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  1. 1. COMPLETE CLINICAL SYLLABUS THE UNIVERSITY OF TEXAS AT ARLINGTON SCHOOL OF NURSING N. 5424 Psychiatric Mental Health Nursing I Fall 2009 Classroom #: Pickard Hall 220
  2. 2. 2 The University of Texas at Arlington School of Nursing Graduate Program N. 5424 Psychiatric Mental Health Nursing I (2-6) (4 credit hours, 2 hour class per week, 6 hrs. clinical weekly) Fall, 2009 Wednesday, 12-6 p.m. Pickard Hall, Room # 220 INSTRUCTORS: Diane Snow, PhD, RN, PMHNP-BC, CARN Clinical Professor Director, PMHNP Program Office #: Room 627 Pickard Hall Office Hours: By Appointment Office Phone: (817) 272-7087 Office Fax: (817) 272-5006 E-mail: snow@uta.edu Website http://www.uta.edu/nursing/MSN/psychiatric.php Larae Huycke, DNP, RN, PMHNP-BC Assistant Clinical Professor Office: # : Room 636 Pickard Hall Office Hours: By Appointment Office Phone: (817) 272-2776 Office Fax: (817) 272-5006 Campus Mailbox: 19407 Email: Huycke@uta.edu Afshin «Pinky » Gutierrez, MSN, RN, PMHNP-BC Clinical Instructor Office #: Pickard Hall RM 626 Office hours: By appointment only Office Phone 817-272-2776 Office Fax: (817) 272-5006 Campus Mailbox: 19407 E-mail: gutierrez@uta.edu Website: http://www.uta.edu/nursing/MSN/psychiatric.php COURSE WEB SITE OR WORLD WIDE WEB SITE: http://www.uta.edu/nursing COURSE PREREQUISITES: NURS 5303; 5305 or concurrent enrollment
  3. 3. 3 REQUIRED TEXTBOOKS: 1. American Psychiatric Association (Text Revision). (2000). 4th ed. Diagnostic and Statistical Manual of Mental Disorders TR. Washington, DC: American Psychiatric Association. ISBN: 9780890420256 2. Fuller, M.A. and Sajatovic, M. (2009). 7th ed. Drug Information Handbook for Psychiatry. Hudson: Lexi – Comp. ISBN: 9781591952534 3. Linehan, M.M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press. IBSN:9780898620344 4. Nichols, M. (2007). Family Therapy: concepts and Methods. 8th ed. Pearson Education. ISBN: 9780205543205 5. Sadock, B. and Sadock, V. (2007). Synopsis of Psychiatry. 10th ed. Philadelphia: Williams &Wilkins. ISBN: 9780781773270 6. Stuart, G.W., Laraia, M.T. (2008). Principles and Practice of Psychiatric Nursing. 9th ed. St. Louis: Mosby. ISBN: 9780323026086 7. Stahl, SM (2008) Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series. (Paperback). 3rd ed. Cambridge: Cambridge University Press. ISBN:9780521673761 8. Corey, G. (2009). Theory and Practice of Counseling and Psychotherapy. 8th ed. Florence: Brooks/Cole. ISBN: 9780495102083 9. Corey, M.S., Corey, G., Corey, C (2008). Groups: Process and Practice. 8th ed. Florence: Brooks/Cole. ISBN:9780495600763 10. Khouzam, H. R., Gill, T. S. Tan, D. T. (2007). Handbook of Emergency Psychiatry. Elsevier Health Sciences. ISBN: 9780323040884 11. Zimmerman, M. Interview Guide for Evaluating DSM-IV Psychiatric Disorders and the Mental Status Examination. (1994). East Greenwich: Psych Products Press. ISBN: 9780963382139 12. Wheeler, K. (2007). Psychotherapy for the Advanced Practice Psychiatric Nurse. Mosby, Incorporated. ISBN: 9780323045223 RECOMMENDED TEXTBOOKS AND MATERIALS: 1. Keltner, N.L. & Folks, D.G. (2005). Psychotropic Drugs.4rd ed. St. Louis: Mosby. ISBN: 9780323030205 2. Connor, DF, & Meltzer, BM. (2006)Pediatric Psychopharmacology Fast Fact. 2006 ISBN 9780393704617 3. Naegle, M.A and D’Avanzo, C.E. (2001). Addictions and Substance Abuse Strategies for Advanced Practice. Boston: Prentice Hall. ISBN: 9780838586761
  4. 4. 4 4. Weiner, M & Lipton, A. The Dementias: Diagnosis, Treatment and Research. (2003). Washington, DC: American Psychiatric Publishing. ISBN: 9781585620432 5. Patterson, J. (2009). Essential Skills in Family Therapy: From The First Interview to Termination.2nd ed. Guilford Press. ISBN: 9781572303072 6. Stahl, Stephen M. Essential Psychopharmacology: The Prescriber's Guide: Revised and Updated Edition (Essential Psychopharmacology Series) 3rd ed. 2009 (Paperback). Cambridge University Press. ISBN: 9780521743990 COURSE DESCRIPTION: Advanced clinical management of individuals, families, and groups at risk for and experiencing acute and chronic psychiatric disorders. STUDENT LEARNING OUTCOMES: 1. Diagnose individuals with less complex acute and chronic psychiatric disorders, integrating neurobiological and psychosocial theories. (MPO 1) 2. Use individual and group therapies to promote health and prevent illness for individuals and families. (MPO 1) 3. Provide individual, group, and family therapies in the treatment of less complex acute and chronic psychiatric disorders. (MPO 1) 4. Provide culturally, spiritually, ethnicity, age, gender, and sexual orientation sensitive mental health care in populations with less complex acute and chronic psychiatric disorders. (MPO 1,3) 5. Use evidence based psychopharmacological and non- pharmacological interventions in the management of less complex acute and chronic psychiatric disorders. (MPO 1,2,3) ATTENDANCE AND DROP POLICY:  Regular class attendance and participation is expected of all students.  Students are responsible for all missed course information. Graduate students who wish to change a schedule by either dropping or adding a course must first consult with their Graduate Advisor. Regulations pertaining to adding or dropping courses are described below. Adds and drops may be made through late registration either on the Web at MyMav or in person through the student’s academic department. Drops may occur until a point in time two-thirds of the way through the semester, session, or term. The last day to drop a course is listed in the Academic Calendar available at http://www.uta.edu/uta/acadcal.
