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Revised March 2011

PREPARED BY: KATHERINE CONLU-BENGAN, RN MSN LEVEL 3 COORDINATOR

NOTED BY: SR. EDITHA A. BAGAYAUA, DC RN MAN DEAN-COLLEGE OF NURSING

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St. Anthony College of Roxas City COLLEGE OF NURSING

Clinical Teaching Plan


Psychiatric-Mental Health Nursing FOCUS OF RELATED LEARNING EXPERIENCE The focus of this experience is for the students to utilize the nursing process in assisting patients manifesting behavioral and psychopathological adaptation in response to stressors and acquire or further enhance their knowledge, skills, and attitude in the care of patients with mental disorders with emphasis on the principles of psychiatric mental health nursing and therapeutic nursing skills. GENERAL OBJECTIVE: This clinical exposure aims to enhance and develop the students knowledge, skills, and attitude in the assessment and management of patients with mental disorders. SPECIFIC OBJECTIVES: After a week of clinical affiliation, the students will be able to: 1. Familiarize and be oriented with the physical set-up of the National Center for Mental Health. 2. Demonstrate the use of therapeutic communication skills and therapeutic use of self with patients experiencing common alteration in psychological health. 3. Utilize the standards of clinical nursing practice as the foundation for professional nursing practice: 3.1. Assess the mental status of individuals experiencing psychological alterations on health. 3.2. Select appropriate nursing diagnoses for individuals experiencing

psychological alterations in health based on psychosocial and psychological assessment data. 3.3. Select nursing interventions to promote, support and strengthen the adaptive capacity of individuals experiencing psychological alterations in health. 3.4. Implement a plan of care. 3.4.1. Implement prescribed psycho-pharmacotherapeutic modalities in providing nursing care. 3.5. Evaluate the nursing plan of care and revise as needed. 3.6. Demonstrate responsibility and accountability for nursing care.

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4. Collaborate, cooperate and establish effective professional working relationships with mental health practitioners, other students, instructor and members of the psychiatric team. 5. Demonstrate qualities necessary for the effective practice of psychiatric nursing: integrity, cooperation, collaboration, dependability, responsibility, judgment, initiative, self-confidence, and appropriate physical presentation. 6. Demonstrate the core competencies necessary for the effective practice of a registered nurse: Safe and Quality Nursing, Management of Resources and Environment, Health Education, Legal Responsibility, Ethico-moral Responsibility, Personal and Professional Development, Quality Improvement, Research, Record Management, Communication, Collaboration and Teamwork. METHODOLOGY: Small group discussions (Clinical Seminars/Conferences) Demonstration of different therapies Nurse-Patient Interaction/Process Recording CLINICAL REQUIREMENT: A. Patient Assignments All students will be given an individual patient assignment. Selection of patient will be made upon the discretion of the staff. During the next hour, you will observe and talk to the patient so that you can arrive at some assessment and nursing diagnoses. It is possible that your initial contact with the patient will be an assessment phase while you attempt to establish and aid the patient to adjust to his/her environment. The individual care of your patient includes close observation and careful listening. You must note their interactions with other patients, with staff and their psychiatrists as well as with you. Furthermore, you need to know information from the chart, results of diagnostic lab tests and have knowledge of the treatment they are receiving. After making the assessment, you need to arrive at the diagnostic statements. Plan nursing care based upon your diagnoses and evaluate your nursing care. This in essence, describes the short nursing care plan. You must become knowledgeable regarding psychotropic medications including dosages, desired effects, precautions, adverse effects, etc. This information is vital in the observation of your patient. These are the major psychiatric clinical placements where you will learn to work with your patients. Process recordings are a means by which this will be facilitated. You will be expected to establish a therapeutic relationship with your patient. Through this relationship or interaction, you will learn about the patient, interaction process, effective therapeutic

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interventions, and yourself. You are expected to become proficient in observing human behaviors and interactions; planning nursing care, implementing these plans; and evaluating the results. B. Group Work You will be assigned to demonstrate in Activities Therapy in the group, one or more times during this rotation. This is an activity therapy/ nursing intervention focused upon assisting the patients to communicate with others and you in a healthy way. Groups assist people to move out or their troubled selves and interact with others. Your participation is essential doe the success of each grouped. C. Clinical Journal You will be expected to write a journal about your reactions to your experiences. Turn your journal after a week of exposure. You are required to include thoughts and reactions to your group leading experience. D. Clinical Seminars/Post Conference Clinical seminars will be held every day. Sessions will begin promptly at 1:00 PM. The conferences will focus on psychiatric conditions, nursing interventions and evaluation. EVALUATION: A. SKILLS a. Process Recording (15%) b. Mental Status Examination & Summary c. Psychiatric Nursing Care Plan 20% 50%

d. Clinical Performance (15%) B. KNOWLEDGE (to include clinical seminars, quizzes, and long test) C. ATTITUDE a. Journal (10%) b. Behavior (10%) TOTAL _________ 100% 20% 30%

