San Pablo Colleges College of Nursing San Pablo City

SECOND SEMESTER A.Y. 2012-2013 TO 2015-2016 RESOURCE UNIT

COURSE NAME: COURSE CODE:

CARE OF CLIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR NCM 105

COURSE DESCRIPTION: The course is designed to focus on health and illness across the lifespan of clients, population groups with acute and chronic psychosocial difficulties and psychiatric illnesses. COURSE CREDIT: 4units lecture ; 2units RLE (2units Clinical)

CONTACT HOURS/SEM: 72 Lecture hours; 102 RLE hours PREREQUISITE: CO-REQUISITE: PLACEMENT : General Psychology, NCM 103 NCM 104 3rd Year; 2nd semester

TERMINAL COMPETENCIES :At the end of the course, and given actual clients with maladaptive patterns of behavior, the student shall be able to: 1. Utilize the nursing process in the care of individuals, families in community and hospital settings. Assess client/s with his/her/their condition through mental status examination, physical examination, interpretation of diagnostic procedures. Identify actual and potential nursing diagnosis. Plan appropriate nursing interventions with client/s and family for identified nursing diagnosis. Implement plan of care with client/s and family. Evaluate the progress of his/her/their clients condition and outcomes of care.

2. Apply knowledge and understanding of maladaptive patterns of behavior in providing safe and quality care to clients. 3. Increase self-awareness and therapeutic use of self in the care of clients. 4. Ensure a well-organized and accurate documentation system. 5. Relate with client/s and their family and the health team appropriately. 6. Observe bioethical concepts/ principles, core values and nursing standards in the care of clients. 7. Promote personal and professional growth of self and others.

CORE VALUES:

Students are expected to: 1. Attain an understanding of core values of the nursing program. 2. Incorporate the core values of San Pablo Colleges which are Righteousness ( Discipline, Awareness, Respect and Excellence ) and Service (Word of God, Work, and Witness).

Specific Objectives Explain the history of psychiatry as a foundation for current psychiatric nursing practice. Identify terms related to mental health concepts. Describe characteristics of mental health and mental illness.

Content I. Overview of psychiatric nursing A. Evolution of mental healthpsychiatric nursing practice B. The mental health nurse 1. Role 2. Essential qualities C. Interdisciplinary team D. The mental health illness continuum II. Mental health-psychiatric nursing practice

Teaching Learning Activities Teacher:Lecture Discussion Film showing: Assign or have students to watch One Flew Over the Cuckoos Nest (1975) by United Artists. This movie will give students a sense of treatment in large institutions in the 1960s.

Resource Material Psychiatric Mental Health Nursing by Sheila Videbeck 4th edition (2008) pp 3-15.

R.L.E. Have students begin their reflective journal the day before their first clinical experience. They can reflect about the feelings they have as they anticipate this new venture. Later in the clinical experience, students can reflect on this entry to see how their feelings may have changed.

Time Evaluation Allotment 4 hrs Oral or written analysis of the film.

A. Personality theories and determinants of psychopathology: Implications for mental healthpsychiatric nursing practice 1. Psychoanalytic 2. Behavioral 3. Interpersonal Identify how several 4. Cognitive of the theoretical 5. Humanistic perspectives have 6. Psychobiologic influenced current 7. Cognitive nursing practice. 8. Psychosocial 9. Psychospiritual 10.Eclectic Explain the basic beliefs and approaches of different personality theories.

Students: Case Study Using small groups, give the students a case study and ask them to describe how the client and problems in the case would be approached by different therapists. Library Activity: Loof for the different Defense Mechanism and give 2 examples each

Psychiatric Mental Health Nursing by Sheila Videbeck 4th edition (2008) pp 45-55

Have students assess their assigned clients according to Eriksons stages of growth and development. Ask them to compare each clients stage of development with his or her chronologic age.

4 hrs Written Output Quiz

Specific Objectives Identify the categories used to assess the clients mental status.