  5. 5. 5 1. A student may not add a course after the end of late registration. 2. A student dropping a graduate course after the Census Date but on or before the end of the 10th week of class may with the agreement of the instructor, receive a grade of W but only if passing the course with a C or better average. A grade of W will not be given if the student does not have at least a C average. In such instances, the student will receive a grade of F if he or she withdraws from the class. Students dropping a course must: (1) complete a Course Drop Form (available online http://www.uta.edu/nursing/MSN/drop_resign_request .pdf or MSN office rooms 605 or 606); (2) obtain faculty signature and current course grade; and (3) submit the form to MSN office rooms 605 or 606. 3. A student desiring to drop all courses in which he or she is enrolled is reminded that such action constitutes withdrawal (resignation) from the University. The student must indicate intention to withdraw and drop all courses by filing a resignation form in the Office of the Registrar or by: (1) Completing a resignation form (available online http://www.uta.edu/nursing/MSN/drop_resign_request .pdf or MSN office rooms 605 or 606; (2) obtaining faculty signature for each course enrolled and current course grade; (3) Filing the resignation form in the School of Nursing office room 606 or 606; and (4) Filing the resignation form in the Office of the Registrar in Davis Hall room 333. 4. In most cases, a student may not drop a graduate course or withdraw (resign) from the University after the 10th week of class. Under extreme circumstances, the Dean of Graduate Studies may consider a petition to withdraw (resign) from the University after the 10th week of class, but in no case may a graduate student selectively drop a course after the 10th week and remain enrolled in any other course. Students should use the special Petition to Withdraw for this purpose. See the section titled Withdrawal (Resignation) From the University for additional information concerning withdrawal. Last Date Drop or Withdraw: -October 30, 2009 TENTATIVE LECTURE/TOPIC SCHEDULE (COURSE CONTENT): Psychiatric Interview Health promotion and prevention in psychiatry Therapies Theories of therapies Individual therapies Group therapies
  6. 6. 6 Family therapies Pharmacotherapeutics Dialectic Behavioral Therapy Cognitive Behavioral Therapy Play therapy Solution Focused therapy Narrative therapy EMDR Trauma focused therapy Grief therapy Geriatric therapy Mental Disorders DSM-IV Neuroscience and psychopathology of mental disorders Personality Disorders TEACHING METHODS/STRATEGIES: Lecture Guest speakers Discussion Clinical decision making exercises Clinical logs and SOAP notes Student presentations Readings and handouts Therapy Supervision Case study presentation Webct dialog and discussion Videos and media Case studies Genograms Therapy Moment Maps COURSE EVALUATION & FINAL GRADING: Evaluation: 1. Preceptor Evaluations -management Pass/Fail 2. Preceptor Evaluation-therapy Pass/Fail 3. Clinical Notebook Pass/Fail 4. Final Clinical Practicum (management) 15% 5. SOAP Notes (2) 10% 6. CDM (2) 10% 7. Family Case Study/Genogram 5% 8. Test #1 15% 9. Test #2 15% 10. Therapy Presentation 5% 11. Final Exam (comprehensive) 15% 12. Moment therapy maps (3) 10% 13. Participation class & webct Pass/Fail 100 Late written assignments will receive a reduction of 5 points a day. Grading: A=92-100 B=83-91 C=74-82 D=68-73 F=Below 68
  7. 7. 7 CLINICAL EVALUATION: Students must pass both the didactic and clinical portions of a clinical course in order to pass the course. In order to pass the clinical portion, the student must receive a passing grade (minimum of 83%) on the faculty evaluation of the student’s clinical performance (Nurse Practitioner Clinical Evaluation). Students who fail a faculty evaluation have a one-time option to retake the practicum. A second faculty member will be present during the clinical performance retake. If the student passes the clinical performance retake (minimum of 83%), the maximum grade the student can receive for the exam for purposes of grade calculation is 83%. If the student fails the retake, the student will receive a grade of “F” for the course. STUDENT REQUIREMENT FOR PRECEPTOR AGREEMENTS/PACKETS: 1. All Preceptor Agreements must be signed by the first day the student attends clinical (may be signed on that day). 2. Student is responsible to ensure that all of his/her preceptor agreements are signed before beginning clinical experience and those agreements are given to Linda Adams by the third week of the semester. (This means that even if a student doesn’t start working with a particular preceptor until late in the semester, s(h)e would contact that preceptor during the first 3 weeks of the semester. 3. Linda Adams or designated support staff will enter the agreement date into Partners database. The Agreement Date” field in Partners is the data that the Preceptor signed the Agreement. (This date must be on or before the student’s first clinical day in order for the student to access E-logs). If this is the first time a preceptor is precepting a graduate nursing student for The University of Texas at Arlington, please have him/her complete the Preceptor Biographical Data Sheet and submit it with his/her Curriculum Vitae. 4. The signed preceptor agreement is part of the clinical clearance process. Failure to submit it in a timely fashion will result in the inability to access the E-log system. CLINICAL CLEARANCE: All students must have current clinical clearance to legally perform clinical hours each semester. If your clinical clearance is not current, you will be unable to do clinical hours that are required for this course and this would result in course failure. STATUS OF RN LICENSURE: All graduate nursing students must have an unencumbered license as designated by the Board of Nurse Examiners (BNE) to participate in graduate clinical nursing courses. It is also imperative that any student whose license becomes encumbered by the BNE must immediately notify the Interim Associate Dean for the MSN Program, Dr. Mary Schira. Failure to do so will result in dismissal from the Graduate Program. The complete policy about encumbered licenses is
