ADN 465 - Psychiatric Mental Health Care

1. Create a comprehensive health status assessment based on the needs of the client with mental health and substance abuse issues.
2. Apply principles of ethics, client safety, health promotion and the nursing process to nursing care of the client with mental health and substance abuse issues.
3. Create and implement an individual plan of care considering unique cultural and spiritual preferences, applicable standards of nursing care, and legal and ethical implications.
4. Assist clients with mental health and substance abuse issues to promote healthy behaviors, cope with health problems, and adapt and/or recover from the effects of disease or injury.
5. Understand individual and team accountability for abiding by all applicable jurisdiction statutes related to psychiatric nursing practice.

Course Objectives:
Unit 1:

• Define mental health and mental illness; describe the continuum between mental health and mental illness.
• Discuss cultural elements that influence attitudes toward mental health and mental illness.
• Cite misconceptions and myths about mental illness.
• Psychophysiological responses to grief and anxiety.
• Relate the purpose of defense mechanisms.
• Define and cite examples of defense mechanisms.
• Discuss legal and ethical issues relevant to psychiatric/mental health nursing.
• Compare and contrast voluntary admission and involuntary commitment.
• Explain the nursing care of patients in seclusion and restraints.
• Compare and contrast the purpose, focus, and goals for a social relationship, intimate relationship, and a therapeutic relationship.
• Define self-awareness and discuss its importance in the nurse-client relationship.
• Define and discuss the role of empathy, genuineness and positive regard on the part of the nurse in the nurse-client relationship.
• Identify behaviors in the nurse that reflect positive regard.
• Describe the four phases of therapeutic relationship development and the goals and tasks associated with each phase.
• Define transference and counter-transference and the influence they may have on the therapeutic relationship.
• Explain the effect/use of self-disclosure in the nurse-client relationship and maintaining professional boundaries.
• Discuss the impact of pre-existing factors on communication.
• Identify your most important values using values clarification.
• Identify how culture influences communication.
• Discuss differences between verbal and nonverbal communication.
• Distinguish between thoughts and feelings and explore their impact on communication and behavior.
• Identify techniques that enhance communication (therapeutic).
• Identify techniques that hinder communication (non-therapeutic).
• Describe active listening.
• Identify, write and critique therapeutic responses through utilization of process recordings (IPR).

Unit 2:

• Identify the role of neurotransmitters in human behavior.
• Discuss the association of endocrine function to the development of psychiatric disorders.
• Explain the relationship between neurotransmitters, psychotropic drugs, and mental illness.
• Identify major classes/sub classes of psychotropic drugs.
• State common side effects of psychotropic drugs.
• Identify various diagnostic procedures used to detect alteration in biological functioning that may contribute to psychiatric disorders.
• Discuss historical perspectives related to psychopharmacology.
• Describe indications, action, contraindications, precautions, side effects and nursing implications for the following drug classifications: antianxiety agents, antidepressants, mood-stabilizing agents, antipsychotics.
• Apply the steps of the nursing process to the administration of psychotropic
• medications.
• Relate the nursing process to psychiatric nursing practice.
• List components of the Mental Status Exam and other psychosocial assessments.
• Define the term therapeutic milieu and describe the role of the nurse in creating a therapeutic milieu.
• Relate the basic assumptions and conditions of a therapeutic milieu.
• Identify the roles of the interdisciplinary team in psychiatry.
• Discuss the functions of different types of groups.
• Describe physical conditions that influence groups.
• Explain curative factors that occur in groups.
• Describe the phases of group development.
• Differentiate between group therapy and therapeutic group work.
• Describe the role of the nurse in group therapy.
• Compare and contrast functional and dysfunctional family behavior.
• Describe the effects of mental illness on families.

