SONOMA STATE UNIVERSITY
Department of Nursing
Spring Semester, 2003
Nursing 206
Course Syllabus

Instructor: Deb Kindy, RN, PhD
Class: Tuesdays 8-10:50am
Room: Salazar 2009 A
Office: Nichols 272
Telephone: 664-2438:
e-mail: deb.kindy@sonoma.edu
Office Hours: Tuesdays, 12:30-2:30pm or by appointment

 

Table of Contents

Quiz Policy

Computer Threaded Discussion Group

Student Presentations

Presentation Planning Sheet

Group Member Participation Collaboration

Midterm evaluation form

Autobiography in Five Chapters

Course Description

This course introduces psychiatric/mental health theoretical foundations of nursing practice. Physiological and psychosocial concepts are explored from individual, family and community perspectives, with an emphasis on primary, secondary and tertiary prevention; the therapeutic use of self; and the appropriate nursing interventions to sustain the individual and family coping with psychopathology.

 

Educational Methods

Educational methods include lectures, group discussions, audiovisuals, collaborative and computer exercises, reading and written assignments, student presentations and guest speakers.

 

Evaluation Methods

A.     Examinations (3) contributing 15% each to your final grade (45% of final grade).

B.     Group presentation and paper contributing 20% of final grade.

C.    Class quizzes/exercises contributing 10% of final grade

D.     Computer exercises contributing 15% of final grade

E.       ATI exam contributing 5% of final grade.

Exams.....................................................45%
Group presentation and paper.............20%
Quizzes/exercises..................................10%
Computer exercises..............................15%
ATI exam...................................................5%
                                                   Total = 100%

 

A final grade of C must be earned to progress in the nursing major.

Required Text

Varcarolis, E. (2002). Foundations of Psychiatric Mental Health Nursing (4th ed.). Philadelphia: W. B. Saunders Company

Varcarolis, E. (2000). Psychiatric Nursing Clinical Guide. Philadelphia: W. B. Saunders Company

Texts and Instructions for Extra Credit

If you would like to earn extra credit or simply venture into very different worlds affecting mental health, the following selections are offered.  Both books can be accessed through Amazon.com or in many local bookstores and are relatively short.  Earn 4 points to be added to your final cumulative class score.

Morrison, T. (1994). The Bluest Eye. New York: Plum

Read then write a three page paper about The Bluest Eye. Your paper should briefly address the psychological impact on Pecola Breedlove, of her sociopolitical, physical and/or economic environment. The book addresses problems common in today's world, but often ignored by "polite" society. Powerful, disturbing, insightful and unforgettable, this book is not for the faint of heart.  The author is the winner of a Nobel and Pulitzer Prize.

 

Ehrenreich, B. (2001).  Nickel and Dimed.  New York: Henry Holt and Co.

Read, then write a three page paper answering the following questions about the book Were your perceptions of blue-collar Americans transformed or reinforced by this book?  How did poverty influence mental health for the author and those with whom she worked?  Will this influence your own treatment of career waiters, maids and salespeople?  While working for The Maids, the author hears Ted claim that he’s “not a bad guy….and cares a lot about his girls.”  How do the assumptions of supervisors such as Ted affect their employees?

Course Objectives

February 4:

Mental health and mental illness
Mental health nursing in the acute psychiatric hospital setting
 

Assignments: Varcarolis; Chapters 1 & 5  Appendix A

Thought for the week: We see the world not as it is, but as we are.