  8. 8. 8 available online at: http://www.uta.edu/nursing/grad/unencumbered MSN GRADUATE STUDENT DRESS CODE: Policy: The University of Texas at Arlington School of Nursing expects students to reflect professionalism and maintain high standards of appearance and grooming in the clinical setting. Clinical faculty have final judgment on the appropriateness of student attire and management of the situation. General Guidelines 1. Jewelry  Needs to be discreet with items, such as: watch, wedding ring, necklace or earrings  No body piercing visible other than ears. 2. Hair  Hair is to be clean, neat, and well groomed. Shoulder length hair or longer must be pulled back behind the ears off the neck when in the clinical, learning resource or simulation lab settings.  Males are expected to be clean-shaven or facial hair/moustache and beards neatly trimmed.  Hair must be of a color found in nature (no pink, blue, etc.). 3. Nails  Nails are to be clean, groomed, and manicured.  Artificial nails are prohibited in the clinical setting.  Nails are to be cut to the tip of the finger and groomed.  Only clear nail polish may be worn. No fingernail jewelry. 4. Other  Makeup will be subdued. Personal hygiene including oral care, daily showering/bathing, and the use of deodorant is expected.  No perfume or scented lotions are to be worn.  Gum chewing is not permitted.  Personal beepers, cell phones, and other such technology shall be utilized only during breaks from patient care. Cell phones must be turned off during clinical and left in the student’s purse or backpack.  Tattoos must be covered and not visible.  Refrain from smoking in clinical attire as the smoke can cling to clothes and be an irritant to patients.
  9. 9. 9  The School of Nursing ID must be worn in all clinical and lab settings. Clinical Attire Options 1. A white lab coat with a UTA insignia patch (suggested) over professional dress or 2. Scrubs if that is the dress for the agency or 3. Business attire for Nursing Administration Students and NP Students based on clinical site. (No lab coat or scrubs required in most PMHNP clinicals) Additional Directions on Attire 1. Clothing needs to be clean and not wrinkled. 2. Undergarments and/or cleavage should not show when leaning or bending over. 3. Professional attire is expected. No jeans/western cut pants, sweatshirts, and shirts of underwear type, see- through clothing, sleeveless shirts or any clothing which exposes a bare midriff, back, chest or underwear. Skirts must be knee length or longer. Appearance must be clean and neat. Low rise scrub pants and rolling down the waist band of scrub pants is prohibited. 4. Shoes are to be closed toed, in good repair and no canvas shoes or flip flops. 5. The UTA Student Picture ID is to be worn above the waist and in clear view when in clinical agencies. Learning Resource Skills Lab/Simulation Lab attire: Students entering the skills or simulation labs must be in appropriate clinical attire. UNSAFE CLINICAL BEHAVIORS: Students deemed unsafe or incompetent will fail the course and receive a course grade of “F”. Any of the following behaviors constitute a clinical failure: 1. Fails to follow standards of professional practice as detailed by the Texas Nursing Practice Act * (available at www.bne.state.tx.us) 2. Unable to accept and/or act on constructive feedback. 3. Needs continuous, specific, and detailed supervision for the expected course performance. 4. Unable to implement advanced clinical behaviors required by the course. 5. Fails to complete required clinical assignments. 6. Falsifies clinical hours. 7. Violates student confidentiality agreement.
  10. 10. 10 *Students should also be aware that violation of the Nursing Practice Act is a “reportable offense” to the Texas Board of Nurse Examiners. BLOOD AND BODY FLUIDS EXPOSURE: A Health Verification form was signed by all MSN students at start of the program documenting personal health insurance coverage. All MSN students have mandatory health insurance and will need to manage exposure to blood and fluids. Current CDC guidelines can be found at: http://www.cdc.gov/ CONFIDENTIALITY AGREEMENT: You signed a Confidentiality Form in orientation and were provided a copy of the form. Please take your copy of this Confidentiality Form with you to your clinical sites. Please do not sign other agency confidentiality forms. Contact your faculty if the agency requires you to sign their confidentiality form. AMERICANS WITH DISABILITIES ACT: The University of Texas at Arlington is on record as being committed to both the spirit and letter of federal equal opportunity legislation; reference Public Law 92-112 - The Rehabilitation Act of 1973 as amended. With the passage of federal legislation entitled Americans with Disabilities Act (ADA), pursuant to section 504 of the Rehabilitation Act, there is renewed focus on providing this population with the same opportunities enjoyed by all citizens. As a faculty member, I am required by law to provide "reasonable accommodations" to students with disabilities, so as not to discriminate on the basis of that disability. Student responsibility primarily rests with informing faculty of their need for accommodation and in providing authorized documentation through designated administrative channels. Information regarding specific diagnostic criteria and policies for obtaining academic accommodations can be found at www.uta.edu/disability. Also, you may visit the Office for Students with Disabilities in room 102 of University Hall or call them at (817) 272-3364. STUDENT SUPPORT SERVICES The University of Texas at Arlington supports a variety of student success programs to help you connect with the University and achieve academic success. These programs include learning assistance, developmental education, advising and mentoring, admission and transition, and federally funded programs. Students requiring assistance academically, personally, or socially should contact the Office of Student Success Programs at 817-272-6107 for more information and appropriate referrals.