Content B. General assessment considerations 1. Principles and techniques of Psychiatric nursing interview 2. Mental status examination 3. Diagnostic examinations specific to psychiatric patients C. Building nurse-client relationship 1. Nurse-client interaction vs. nurse-client relationship 2. Therapeutic use of self 3. Therapeutic communication a. Characteristics b. Techniques 4. Goals in the one-to-one relationship 5. Phases in the development of nurse-client relationship D. Documentation in psychiatric nursing practice 1. Problem-oriented recording a. SOAP 2. Narrative recording 3. Process recording E. Therapeutic modalities, psychosocial skills and nursing strategies 1. Biophysical /somatic interventions a. Electroconvulsive and other somatic therapies b. Psychopharmacology

Teaching Learning Activities Teacher: Ask students to complete the McMaster Family Assessment Device in Box 8-3 in the textbook.

Resource Material Psychiatric Mental Health Nursing by Sheila Videbeck 4th edition (2008) pp 144-145 Psychiatric Mental Health Nursing by Sheila Videbeck 4th edition (2008) pp 83-98

R.L.E. In the National Institute for Mental health Assign students to complete a psychosocial assessment using the Psychosocial Assessment Tool form.

Time Evaluation Allotment 4 hrs Written Output Quiz

Describe the importance of selfawareness and therapeutic use of self in the nurseclient relationship.

Library Activity: Assignment: Identify the different therapeutic communication technique and non thereapeutic communications style. Students can practice what they would say to a client in a variety of hypothetical situations. This can be done in roleplaying fashion in small groups

4 hrs Class Participatio n Recitation

Ask students to identify which phase of a therapeutic relationship was evident during interactions with assigned clients. They should be able to give specific examples of Psychiatric what was said or done Nursing:Biological to support the and Behavioral identification of the Conceopts by phase. Deborah Antai Otong (2007) pp 107-111 Psychiatric Mental Health Nursing by Sheila Videbeck 4th edition (2008) pp 56-60, 305-308

Quiz 1 hr

Describe psychosocial treatment modalities.

Teacher: Lecture/Duscussion Powerpoint presentation

8 hrs Quiz

Specific Objectives Develop a plan of care using biological and behavioral interventions.

Content 2. Supportive Psychotherapy a. Nurse-patient relationship therapy b. Group therapy c. Family therapy 3. Counseling 4. Mental health teaching/client education 5. Self-enhancement, growth/therapeutic groups 6. Assertiveness training 7. Stress management 8. Behavior modification 9. Cognitive restructuring 10. Milleu therapy 11. Play therapy 12. Psychosocial support interventions 13. Psychospiritual Interventions 14. Alternative Medicine /Therapies

Teaching Learning Activities Student: Group discussion about the benefits of pharmacological and non-pharmacological interventions in the treatment of specific mental disorders and the relevance of the biological-behavioral interface. Use a debate and focus on alternative therapies versus traditional therapies to treat anxiety disorders

Resource Material Psychiatric Nursing:Biological and Behavioral Conceopts by Deborah Antai Otong (2007) pp 693-836

R.L.E. Invite an advanced practice psychiatric nurse to present various pharmacological agents, emphasizing their major behavioral and biological effects.

Time Allotment

Evaluation Group Report

Active Participation

End of Prelim

F. Concept of Anxiety 1. Defining characteristics of Anxiety 2. Levels of Anxiety Discuss the use of 3. Manifestations of Levels of defense Anxiety mechanisms by a. Physiologic people with anxiety. b. Psychologic 4. Ego Defense Mechanisms a. Four levels of Defense Describe anxiety as response to stress.

Student: Recall and assess their own anxiety levels during their clinical experience.

Psychiatric Mental Health Nursing by Sheila Videbeck 4th edition (2008) pp 242-245

Assign the student to work with an anxious client. The student can assess the clients anxiety level.

4 hrs Recitation

Specific Objectives Relate crisis to stress and identify approaches to crisis intervention.

