RNRS 206: Mental Health Concepts

• Analyze the concept of safety and its impact on health care delivery. \\n
• Summarize the application of the nursing process and clinical judgment in the care of patients with alterations in behavior, stress and coping, mood and affect, cognition, perceptions of self/individual. \\n
• Explain the contents of a teaching plan for patients with alterations in behavior, stress and coping, mood and affect, cognition, perceptions of self/individual. \\n
• Implement therapeutic communication and documentation techniques applied to patient care situations. \\n
• Distinguish the patients' cultural, ethnic, or spiritual needs and its impact on the patient's health and delivery of care. \\n
• Analyze concepts as it applies to caring interventions.

NCLEX Client Need Categories:

Health and illness concepts, professional nursing concepts, health care recipient, and application of concepts to nursing skills. 

Psychosocial Integrity (Health and illness)

• Concept - Stress and coping
  • Exemplars - Effective coping, maladaptive coping strategies, behavioral interventions, crisis intervention, anxiety continuum including panic, PTSD/Trauma Informed Care, anxiety disorders, obsessive-compulsive disorder (OCD), adjustment disorders. 
• Concept - Mood and affect
  • Exemplars - Suicide, depression (including postpartum), mania. 
• Concept - Cognition
  • Exemplars - Delirium and dementia, Alzheimer's disease, psychosis, mental health concepts (acute and chronic, sensory and perception alterations), visual, auditory and cognitive distortions, support systems for patients with impaired cognition. 
• Concept - Behavior
  • Exemplars - Addictive behaviors (substance use and other dependencies), behavioral interventions, assault, violence behaviors abuse across the lifespan, management of assaultive behaviors (MAB) skills. 

Safe and Effective Care Environment: Safety and Infection Control; Psychosocial Integrity (Professional nursing concepts)

• Concept - Safety
  • Exemplars - Safety plan (newborn, violence)
• Concept - Communication
  • Exemplars - Therapeutic and non-therapeutic communication.

Psychosocial Integrity (Health care recipient)

• Concept - Individual/Self
  • Exemplars - Personality disorders, eating disorders

Psychosocial Integrity (Application of concepts to nursing skills)

• Concept - Safety
  • Exemplars - Management of assaultive behaviors
    • Assessing for abuse: Newborn, infant, child, older adult
    • Suicide risk assessment, caring for suicidal patient.

Modules/Learning Objectives

1. Behavior

   1. Discuss the concept of behavior (Ticket to class).

   2. Summarize behaviors that positively affect health (Ticket to class).

   3. Differentiate between adaptive and maladaptive behaviors.

   4. Compare and contrast the relationship between behaviors and other concepts.

   5. Explain the promotion of healthy behaviors and the prevention of addiction, violence or other maladaptive behaviors.

   6. Differentiate common assessment procedures and tests used to evaluate individuals with suspected maladaptive behaviors.

   7. Analyze nursing interventions for patients with maladaptive behaviors.

   8. Summarize collaborative therapies used by interprofessional teams for patients with maladaptive behaviors.

   9. Distinguish lifespan considerations in the care of patients who engage in maladaptive behaviors.

2. Mood and Affect

   1. Analyze the concept of mood and affect.

   2. Differentiate alterations in mood and affect.

   3. Explain the relationship between mood and affect and other concepts.

   4. Explain the promotion of a healthy mood and affect.

   5. Differentiate common assessment procedures and rating scales used to assess mood and affect.

   6. Analyze nursing interventions for patients with alterations in mood and affect.

   7. Implement collaborative therapies used by interprofessional teams for patients with alterations in mood and affect.

   8. Summarize lifespan considerations in the care of patients with alterations in mood and affect.

3. Cognition

   1. Analyze the physiology of normal cognition.

   2. Differentiate alterations in cognition.

   3. Outline the relationship between cognition and other concepts.

   4. Explain measures to promote optimal cognition.

   5. Differentiate common assessment procedures and tests used to evaluate cognition.

   6. Analyze nursing interventions for patients with alterations in cognition.

   7. Examine collaborative therapies for patients with alterations in cognition.

   8. Examine lifespan considerations in the care of patients with alterations in cognition.

4. Stress and Coping

   1. Contrast stress and homeostasis. (Ticket to class)

   2. Review types of stressors and the psychodynamics of coping. (Ticket to class)

   3. Discuss the manifestations and indicators of stress.

   4. Explain the relationship between stress and coping and other concepts.

   5. Differentiate alterations in coping.

   6. Explain the promotion of healthy coping and the prevention of stress-related illness.

   7. Differentiate among common assessment procedures and tests used to evaluate levels of stress and coping mechanisms.

   8. Analyze nursing interventions for patients with alterations in stress and coping.

   9. Compare and contrast collaborative therapies used by interprofessional teams for patients with stress-related illness and alterations in coping.