  11. 11. 11 STUDENT CODE OF ETHICS: The University of Texas at Arlington School of Nursing supports the Student Code of Ethics Policy. Students are responsible for knowing and complying with the Code. The Code can be found in the student Handbook online: http://www.uta.edu/nursing/handbook/toc.php ACADEMIC INTEGRITY: It is the philosophy of The University of Texas at Arlington that academic dishonesty is a completely unacceptable mode of conduct and will not be tolerated in any form. All persons involved in academic dishonesty will be disciplined in accordance with University regulations and procedures. Discipline may include suspension or expulsion from the University. "Scholastic dishonesty includes but is not limited to cheating, plagiarism, collusion, the submission for credit of any work or materials that are attributable in whole or in part to another person, taking an examination for another person, any act designed to give unfair advantage to a student or the attempt to commit such acts." (Regents’ Rules and Regulations, Series 50101, Section 2.2) PLAGIARISM: Copying another student’s paper or any portion of it is plagiarism. Additionally, copying a portion of published material (e.g., books or journals) without adequately documenting the source is plagiarism. If five or more words in sequence are taken from a source, those words must be placed in quotes and the source referenced with author’s name, date of publication, and page number of publication. If the author’s ideas are rephrased, by transposing words or expressing the same idea using different words, the idea must be attributed to the author by proper referencing, giving the author’s name and date of publication. If a single author’s ideas are discussed in more than one paragraph, the author must be referenced at the end of each paragraph. Authors whose words or ideas have been used in the preparation of a paper must be listed in the references cited at the end of the paper. Students are encouraged to review the plagiarism module from the UT Arlington Central Library via http://library.uta.edu/tutorials/Plagiarism BOMB THREATS: If anyone is tempted to call in a bomb threat, be aware that UTA will attempt to trace the phone call and prosecute all responsible parties. Every effort will be made to avoid cancellation of presentations/tests caused by bomb threats. Unannounced alternate sites will be available for these classes. Your instructor will make you aware of alternate class sites in the event that your classroom is not available.
  12. 12. 12 E-CULTURE POLICY: The University of Texas at Arlington has adopted the University email address as an official means of communication with students. Through the use of email, UT- Arlington is able to provide students with relevant and timely information, designed to facilitate student success. In particular, important information concerning department requirements, registration, financial aid and scholarships, payment of bills, and graduation may be sent to students through email. All students are assigned an email account and information about activating and using it is available at www.uta.edu/email. Students are responsible for checking their email regularly. STUDENT EXCELLENCE AWARD: Award for student excellence in clinical nursing. Each semester, students in clinical courses are eligible for consideration. Nominations for the award are made by the clinical faculty in each course with a clinical component. Students are honored at an end-of-the-semester awards ceremony. Detailed information is available at: www.uta.edu/nursing/handbook/studentexcellenceaward GRADUATE PROGRAM SUPPORT STAFF: Shelby Green, Sr. Office Assistant Office # 610 – Pickard Hall (817) 272-2043, ext 2-4856 Email: shelby@uta.edu Felicia Chamberlain, Administrative Assistant Office #611 – Pickard Hall, (817) 272-0659 (817) 272-0659 Direct Line, (817) 272-0663 Fax Email: chamberl@uta.edu (Contact for Preceptor data base & clinical clearance needs) LIBRARY INFORMATION: Helen Hough, Nursing Librarian (817) 272-7429, Email: hough@uta.edu Research Information on Nursing: http://libguides.uta.edu/nursing MISCELLANEOUS INFORMATION: Inclement Weather (School Closing) Inquiries: Metro (972) 601-2049 Fax Number - UTA School of Nursing: (817) 272-5006 Attn: Graduate Nursing Programs Office UTA Police (Emergency Only): (817) 272-3003 Mailing Address for Packages: UTA School of Nursing C/O Dr. Diane Snow 411 S. Nedderman Drive, Pickard Hall Arlington, Texas 76019-0407
  13. 13. 13 GRADUATE NURSING WEBSITES Description Website University of Texas Home Page http://www.uta.edu Graduate Catalog & Faculty http://www.uta.edu/gradcatalog/nursing Graduate Nursing Programs http://www.uta.edu/nursing/MSN/administration.php http://www.uta.edu/nursing/MSN/practitioner.php Graduate Nursing Courses & Syllabi http://www.uta.edu/nursing/MSN/grad-courses1.php Faculty and Staff Email Contacts and Biosketches http://www.uta.edu/nursing//faculty.php Graduate Student Handbook http://www.uta.edu/nursing/handbook/toc.php  Miscellaneous Graduate MSN Forms: o Banking Clinical Hours o Code of Ethics o Drop Request o E-log Consent Form o Liability Policy o Master’s Completion Project Forms o Nurse Admin Preceptor Package o Nurse Practitioner Preceptor Package o Personal Insurance Verification Form o Petition to Graduate Faculty o Resignation Request o Student Confidentiality Statement o Traineeship Statement Forms http://www.uta.edu/nursing/MSN/forms.php  Clinical Evaluation MSN Forms: o Educator Evaluation o Faculty Evaluation of Preceptor o NP Clinical Evaluation (Practicum Tools) o Nurse Admin Faculty Eval of Preceptor o Nurse Admin Preceptor Eval of Student o Preceptor Evaluation of Student o Psych Therapy Preceptor Eval of Student o Student Evaluation of Preceptor o Student Self Evaluation Clinical Online Submission (Elogs) http://www.totaldot.com/ Criminal Background Check (Group One) http://www.dfwhc.org/GroupOne/ Instructions for E-Reserves http://pulse.uta.edu/vwebv/enterCourseReserve.do Select under Library Catalogs (UTA Library Catalogs) Select Course Reserves Look for Instructor’s Name, Click Search, Select Article Password is course abbreviation and course number. ALL CAPS no spaces (ex. NURS5340).