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DAY Monday TIME 7:00 AM 7:00 8:00 AM 7:30 9:00 AM 9:00 9:15 AM 9:15 10:30 AM 10:30 12:00 NOON ACTIVITIES Arrival at NCMH Pre-Conference Orientation BREAK Feeling Reaction Session/Self-Awareness Orientation to the assigned Pavilion Assignment of patients Initial interaction with patients (NPI) 12:00 1:00 PM 1:00 2:30 PM LUNCH BREAK Continuation of SelfAwareness Tuesday 7:00 AM 7:00 8:00 AM 7:30 9:00 AM Arrival at NCMH Pre-Conference Activities of Daily Living (VS taking, Personal Hygiene, Exercise) 9:00 9:15 AM 9:15 10:30 AM 10:30 10:45 AM 10:45 11:30 AM 11:30 12:00 NN 12:00 1:00 PM 1:00 2:00 PM 2:00 2:45 PM 2:45 3:00 PM NPI Remotivation Therapy BREAK Small Group Discussion Play Activities NPI LUNCH BREAK Clinical Discussion Occupational Activity: Crafts Making NPI Post- Conference

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DAY Wednesday TIME 7:00 AM 7:00 8:00 AM 7:30 9:00 AM ACTIVITIES Arrival at NCMH Pre-Conference Activities of Daily Living (VS taking, Personal Hygiene, Exercise) 9:00 9:15 AM 9:15 10:30 AM 10:30 10:45 AM 10:45 11:30 AM 11:30 12:00 NN 12:00 1:00 PM 1:00 2:00 PM 2:00 2:45 PM 2:45 3:00 PM Thursday 7:00 AM 7:00 8:00 AM 7:30 9:00 AM NPI Music and Arts Therapy BREAK Play Activities NPI LUNCH BREAK Clinical Discussion Bibliotherapy NPI Post- Conference Arrival at NCMH Pre-Conference Activities of Daily Living (VS taking, Personal Hygiene, Exercise) 9:00 9:15 AM 9:15 10:30 AM 10:30 10:45 AM 10:45 11:30 AM 11:30 12:00 NN 12:00 1:00 PM 1:00 2:00 PM 2:00 2:45 PM 2:45 3:00 PM NPI Newspaper reading BREAK Food Preparation Activities Play Activities: Group Singing NPI LUNCH BREAK Clinical Discussion Health Education NPI Post- Conference

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DAY Friday TIME 7:00 AM 7:00 8:00 AM ACTIVITIES Arrival at NCMH Activities of Daily Living (VS taking, Personal Hygiene, Exercise) 8:00 9:00 AM 9:00 12:00 NN 12:00 1:00 PM 1:00 PM 3:00 PM NPI Socialization Lunch Break Evaluation Exam

Note: Ground tour of the whole facility and ECT observation will be in line with the available schedule as noted by the NSO.

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St. Anthony College of Roxas City COLLEGE OF NURSING Psychiatric-Mental Health Nursing SELF-AWARENESS ACTIVITY Below are statements that will guide you in understanding yourself. Feel free to give your answers.

Who am I?
1. I would describe myself physically as .

2. I would describe my personality as .

3. Others would describe me as .

4. When I think about who I am, I am most proud of .

5. I was most ashamed of .

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6. I get angriest when

7. When I am nervous I usually

8. People are essentially (good, bad, neutral)

9. Characteristics of other people that impress me most include

10. Goals I want to achieve a. With this course b. In my lifetime

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Process Recording Students Name Age Date Description of setting where conversation took place and clients behavior observed as student approaches: Write interaction in verbatim form - no summarization. Hospital # ______________ Clients Initials Ward ____________________

Your goal(s) for interaction:

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Communication Techniques Utilized

NURSE Verbal Nonverbal

CLIENT Verbal Nonverbal Analysis

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St. Anthony College of Roxas City COLLEGE OF NURSING Psychiatric-Mental Health Nursing

NURSING MENTAL STATUS EVALUATION/NURSING ASSESSMENT


Date of Evaluation Patient's Initials_____ Age Name of Evaluator Gender____ Race/Ethnicity Date of Admission

Weight______ Height_______ *BMI_______ Type of Admission: Voluntary Involuntary Presenting Problem (Include Stressors, Suicidal/Homicidal Ideations/Plan/Method,