Objectives:

1) Assess your own mental health using the five signs of mental health in Chapter 1
2) Summarize factors that affect mental health and how they influence a holistic nursing assessment
3) Discuss dynamic factors that contribute to making a clear-cit definition of mental health elusive
4) Explain how epidemiological studies can improve medical and nursing care
5) Demonstrate how the DSM-IV-TR multiaxial system can influence a clinician to consider a broad range of information before making a DSM diagnosis
6) Compare and contrast the difference between DSM -IV-TR diagnosis and a nursing diagnosis
7) Give examples of norm considerations and other cultural influences possible affect on accurate DSM-IV-TR diagnosis
8) Analyze the psychiatric hospital experience from the client's perspective
9) Explain collaboration within the mental health team
10) Describe the role of the nurse as advocate and provider of care
11) Explain interrelationships among the managed care system, the clinical pathways, and the role of the case manager
12) Discuss the managerial and coordinating roles of nursing on an inpatient acute care unit

Websites:
www.apna.org
www.nursefriendly.com/nursing/directory/spec/psych.html
www.nursefriendly.com/nursing/humor/psychiatric.jokes.nursing.humor.html
www.rpnam.mbca/links.html

February 11

Assessment Strategies and the Nursing Process

    Relevant Theories and Therapies for Nursing Practice

Developing Therapeutic Relationships

The Clinical Interview and Communication Skills
 

Assignments: Varcarolis; Chapters 2, 9, 10 & 11, Appendix C

Thought for the week: Let go. Why cling to the pain and the wrongs of yesterday? Why hold on to the very things that keep you from hope and love? Buddha

Video: Conducting the Patient Interview (library reserve)

 

Understanding biological basis of psychotropic drugs
Legal and ethical guidelines for safe practice

Assignments: Varcarolis; Chapters 3 & 8: Appendix D & E

Thought for the week: We are what we think. All that we are arises with our thoughts. With our thoughts, we make our world. Buddha

---

 

February 25

Mood disorders: depression and bipolar disorders
Understanding stress and holistic approaches to stress

Assignments: Varcarolis; Chapters 12, 18 & 19;

Video: Depression and Manic Depression (library reserve)

Thought for the week: From this hour I ordain myself loos'd of limits and imaginary lines. Walt Whitman

Objectives:

1) Compare major depression and dysthymia
2) Discuss links between the stress and biological model of depression
3) Identify and discuss the areas of assessment for a depressed person
4) Name unrealistic expectations that a nurse may have while working with a depressed person and compare them with your reactions
5) Identify six principles of communication appropriate for a depressed person
6) Identify the special considerations in terms of nutrition, elimination, rest and sleep, hygiene and activities and recreation for a depressed person
7) Identify side effects, actions and drug interactions for the various antidepressants
8) Identify foods and drugs that are contraindicated with MAOI's
9) Describe the procedures used in ECT and important nursing actions before, during and after the procedure.
10) Explain the rationale for 5 principles of communication that may be used with a client in the manic phase of bipolar disorder
11) ID the expected moods, behaviors and thought processes of a client with mania
12) Identify interventions for the nutritional, rest and sleep, elimination, dress and hygiene and physical activities needs of the client in the manic phase of bipolar disorder.
13) Identify side effects with lithium, early signs of lithium toxicity, advanced signs of lithium toxicity and severe toxic effects of lithium
14) Describe areas for client education relative to lithium carbonate
15) Distinguish between early and severe lithium toxicity
16) What behaviors are indications for the use of seclusion with a person who is in the manic phase of bipolar disorder
17) Distinguish between the focus of treatment for a person in the acute manic phase and that of a person in the continuation or maintenance of a bipolar 1 disorder
18) Recognize the short and long-term physiolocial consequences of stress
19) Identify the relation between stress and anxiety
20) Analyze the ways in which culture can affect a person's perception and reaction to stress
21) Differentiate between four categories of coping and give at least 2 examples of each
22) Discuss at least two behavioral techniques to lower stress and anxiety
23) Explain how cognitive techniques help lower stress


Websites:

http://bipolar.about.com/health/bipolar/mbody.htm
www.pendulum.org
www.mentalhealth.com/dis/p20-nd02.html
www.depression.com
www.psycom.net/depression.central.html
www.depression.about.com/health/depression/mbody.htm
www.mhsanctuary.com/bipolar/chat.html/

March 11
Schizophrenia and other psychotic disorders
Severe mental illness: crisis stabilization and rehabilitation

Assignments: Chapter 20 and 28

Edwards, C. (1997). Understand. In J. Young-Mason (ed.) The Patient's Voice: Experiences of Illness. Philadelphia: F. A. Davis Company. pp.49-52 - Two copies on reserve in library

Write a brief essay about the Edward essay addressing the following:

How would you approach someone who is experiencing delusions? Discuss the
viability/reality of the author's suggestions for a creative approach.

