Mental Health Nursing

Course Objectives:

  1. Discuss the evolution of major social, cultural, and historical factors and their influence on psychiatric nursing  practice.

2. Utilize the nursing process to provide nursing care to individuals and families with psychosocial and/or mental health needs within the context of IFGC.

3. Differentiate between

     therapeutic and non-   therapeutic communication  techniques, identify components of nonverbal expression, and describe boundary issues associated with touch and proxemics while taking into account the cultural differences that exist among patients and their families from various ethnocultural backgrounds.

4.   Demonstrate accountability for legal/ethical aspects in providing nursing care

     to individuals and their families with psychosocial and/or mental health needs within the context of their IFGC.

 5 . Utilize knowledge of growth and development in providing nursing care to individuals and their families with psychosocial needs and/or mental health needs.

6. Identify relevant research findings related to mental health nursing.

7. Discuss the theoretical knowledge regarding the etiology and symptomatology of current psychiatric/mental health diagnostic categories.

  8. Evaluate major concepts and theories related to the adaptive/maladaptive behaviors of individuals with psychosocial and/or mental health needs.

9. Relate services   available to individuals    and their families with   psychosocial and/or   mental health needs, with consideration for cultural background within the scope of their    aggregates, community and society.

Required Textbooks/Items:

Access to The Neighborhood 2010 through code: ISBN: 0132539837  either in Family Health I or our

class (register only once for both classes).

Townsend, M.C. (2008).  Psychiatric mental heath nursing. (6th ed.)Philadelphia: F.A. Davis.

Mental Health Course Packet, found at the MSU bookstore

Five (5) red, not green, parscore scantrons for the scheduled exams and bring them to class

prior to the day of the first exam.

Optional book (not required):

Pederson, D. D. (2008). PsychNotes: Clinical Pocket Guide. (2^nd ed.) Philadelphia: F.A. Davis.

Attendance:

1.   Classroom attendance and participation are expected.  Students are responsible for lecture/

discussion content, announcements, and other information presented in class and on Blackboard. 

Students must receive permission from individual lecturers to tape any content. Students are expected

to read and complete other required assignments in advance of class.

2.    If a student is to be absent from an exam, he/she must notify the course coordinator at least 2 hours

prior to the exam by leaving a voice mail or email. Failure to comply with this policy may result

 in a “0” for the exam missed. There are 4 make-up exam days scheduled during the semester. (See calendar

for dates) that will take place in Dillard     at 8:00 on the next class day after an exam. The format for any

make-up exam may not be multiple choice; it may be essay, short answer, and/or fill in the blank.

3.   Clinical attendance is required.  In the event of an absence, the student is responsible for notifying

 the clinical instructor prior to the scheduled time of the clinical experience. A clinical absence will be

made up and scheduled at the discretion of the faculty member.

Course Content:

1. Theory

Class evaluation will be based on grades from four unit exams, written clinical assignments, and a

comprehensive final exam.

Grading Scale:

      100-90                                     A

        89-80                                     B

        79-74                                     C

        73-65                                     D

        64 and below                        F

NOTE: Earned credit points will be added to the lowest exam grade and prior to determining the overall

74% average exam requirement. An average of 74% on all written exams, including the final, is required.

An average ofless than 74% on all 5 exams with earned credit points will result in course failure.

     There will be no rounding of grades. No final grade will exceed 100. The final exam is on a laptop.

Evaluation Methods:

Exam I..................................................................             15%

Exam II................................................................             15%

Exam III...............................................................             15%

Exam IV...............................................................             15%

Final (Comprehensive).........................................             15%

Clinical Assignments............................................             25%

*Earned Credit (possible 7 points max)

.............. Total            100%

Test reviews will occur only AFTER all students have completed the exam. Test reviews will not take place

during class time and will occur after the make up exam is offered at 8:00 am the next class day (Dillard  

124).  Attendance is encouraged but not required. Only the top frequently missed questions will be  

addressed at that time. You may, however, schedule an appointment with your assigned clinical instructor

as needed for clarifications of specific concerns or questions about your grade.