Hallucinations, Delusions, Maladaptive Coping Related to Current Admission):


Past Psychiatric History:

Course of Illness (Include Stressors, Suicidal/Homicidal Ideations, Hallucinations, Delusions):

Past Suicide Attempts (Include Methods): Past Psychiatric Hospitalizations (Include Reasons for Previous Admissions):

Family Psychiatric History:

Past Psychiatric Medication History (Include Medications and Compliance/Noncompliance):

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Current Health Problems Use of Alcohol or Drugs Immediately Prior to Admission

*Calculating BMI: (Weight in pounds) divided by( Height in Inches) x(Height in Inches) x 703 Below 18.5 Underweight Normal 25-29.9 Overweight 30 and above Obese

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APPEARANCE

COMMENTS AND/OR PROBLEMS IDENTIFIED

Clean Groomed Disheveled Dirty Manner of Dress: Appropriate Unkempt Dirty Seductive Tattoos : Describe:__________ Piercings : Describe: __________ General State of Nutrition: General State of Health: Eye Contact: Good Pupil Dilation Posture Gait Fair Poor

Pupil Constriction

Appears stated age older younger General Description:

SPEECH Rate: Slow Rapid Excessive Volume: Loud Soft Amount: Impeded Absent Tonal Quality: _________________________________________ Other: Pressured Stuttering Slurring

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COMMENTS AND/OR PROBLEMS IDENTIFIED Decreased

MOTOR ACTIVITY

Level of Activity: Type of Activity: Unusual Mannerisms:

Normal Increased Tics Tremors Compulsions

MOOD/AFFECT Affect: Range Broad Flat Constricted Blunted Bright Anxious Sullen Expansive Angry/Aggressive Affect: Stability Stable

Affect: Appropriateness Congruent

Stated Mood (What the patient says):

PERCEPTIONS Hallucinations: Auditory Visual Tactile Gustatory Olfactory Illusions None Describe:

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COMMENTS AND/OR PROBLEMS IDENTIFIED

THOUGHT CONTENT

Delusions: Persecutory Religious Somatic Grandiose None Suicidal No Plan (Only Suicidal Thoughts) With Plan Method: (Describe): Actual Attempt (Prior to Admission) Homicidal No Plan (Only Homicidal Thoughts) With Plan Method: (Describe): Self Mutilation (Describe): None Depersonalization Hypochondriasis Magical Thinking Phobias Clarity of Content: Coherent

Ideas of Reference Obsessions Vagueness

THOUGHT PROCESSES

COMMENTS AND/OR PROBLEMS IDENTIFIED

Circumstantial Flight of Ideas Loose Association Neologisms Tangential Thought Blocking Word Salad Perseveration Coherent

LEVEL OF CONSCIOUSNESS Orientation: Time Place Confused Person Lethargic Alert

MEMORY (Assess informally only) Remote Recent Immediate

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JUDGMENT

COMMENTS AND/OR PROBLEMS IDENTIFIED Variable

Good Describe:

Fair

Poor

Inconsistent

INSIGHT Good Describe: Fair Poor Inconsistent

PSYCHOLOGICAL TESTING RESULTS OF NOTE Describe:

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SUBSTANCE ABUSE (If positive for history and/or current use, describe) Past Use: No Yes Current Use: No Yes: (Last Use:_____________) If Yes: Alcohol Drugs (include types below) Tobacco Other Describe, including how much consumed on a typical day/week and when was last use? COMMENTS AND/OR PROBLEMS IDENTIFIED

SPIRITUAL What gives life meaning? Is patient active in a spiritual community? No Yes If Yes, Describe:

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PATIENT STRENGTHS AND ASSETS INVENTORY (Mark all applicable and add additional assets, as identified)
Support of family & friends Motivated for treatment Education Capable of insight into problems Good social support network Leisure interests Possesses technical/vocational skills Capable of independent living Sense of humor Religious affiliation/support network Good physical health Recreational interests

(If checked, describe):

Psychiatric Diagnosis (Axis I) Diagnosis: Corroborating Evidence of Diagnostic Criteria from the 1:1 Interview:

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Disorders of the Personality or Mental Retardation (Axis II) Diagnosis: Corroborating Evidence of Diagnostic Criteria from the 1:1 Interview:

General Medical Conditions (Axis III) Diagnosis: _____________________________________________________________________

Psychosocial/Environmental Problems (Axis IV) (Describe) A. Problem with Primary Support Group B. Problem Related to the Social Environment C. Educational Problems