Turn it in at the beginning of class.

Video: I'm Still Here (in class

Thought for the week: After all, what is reality anyway - nothing but a collective hunch. Lily Tomlin

Objectives:

1) Describe the progression of symptoms from the prodromal to the acute phase of schizophrenia
2) Discuss the neurobiological, anatomic, and viral research findings the indicate schizophrenia is a neurological disease
3) Differentiate between the positive symptoms and negative symptoms of schizophrenia.
a. How do they respond to standard antipsychotic medications
b. How do they affect quality of life
c. How do they influence the appearance and prognosis of the disease
4) Identify common reactions of nurses when working with clients with schizophrenia
5) Identify interventions for a client who is hallucinating, delusional and exhibiting looseness of association
6) Describe elements of client education for those taking antipsychotic drugs
7) Compare the properties of the standard and atypical antipsychotic drugs in relation to:
a. Target symptoms
b. Indications for use
c. Side effects and toxic effects
d. Needs for client and family education and follow-up
8) Identify individual, family and group therapy useful for clients with schizophrenia and their families.
9) Differentiate among the three phases of schizophrenia as to symptoms, focus of care, and need for interventions
10) Plan nursing interventions for a client with paranoid, agitated, withdrawn and disorganized symptoms in terms of:
a. Counseling techniques
b. Self-care needs
c. Therapeutic milieu
11) Discuss the behavioral and psychological manifestations of severe mental illness as it relates to the person's daily functioning, non-adherence to treatment and interpersonal relationships
12) Describe the reciprocal relationships between the family and the mentally ill person
13) Explain the role of case manager in the care of the severely mentally ill person
14) Explain the role of the nurse in the care of the severely mentally ill person
15) Analyze why it is important for a severely mentally ill person to work

 

March 18

Personality disorders
Anger and aggression
Crisis

Assignments: Chapters 16, 22 & 24

Videos: Violence and Aggression (library reserve)

The Mind of a Killer (library reserve)

Between the Lines: (library reserve) poetic account of self-mutilation from the perspective of those doing it (library reserve)

Thought for the week: In the midst of winter, I finally learned that there was in me, an invincible summer. Albert Camus

Objectives:

Websites:

http://pdf.uchc.edu
http://personalitydisorders.mentalhelp.net/
www.health-center.com/english/brain/personality
www.mentalhealth.about.com/health/mentalhealth/cs/personalitydisordrs/index_2.hml
www.expage.com/pag/bpdchat
www.focusas.com/personalitydisorders.html
www.personalityresearch.org/pd.html
www.hollandcrosspsych.com/cdpd.htm

 

March 25

Understanding anxiety and anxiety defenses
Anxiety disorders

Assignments: Chapters 13 & 14

Video: Twitch and Shout (library reserve)

Fight or Flight (library reserve)

Thought for the week: Forgiveness is giving up all hope of a better past. Frederick Luskin

Objectives:

1) Identify various theories of the causes of anxiety disorders
2) Describe clinical manifestations of each anxiety disorder
3) Identify examples of primary and secondary gain
4) Describe clinical manifestations, nursing interventions and realistic outcome criteria for each anxiety disorder
5) Identify psychiatric treatment modalities useful for each anxiety disorder
6) Discuss medication teaching plans persons taking anxiolytics
7) Recognize feelings that are commonly experienced by nurses caring for clients with anxiety disorders
8) Explore the difference between normal, acute and chronic anxiety
9) Compare nad contrast the 4 levels of anxiety in relation to perceptual field, ability to learn and physical and other defining characteristics
10) ID five properties of defense mechanisms
11) Define mature, neurotic, immature and psychotic defense mechanisms

