Santa Monica College



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Santa Monica College



Course Outline for

Nursing 25

Course Title: Nursing 25 Units: 1.5

IGETC Area:

Date Submitted: Spring 2002 CSU GE Area:

Updated: Transfer: CSU


  1. Catalogue Description:

Prerequisite: Nursing 20, 20L, or acceptance into advanced placement and

completion of Nursing 19 with a “C” grade or better.

Corequisite: Nursing 25, Nursing 28

Advisory: Speech 5, Psychology 19
The focus of this specialty course is to introduce the nursing student to the principles of psychiatric-mental health nursing as applied to patients across the life span. Emphasis will be placed on meeting self-care deficits of patients exhibiting symptoms of common psychiatric disorders and patients experiencing emotional responses to stress and illness. The course will cover concepts of mental health, mental illness, stress and coping, assessment of common psychiatric disorders, biological and psychosocial modes of intervention, and therapeutic nursing responses.

  1. Required Text and References:

Fortinash, Katherine M. and Holoday-Worret, Patricia A., Psychiatric Mental Health Nursing. 3rd Ed. Mosby, Inc., St. Louis, 2004.

Doenges, Marilyn, Nurse’s Pocket Guide: Nursing Diagnoses with Interventions. 7th Ed. Philadephia: F.A. Davis Co., 2000.

Luckenotte, Annette G., Gerontologic Nursing. 2 nd Ed. St. Louis:  Mosby, Inc., 2000.



lll. Course Objectives:

Upon completion of this course, the student will be able to:



  1. Apply Orem’s Self-Care Model and the nursing process to plan and implement nursing care in various healthcare settings for actual or simulated patients who demonstrate symptoms related to ineffective coping patterns, anxiety, personality disorders, substance abuse disorders, mood disorders, psychotic disorders, issues of abuse and crisis.

  2. Identify areas of psychosocial dysfunction, which adversely affect a patient’s health status.

  3. Identify and plan nursing interventions to support actual or simulated patients experiencing emotional responses to medical illness.

  4. Describe sociocultural and lifespan considerations significant to mental health treatment.

  5. Demonstrate competency in establishing and maintaining a therapeutic nurse-patient relationship with actual or simulated patients experiencing mental health problems utilizing effective communication techniques.

  6. Discuss the legal and ethical issues associated with psychiatric nursing including the rights and restrictions of voluntary and involuntary patients, confidentiality, the right to the least restrictive treatment alternative and the right to refuse medication.

  7. Differentiate between normal age-related behavioral changes and symptoms of mental illness in children, adolescents, and older populations.



Theoretical Objectives:

Upon completion of this course, the student will be able to:


Introduction to Psychiatric Mental Health Nursing

  1. Differentiate between the concepts of mental health and mental illness.

  2. Discuss psychiatric-mental health nursing from a historical perspective.

  3. Explain the influence of culture on the diagnosis, treatment and nursing

interventions for mental illness.

  1. Explain the relevance of Maslow’s Hierarchy of Needs to patient

assessment and planning of nursing interventions.

  1. Describe the roles of neuroanatomy and neurophysiology in the etiological

theories of mental illness.

  1. Identify the major components and relevance to nursing care of the

following developmental theories: psychoanalytical theory, psychosocial

development theory, and behavioral theory.



Stress, Coping Skills and Stress Management


  1. Explain the effect of prolonged stress on physical and mental health.

  2. Identify four diseases of adaptation.

  3. Describe the four levels of anxiety and common behavioral responses of

each.

  1. Identify common coping behaviors used to relieve anxiety.

  2. Discuss the adaptive and maladaptive uses of ego defense mechanisms to

relieve anxiety.

  1. Differentiate between the following ego defense mechanisms:

compensation, denial, displacement, identification, intellectualization, projection, rationalization, reaction formation, regression, repression, sublimation and suppression.

  1. Identify various stress management strategies appropriate to reduce stress

in patients and nurses.

Legal and Ethical Issues



  1. Identify the criteria for involuntary hospital commitment.

  2. Compare the rights and restrictions of patients committed to voluntary and

involuntary hospital admissions.

  1. Discuss the patient’s right to confidentiality and situations when

confidentiality may be violated.

  1. Discuss the right to the least restrictive treatment setting.

  2. Discuss the patient’s right to refuse treatment.

  3. Discuss nursing responsibilities for care of the patient in restraints or

seclusion including appropriate use of these measures, assessment and

documentation.