D. Occupational Problem E. Housing Problems F. Economic Problems G. Problems with Access to Health Care Services H. Problems Related to Interaction with the Legal System/Crime I. Other Psychosocial and Environmental Problems ____________________________________ (If checked, describe):

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Global Assessment Functioning (Axis V) ____ 91-100 Superior Functioning ____ 41-50 Serious Symptoms Danger ____ 81-90 Minimal Symptoms Information ____ 71-80 Transient Symptoms ____ 61-70 Mild Symptoms ____ 51-60 Moderate Symptoms ____ 21-30 Inability to Function ____ 11-20 Some Danger of Hurting Self or Others ____ 31-40 Difficulty Functioning ____ 0 Inadequate ____ 1-10 Persistent

GAF Score at time of Admission: ____ GAF Score at present time (your score) ____

(Cite corroborative evidence):

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Developmental Milestones (Must be completed on patients age 18 or less.) Summarize assessment referencing theorist, (e.g., Erikson, Piaget, etc.):

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PATIENTS MEDICATIONS

Name

Generic

Class of Drug

Patients Dose and Route

Usual Dose Recommended

Target Symptoms Drug is Intended to Address

Top 3-5 Nursing Implications

1.

2.

3.

4.

5.

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St. Anthony College of Roxas City COLLEGE OF NURSING

Psychiatric-Mental Health Nursing Comprehensive Psychiatric Nursing Care Plan

The purpose of the Psychiatric Nursing Care plan is to teach you to skillfully assess a psychiatric patient, develop critical thinking skills to prioritize treatment goals, implement appropriate interventions, and evaluate the care that was given. In addition, this tool will allow you to focus on prevention concepts and discharge planning skills.

The particular diagnostic problems you will be asked to address have been selected because they are the most frequently occurring mental health problems and ones that you will deal with as a professional nurse in a variety of settings. General Guidelines

I.

Assessment A. B. History of Illness, Family History of Psychiatric Illness, Course of Treatment Summarize in narrative form mental status exam/nursing assessment including: 1. 2. 3. Patients strengths and successful coping skills Pertinent findings of mental status exam and psychosocial assessment Axes I, II, III, IV, V diagnoses (Briefly discuss key symptoms of these diagnoses and patient's manifestations of these symptoms.)

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II.

Planning and Intervention This section of the paper should focus on your planning and intervention with this patient. A. Nursing Diagnosis: 1. 2. State three nursing diagnoses based on your assessment. "At risk" diagnoses may be used only with "related to" and "evidenced by" statements. Each diagnosis is a 3 part statement which specifies: The patient's problem (response to an actual or potential health problem) Possible etiology ("related to") Pertinent signs and symptoms ("evidenced by") B. For the nursing diagnosis of HIGHEST PRIORITY C. D. Describe your rationale in selecting this diagnosis as having the "highest priority" Develop three short term goals and one long term goal. (Specify time frames.)

Describe your nursing interventions with rationale for each, include the reference source for each rationale. Evaluate your effectiveness and what you would change, if anything, to improve your care of this patient.

III.

Health Teaching A. Based on the Nursing Mental Status Evaluation and information gained while providing care to the patient, describe three pertinent health teaching needs. B. C. Select the one of HIGHEST PRIORITY and state your rationale for choosing it as having the "highest priority". Assessment - Briefly describe the teaching-learning principles you considered prior to teaching, such as 1. 2. The learner's: readiness, developmental capabilities, cognitive state. Suitability of the environment for teaching-learning.

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D.

Planning 1. 2. List one goal (general) and two behavioral objectives (specific) for your health care teaching. Briefly describe the content of your teaching. Include a visual aid/handout. Cite references. Describe your implementation Describe the patient's response

E.

Implementation 1. 2.

F.

Evaluation 1. 2. Using your criteria evaluate your effectiveness Describe how you would change your teaching based on the evaluation data from your patient and yourself.

IV.

Discharge Planning A. If there are established discharge plans for your patient, cite these and evaluate them based on the information in your assessment and information gained in providing care to the patient.

B.

If there are no established discharge plans for your patient, describe a realistic plan and rationale. (Plan should be based on information gained in the Nursing Mental Status Evaluation and information gained in providing care to the patient).

V.

Prevention State two strategies of prevention with rationale that may be helpful in preventing relapse for this patient.

VI.