April 15

People with eating disorders
Somatoform and dissociative disorders

Assignments: Varcarolis; Chapter 15 & 17

Video: The Hunger Within (library reserve)

Thought for the week: Have light hearted compassion for yourself

Objectives:

1) Distinguish between somatoform disorder and dissociative disorders
2) Discuss theories of the causes of somatoform and dissociative disorders
3) Identify characteristics of somatoform and dissociative disorders according to DSM IV
4) Discuss some common reactions that nurses experience when working with clients with somatoform disorders and clients with dissociative disorders
5) Plan interventions for clients with somatoform disorders and dissociative disorders
6) Describe how the psychosocial assessment is particularly useful for clients with somatoform disorder.
7) ID interventions for a somatizing client who is receiving lots of secondary gain from their symptoms
8) Describe the differences between amnesia and fugue
9) List at least eight questions useful in assessing a client with DID
10) ID the most important outcome criteria for clients with DID
11) ID factors that make therapy complex and challenging (e.g. cognitive, comorbid, and interpersonal factors) for a person with DID
12) Identify major theories of eating disorders
13) Compare the signs and symptoms of anorexia nervosa with those of bulimia nervosa
14) Identify life-threatening conditions for those with anorexia and bulimia
15) Recognize which therapeutic interventions are appropriate for the acute phase of anorexia and which are appropriate for the long-term phase of treatment
16) Explain the basic premise of cognitive-behavioral therapy in the treatment of anorexia nervosa
17) Describe seven group dynamics or themes seen in families with a member who has an
eating disorder

Websites:

www.mental-health-matters.com/dissoci.html
www.voiceofwomen.com/center/html
www.eatingdisorders.about.com/health/eatingdisorders/mbody.htm
www.somethingfishy.org/
www.purgatory.net/merits/somatoform.htm
www.intelihealth.com/IH/ihtIH/WSIHW000/8271/8656.html
www.mhsanctuary.com/ptsd/chat.html

 

April 22

Suicide
Family Therapy

Assignments: Varcarolis, Chapters 23 & 35

Computer Threaded Discussion Group: Exercise 1 (see syllabus, page 18)

Video: On Our Own Terms, part 3 (library reserves)

Gay Youth (library reserve)

Thought for the week: What lies in our past and will emerge in our future is small indeed compared to what we have right now.

Objectives:

1) Describe the profile of suicide in the United States, including clues, professions at risk, most common psychopathology, populations at risk, and when people may commit suicide
2) Identify common precipitating events
3) Using the SAD PERSON scale, explain the ten risk factors to consider when assessing for suicide
4) Describe expected reactions a nurse may have when beginning work with suicidal clients
5) Give examples of primary, secondary and tertiary interventions
6) Distinguish between interventions the nurse may carry out

a. In the community
b. In the hospital
c. On a telephone hotline

7) Formulate a "no suicide" contract
8) Develop a care plan for a client in the hospital and in the community
9) Compare diverse forms of family
10) Identify characteristics of a healthy family
11) Identify outcome criteria that a nurse and family might develop
12) Compare and contrast the insight-oriented models of family therapy with behavioral family therapy
13) Identify family theorists and their contributions
14) Analyze the meaning and value of the family's sociocultural context when assessing and planning intervention strategies
15) Formulate outcome criteria a counselor and family might develop
16) Explain the importance of the nurse's role in psychoeducational family therapy
17) Identify some strategies for family intervention

Websites:

www.metanoia.org/suicide/
http://suicidecrisiscenter.com
www.save.org/
http://suicide.mentalhelp.net/
www.siec.ca/
www.yellowribbon.org
www.hemlock.org/

April 29

Family Violence
Sexual Assault

Assignments: Varcarolis; Chapters 25 & 26

Videos:Domestic Violence and Childhood Trauma, part 6 (library reserve)