   10. Determine lifespan considerations related to alterations in stress and coping.

5. Safety

   1. Assume the attributes of safety.

   2. Examine the relationship between safety and other concepts.

   3. Differentiate common assessment data used to examine safety.

   4. Compare and contrast evidence-based interventions that can be implemented to promote patient safety.

   5. Evaluate collaborative efforts used by interprofessional teams for safety in healthcare settings.

6. Communication

   1. Review the process of communication (ticket to class)

   2. Differentiate the various forms of communication (ticket to class)

   3. Outline the relationship between communication and other concepts

   4. Analyze the factors that influence the communication process.

   5. Analyze the barriers to effective communication.

   6. Compare and contrast the types of therapeutic communication

   7. Differentiate considerations related to communication throughout the lifespan

7. Individuals/Self (PCC)

   1. Outline the relationship between the individual/self-concept and other concepts. (ticket to class)

   2. Explain measures to promote optimal individual health (ticket to class).

   3. Analyze the psychosocial processes related to the individual/self.

   4. Differentiate alterations in the individual/self.

   5. Differentiate common assessment procedures and tests used to evaluate the individual’s self-concept.

   6. Analyze nursing interventions for patients with alterations in the individual/self-concept.

   7. Examine collaborative therapies for patients with alterations in cognition.

   8. Examine lifespan considerations related to the development of the individual/self.

Clinical Course Learning Outcomes (Adopted from NOF Toolkit, 2016) 

Patient-Centered Care:

Provide holistic care that recognizes an individual’s preferences, values, and needs and respects the patient or designee as a full partner in providing compassionate, coordinated, age and culturally appropriate, safe and effective care.

Knowledge

• Understands multiple dimensions of patient-centered care including:
  1. Patient/family/community preferences, values. 
  2. Coordination and integration of care. 
  3. Information, communication, and education. 
  4. Physical comfort and emotional support. 
  5. Involvement of family and significant other. 
  6. Care transition and continuity. 

Attitudes/Behaviors

1. Values and respects assessing health care situation from the patient's perspective and belief systems. 
2. Respects and encourages the patient's participation in decisions about health care and services. 

Skills

1. Assesses patient values, preferences, decisional capacity, and expressed needs as part of ongoing assessment, clinical interview, implementation of care plan, and evaluation of care.
2. Communicates patient values, preferences, and expressed needs to other members of health care team. 

Professionalism:

Demonstrate accountability for the delivery of standard-based nursing care that is consistent with moral, altruistic, legal, ethical, regulatory, and humanistic principles.

Knowledge

• Understands the professional standards of practice, the evaluation of that practice, and the responsibility and accountability for the outcome of practice.

Attitudes/Behaviors

1. Accepts responsibility for own behavior. 
2. Respects others during clinical activities (i.e., no talking while others are talking, cell phones are silenced, no inappropriate use of computers).

Skills

1. Implements plan of care within legal, ethical, and regulatory framework of nursing practice. 
2. Demonstrates ability for reflection in action, reflection for action, and reflection on action. 
3. Serves a patient advocate. 
4. Utilizes an ethical decision-making framework in clinical situations. 
5. Complies with the Standards of Practice, policies, and procedures of the nursing program and the clinical agencies. 
6. Completes assignments as required and scheduled. 
7. Provides prior notification to appropriate faculty when they are unable to meet commitments or requirements. 
8. Participates in clinical activities as scheduled, arriving on time and prepared for daily assignments throughout the length of the nursing program. 
9. Demonstrates professional appearance and professional presentation in clinical settings. 
10. Demonstrates respect and politeness to all individuals regardless of culture, ethnicity, religion, work experience, gender, age, and sexual orientation. 
11. Maintains confidentiality of all patient information in conversation, electronic, and written means. 
12. Provides and receives constructive feedback to/from peers and instructors. 

Leadership:

Influence the behavior of individuals or groups of individuals within their environment in a way that will facilitate the establishment and acquisition/achievement of shared goals.

Knowledge

• Identifies leadership skills essential to the practice of nursing. 

Attitudes/Behaviors

1. Recognizes the role of the nurse as leader. 
2. Accepts accountability for nursing care delegated to others. 
3. Recognizes the value of leadership to empower others and enhance collaboration and shared decision making. 