Application of the Nursing Process to Psychiatric-Mental Health Nursing

  1. Describe the steps of the nursing process and application of Orem’s Self-

Care model as related to psychiatric-mental health nursing practice.

  1. Identify commonly used NANDA nursing diagnoses in psychiatric

nursing.

  1. Identify the six standards of care for psychiatric nursing and describe

nursing actions associated with each.

  1. Discuss the importance of the psychiatric interview process and the stages

of the interview.

  1. Identify the categories of information addressed in a psychiatric history

and assessment.

  1. Discuss the components of the mental status examination.

  2. Describe mental status assessment of the adult and the older adult patient.

  3. Explain the DSM (Diagnostic and Statistical Manual of Mental Disorders)

diagnostic system and the use of the five axes.

  1. Compare and contrast primary, secondary, and tertiary prevention in

community mental health nursing.

Relationship Development and Therapeutic Communication


  1. Identify examples of nonverbal communication exhibited in interactions

between patients and healthcare providers.

  1. Compare and contrast therapeutic and nontherapeutic verbal

communication techniques in simulated nurse-patient interactions.

  1. Describe behaviors of active listening.

  2. Describe therapeutic feedback.

  3. Discuss measures to enhance communication with older adults exhibiting

symptoms of psychiatric disorders.

  1. Discuss the benefits of assertive communication for patients and nurses.

  2. Differentiate between assertive and aggressive communication.

  3. Discuss techniques and rationales for intervening in psychotic

communication.

  1. Discuss the relevance and the dynamics of a therapeutic nurse-client

relationship.

  1. Identify goals of a therapeutic relationship.

  2. Discuss the essential conditions for a nurse-patient therapeutic relationship

to occur, including trust, empathy, rapport, and respect.

  1. Describe the phases of relationship development and the tasks associated

with each phase.

  1. Discuss the concept of therapeutic use of self.

  2. Define transference and countertransference and their significance in a

therapeutic nurse client relationship.

Treatment and Intervention Modalities


  1. Define milieu therapy.

  2. Discuss conditions that promote a therapeutic community.

  3. Describe the responsibility of the nurse in maintaining a therapeutic

milieu.

  1. Contrast the therapeutic functions of four types of groups.

  2. Discuss curative factors that occur in the group process.

  3. Discuss the role of the nurse in group interventions.

  4. Contrast the advantages and disadvantages of group therapy and

individual therapy.

  1. Discuss the use of behavior therapy as a psychiatric nursing intervention.

  2. Apply principles of behavior therapy to a simulated patient problem.

  3. Define crisis and cite examples of various types of crises.

  4. Discuss the goals of crisis intervention.

  5. Identify the steps of crisis intervention.

  6. Identify the role of the nurse in crisis intervention.

  7. Discuss nursing care of the patient displaying behaviors of anger and

aggression including etiology, situational triggers, signs of escalation, and

nursing interventions to prevent and manage expression of anger and aggression.



Psychopharmacology


  1. Identify target symptoms, expected side effects and safe administration

guidelines for antipsychotic, antidepressant, mood stabilizing, anxiolytic

and antiparkinsonism medications.



  1. Identify the extrapyramidal symptoms of pseudoparkinsonism, akathisia,

dystonia/dyskinesia and tardive dyskinesia.

  1. Identify symptoms of neuroleptic malignant syndrome.

  2. Discuss nursing implications for psychopharmacological treatment of

older adults and patients with specific medical problems.

  1. Plan nursing interventions to prevent or alleviate side effects of

antipsychotic, antidepressant, mood stabilizing, anxiolytic and antiparkinsonism medications.

  1. Design teaching plans to instruct patients and their families in the safe use

of antipsychotic, antidepressant, mood stabilizing, anxiolytic and antiparkinsonism medications.

  1. Identify common reasons for medication non-compliance and nursing

interventions to promote compliance.

Schizophrenia and Other Psychotic Disorders


  1. Define schizophrenia and describe the subtypes.

  2. Discuss current biological, psychosocial and environmental etiological

theories associated with schizophrenia.

  1. Describe the cognitive, affective, social, and behavioral changes seen in

people with schizophrenia.