  14. 14. 14 University of Texas at Arlington School of Nursing Graduate Program N. 5424 Psych – Mental Health I Course Schedule Fall 2009 (Subject to Change) Date/Time Topic Readings Assignments* Speaker 8/26/09 12-1pm Course Overview Syllabus Faculty 1-2 pm 2-2:45 Role of PMHNP and competencies; Scope and Standards of Psychiatric Nursing; outcome survey results; APRN consensus Certification issues Family and Adult PMHNP Boundaries/transference/counter transference Webct. Articles Scope and Standards (TBA) Wheeler, Chapter 1 Sadock p 1-4 Stuart/Laraia on boundaries Diane Pinky, Diane, Larae 2:45 -4: 30 Neurobiological update Review: Psychopathology; Erickson, Piaget Defense Mechanisms Sadock & Sadock Ch 3 70-86 (review) 87-94 memory, etc Neuroimaging 110-117 Neurochemistry 94-110 Psychoneuroimmunology , chronobiology 121-127 Neurogenetics: 128-132 Keltner & Folks, Ch.2 Functional anatomy (supplemental-optional) Stahl, (Essential Psychopharmacology 3rd edition. Chapters on neurochemistry, genomics Corey Individual therapy Review: Erickson, Piaget, defense mechanisms Articles on webct. Diane
  15. 15. 15 Date/Time Topic Readings Assignments* Speaker 4:30-6pm Intro to Group Therapy-ethics, Confidentiality, purpose of group, curative factors: Yalom Stuart & Laraia, chapter on group (or any psych undergrad text) Diane Corey & Corey, Group Process Ch. 1-3 Sadock 934-40 Sept 9, 2009 12-1 Making an Accurate DSM IV diagnosis DSM-IV –specifiers, rules of precedence, multiple diagnoses, V codes Bring DSM-IV Read DSM IV for rules of precedence, specifiers, V codes, etc. anxiety, mood, psychosis, dementia specifiers and course of illness etc Diane, Larae, Pinky 1-2 Cognitive behavior therapy Sadock & Sadock, pg. 958- 961; Stuart & Laraia-ch 31 Articles on Webct Corey-chapter on CBT Barbara Warren, MSW, TBC 2-3 Womens group therapy strategies Articles on webct Barbara Warren, MSW, TBC 3-4:30 Introduction to Family Therapy- The Initial Interview and Hypothesizing Structural Family Therapy Nichols Family therapy – Intro, Structural, Sadock 924-40 Essential Skills in Family Therapy Ch. 1,2,3 Stuart & Laraia, Ch. 34 Corey, Ch. 13 (counseling text) Diane Snow 4:30-6:30pm Overview of Individual therapy Corey Individual therapy- Read chapters on Psychoanayltical Existential Person Centered Diane
  16. 16. 16 Date/Time Topic Readings Assignments* Speaker Gestalt Reality therapy CBT 9/14/09 CDM #1 Due on webct. Returned 09/28/09 09/28/09 TMM #1 due Return 10/12/09 9/23/09 12-1:30 pm Test 1 Test blueprint (TBC) Role 8 Neuro,theory-12 DSM=IV 8 CBT -10 Womens groups 6 Group-12 Indiv -15 Family therapy-10 1:30-3 pm Brief solution focused therapy Corey, p. 433-35 Sadock & Sadock, 930-33 Nichols Chapter 6,7 Readings on Webct. Jeanneane Cline MSN, RN TBC 3-4:30 pm Narrative Therapy and Medical Therapy Corey, 431-438 Nichols-Chapter 6 and 7 Articles on webct (links) Mary Bittle (TBC) 4:30-6pm CBT workshop TBA Readings on Webct Nichols Chapter 10 S & S Diane, Larae and Pinky 10/12/09 SOAP #1 due Return 10/26/09 10/14/09 Clinical notebooks due and class 12-2PM Personality Disorders Sadock & Sadock, Ch. 27 Dr. H. Cohen, MD TBC DSM IV (Personality Disorders) Stuart and Laraia, Ch. 22 Shader, Ch. 13
  17. 17. 17 Date/Time Topic Readings Assignments* Speaker 2-3:30 pm EMDR Articles on webct. TBC 3:30-5pm Therapy with teens (Motivational interviewing, Group strategies) TBA Wesley Rangle, TBC 5-6:30 pm Family Therapy Addicted Family Strategic family therapy Strategic chapters 6, 7; Sadock 940-924 Diane 10/19/09 TMM #2 due Returned by 11/2/09 10/28/09 12-1:30pm Test 2 Test Blueprint TBA Family with addiction-6 Therapy with teens -10 EMDR-8 Personality disorders-15 BSFT -10 Narrative therapy- 8 CBT -8 1:30-3:30 pm Dialectical Behavioral Therapy Linehan, M.-Skills Training Manual for Treating Borderline Personality Disorder p. 1- 104 Sadock & Sadock 944-46 TBA 3:30-4:30 pm Transgenerational Family Therapy Bring genogram of your family Nichols-chapter on Bowen S& S 942-43 Stuart & Laraia –ch 33 Diane 4:30-6pm Articles on webct.