Unit 3:

• Explain Seyle’s theory of stress and explain the relationship between anxiety and neurochemical and physiological response to anxiety.
• Identify physiological and psychological responses to stress, anxiety and grief.
• Identify common stressors.
• Distinguish symptoms reflective of each of the four levels of anxiety.
• Match appropriate nursing interventions to each level of anxiety.
• List adaptive and maladaptive coping strategies.
• Recognize and differentiate primary gain, secondary gain, and tertiary gain
• Define crisis.
• Identify the stages of a crisis.
• Identify types of crisis that occur in people’s lives.
• Discuss the goal of crisis intervention.
• Identify the role of the nurse in crisis intervention.
• Apply the nursing process to client’s expressing anger or aggression.
• List medications used in the management of aggressive patients.
• Differentiate the terms stress, anxiety, and fear.
• Differentiate between normal anxiety and compare to pathological anxiety.
• Identify predisposing factors in the development of anxiety disorders.
• Distinguish between the different anxiety disorders.
• Apply the nursing process to the client with an anxiety disorder.
• Discuss various treatment modalities relevant to anxiety disorders.
• Identify the defense mechanisms used in anxiety disorders.
• State the actions, side effects, and nursing implications for anti-anxiety medications.
• Describe various types of trauma - and stressor - related disorders and identify
• symptomatology associated with each.
• Identify predisposing factors in the development of trauma - and stressor - related disorders.
• Apply the nursing process to the care of client’s with trauma - and stressor - related disorders.
• Discuss various modalities relevant to treatment of trauma - and stressor - related disorders.
• Discuss various types of somatic symptom and dissociative disorders and identify symptoms associated with each.
• Identify predisposing factors in the development of somatic symptom and dissociative disorders.
• Apply the nursing process in the care of client’s with somatic symptom and dissociative disorders.
• Discuss various modalities relevant to the treatment of somatic symptoms and dissociative disorders.

Unit 4:

• Discuss the concepts of schizophrenia and other psychotic disorders.
• Identify predisposing factors in the development of these disorders.
• Recognize signs and symptoms for schizophrenia.
• Describe various types of schizophrenia and other psychotic disorders.
• Identify symptomatology associated with these disorders and use this information in client assessment.
• Define and differentiate between hallucinations, illusions, and delusions.
• Describe appropriate nursing interventions for behaviors associated with these disorders.
• Identify communication techniques/approaches to use when caring for delusional or hallucinating patient.
• Describe relevant criteria for evaluating nursing care of clients with schizophrenia and other psychotic disorders.
• Identify topics for client and family teaching relevant to schizophrenia and other psychotic disorders.
• Explain the schizophrenic client’s vulnerability to abusing substances and strategies to prevent relapse.
• Discuss various treatment modalities relevant to the treatment of schizophrenia and other psychotic disorders.
• State the mechanism of action, side effects, and nursing implications for clients on antipsychotics.
• Explain drug therapy (antiparkinsonian drugs and antihistamines) used to
• prevent/minimize side effects of antipsychotics and list possible medications used.

Unit 5:

• Discuss the theory of grief as proposed by Elisabeth Kubler-Ross.
• Explain anticipatory grieving.
• Differentiate between adaptive and maladaptive responses to loss and identify when the work of mourning has been successful.
• Describe grieving behaviors common to individuals across the life span.
• Explain the relationship between grief and the development of depression.
• List nursing interventions nurses can implement when working with a grieving patient.
• Recognize the importance of cultural and developmental considerations in the bereavement process.
• Discuss epidemiological statistics related to depression.
• Compare and contrast major depressive disorder and dysthymic disorder.
• Differentiate depressive and bipolar disorder.
• Compare and contrast the etiological theories and predisposing factors for the development of depression.
• Discuss implications of depression related to developmental stage.
• Utilize the nursing process in providing care for the client with depression.
• Identify symptoms associated with depression and use this information in client assessment including the following areas: affect, thought processes, feelings, physical behavior, and communication.
• Utilize therapeutic communication appropriate to the client with a depression.
• Describe the use of cognitive therapy in the treatment of the client with depression.
• State the mechanisms of action, major side effects, and nursing implications for the client on drug therapy for depression.
• Discuss mechanism of action, indications, contraindications, and complications of ECT.
• Describe the role of nurse in the administration of ECT.
• Identify education topics for the client with a depressive and their family.
• Discuss epidemiology, etiology, and risk factors related to suicide; including those specific to the adolescent.
• Identify persons at risk for suicide.
• Apply the nursing process in care of suicidal clients and their significant others.
• Describe various types of bipolar disorders.
• Identify predisposing factors in the development of bipolar disorder.
• Identify symptoms of bipolar disorder and use this information in client assessment.
• Apply the nursing process in caring for a client with bipolar disorder.
• Discuss various modalities used in the treatment of bipolar disorder.
• State the mechanism of action, major side effects, and nursing implications for the client on a mood stabilizer.
• Distinguish between signs of early and severe lithium toxicity.