1.  Clinical Experience (90 required hours for NURS 3412):

                  Orientation days               3 days (8+4=2)                 14

Clinical days                     8 days x 8 hrs                   64

Addiction Recovery Group                                         2

Cafeteria Option                                                          5

Clinical Evaluation     30min @ end of clinicals          .5

Communication exercise                                               .5

Medication quizzes                                                      2

TBA activities*_                                                          2                                      

                                                      Total:                   90 hours

*TBA activities are special events that arise during the semester that deal with mental health issues.

One of them occurs on Sept. 23 at 8:00pm in CSC Comanche Suites and is entitled Drunk Sex or Date

Rape…Can you tell the difference? In order to receive credit for being there, students must sign the roster

sheet  upon arrival and must remain for the entire event.

All students are required to complete the communication exercise online usingBlackboard. It is

important that you be as honest as possible when answering these questions. Follow instructions. All

students must complete the 20 min. assignment by its deadline Aug 27^th at 5:00pm.

*Cafeteria* Options:

                 Each student will select one of the activities listed below. Requirements with regard to

written activities, travel, dates and hours of experience vary. See Blackboard Cafeteria Options Icon for

more specifics. Each student must sign up and commit to one of the following 3 activities:

1. Vernon State Hospital (Forensic Mental Health)
2. Ride Along Program-Wichita Falls Police Department (Substance Abuse, Domestic Violence)
3.  Allred Prison Tour (2.5 hrs) AND the Assoc. of Retarded Citizens (2.5 hrs)

NOTE: Please select carefully. “Signing up” serves as a contract between the student, the faculty

and the agency utilized. No trades/changes can be made after you have signed up. Read directions before

signing up. To sign up, go to Blackboard and click on Cafeteria Options, then click on the option you want.

Click on “sign in”. The software will automatically type in your name. You do not need to type in your

 name. Note that there is a limited number for each option, so if that option is full, you will have to sign

up for another option. Students are expected to make up any absence from a cafeteria option.

Clinical Cafeteria Options:

Vernon State Hospital (State Forensic Hospital)   (10 slots)

Location: 4730 College Dr, Vernon, TX ( About 50 miles from Wichita Falls)

Dates/ Times:   Tuesday, Nov. 16  at 8:00 am. (Departure from Dillard pkg lot is 7:00AM)

Overview: As a member of a clinical group, you will tour the facility for the state of Texas where individuals who are considered to be “criminal” and mentally ill are admitted. This is a high security facility. It has a fence and a large security force in addition to mental health staff and professionals. You will tour the facility, visit a clinical unit and receive an overview of the mission by resident staff.

Pros and/or Cons of This Selection:

            This requires travel time in addition to the 4 clinical hours. It is accompanied by one of the professors. It is a “group” experience (10 students) rather than an “individual” experience. There are no written requirements/assignments following completion of the clinical.

Ride Along  (Wichita Falls Police Department)  (28 slots)

Location: Wichita Falls Police Department

Dates/Times:  Friday or Saturday night (Dates: 9/10, 9/11, 9/17, 9/18, 10/1, 10/2, 10/15, 10/16, 10/29, 10/30, 11/12, 11/13, and 11/26, 11/27)                 

                       8PM to 2AM (You can select any 4 hour block within this time range)

Overview: You will ride along with a police officer in his police car. You will be an observer during his routine night’s activities. These hours were selected in order to increase the likelihood of observing legal intervention with domestic violence, substance abuse related issues and other mental health difficulties within the local community. The Ride Along Program is a routinely operating part of the Wichita Falls Police Department that is available to any citizen who wishes to better understand the issues facing local law enforcement.