Recovery From Sexual Abuse (library reserve)

Thought for the week: I love you for putting your hand into my heaped-up heart, and passing over all the foolish and frivolous and weak things...and for drawing out into the light all the beautiful, radiant belongings that no one else had looked quite far enough to find. Anonymous

Objectives:

1) Discuss the epidemiological theory of violence in terms of stresses on the perpetrator, vulnerable person, and environment that could escalate anxiety to the point violence becomes the relief
2) Compare 3 characteristics of perpetrators with 3 characteristics of vulnerable persons
3) Name 3 indicators of physical violence; sexual violence; neglect; emotional violence
4) Describe 4 areas for assessment of a person experiencing family violence
5) Identify interventions appropriate for working with the perpetrator and victim
6) Describe a safety plan including the essential elements for an abused spouse
7) Compare primary, secondary and tertiary levels of intervention
8) Identify 2 common emotional responses of nurses when working with a person experiencing family violence
9) Describe possible referrals for a violent family in this or your home community
10) Discuss psychotherapeutic modalities useful for violent families
11) Define sexual assault and differentiate between its subtypes
12) Discuss reasons rapes go unreported
13) Distinguish between the acute and long-term phases of the rape-trauma syndrome and identify some common reactions during each
14) Identify areas to assess when working with a person who has been sexually assaulted
15) Formulate long-term and short-term outcomes for a rape survivor
16) Analyze your thoughts about the myths of rape and its impact on survivors
17) ID six overall guidelines for nursing interventions
18) Identify counseling techniques that are useful when working with a person who has been sexually assaulted
19) Describe the role of a sexual assault nurse examiner
20) Discuss the responsibilities of the nurse when a rape survivor is discharged from the emergency department
21) Describe the nurse's role when staffing a rape-crisis hotline
22) Discuss the long-term psychological effects of sexual assault that might lead to psychotherapy
23) Identify outcome criteria that would signify phases of recovery for a person surviving a
sexual assault

Websites:

www.fvpf.org/
www.famvi.com/
www.ama-assn.org/public/release/assault/fv-guide.html
www.dmoz.org/society/issues/violence/family_violence/
www.vix.com/men/abuse/abuse.html
www.rainn.org/
http://members.aol.com/ncmdr/
www.geocities.com/HotSprings/2402

 

 

May 6

Care of the chemically impaired
Therapeutic groups

Assignments: Varcarolis; Chapters 27 & 34

Computer Threaded Discussion Group: Exercise 2 (see syllabus page 18)

Video:Nursing Care of Clients with Substance Abuse (library reserve)

Group Work with Prison Population (library reserve)

Thought for the week: Rejoice in other people's success knowing there is plenty for everyone. Louise Hay

Objectives:

1) Compare the terms substance abuse and substance dependence
2) Explain the difference between tolerance and withdrawal, and give a clinical definition of each
3) Discuss the assessment process to be used with a person who is chemically dependent
4) Describe enabling behaviors
5) Describe the difference between the behaviors of an alcoholic person and a nondrinker in relationship to blood alcohol levels.
6) Contrast the symptoms of alcohol withdrawal and delirium
7) Discuss treatment for a person who is withdrawing from alcohol delirium, including nursing care and pharmacology
8) Compare the signs of intoxication, overdose, and withdrawal symptoms from cocaine and amphetamine use
9) Compare the symptoms of narcotic intoxication and those of narcotic withdrawal
10) Evaluate the effects of the techno drugs ecstasy, Rohypnol, Eve and other recreational drugs
11) Discuss the synergistic and antagonistic effects of drugs in polydrug abusers and give an example of each
12) Analyze the pros and cons of the following treatments for narcotic addictions:

a. Methadone or L-alpha acetylmethadol (LAAM)
b. Maintenance
c. Therapeutic communities
d. Self-help, abstinence-oriented model

