmas, evidence based best practice
  • How did a research article help me choose an evidence based intervention?
  • Reflect on the assigned research article and how the study results will impact the practice of psychiatric-mental health nursing.
  • Discuss the ethical principles applicable to the assigned research study and how the human rights of the study participants were protected.
Clinical Skills Checklist
  • Knowledge of evidence supporting clinical skill (Standard 9. Evidence-Based Practice)

Organizations & Journals

Organizations and Website Resources

Agency for Health Care Research and Quality (AHRQ)
http://www.ahrq.gov/

American Psychiatric Association (APA)
http://www.apa.org/

American Psychiatric Nurses Association (APNA)
www.apna.org

Crisis Prevention Institute (CPI)
http://crisisprevention.com/

Eastern Nurse Research Society (ENRS)
http://www.enrs-go.org/

International Association of Trauma Professionals (IATP)
http://www.traumapro.net/

International Society of Psychiatric Mental Health Nurses (ISPN)
http://www.ispn-psych.org

Mental Health America (MHA)
www.mhanational.org/

National Alliance on Mental Illness (NAMI)
https://www.nami.org/

National Association of State Mental Health Program Directors
http://www.nasmhpd.org/

National Center for PTSD
http://www.ptsd.va.gov/

National Center on Minority Health and Health Disparities (NCMHD)
http://www.nimhd.nih.gov/

National Child Traumatic Stress Network (NCTSN)
http://www.nctsn.org/

National Institute on Drug Abuse (NIDA)
https://drugabuse.gov/

National Institute of Health (NIH)
http://www.nih.gov/

National Institute of Mental Health (NIMH)
https://www.nimh.nih.gov/index.shtml

National Institute of Nursing Research (NINR)
https://www.ninr.nih.gov/

Southern Nursing Research Society (SNRS)
http://www.snrs.org/

Substance Abuse and Mental Health Services Administration (SAMHSA)
http://www.samhsa.gov/

United States Preventative Services Task Force (USPSTF)
http://www.uspreventiveservicestaskforce.org/BrowseRec/Index

Journals of or relating to topics in PMH Nursing

Administration and Policy in Mental Health and Mental Health Services Research

Applied Nursing Research

Archives of Psychiatric Nursing

British Journal of Mental Health Nursing

Child and Adolescent Psychiatry and Mental Health

Human Psychopharmacology: Clinical and Experimental

International Clinical Psychopharmacology

International Journal of Law and Psychiatry

International Journal of Mental Health Nursing

Internet Interventions

Issues in Mental Health Nursing

Journal of the American Psychiatric Nurses Association

Journal of Child and Adolescent Psychiatric Nursing

Journal of Nursing Ethics

Journal of Nursing Measurement

Journal of Nursing Scholarship

Journal of Psychiatric and Mental Health Nursing

Journal of Psychopharmacology

Journal of Psychosocial Nursing

Journal of Psychosocial Nursing and Mental Health Services

Journal of Psychiatric and Mental Health Nursing

Journal of Transcultural Nursing

Mental and Physical Disability Law Reporter

NAMI Advocate

Nursing Research

Progress in Neuro-Psychopharmacology and Biological Psychiatry

Psychiatry

Research in Nursing and Health

Substance Abuse

Therapeutic Advances in Psychopharmacology

Western Journal of Nursing Research

Created by the APNA Education Council, Undergraduate Branch

Co-Chairs: David Sharp, RN, PhD & Diane Esposito, PhD, ARNP, PMHCNS-BC

Faculty Contributors: Barbara K. Buxton, PhD, PMHCNS-BC, RN; Shirlee Davidson, MSN, RN; Linda Etchill-Ewald MS, BSN, PMHCNS-BC; Sandra Gamble, MSN, BS, RN; Ann Harms, EdD, RN; Todd Hastings, PhD, RN; Mary Justice, MSN, RN, CNE; Beth King, PhD, RN, PMHCNS-BC; Barbara Kovac, NPP, MSN, RN; Brenda G. Kucirka, PhD, PMHCNS-BC, CNE; Marla McCall, PMHNP; Janet Merritt, PhD, APRN-BC, RN; Leslie Miles, DNP, APRN, BC; Melissa Neathery, MSN, RN, CNE; Karen Pounds, PhD, APRN, BC; Kimberly Sharp, PhD, RN; Traci T. Simms, DNS, RN, CNS/PMH-BC; Janet Sobolov, MS, RN-BC; Janet Standard, DNP, PMHNP-BC; Jill G. Steinke, MS, RN; Marianna K. Sunderlin, MSN, ACNS-BC, RN; Grace Wlasowicz, RN, Ph.D., PMHNP-BC