Pros and/or Cons of this selection:

            The days of the week and the hours of day are not during your typically scheduled clinical day. These are nighttime/early morning hours which are generally hours of sleep! This is an “individual” activity as the police department rules allow only one ride-along per car. However, there will likely be 2 students per night riding in patrol cars so you could carpool if you choose to and from the police department. There is a written application that must be completed prior to authorization/permission to ride. (See Forms icon)  This process includes a criminal history check. If you have a felony record or other criminal charges you need not select this option as you will not be approved. No faculty is present for these experiences. Special consideration:  Some “time flexibility is required if you select this option. You are “riding along” with a working police officer. If he/she takes a call and is involved in working the case, he/she can not just stop and pick you up at the station or take you back to your car at the police station because your 4 hours is due to start or completed. You would have to understand that the police responsibility is first to the job. The officer will pick you up and take you back to the police station and your car as soon as is possible however. Although this is not expected to occur, it could.

Allred Prison Tour AND ARC  (60 slots)

Address for Allred Prison: 2101 FM 369 North, Iowa Park, TX

Allred Prison tours take place on two November days with 3 different time slots. We suggest that students car pool there. Bring your photo ID. Please plan to arrive at least 10 minutes early for the time allotted. Tardiness may cause you to miss the tour and result in a loss of the clinical hours allotted to this experience. Faculty will be there to escort you along with the Prison supervisor. You will get to tour the facility for 1.5 hrs, with special attention to the medical unit where you will get to talk with the nurses and other staff. Only 20 students can sign up for each of the three tours. Check the calendar for dates and times. Directions and instructions are on Blackboard under the Clinical & Earned Credit Forms icon.

AND

The Association of Retarded Citizens (ARC) holds a dance or a bingo event on the third Monday of each month. Mental retardation is not “mental illness”. As a result, clients with mental retardation are not “hospitalized” for this diagnosis. This is an opportunity for you to participate in community based activities available for this population. These activities are held at the Elk’s Lodge, 4205 Seymour Hwy, Wichita Falls. See directions hyperlink online for directions. The time is always 7:00 to 9:00 pm. You should arrive 15 minutes early in order to sign-in and help staff to get ready. Current dates are on your calendar. A maximum of 20 students can attend on any one night and you must sign up on Blackboard. You are also required to sign a sign-in sheet at the event to prove you were there. 

Pros and/or Cons of this selection:

This option has two events that occur on different days. You will need to sign up for both events. The drive to the prison takes about 20 mins. It is a “group” experience rather than an “individual” experience. There are no written assignments following completion of the clinical. At Allred Prison you have an opportunity to talk with the forensic nurses about what it is like to work in a state correctional facility. These jobs are one of the highest paid positions in the area for a BSN, and the benefits are excellent. As for the ARC event, past students have said that the ARC dance or bingo event is one of the best times that they have had in nursing school.

Clinical Evaluation:

The essential competency for this course is effective therapeutic communication. This will be

determined by a minimum grade of 74 on your MMSE AND a first- or second-attempt  IPR.

       Performance Grading:  

      Clinical performance will be routinely evaluated on a pass/fail basis.

      *Clinical failure constitutes course failure.

1. Greater than 10% or nine (9) hours of unexcused clinical absences results in course

                        failure. Students will be asked to provide proof of their excused absence. Missed clinical

                        experiences must be made up at the discretion of the clinical instructor. In some cases, there

                        will be             scheduled make up days to choose from for clinical make up days. Overall clinical

                        performance will be evaluated by the clinical instructor daily.

1. A grade of less than 74 on an MMSE OR a second-attempt IPR.
2. Clinical behavior that is or has the potential to be unsafe for the client or to cause a client

            undue psychological and/or physical discomfort constitutes unsatisfactory clinical

            performance.

                        *Infractions constituting a clinical failure:

            Incidents of attending clinical inadequately prepared in caring for the patient, including

            noncompliance with required immunizations, criminal background checks, etc.

            Failures to recognize the concepts of nursing tasks/skills.