Content

G. Crisis 1. Types of crisis 2. Phases of Crisis Development 3.Characteristics of Crisis 4. Crisis Intervention III. Care of clients with maladaptive patterns of behavior across the lifespan (childhood, adolescent, adulthood) A. The Nursing Process applied to Utilize the nursing Psychiatric Nursing Practice: process in 1. Assessing human response to psychiatric nursing the different maladaptive patterns practice. of behavior a. Self-awareness and Use of Review major Self components of the b. Bio-Psycho-Social and nursing process. Behavioral data Develop an 2. Nursing Diagnosis and individualized plan Outcome identification of care for the client 3. Planning and implementing with a mental nursing intervention illness. a. Biological b. Psychosocial 4. Evaluation and treatment outcomes Apply knowledge and understanding B. Maladaptive Patterns of of the different Behavior maladaptive 1. Age-Related Maladaptive patterns of behavior Patterns: Disorders Across the by: Lifespan

Teaching Learning Activities Teacher: Case Study Small group discussions: Using small groups, give the students a case study and ask them to describe how the client and problems in the case would be approached by different interventions.

Resource Material Psychiatric Mental Health Nursing by Sheila Videbeck 4th edition (2008) pp 56

R.L.E. Have students identify and assess their clients (and their own) crisis causing situations.

Time Allotment

Evaluation

Students: Discuss a plan of care for specific patients and ask questions that involve the nursing process and critical thinking skills. Library Activity: Look for samples of psychiatric Nursing Care Plans

Psychiatric Nursing:Biological and Behavioral Conceopts by Deborah Antai Otong (2007) pp 107-111

Invite a generalist and advanced-practice nurse to present a case utilizing the nursing process and compare level of approaches and complexity of care.

I hr

Active Participation

Teacher: Lecture Discussions Case examples Audio visuals

Psychiatric Mental Health Nursing by Sheila Videbeck 4th edition (2008)

Select clients and have students identify maladaptive patterns of behavior and disorders.

I hr

Specific Objectives 1.Discussing the etiology of the illness. 2.Assessment of the client including subjective and objective cues. 3.Developing nursing care plan appropriate for a certain disorder. 4,Applying various interventions appropriate for the clients problems. 5.Evaluating the effectiveness of the nursing interventions and treatment modalities to the client. 6.Providing education to the client.

Content

Teaching Learning Activities Student: Role-play various anxiety disorders integrating the nurseclient interaction to depict specific anxiety disorders and the role of the nurse during the interviewing and assessment process.

Resource Material Psychiatric Nursing:Biological and Behavioral Conceopts by Deborah Antai Otong (2007) Psychiatric Nursing by Norman Keltner 5th edition (2006) Psychiatric Nursing by Sia 2nd edition (2008)

R.L.E.

Time Allotment 3 hrs

Evaluation

2. Anxiety-Related Disorders a. Anxiety disorders across the lifespan Panic Disorder Phobias Post traumatic stress disorder Acute Stress disorder Obsessive-compulsive disorder Generalized Anxiety Disorder b. Somatoform disorders Somatization disorder Conversion disorder Hypochondriasis Pain disorder Body Dysmorphic disorder c. Dissociative disorders Depersonalization Psychogenic Amnesia Psychogenic Fugue Dissociative Identity Disorder/ Multiple Personality disorder 3. Psychophysiologic Response and Sleep

Present case histories of clients experiencing anxiety disorders. Discuss several treatment modalities for clients experiencing anxiety disorders such as progressive relaxation, visual imagery, and psychopharmacological interventions.

Active Participation Quiz

Library Activity: Assignment: Identify each symptoms of different anxiety related disorders.

Debate: Use a group discussion concerning sleep disorders to debate the pros and cons of sleep aids such as alternative therapies.

Role-play the data collection process and focus on information about sleeping patterns.