Unit 6:

• Define the term personality.
• Review various theorists and theories of personality development.
• Distinguish among the three clusters of personality disorders.
• Describe symptomatology associated with a specific cluster of personality disorder.
• Identify predisposing factors related to borderline personality disorder, and use this in assessment.
• Apply the nursing process to the client with borderline personality disorder and antisocial personality disorder.
• Discuss various treatment modalities for the treatment of various personality disorders.
• Identify and differentiate between various eating disorders.
• Identify etiological implications and predisposing factors in the development of eating disorders.
• Identify nursing interventions for a client with an eating disorder.
• Discuss various treatment modalities relevant to the treatment of eating disorders.
• Describe epidemiological statistics associated with victims of violent behavior.
• Identify characteristics of victims and victimizers.
• Identify predisposing factors of abusive behavior.
• Identify nursing interventions for the victim of abuse.
• Explain how all clients can be assessed for evidence of domestic violence.
• Define sexual assault and rape.
• Describe the profile of the victim and the perpetrator of sexual assault.
• Distinguish between the acute and long-term phases of the rape-trauma syndrome and identify some common reactions during each phase.
• Identify areas to assess and interventions to implement when working with sexual assault victims.
• Identify the role of the Sexual Assault Nurse Examiner (SANE) nurse in the emergency setting.
• Analyze your thoughts and feelings in regards to working with perpetrators and victims of violence.

Unit 7:

• Define addiction, intoxication, tolerance, and withdrawal.
• Discuss predisposing factors implicated in the etiology of substance-related and addictive disorders.
• Explain the use of defense mechanisms in clients with substance-related and addictive disorders.
• Identify symptomatology and use the information in assessment of clients with various substance-related and addictive disorders.
• Distinguish between the symptoms of opioid intoxication, overdose, and withdrawal.
• Compare and contrast the signs and symptoms of intoxication, overdose, and withdrawal for cocaine and amphetamines.
• Distinguish between the symptoms seen in alcohol withdrawal and those of alcohol delirium and discuss recommended treatment for each.
• Describe the signs of alcohol poisoning and the appropriate treatment.
• Outline nursing care for the client who is intoxicated, overdosed, or withdrawing from a substance.
• Develop self-awareness relative to substance abuse.
• Discuss characteristics of the impaired nurse and list appropriate steps to take if one observes an impaired nurse.
• Discuss the issue of substance-use and addictive disorders within the profession of nursing.
• Discuss the effects of chronic alcohol abuse on various body systems.
• Define codependency and identify behavioral characteristics associated with the disorder.
• Describe aspects of enabling behaviors and give examples.
• Describe various treatment modalities relevant to treatment of individuals with substance-related and addictive disorders.
• Define and differentiate among delirium and various neurocognitive disorders.
• Discuss predisposing factors implicated in the etiology of delirium and neurocognitive disorders.
• Describe clinical symptoms and use the information to assess clients with delirium or a neurocognitive disorder.
• Apply the nursing process in the care of a client with delirium or neurocognitive disorder.
• Summarize the essential nursing interventions for a patient with delirium.
• Define and give an example of the following symptoms assessed during the progression of Alzheimer’s disease: (a) amnesia (b) apraxia (c) agnosia and (d) aphasia.
• Review management of catastrophic reaction in the patient with Alzheimer’s.
• Describe various treatment modalities relevant to care of clients with delirium or a neurocognitive disorder.
• Discuss drug therapy for patients with a neurocognitive disorder.
• Formulate a teaching plan for a caregiver of a patient with Alzheimer’s disease including communication, safety and health maintenance.
• Discuss resources/supports for caregivers of a patient with Alzheimer’s.

Unit 8:

• Explore genetic and environmental factors that contribute to infant, child, and
• adolescent psychiatric disorders.
• Identify predisposing factors of mental health and positive development in children and adolescents.
• Discuss interventions to prevent psychiatric disorders in children.
• Define the term resilience and explain how resiliency can mitigate risk factors for mental illness.
• Describe symptoms of the common childhood and adolescent psychiatric disorders.
• Plan nursing care for the child or adolescent with a mental illness.
• Discuss treatment modalities for the child or adolescent with a psychiatric disorder.