            Incidents of disregarding professional ethics include, but is not all inclusive:

                        Nonconforming to the dress code

                        Unprofessional/inappropriate language or gestures

                        Unprofessional/inappropriate behavior, including repeated tardiness

                        Disregarding patient confidentiality

                        Patient negligence

                        Leaving the premises without permission

            Omissions  

                        Falsification and/or lying

                        Violation of appropriate boundaries

                        Unable to accept and/or act on constructive feedback 

1. All clinical experiences are required for successful completion of the course.  Failure to complete a clinical experience will result in a loss of the assigned clinical hours for that experience, this includes inappropriate or inadequate therapeutic communication (See page 5, item 2). NOTE: Should a student demonstrate inappropriate or inadequate therapeutic communication during clinicals, additional verbal or written evidence may be required to receive a satisfactory pass for the clinical hours for that day.

Written Clinical Assignments:

All written clinical assignments are to be completed by individual students. These are not group assignments. Your home instructor is your initial clinical instructor. Your homeinstructor will be grading the majority of your clinical assignments. All forms and instructions can be found on Blackboard. Failure to submit any assignment on the due date and time will resultin areduction of 10% of the total points for each day it is late.

1. Two interpersonal process recordings (IPR)/care plan assignments are required. Effective communication is common to all nursing practice and essential to mental health nursing.  The IPR/Care plan reflects the development of the nurse-client relationship and both will be with clients in your clinical setting. Among the areas of focus for the IPR/Care Plan include: establishing rapport; maintaining trust; communicating therapeutically; and implementing the nursing process with clients exhibiting alterations in thought, feeling, and/or behavior. IPR/Care plans will be graded according to the rubric provided in Blackboard, and will include conducting a current Global Assessment of Functioning scale. Any student who makes a grade of 87 or above on the first-attempt IPR will have demonstrated competency for the IPR assignment and not need to do a second one. Students scoring less than 87 on the first attempt IPR, must do a second IPR, which must have a minimum grade of 74 to pass the class. A sample IPR/Care plan is available on Blackboard. No resubmissions will be allowed for the  IPRs or any other clinical assignment. All IPRs must be submitted via the Drop box on Blackboard.  
2. One Mini-Mental Status Exam (MMSE) will be conducted and documented with your clinical instructor or preceptor. Directions are included on the MMSE forms, as is a grading rubric. (See Blackboard “Forms” icon). A grade of 74 or greater must be achieved to demonstrate competency for the MMSE. A grade less than 74 fails the student in clinicals.
3. One Addiction Recovery Evaluation form will be completed after attending a meeting (Alcoholics Anonymous, Alanon, substance addiction, etc.) We strongly urge you to attend as pairs. You must call ahead to assure that you are “welcome” and that the meeting is open to the public as some meetings are closed to the public. Forms and directions and a grading rubric are available on Blackboard.
4. During a clinical post conference, each student will verbally present and provide awritten summary of assigned drugs utilizing the provided criteria. Your clinical instructor will provide the structure for your presentation. Drug assignments will be made during the clinical orientation day.
5. A personal learning journal (a minimum of 3 entries) is an ongoing developmental record of student’s reflections on weekly learning and clinical experiences. The first journal entry should be written after your first day of clinical. The second journal entry should be written after your first clinical in your second clinical site, or if you are in a precepted clinical, after your 5^th clinical day. The third journal entry should be written after your cafeteria option(s) are completed. All entries are to be written in narrative form and are required to be submitted electronically to your homeroom clinical instructor within 48 hours of completing your clinical day. The contents of each journal will be considered confidential and not shared with anyone! Journal entries are not a record of events or activities, but of individual responses to the activities. Students need to express links between the course concepts and personal interests (for example, family and friends who struggle with mental health issues) and the student’s intended area of practice. The faculty encourages students to integrate their clinical knowledge into a personal learning plan so that students can incorporate psychological principles into their specific areas of interest. NOTE: Late entries will not be accepted. Failure to write 3 entries will result in a deduction of 1 point for each missing entry. No half points are awarded.
6. Teaching is a primary nursing intervention regardless of what field of nursing that you might choose. It is especially relevant in mental health nursing. According to the Standards of Psychiatric Mental Health Nursing Practice (ANA, 2000), “The psychiatric-mental health nurse, through health teaching, assists patients in achieving satisfying, productive, and healthy patterns of living.” Teaching a client with mental illness often presents new challenges for the nurse related to cognitive interference and/or impairment. The text, Chapter 24, Client Education, addresses teaching-learning strategies. See the Teaching Guides on the CD that accompanied the textbook for additional information as well. Because this information will not be addressed during lecture time, you may complete the Teaching Tool (See this icon in Blackboard) with one client during clinicals. You would identify a client with a teaching need (such as in your MMSE report), prepare the teaching plan with help from your clinical instructor. When ready to teach your client the topic you choose, inform your clinical instructor or preceptor so that s/he can be present during your teaching session. You are to evaluate the process and submit the completed form along with any related teaching materials to your clinical instructor. This is optional.
7. Students will take a med quiz early on to determine how much information they retained from the Pharmacology class on psychotropic drugs.During clinicals, each student is required to research assigned drugs to be presented in their clinical group on a designated date. By the end of the regularly scheduled clinicals, a total of 14 drugs will have been presented. Find list of 14 drugs under the Clinical & Earned Credit icon in Blackboard. Every student will have a copy of the summary of each drug. A required 25 question med quiz will be given on the last day of class.