Skills

• Integrates leadership skills of systems thinking, communication, and facilitating change in meeting patient care needs. 

System-Based Practice:

Demonstrate an awareness of and responsiveness to the larger context of the healthcare system, and will demonstrate the ability to effectively call on work unit resources to provide care that is of optimal quality and value (Adapted from ACGME, n.d.).

Knowledge

• Understands role and responsibilities as a member of the health care team in planning and using work unit resources to achieve quality patient outcomes. 

Attitudes/Behaviors

1. Recognizes the complexity of individual and team practice on a work unit. 
2. Appreciates role in identifying work unit inefficiencies and operational failures. 

Skills

1. Plans, organizes, and delivers patient care in context of the work unit. 
2. Participates in solving work unit inefficiencies and operational failures that impact patient care, such as those involving supplies, medications, equipment, and information. 
3. Considers resources available on the work unit when contributing to the plan of care for a patient or group of patients. 
4. Collaborates with members of the healthcare team to prioritize resources, including one's own work time and activities delegated to others, for the purposes of achieving quality patient outcomes. 
5. Evaluates outcomes of one's own nursing care. 
6. Uses education and referral to assist the patient and family through care transitions. 

Informatics and Technology:

Use advanced technology to analyze as well as synthesize information and collaborate in order to make critical decisions that optimize patient outcomes. (National Academies of Sciences, Engineering, and Medicine. 2015).

Knowledge

• Understands the use of electronic communication strategies among healthcare providers in the healthcare system. 

Attitudes/Behaviors

• Values and protects confidentiality of protected health information. 

Skills

1. Uses the electronic health record system to access relevant patient information, including accessing and interpreting patient history, diagnostic and laboratory findings. 
2. Utilizes technology fully and accurately documents patient assessment, plan of care, referrals, care provided. 

Communication:

Interact effectively with patients, families, and colleagues, fostering mutual respect and shared decision making, to enhance patient satisfaction and health outcomes.

Therapeutic Communication

Knowledge

1. Understands the principles of effective communication through various means.
2. Knows grammar, spelling, and health care terminology. 

Attitudes/Behaviors

• Values individual cultural and personal diversity. 

Skills

1. Uses clear, concise, and effective written, electronic, and verbal communications.
2. Documents interventions and outcomes of care according to professional standards and work unity policy. 
3. Demonstrates effective interviewing techniques and adapts communication as needed based on patient's response. 

Collegial Communication

Skills

• Uses standardized communication approaches (e.g. SBAR) in all communications and in care transitions. 

Teaching and Learning

Knowledge

• Understands the principles of teaching and learning. 

Attitudes/Behaviors

• Values different means of communication used by patients and families. 

Skills

• Assesses factors that influence the patient's and family's ability to learn, including readiness to learn, preferences for learning style, and levels of health literacy. 

Teamwork and Collaboration:

Function effectively within nursing and interdisciplinary teams, fostering open communication, mutual respect, shared decision making, team learning, and development (Adapted from QSEN, 2007).

Knowledge

1. Identifies own strengths, limitations, and values in functioning as a member of a team.
2. Understands the impact of the effective collegial communication on patient outcomes. 
3. Discusses how authority and hierarchy influence teamwork and patient safety. 

Attitudes/Behaviors

• Appreciates the importance of collaboration. 

Skills

1. Acts with honesty and integrity when working with patients, families, and team members. 
2. Functions competently within own scope of practice as a member of the health care team. 
3. Follows communication practices to minimize risks associated with transfers between providers during care transitions. 
4. Contributes to effective team functioning. 

Safety:

Minimize risk of harm to patients and providers through both system effectiveness and individual performance (QSEN, 2007).

Knowledge

1. Identifies human factors and basic safety design principles that affect safety. 
2. Describes the benefits and limitations of commonly used safety technology. 

​Attitudes/Behaviors

• Recognizes that both individuals and systems are accountable for a safe culture. 

​Skills

1. Demonstrates effective use of technology and standardized practices that support safe practice. 
2. Communicates observations or concerns related to hazards and errors involving patients, families, and/or healthcare team. 
3. Sufficiently prepares for and completes clinical assignments to implement safe and effective care, including identifying key nursing assessment data, analyzing data, developing priority nursing diagnoses, plans of care, interventions, evaluation criteria. 
4. Incorporates clinical judgment in the performance of care, skills, and education. 

Quality Improvement:

Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems (QSEN, 2007)

Knowledge

• Comprehends that nursing contributes to systems of care and processes that affect outcomes. 