2 hr

Specific Objectives

Teaching Learning Activities 4. Personality Disorders Student: Film Showing of Girl, Interrupted (1999) by a. Childhood Personality disorders Columbia Pictures. This Conduct disorder movie portrays borderline Oppositional Defiant personality disorder, the Behavior diagnosis of the main b. Odd/eccentric behaviors character, and antisocial Paranoid personality personality disorder in disorder one of the supporting Schizoid personality disorder roles. Schizotypal personality Have students assess disorder themselves in relation to c. Dramatic, emotional, erratic the cluster types of behaviors temperament. In small Antisocial personality groups or as a class, they disorder can discuss their findings. Borderline personality Debate: disorder Have students debate the Narsicistic personality issue of whether clients disorder with an antisocial Histrionic personality personality disorder who disorder commit crimes are more d. Anxious, fearful behaviors appropriately managed Obsessive compulsive by the mental health personality disorder system or by the legal system. Dependent personality disorder Film Showing: Avoidant personality disorder Many movies portray e. Passive aggressive substance abuse in very 5. Substance-related disorders: realistic terms. Students substance abuse, dependence, can be assigned to view intoxication, withdrawal and one of these movies, or polysubstance dependence different students can be

Content

Resource Material

R.L.E. Assign students to work with a client with a personality disorder as a primary or secondary diagnosis. In conference, students can be encouraged to talk about the experience. Ask students to discuss the care of a client with a personality disorder with experienced nurses in the clinical setting. What reactions did they observe? What are the major barriers to working with these clients? What beliefs about these clients do experienced staff hold?

Time Evaluation Allotment 4 hrs Oral or written analysis of the film Quiz

Class Participatio n

Assign students to work with a client who has a diagnosis of substance abuse (if such clients are available in the clinical setting). If not, it may be

2 hrs

Oral or written analysis of the film

Specific Objectives

Content a. Central nervous system depressants Alcohol Sedatives-hypnotics and anxiolytics Opioids b. Central nervous system stimulants Caffeine Nicotine Amphetamine and cocaine c. Hallucinogens d. Cannabis e. Inhalants f. Nursing Issues 6. Mood disorders a. Reactive attachment disorder b. Bipolar I disorder c. Bipolar II disorder d. Cyclothymic disorder e. Dysthymic disorder f. Major depressive disorder g. Clients at risk for suicidal and self-destructive behavior

Teaching Learning Activities assigned to view several of the movies, and then to discuss and compare the various stories. Suggestions are When a Man Loves a Woman (1994) by Touchstone Pictures; Clean and Sober (1988) by Warner Brothers; and 28 Days (2000) by Columbia Pictures. In addition, My Name is Bill W. (1989) by Warner Brothers is the story of the men who founded AA in the 1930s. Assign students to watch Mr. Jones (1993) by Columbia Pictures. The symptoms of bipolar disorder, both depression and mania, are portrayed very realistically. In addition, there is the ethical dilemma of a personal relationship between the client and psychiatrist. Small Group: Have students discuss the myths and facts about suicide listed in Box 15-2 in the textbook.

Resource Material

R.L.E. useful to have a guest speaker from a treatment program talk with the class. Ask students to assess the alcohol and/or drug use of clients being treated for another mental illness. What is their family history? Does their alcohol intake increase when they are stressed?

Time Evaluation Allotment Long Quiz

Assign students to work with clients diagnosed with a mood disorder (keeping in mind the severity of the clients disorder). Ask students to discuss how they felt at the end of the experience. Have students recognize how much energy the nurse expends when working with clients with mood disorders.

4 hrs

Specific Objectives

Content 7. Schizophrenia and other Psychoses a. Schizophrenia Catatonic type Paranoid type Undifferentiated type Disorganized type Residual type

b. Other Psychotic disorders Schizophreniform disorder Schizoaffective disorder Delusional disorder Brief psychotic disorder Shared psychotic disorder

8. Cognitive disorders a. Fetal alcohol syndrome b. Attention deficit hyperactive disorder c. Autism d. Delirium e. Dementia f. Alzheimers disease g. Diffuse Lewy body disease h. Korsakoffs disease i. Huntingtons disease j. Picks disease k. Vascular and multi-infarct dementia

Teaching Learning Activities Assign students to view a movie about schizophrenia to discuss in class. A Beautiful Mind (2002) by Universal Studios is based on the life story of John Nash, who struggled with schizophrenia for years and yet won a Nobel Prize. Library Activity: Borrow the VCD of Schizophrenia and make a reaction paper Teacher: Use diverse educational approaches, such as role playing, guest speakers, and Internet web sites, to help students understand the basis of underlying biological disturbances and manifestations of cognitive disorders. Student: Assign students to select a child or adolescent and with a cognitive disturbance and compare the course and symptoms unique to age groups.