Clinical Assignments Grading and Due Dates:

                        Seven (7) assignments required of each student:

1. IPR/Care Plan Assignment #1 due Oct 11                                   75 points

Second-attempt IPR due Nov 8

1. MMSE due by last clinical day                                                       8 points
2. Addiction Recovery Evaluation due Nov 15                                8 points
3. Drug presentation/summary (TBA)                                                2 points
4. Journal entries (3)                                                                            3 points

Any 2 of the following options will count 2 points each:                   4 points

Depression Scale                                                                                

Suicide Lethality Scale                                                                      

Ethnocultural/Spirituality Assessment                                               

Teaching Tool

OR an alternate assessment approved by a clinical instructor                                                                                   

Total                                                    100 points

All written assignments with due dates are due on scheduled class days. Precepted students will establish due dates with their assigned faculty member. The first four papers are to be turned in NO LATER THAN 3:00 pm on the due date either in hard copy (MMSE) or they may be placed in Drop box on Blackboard to your clinical instructor. The remaining assignments are turned into your clinical instructor directly.

Earned Credit Opportunities:

Overview:Earned credit activities are intended to provide students with additional methods/opportunities to learn course information with regard to specific learning objectives for this course. These activities are NOT required. Each activity will be graded and has a value of one (1) or (2) points.  Points earned will be added to your lowest exam grade in determination of the required 74 average. A student can attend as many activities for earned

credit as s/he desires to enhance their learning, however, only 7 points can be earned for credit regardless of the number of completed activities.

Example:

   Exam I                           75

+ Exam II                         74

+ Exam III                                     72

+ Exam IV                         72

+ Final Exam 70 + 7 pts = 77

                                          370 divided by 5 = 74% (passing avg) If this student had not earned the 7 earned credit points, they would have made 72.6 (not a passing grade). 363 divided by 5 = 72%. Equally as important, these activities often help students to perform better on exams and therefore result in increased letter grades.