Attitudes/Behaviors

• Recognizes that quality improvement is an essential part of nursing. 

Skills

• Actively seeks information about quality initiatives in their own care settings and organization. 

Evidence-Based Practice:

Identify, evaluate, and use the best current evidence coupled with clinical expertise and consideration of patients’ preferences, experience and values to make practice decisions (Adapted from QSEN, 2007).

Knowledge

• Identifies evidence-based rationale when developing and/or modifying clinical practices. 

Attitudes/Behaviors

• Values the concept of evidence-based practice as integral to determining best clinical practice. 

Skills

• Bases individualized care on best current evidence, patient values, and clinical expertise. 

Laboratory Objectives: 

1. Safety

   1. Management of Assaultive Behaviors (MAB) or Assault Response Competency (ARC)
   2. Skills: Assessing for abuse: Newborn, Infant, Child, Older Adult
   3. Suicide Risk Assessment, Caring for a Suicidal Patient

VII.   Clinical Course Learning Outcomes 

Patient-Centered Care: Provide holistic care that recognizes an individual’s preferences, values, and needs and respects the patient or designee as a full partner in providing compassionate, coordinated, age and culturally appropriate, safe and effective care.

Knowledge: 

1. Understands multiple dimensions of patient-centered care including:

a. Patient/family/community preferences, values

b. Coordination and integration of care

c. Information, communication, and education

d. Physical comfort and emotional support

e. Involvement of family and significant other

f. Care transition and continuity

Attitudes/Behaviors:

1. Values and respects assessing health care situation from the patient’s perspective and belief systems.

2. Respects and encourages the patient’s participation in decisions about health care and services.

Skills: 

1. Assesses patient values, preferences, decisional capacity, and expressed needs as part of ongoing assessment, clinical interview, implementation of care plan, and evaluation of care.

2. Communicates patient values, preferences, and expressed needs to other members of health care team.

Professionalism: Demonstrate accountability for the delivery of standard-based nursing care that is consistent with moral, altruistic, legal, ethical, regulatory, and humanistic principles.

Knowledge: 

1. Understands the professional standards of practice, the evaluation of that practice, and the responsibility and accountability for the outcome of practice.

Attitudes/Behaviors:

1. Accepts responsibility for own behavior.

2. Respects others during clinical activities (i.e., no talking while others are talking, cell phones are silenced, and no inappropriate use of computers).

Skills:

1. Implements plan of care within legal, ethical, and regulatory framework of nursing practice.

2. Demonstrates ability for reflection in action, reflection for action, and reflection on action.

3. Serves as a patient advocate.

4. Utilizes an ethical decision-making framework in clinical situations.

5. Complies with the Standards of Practice, policies, and procedures of nursing program and/or clinical agency.

6. Completes assignments as required and scheduled.

7. Provides prior notification to appropriate faculty when he/she is unable to meet commitments or requirements.

8. Participates in clinical activities as scheduled, arriving on time and prepared for the daily assignment throughout the length of the nursing program.

9. Demonstrates professional appearance and professional presentation in clinical settings.

10. Demonstrates respect and politeness to all individuals regardless of culture, ethnicity, religion, work experience, gender, age and sexual orientation.

11. Maintains confidentiality of all client information in conversation, electronic and written means.

12. Provides and receives constructive feedback to/from peers and instructor.

Leadership: Influence the behavior of individuals or groups of individuals within their environment in a way that will facilitate the establishment and acquisition/achievement of shared goals.

Knowledge:

1. Identifies leadership skills essential to the practice of nursing.

Attitudes/Behaviors:

1. Recognizes the role of the nurse as leader.

2. Accepts accountability for nursing care delegated to others.

3. Recognizes the value of leadership to empower others and enhance collaboration and shared decision making.

Skills:

 1. Integrates leadership skills of systems thinking, communication, and facilitating change in meeting patient care needs.

System-Based Practice: Demonstrate an awareness of and responsiveness to the larger context of the healthcare system, and will demonstrate the ability to effectively call on work unit resources to provide care that is of optimal quality and value (Adapted from ACGME, n.d.).

Knowledge:

1. Understands role and responsibilities as a member of the health care team in planning and using work unit resources to achieve quality patient outcomes.

Attitudes/Behaviors:

1. Recognizes the complexity of individual and team practice on a work unit.

2. Appreciates role in identifying work unit inefficiencies and operational failures.

Skills:

1. Plans, organizes, and delivers patient care in the context of the work unit.

2. Participates in solving work unit inefficiencies and operational failures that impact patient care, such as those involving supplies, medications, equipment, and information.