  1. Differentiate among the terms used in the mental status assessment of the

patient with a psychotic disorder including psychosis, delusion,

hallucination, illusion, and magical thinking.



  1. Differentiate between positive and negative symptoms of schizophrenia.

  2. Identify nursing interventions related to counseling, milieu therapy,

psychobiology and health teaching to assist patients with symptoms of schizophrenia.

  1. Assess symptoms, identify nursing diagnoses, and develop a nursing care

plan for a simulated patient with schizophrenia based on Orem’s Model and the nursing process.

Mood Disorders


1. Identify the biological and psychosocial theories regarding the etiology of

mood disorders.



  1. Differentiate between the symptoms and treatment for the following mood

disorders: major depression, bipolar disorder, cyclothymic disorder, dysthymic disorder and schizoaffective disorder.

  1. Differentiate among terms used in the mental status exam to describe

affect and speech.

  1. Describe assessment of depression in a child, adult and older adult

utilizing a standardized assessment tool.

  1. Identify nursing interventions related to counseling, milieu therapy,

psychobiology and health teaching to assist patients with symptoms of major depression and bipolar disorder.

  1. Assess symptoms, identify nursing diagnoses, and develop a nursing care

plan for a simulated patient with mood disorder based on Orem’s Model and the nursing process.

  1. Identify indications, contraindications, side effects and nursing

responsibilities in the use of electroconvulsive therapy (ECT).

  1. Compare and contrast behaviors associated with sadness and the clinical

disorder of major depression.

  1. Describe the prevalence of depression in older adults.

  2. Contrast criteria for differentiating depression from dementia in older

adults.

  1. Explain unique issues regarding assessment, therapeutic interventions, and

psychopharmacological treatment of depression in older adults.

Suicide


  1. Discuss social, cultural, psychological and physical factors related to the

incidence of suicide.

  1. Identify behavioral changes evident of possible suicide attempt.

  2. Discuss the risk periods and risk factors associated with suicide.

  3. Identify the psychiatric and medical conditions that significantly increase

a patient’s risk of suicide.

  1. Assess the lethality of a suicide plan and the degree of a client’s suicide

risk.

  1. Describe appropriate goals of care and nursing interventions for behaviors

associated with suicide.

  1. Identify the populations that have the highest risk for suicide attempts and

suicide.

  1. Discuss prevalence, risk factors, and behaviors associated with suicide in

older adults.

  1. Identify the elderly group at highest risk for suicide and discuss related

management techniques.

Grief


  1. Discuss the concept of grief as a psychological response to stress.

  2. Describe variables that contribute to the intensity of the grief response.

  3. Discuss anticipatory grief.

  4. Describe the following dysfunctional grief responses: prolonged grief,

delayed or inhibited grief, and distorted grief.

  1. Describe appropriate nursing interventions for behaviors associated with

grief.

Personality Disorders


  1. Contrast the definitions of personality and personality disorder.

  2. Describe the symptoms associated with paranoid, anti-social and

borderline personality disorders.

  1. Assess symptoms, identify nursing diagnoses, and develop a nursing care

plan for a simulated patient with paranoid, borderline and antisocial personality disorders based on Orem’s Model and the nursing process.

  1. Describe nursing interventions for behaviors associated with personality

disorders including the techniques of limit-setting, confrontation and time-out.
Substance-Related Disorders

  1. Differentiate between substance abuse, dependence, intoxication, and

withdrawal.

  1. Identify symptoms of intoxication, withdrawal and dependence from:

alcohol, sedative- hypnotics, anxiolytics, CNS stimulants, opioids, hallucinogens, and cannabis.


  1. Discuss the major biopsychosocial theories explaining the causes of

substance related disorders.

  1. Explain the dynamics of codependency.

  2. Identify common nursing diagnosis, goals, interventions and outcome

criteria for the care of the patient and family affected by substance-use disorders and substance-induced disorders.

  1. Identify topics for patient and family teaching relevant to substance-use

disorders and substance-induced disorders

  1. Describe modes of pharmacological and psychosocial treatment for the

patient with substance-related disorders.
Eating Disorders

  1. Compare and contrast the epidemiology and symptoms of the following

eating disorders: anorexia nervosa, bulimia nervosa, and obesity.

  1. Identify etiological implications in the development of eating disorders.

  2. Discuss terms related to family influences in eating disorders:

enmeshment, over protectiveness, rigidity, and conflict avoidance.