Activities:

1. Etiology and symptomatology for mental illness varies. Students and their clients often ask about heredity and/or cultural influences. Much work has been done with “family of origin” with some of the diagnoses. A genogram (pronounced: jen-uh-gram) is a graphic representation of a family and its relationships among individuals. It goes beyond a traditional family tree by allowing the user to analyze hereditary patterns and psychological factors that impact relationships. Genograms allow a health professional and the patient to quickly identify and understand various patterns in the patient's family history which may have had an influence on the patient's current state of mind. The genogram maps out types of relationships and traits. Instructions can be found in the Earned Credit section of Blackboard. Satisfactory completion of a genogram (not just a family tree) can earn one (1) point.

1. Students can view a total of two (2) of the recommended movies for a total of 4points (up to 2 points for each movie). The Course Packet has recommended movies for most of the lectures. Students may view and respond to the written questions to only one movie per lecture content (e.g. only one movie on depression). These written responses must be turned into the drop box in Blackboard by the exam date for that content (Sept 13 for movies in Unit I). One or two points can be earned for each movie viewed with correct answers to the reflection questions. The film lab at the beginning of the semester is an example of what we expect you to be able to learn from each movie.

1. In an effort to help students see the correlation between study efforts and exam scores, as well as assess the effectiveness of study strategies, students are asked to complete a short form at the end of the first two exams only. A second form of questions is available for completion after a student learns of their exam grade. The first form is handed in at the end of each exam. The second form with attachments is to be completed and handed in during prior to the next exam. Students who turn in both forms for an exam will earn one earned credit point for a total oftwo (2) points (one for each exam). Perhaps more importantly the student will be able to improve study habits and improve the individual exam grades as the semester progresses.

1. The Neighborhood is an online virtual community that supports learning throughout the nursing program. The faculty will be giving out 10 scenarios among the families in the Neighborhood. Up to two students may sign up for 1 point for each of the 10 scenarios. If you would like to earn this point, sign  up on Blackboard for the slot you are interested in and be prepared to relate the content of that lecture content that day (Depression on Sept 15^th for instance) to the family scenario you read about. 

4.      Dress for the NURS 3412 clinical experience is street clothes with student name tag.  Inappropriate dress may include but is not limited to shorts, sweat suits, baseball caps, lab coats, suggestive clothing, T-shirts and/or attire with suggestive pictures, slogans, or wording.  Jeans in good condition are appropriate. Also, please wear comfortable shoes and have jackets as needed for being outside. Each facility has its own dress code and contraband list that must be followed.

5.      Work (employment) hours regardless of location will not count as clinical hours for course credit.

6.     Written student assignments may be kept on file by faculty.  NOTE: It is recommended that students make a back-up copy of all should a need arise.

7.      Blackboard: Course content will be available via Blackboard. Students are responsible for downloading all written/printed materials for their use in class. Students needing assistance with using Blackboard may access instructions via the MSU Home Page.

8.      E-mail: Please email professors at their personal mwsu emails(see Header of Syllabus) unless responding to a question onBlackboard. Please allow the professors 48 hrs to respond to your emails.

9.      Behaviors that detract from the learning process will NOT be tolerated. In order to maintain an environment conducive to learning, please turn off or silence all electronic devices before class begins. If an electronic device disrupts the class, the student will be asked to leave the classroom for the day the disruption occurs, including exam days. You are welcome to use laptops to take notes in class, but they must be silenced. The faculty recognizes that there are emergencies that must be dealt with as

         they arise. If you anticipate an emergency situation, please notify the instructor prior to the beginning of class so that a student’s exit and/or absence will be understood.

10.    No student will be admitted after 3:00 PM on exam days. No exceptions. Make up exams are scheduled on the calendar.

11.     The last day to drop a class with a “W” (withdrawal) will be Oct 18 at 4:00pm. Drops after this date will receive grades of “F”.

1. Greater than 10% or nine (9) hours of unexcused clinical absences results in course

                        failure. Students will be asked to provide proof of their excused absence. Missed clinical

                        experiences must be made up at the discretion of the clinical instructor. In some cases, there

                        will be             scheduled make up days to choose from for clinical make up days. Overall clinical

                        performance will be evaluated by the clinical instructor daily.