3. Considers resources available on the work unit when contributing to the plan of care for a patient or group of patients.

4. Collaborates with members of the healthcare team to prioritize resources, including one’s own work time and activities delegated to others, for the purposes of achieving quality patient outcomes.

5. Evaluates outcomes of one’s own nursing care.

6. Uses education and referral to assist the patient and family through care transitions.

Informatics and Technology: Use advanced technology to analyze as well as synthesize information and collaborate in order to make critical decisions that optimize patient outcomes. (National Academies of Sciences, Engineering, and Medicine. 2015).

Knowledge:

1. Understands the use of electronic communication strategies among healthcare providers in the healthcare system.

Attitudes/Behaviors:

1. Values and protects confidentiality of protected health information.

Skills:

1. Uses the electronic health record system to access relevant patient information, including accessing and interpreting patient history, diagnostic and laboratory findings.

2. Utilizes technology fully and accurately document patient assessment, plan of care, referrals, care provided. 

Communication: Interact effectively with patients, families, and colleagues, fostering mutual respect and shared decision making, to enhance patient satisfaction and health outcomes.

Therapeutic Communication

Knowledge:

1. Understands the principles of effective communication through various means.

2. Knows grammar, spelling, and health care terminology.

Attitudes/Behaviors:

1. Values individual cultural and personal diversity.

Skills:

1. Uses clear, concise, and effective written, electronic, and verbal communications.

2. Documents interventions and outcomes of care according to professional standards and work unit policy.

3. Demonstrates effective interviewing techniques and adapts communication as needed based on patient’s response.

Collegial Communication

Skills:

1. Uses standardized communication approaches (e.g. SBAR) in all communications and in care transitions.

Teaching and Learning

Knowledge:

1. Understands the principles of teaching and learning.

Attitudes/Behaviors:

1. Values different means of communication used by patients and families.

Skills:

1. Assesses factors that influence the patient’s and family’s ability to learn, including readiness to learn, preferences for learning style, and levels of health literacy.

Teamwork and Collaboration: Function effectively within nursing and interdisciplinary teams, fostering open communication, mutual respect, shared decision making, team learning, and development (Adapted from QSEN, 2007).

Knowledge:

1. Identifies own strengths, limitations, and values in functioning as a member of a team.

2. Understands the impact of the effective collegial communication on patient outcomes.
 
3. Discusses how authority and hierarchy influence teamwork and patient safety.

Attitudes/Behaviors:

1. Appreciates the importance of collaboration.

Skills:

1. Acts with honesty and integrity when working with patients, families, and team members.

2. Functions competently within own scope of practice as a member of the health care team.

3. Follows communication practices to minimize risks associated with transfers between providers during care transitions.
 
4. Contributes to effective team functioning.

Safety: Minimize risk of harm to patients and providers through both system effectiveness and individual performance (QSEN, 2007).

Knowledge:

1. Identifies human factors and basic safety design principles that affect safety.

2. Describes the benefits and limitations of commonly used safety technology.

Attitudes/Behaviors:

1. Recognizes that both individuals and systems are accountable for a safe culture.

Skills:

1. Demonstrates effective use of technology and standardized practices that support safe practice.
 
2. Communicates observations or concerns related to hazards and errors involving patients, families, and/or healthcare team.
 
3. Sufficiently prepares for and completes clinical assignments to implement safe and effective care, including identifying key nursing assessment data, analyzing data, developing priority nursing diagnoses, plans of care, interventions, evaluation criteria.
 
4. Incorporates clinical judgment in the performance of care, skills, and education.

Quality Improvement: Use data to monitor the outcomes of care processes, and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. (QSEN, 2007)

Knowledge:

1. Comprehends that nursing contributes to systems of care and processes that affect outcomes.

Attitudes/Behaviors:

1. Recognizes that quality improvement is an essential part of Nursing.

Skills:

1. Actively seeks information about quality initiatives in their own care settings and organization.

Evidence-Based Practice: Identify, evaluate, and use the best current evidence coupled with clinical expertise and consideration of patients’ preferences, experience and values to make practice decisions (Adapted from QSEN, 2007).

Knowledge:

1. Identifies evidence-based rationale when developing and/or modifying clinical practices.

Attitudes/Behaviors:

1. Values the concept of EBP as integral to determining best clinical practice.

Skills:

1. Bases individualized care on best current evidence, patient values, and clinical expertise.