  1. Identify common nursing diagnoses, goals and interventions for patients

with eating disorders, including nutritional rehabilitation, psychotherapy, maintenance, and follow-up care.

  1. Describe strategies for safe refeeding of the underweight and

malnourished patient.

  1. Discuss the treatment goals of nutritional care for patients with anorexia

nervosa or bulimia.

Anxiety Disorders


  1. Differentiate between normal anxiety and abnormal anxiety.

  2. Describe the clinical manifestations of the following anxiety disorders

generalized anxiety disorder, panic disorder, phobic disorders, obsessive-compulsive disorder, and post-traumatic stress disorder.

  1. Describe nursing interventions for behaviors associated with anxiety.

  2. Assess symptoms, identify common nursing diagnoses, and develop a

nursing care plan for a simulated patient with an anxiety disorder based on Orem’s Model and the nursing process.
Anxiety-Related Disorders

1. Define somatoform disorders



  1. Differentiate between the diagnostic categories of somatoform disorders

and psychological factors affecting physical functioning.

  1. Define conversion disorder, body dysmorphic disorder, pain disorder,

hypochondriasis, and somatization disorder.

  1. Identify physical problems affected by psychological factors.

  2. Identify common nursing diagnoses, goals and interventions for patients

with psychophysiological disorders.
Victims of Abuse

  1. Define sexual, physical and psychological abuse.

  2. Define physical and emotional neglect.

  3. Identify behaviors and clinical evidence of abuse, neglect and exploitation.

  4. Identify characteristics of persons at risk for becoming abuse victims or

perpetrators.

  1. Discuss nursing care for abuse victims.

  2. Discuss the legal issues of reporting and documentation of abuse.

  3. Describe common feelings among nurses encountering abuse victims and

victimizers in the health care setting and the effect of these reactions on

nursing care.


Psychiatric Disorders First Diagnosed in Infancy, Childhood or Adolescence

  1. Identify symptomotology associated with the following psychiatric

disorders usually first diagnosed in infancy, childhood or adolescence: Mental Retardation, Autistic Disorder, Attention Deficit Disorder/Hyperactivity Disorder, Conduct Disorder, Oppositional Defiant Disorder, Tourette’s Syndrome, Separation Anxiety Disorder.

  1. Identify nursing diagnoses common to clients with the above disorders.

3. Describe treatment modalities relevant to the above disorders.

lV. Methods of Presentation:

Lectures, discussions, role play, case studies, small group work, assigned readings and videos, and computer assisted instruction.



      1. Course Content:


Coverage Topic

12.5%


Introduction to Psychiatric-Mental Health Nursing

Concepts of Mental Health and Mental Illness

Ethical and Legal Issues

12.5%


Therapeutic Communication and the Therapeutic Relationship

12.5%


Psychiatric Nursing Process

Treatment and Intervention Modalities

Psychopharmacology

12.5%


Application of the Nursing Process for People with Schizophrenia and Other Psychotic Disorders

Application of the Nursing Process for People with Mood Disorders



12.5%

Application of the Nursing Process for People with Substance-Related Disorders

Understanding Grief and Suicide


12.5%

Application of the Nursing Process for People with Anxiety Disorders

Application of the Nursing Process for People with Anxiety-Related Disorders

Crisis Intervention


12.5%

Application of the Nursing Process for People with Personality Disorders

Anger Prevention and Management


12.5%

Application of the Nursing Process for People with Eating Disorders

Application of the Nursing Process for People with Psychiatric Disorders First Diagnosed in Infancy, Childhood or Adolescence





Vl. Methods of Evaluation:


  1. Exams are multiple choice, fill-in, short answer and essay. Other projects (if assigned) will be graded according to specified guidelines.

  2. Students must pass both Nursing 25 (theory) and Nursing 25 L (clinical) in order to successfully pass N 25 and progress to the next course.

  3. A passing grade in the nursing program begins at 75% of the total possible course points. A final score below 75% is considered a failing grade. A failing grade in Nursing 25 L constitutes a failing grade in Nursing 25 regardless of the percentage of points earned in the theory course.

Assignments 5 %

Exams and quizzes 52%

Final Exam 43 %


A = 92% – 100%

B = 83% – 91%

C = 75% – 82%

D = 70% – 74%



F = 0% – 69%





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