  18. 18. 18 Date/Time Topic Readings Assignments* Speaker 11/09/09 CDM #2 due Return 11/23/09 11/18/09 12-3 Therapy Presentations (10-15 minutes each) with demonstration 3-4:30pm Anxiety disorders therapy with children TBA Articles on webct. Kathleen Norris TBC 4:30-6pm Child CBT therapy and play therapy TBA TBC 11/23/09 SOAP #2 due Return 12/7/09 12/04/09 TMM #3 due Return 12/09/09 12/02/09 Note Time 11-1:30 pm Comprehensive Final Exam Clinical notebooks due 1:30-5pm Family case studies presentations with genograms
  19. 19. 19 N5424 Psychiatric Mental Health Nursing I SOAP NOTE GRADING SHEET Student:______________________________ Grade:_____________________ Date:_________________________________ Faculty/advisor:_____________ Points 20 pts _____ A. Subjective data appropriately documented (if not all areas assessed,indicate which you would add in italics) 20 pts _____ B. Objective data appropriately documented 15 pts _____ C. Nursing and medical diagnosis(es)formulated. Include differential diagnosis and rule outs. Include DSM-IV criteria for Axis I diagnosis.And indicate which criteria patient met and conclusion about decision 20 pts _____ D. Management plan cost-effective and evidence based.Include labs to order, meds and dosage, counseling and referrals, teaching plan, follow up (add to what was actually done- in italics) 10 pts _____ E. Neurobiology of disorder(s). (Include genetics,neurotransmitters, neuroanatomical changes, current theories of causation,cultural factors) as it relates to patients family history and environmental stressors (trauma, etc) 15pts ______ F. Rationale for each part of management plan (labs; meds: why this med, what is neurochemistry action of med, pharmacokinetics, side effects to monitor, expected benefits, contraindications; counseling-goals,rationale for this type of therapy, expected benefits, teaching, referrals, follow-up) Credit _____ G. Include references from at least 3 sources including one article from refereed journal Grade ____________ Comments: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________
  20. 20. 20 N5424 Psychiatric Mental Health Nursing I SOAP NOTE GRADING SHEET Student:______________________________ Grade:_____________________ Date:_________________________________ Faculty/advisor:_____________ Points 20 pts _____ A. Subjective data appropriately documented (if not all areas assessed,indicate which you would add in italics) 20 pts _____ B. Objective data appropriately documented 15 pts _____ C. Nursing and medical diagnosis(es)formulated. Include differential diagnosis and rule outs. Include DSM-IV criteria for Axis I diagnosis.And indicate which criteria patient met and conclusion about decision 20 pts _____ D. Management plan cost-effective and evidence based.Include labs to order, meds and dosage, counseling and referrals, teaching plan, follow up (add to what was actually done- in italics) 10 pts _____ E. Neurobiology of disorder(s). (Include genetics,neurotransmitters, neuroanatomical changes, current theories of causation,cultural factors) as it relates to patients family history and environmental factors (e.g. trauma, stressors) 15pts ______ F. Rationale for each part of management plan (labs; meds: why this med, what is neurochemistry action of med, pharmacokinetics, side effects to monitor, expected benefits, contraindications; counseling-goals,rationale for this type of therapy, expected benefits, teaching, referrals, follow-up) Credit _____ G. Include references from at least 3 sources including one article from refereed journal Grade ____________ Comments: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________
  21. 21. 21 University of Texas at Arlington School of Nursing N5424 Psychiatric-Mental Health Nursing I Fall 2009 Student____________________________ Advisor:_______________________________ Date___________________________ ASSIGNMENTS/GRADE SUMMARY ASSIGNMENTS DUE DATE GRADE 1. SOAP Notes (2 total) 10/12 _______ 10% _______ 11/23 2. Clinical Decision Making (1) 10% _____ 9/14 Clinical Decision Making (2) 11/09 ______ 3. Preceptor Evaluations 12/02/09 Pass/Fail______ 4. Sites where spend 12 hrs or more are required Pass/Fail_____ 5. Practicum Evaluation TBA 15%___ 6. Family Case Study 12/02 5%______ 7. Clinical Notebook 10/14 Pass/Fail 12/02 Pass/Fail_____ (Objectives summarized, E log summary, Tally-signed by preceptors) 8. Evaluation of Preceptors/Faculty 12/02 Credit ______ 9. Test 1 09/23 15% _______ 10. Test 2 11/04 15% ________ 11. Therapy Presentations 11/18 5% __________ 12. Comprehensive Final Exam 12/02 15% __________ 13. Therapy Moment Mapping 9/28 5% _____ 10/19 ____ 12/04 ____ 13. Webct participation, classroom participation 12/02 Pass Fail_________ Respond to discussion of therapy moment mapping Submitted by peers, and respond to peers response to Your moment mapping; classroom-case studies,come Prepared to discuss topics. FINAL COURSE GRADE: 100% ______
  22. 22. 22 University of Texas at Arlington School of Nursing Graduate Program Psychiatric Mental Health Nurse Practitioner Program N5424 Fall 2009 THERAPY MOMENT MAP Name Clinical Advisor______________ Date: _____________________ # 1, #2 _#3___________ Select 5 –10 minute segment of a therapy session and present on webct in discussion board. Use power point. Can be from individual, group or family therapy experience. The focus is on developing skills, self-reflection, application of theory, and developing as a therapist, and provides “peer supervision” as well as faculty supervision. (not required of post masters students with waiver of therapy requirement-will be given alternate assignment) Respond to each classmate’s TMM on webct. Scenario and purpose Points Actual 1. Client description 10 Describe appearance, mood, affect of client Age, gender, cultural identity, other identifying factors 2. Setting Description 5 Describe the room and where everyone is placed. 3. Background description 10 What was happening just before the session What do you know, if anything about emergent situations between sessions, where the patient was just before the session, and what the transition was like. Discuss the circumstances of the therapy session that led you to the therapy moment 5. Purpose of the interaction. 10 Identify the therapy goal for the session using an identified theoretical framework 6. Image that depicts your visualized 5 outcome of the therapy session for the patient. This should include an image from clip art or photo or drawing, not just a verbal image. 7. Description of obstacles the patient may have 5 toward meeting the imagined outcome Therapy Moment Map Dialogue 8. Dialogue displays an example of an intervention 5 that can be analyzed to demonstrate students clinical reasoning process