Student Learning A. B. C. D. What feelings were elicited in you by this patient? What were the patient's responses to you? What did you learn from this patient? In what other professional settings would you anticipate being able to use the knowledge gained from this experience?
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St. Anthony College of Roxas City COLLEGE OF NURSING Psychiatric-Mental Health Nursing Grading Criteria for Nursing Care Plan Students Name:

Date: Points

Part I Part II -

Assessment (20%) Planning and Intervention (30%)

Part III -

Health Teaching (20%)

Part IV -

Discharge Planning (5%)

Part V Part VI -

Relapse Prevention (5%) Student Learning (10%)

Part VII -

Style and Format (10%)

Total points possible (100%) Total points earned Points deducted for late submission

100 points NCP

Nursing Care Plan = 15% of Total Course Grade

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St. Anthony College of Roxas City COLLEGE OF NURSING Psychiatric-Mental Health Nursing

Criteria for Teaching Project

1.

Assessment Assess the learning needs of your patients or peers in the clinical setting. Prioritize these needs and select one based on the need and your ability to teach this information. (Discuss your assessment methodology and teaching project selection with your instructor.)

2.

Planning Develop a teaching plan based on sound teaching-learning principles. List 1 (one) goal and at least 4 (four) behavioral objectives for your teaching project.

3.

Intervention Present your project at an approved time during the clinical rotation (arrange this with your instructor.)

4.

Evaluation Write an evaluation of the effectiveness of your presentation. Use your objectives as criteria for this evaluation.

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St. Anthony College of Roxas City COLLEGE OF NURSING Psychiatric-Mental Health Nursing

Psychiatric-MH Nursing Client Teaching and Clinical Conference Presentation Documentation Form This format may be required, specific to instructor. Instructions for nursing students: Use this five-column format to provide documentation of educational criteria: objectives, content, time frames, names of presenters, and teaching learning strategies. Demonstrate, through completion of this form, that the teaching activity facilitates the accomplishment of the overall goal and objectives and include at least two references from peer-reviewed journals. Title of Activity: __________________________________________________ Overall Goal of Activity: _______________________________________________________________________ Presenter(s): ________________________________________________ Objectives (List 4 learner objectives in behavioral/measurable outcomes for evaluation.) Content (Provide an outline/description of the content presented and indicate to which objective(s) the content is related. It must be more than a restatement of the objective.) Time Frame (Provide a time frame in minutes for each objective/ topic or content area for presenter-directed activities.) Presenter (List the presenter for each objective/topic or content area in presenter-directed activities. (This column should delineate who is doing what when team teaching.) Teaching Strategies, Teaching Principles, and References (List the teaching strategies and references utilized by each presenter for each objective, topic or content area such as resources, materials, delivery methods.)

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Objectives (List 4 learner objectives in behavioral/measurable outcomes for evaluation.) Content (Provide an outline/description of the content presented and indicate to which objective(s) the content is related. It must be more than a restatement of the objective.) Time Frame (Provide a time frame in minutes for each objective/ topic or content area for presenter-directed activities.) Presenter (List the presenter for each objective/topic or content area in presenter-directed activities. (This column should delineate who is doing what when team teaching.) Teaching Strategies, Teaching Principles, and References (List the teaching strategies and references utilized by each presenter for each objective, topic or content area such as resources, materials, delivery methods.)

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St. Anthony College of Roxas City COLLEGE OF NURSING Psychiatric-Mental Health Nursing Evaluation Criteria for Teaching Project

MANNER OF PRESENTATION 1. Uses good communication skills throughout the presentation.

COMMENTS

2. Presents the information clearly, concisely, and at an easily understood level.

3. Audiovisuals are easily read or heard and attractively done.

4. Promotes participation at an appropriate level.

5. Is knowledgeable about the topic and answers questions appropriately.

SUMMARY COMMENTS

Name of Student Presenting

Topic

Date

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St. Anthony College of Roxas City COLLEGE OF NURSING Psychiatric-Mental Health Nursing

HEALTH TOPICS FOR HEALTH TEACHING

GENERAL MENTAL HEALTH: Relapse triggers Symptom management Stress reduction Positive coping skills Relaxation techniques Alternative treatment approaches (yoga, meditation, etc.) Effective discharge planning Co-morbidity (how mental illness can impact physical well being) Ways to get a better nights sleep Anger management Communication skills/appropriate ways to ask for help, etc. Conflict resolution Bereavement & loss/the grieving process

GENERAL HEALTH TOPICS: Hypertension management Diabetes prevention & management Nutrition Weight management or reduction Healthy snacks Reduction of trans fats & other unhealthy additives Food pyramid & its application Food serving sizes and proportions Shopping for healthy foods on a budget Cancer screenings and prevention Safe food handling practices First aid for the home (not full coursejust the basics) Medication management Upper respiratory infections and the flu (signs of each) Hygiene and disease prevention Tuberculosis & prevention Exercise (safe, easy & effective routines for anyone) Prevention of osteoporosis Oral hygiene

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