13) Identify principle of psychotherapeutic intervention for a substance abusing client
14) Recognize the phenomenon of relapse as it effects substance abusers during different phases of treatment
15) ID steps for relapse prevention
16) Discuss therapeutic modalities used with substance abusers
17) List appropriate steps you would take in observing a chemically impaired coworker
18) Identify indicators that a person is successfully recovering from substance abuse
19) Identify the basic concepts used in group therapy
20) Describe the different roles group members may adopt
21) ID three facilitating techniques in a small group setting
22) Distinguish between the guideline for developing an inpatient and outpatient group
23) Compare the four phases of group development
24) Identify interventions for group members who monopolize, complain but reject help and chronically helps others
25) Identify intervention possibilities when leading a group for people with serious and persistent mental illness; people with a mental disorder and substance abuse; and people with an eating disorder

Websites:

www.medicineau/cllinical/icu/articles/subabuse.html
www.texmed.org/cme/phn/aap/statistics.asp
www.nida.nig.gov/HSR/da-tre/BrownComordibity.html
www.dmoz.org/Health/Substance_Abuse/alcoholism/chats_and_Forums

May 13

STUDENT PRESENTATIONS: Groups 1 - 4

May 20

STUDENT PRESENTATIONS: Groups 5 - 8

Thought for the week: The tectonic layers of our lives rest so tightly one on top of the other that we always come up against earlier events in laters ones, not as matter that has been fully formed and pushed aside, but absolutely present and alive. Bernhard Schlink

May 27

FINAL EXAM

Thought for the week: Success is:

To laugh often and love much;
To win the respect of intelligent persons and the affection of children;
To earn the approbation of honest citizens and endure the betrayal of false friends;
To appreciate beauty;
To find the best in others;
To give of one's self;
To leave the world a bit better, whether by a healthy child, a garden patch or a redemmed social condition;
To have played and laughted with enthusiasm and sung with exultation;
To know even one life has breathed easier because you have lived-
This is to have succeeded.
Ralph Waldo Emerson

Quizzzzzz Policy

Make up quizzes will not be allowed for any reason if class is missed or you arrive after the quiz is completed. Quizzes will be given during the first 5 to 10 minutes of class. Please drive safely and plan accordingly, perhaps leaving home a bit earlier.

Each quiz will consist of 1 (essay) or 5 to 10 (multiple choice, T, F or short answer) question/s taken from the reading assigned for that week. For those who miss class you may make up points by doing the extra credit assignment.

Computer Threaded Discussion Groups

- Each group has it's own bulletin board within which to work. It is located on the class website

- All assignments are group specific. That means you work only within your group for all assignments. This will cut down tremendously on your work.

- All parts must be completed to attain points. Partial points for partial completion will not be awarded. Conciseness (written in a few well chosen words), and organization are essential to produce a clear opinion in one paragraph.

I will grade according to posting deadlines, participation, critical thinking, conciseness and appropriate information exchange. Do not write platitudes such as "Great job, I agree 100%" when critiquing another's ideas. You may indeed agree with the person, but why do you agree? What aspects of the opinion resonate with you and why? How might the opinion be challenged for deeper thinking? Remember, you each have your own perspective based on life experience and to some extent genetics. No one perspective is more valuable than another. Give yourself a treat and try on some different glasses this semester. You can accept a person's opinions without assuming or condoning them.

If you post past the deadline it will create a domino effect within the group so for the sake of your colleagues, be sure to post on time.

Group 1: Shino, Christie, Sadie, Mary, Healther, Carol B.

Group 2: Amy, Megan, Nicole F., Elizabeth, Rachelle, Rosa

Group 3: Lisa, Laura, Natalie, Erin, Keely, Nichole S.

Group 4: Katie, Kathryn, Alyson, Tammy, Veronica, Kimberly

Group 5: Carol H, Nanci, Maria, Jessica, Jane, Lorraine

Group 6: Sonya, Elaine, Julie, Angelique, Linda, Kathy