  23. 23. 23 Analysis 9.Description of what you are thinking and feeling 15 during the therapy moment to enlighten others about the rationale for interventions 10. Analysis of the intervention 10 is accurate and organized according to the theory of particular therapeutic approach and the relationship (with references) 11.Image of a future moment 5 that will attract the patient toward achieving the outcome. 12.Analysis of the client’s perception of you What do you think she/he perceives of you during this 10 therapy moment? What do you think about yourself as beginning therapist? 13. Discussion Questions: 10 At least two discussion questions to guide discussion about the therapy moment References –At least 2 Credit Total 100
  24. 24. 24 The University of Texas at Arlington School of Nursing Psychiatric-Mental Health Nurse Practitioner Program N5424 FAMILY CASE PRESENTATION The purpose of this assignment is to practice, in a "grand rounds" format, the written and verbal ability to "present" a family client and overall plan of care to your peers. Select one family that you are familiar with from your practicum experience. Select one family therapy/theory and analyze the family from this perspective. E.g Minuchin, Bowen, Satir, Present the following information. You may use 2 or more perspectives if you wish, being sure to point out which theory you are using at the time. Maximum Actual Structural Data ___10___ _______ Who is in the family What brought them for help? What is their home like? What is their environment like? Occupation-work info? Socio-economic data? Religious information? Previous experience with therapy? Medical diagnoses ofmembers? (include psychiatric/addictive disorders) Lifestyle Marital status Family History ___25___ ______ Analyze using concepts and assumptions from family systemtheory that you have selected. GENOGRAM with correct symbols & detailed key Strengths of family over time Family system theory analysis ___30___ ______ Describe theory used (concepts) Analyze family dynamics using concepts and assumptions from family systemtheory of choice e.g. Structural therapy: boundaries,subsystems Family Therapy ___25___ ______ # Sessions Goals of session(s) Who attended,etc. Strategies used Examples of dialogue Presentation Skills ___10___ ______ Organized, systematic Within time frame Handout of significant data 100 100
  25. 25. 25 The University of Texas at Arlington School of Nursing N5424-Psychiatric Mental Health Nursing I Therapy Presentation The purpose of this assignment is to present a variety of therapy approaches that are practical and helpful for mental health and addictive disorders. Please choose one of the following types of therapies and prepare a handout for classmates and 3 -page report on the selectedtherapy approach, and present to class, including an example to use with the class. Upload 3 page paper to webct. Selectedtherapies –Select 1 Cognitive Behavioral Therapy Rational Emotive therapy Existential therapy Gestalt Therapy Brief Solution Therapy Exposure Response Prevention Therapy Motivational Interviewing/Stages of Change EMDR therapy Neurolinguistic Programming Play therapy Biofeedback Dialectic Behavioral Therapy Reminiscence Therapy Grief therapy Family brief solution therapy Suggestion If Family PMHNP major, choose a type of child therapy or apply type to children and/or adults If Adult PMHNP major, focus on application to adults –e.g. Use of CBT with eating disorders Criteria Maximum Actual Points Points 1. Choose a disorder and a therapy approach. Present key 40 concepts of the therapy and how it is useful with a selected clinical problems-e.g. PTSD, Substance Abuse, Children with OCD (paper and presentation) 2. Present evidence to support your choice of therapy, 25 use 3-5 references, one of which is a research based article. 3. Thoroughness and creativity of report. 15 4. Presentation skills (involve the class in a selectedintervention) 20 __________________________________________________________________________________________ TOTAL: 100
  26. 26. 26 UTA School of Nursing Graduate Program Fall 2009 N5424--Psychiatric Mental Health Nursing I Clinical Notebook Grading Sheet Journal Check #1 Journal Check #2 Clinical notebook grading sheet _____________ ___________ Clinical Objectives/Evaluation (P/F) __________ ____________ Present to each preceptor specific clinical objectives for the experience and discuss ways to achieve these objectives. Evaluate each objective and describe your experiences towards these objectives in journal format. E- Log –Print Out (P/F) __________ ____________ Record all patients seen during yourclinical rotations.Include therapy patients.Should have close to one patient per hr at minimum of clinical time Axis I. Axis II, III (use ICD-9 codes), Axis IV and V categories are provided. Include summary print out.Therapy-enter patients such as 2-3 from each group session,all family members from family therapy, all individual therapy patients. Use correct billing codes for psychiatry Clinical Hours Tally Sheet (P/F) __________ ____________ This is a record of your clinical time towards your overall experience, recording in appropriate category. Carry forward hours from other courses as indicated. These hours are determined based on choice as Family or Adult PMHNP major. Must have Preceptor signatures each day. Can put on separate Page. Preceptor evaluation of student (12 hours or more) __________ ______________ Psychotherapy evaluation of student (12 hours or more) ___________ ______________ www.uta.edu/nursing/MSN/forms Student Evaluation of All Preceptors _____________ Overall neatness and organization (P/F) __________ ____________ Notebook is organized, assignments are easy to locate. Grading sheets are included. Send assignments to instructor by webct. Include all preceptor agreements copies. ____________________________________________________________________________________________________________ Overall grade (Criteria Pass/Fail) __________ ____________ Comments:
  27. 27. 27 UTA School of Nursing PMHNP Program Initial Psych Evaluation Template The following is a suggestedformat for Initial Psychiatric Evaluations -Please note that this is only a template. You are not required to use this. For child, adjust language to developmental level of child, and add developmentally specific questions on parenting, discipline, ADHD etc. For older adult or disabled, add functional assessmentand additional questions on cognitive function, memory, executive function, MMSE score. Client (age, marital status, reliable?) Source of Data: Chief Complaint: What can I help you with today? (build rapport!) History of Present Illness: (explore issues in depth-get details and validate patient’s feelings.Do symptom analysis of each area of concern) When did symptoms begin? What was going on in your life when this began? Have you ever had this before? How long has this been going on? Is there anything that you can do to make it better? Any meds? Did they help? Neurovegetative Symptoms: Sleep: Any initial, middle, or terminal insomnia? When did this start? What time do you go to sleep and wake up in the morning? How many hours do you sleep? Do you wake up before the alarm? Do you feel rested when you get up? Do you have nightmares? Do you take any medications to help you go to sleep?