Resource Material

R.L.E. In preconference, roleplay how students might respond when a client makes a delusional statement. Assign the student to assess a client receiving antipsychotic medication for side effects. After caring for a client with schizophrenia, discuss any difficulties the student encountered in establishing trust and how the student felt during that experience. Assign students to work with clients diagnosed with a cognitive disorder (keeping in mind the severity of the clients disorder). Ask students to discuss how they felt at the end of the experience. Present several case histories of clients with cognitive disorders and discuss several treatment modalities.

Time Evaluation Allotment 4 hrs Recitation

End of Midterm

4 hrs

Specific Objectives

Content 9. Eating disorders a. Pica b. Rumination c. Feeding disorders d. Anorexia nervosa e. Bulimia nervosa

Teaching Learning Activities Teacher: Use role-playing for an interview with a client with an eating disorder. Use group discussions to review myths about eating disorders.

Resource Material

R.L.E. invite a client in recovery with an eating disorder to discuss her history and current remission. Invite a team that specializes eating disorders to present a case conference. Bring to the conference and discuss items from the media that stereotype men and women in particular wants. Invite a panel that consists of individuals willing to discuss issues relative to sexual orientation.

Time Evaluation Allotment 2 hrs Active Participation

10. Psychosexual disorders a. Gender identity disorder b. Sexual dysfunctions c. Paraphilias

Teacher: Create a client scenario and role model sexual history taking with classmates, and use the comprehensive sexual history model. Student: Present case histories of clients and develop plans of care across the life span. Library Activity: Read in advance reference concerning abuse and violence and differentiate the form abuse in child, spouse and elderly.

2 hrs

Individual Report

Specific Objectives

Content 11. Abuse and violence a. Victims of violent behavior Child Spouse Elderly b. Torture and ritual abuse c. Rape and sexual assault

Teaching Learning Activities Teacher/Student: Select a scenario and ask students to role play interviewing a survivor and perpetrator (separately) and discuss their feelings and thoughts about the experience.

Resource Material

R.L.E. Invite volunteers from local womens shelters to share their experiences. Invite rape crisis counselors to discuss the role of these services and potential volunteer opportunities.

Time Evaluation Allotment 2 hrs Active Participation Quiz

Discuss the history of legal and ethical changes in mental health treatment. Define commonly held ethical principles. Discuss client rights and the application of rights in the clinical setting. Identify legal and ethical issues affecting the psychiatric nurse today and in the future.

C. Legal issues affecting mental health nursing D. Future trends and issues in mental health nursing practice E. Community-based mental health programs

Teacher: Debate Divide students into groups and ask them to debate various legal and ethical issues, including the right to refuse medication, breach of confidentiality, and other controversial topics.

Above mentioned Textbooks Journals Internet sources

Use the ethical decisionmaking model and discuss how you would analyze case examples such as: 1. If a neighbor called to ask for your help in admitting a relative to a psychiatric facility 2. What changes would you like to see take place in your community that would affect mental health care? What could you do directly or indirectly to influence or support these innovations?

4 hrs

3 hrs

4 hrs

End of Finals

REFERENCES: Psychiatric Mental Health Nursing by Sheila Videbeck 4th edition (2008) Psychiatric Nursing:Biological and Behavioral Conceopts by Deborah Antai Otong (2007) Psychiatric Nursing by Norman Keltner 5th edition (2006)

Enriched by:

Prof. Melchor Felipe Q. Salvosa Level III Instructor

Flordeliza N. Ticzon Librarian

Dr. Aloysius M. Quiambao Curriculum Committee

Approved by:

Dr. Anita R. Rico Dean, College of Nursing