  28. 28. 28 Do you feel tired during the day? Do you take naps? Have you changed yourroutine? Do you drink caffeine before going to bed? Does your mind race when you try to go to sleep? Appetite and weight: Have you lost or gained any weight? If yes, over what period of time? Do you feel that you need to loose weight? Do you ever binge or fast? Use any laxatives or vomiting? Are you afraid of gaining weight? What do you think about the appearance of your body? How often do you weigh? What is your usual food intake in a day? Does food interest you? Are you preoccupied with food? Energy: Is there a certain time of the day that you have more energy? Do you feel you have more or less energy? How would you describe your energy level? How often? Anhedonia: What do you enjoy doing? Are activities that you use to enjoy still enjoyable? Are you able to concentrate? Mood: Rate mood on 1-10 scale with 10 as best Have you been feeling sad? Tearful-how often Have you felt irritable, or angry (if anger evaluate extent of anger-level of violence; e.g. road rage, yelling, physical violence) Diurnal variation of mood: Are there certain times of the day that you feel better or worse than others? SI/HI Have you every thought it would be better if you were dead?
  29. 29. 29 Have you had thoughts ofwanting to kill yourself? Or hurt yourself? Do you have a plan Do you feel your life is worth living? Or do you feel hopeless? Have you ever had suicide attempt in past? When / type? Have you ever thought that things would be better if someone else was dead? Plan? Intent? Anxiety: (if yes to any of these screening questions, you will need to go into the complete criteria for each of the different anxiety disorders) Do you worry a lot? Do you ever feel restless,fidgety, or jittery? Do you have difficulty sitting still or concentrating? Do you have problems leaving the house? Ever had panic attacks? (give example of the symptoms and time frame) Thoughts that occurover and over? Do you have rituals that you do over and over? Like counting,checking, washing, Do you have fears of being criticized by others when out in public? Do you avoid going places or doing things because ofyour anxiety? Manic Symptoms: (if yes, need thorough details of duration of symptoms to determine if meets criteria for hypomania or mania episodes (BPI or II) Can you go days without sleeping or ever feel rested after little sleep? Is that happening now? Recently? Do you ever have periods of extreme happiness or irritability during these times? Sudden changes in mood? Are you extremely talkative or someone told you are during these times? Racing thoughts? Spending sprees ? otherreckless behavior? Increased sexual activity during these times Start projects don’t finish? Feel you have special gifts-the best at something, feel invincible? (get duration, severity, consequences) Psychosis:Hallucinations? (here need to come up with way to ask this) Delusions? (here you need to come up with a way to evaluate for paranoia, grandiose ideas, delusions of control, etc)
  30. 30. 30 Sexual interest/performance: Are you sexually active? Change in sex drive? Disinterested in sex or problems with performance? Psychiatric History: Have you ever peen diagnosed with any psychiatric disorders? Have you ever been treated for a mental illness or stress problem? What meds were tried and did they work? Ever been hospitalized? (get details) Ever attempted suicide? (get details) Ever go to counseling? (get details) Alcohol and Other Drug use History: Tobacco, alcohol, illicit drugs? What kind and how often? IV drug use? First and last use Do you feel you may have a problem? (insight) CAGE questionaire Financial burden? Caffeine? Ever took more prescription drugs than prescribed? OTC Go through each class Marijuana, cocaine, opiates,benzo, hallucinogens, nicotine? Any consequences ofusing drugs or alcohol-give example? Any illegal activities? E.g drink when driving? Cannot go without drugs or alcohol? Use more than intended? Ever treated? (get details) detox, AA-how long (use NIAAA standards forscreening: Ever drink 4 drinks or more (women), 5 or more (men) in past year? Use standards for moderate drinking: No more than 7 drinks/week women, 14 drinks/men Current Health Status: Allergies: drugs,environmental, seasonal? Medical Conditions: Head injuries, seizures, trauma Current prescribed medications: OTC and herbal?
  31. 31. 31 Health maintenance behaviors: Do you exercise? How much and how frequently? When last physical exam? Last pap? Childhood immunizations? What is your diet like? Last physical exam: When? Mammogram, Dental check up? Past Health Status: Major Illnesses: Heart disease,resp., diabetes Accidents:broken bones,head injuries, seizures, convulsions? Lost consciousness? Menstrualhx/pregnancy hx, etc Hospitalizations: Surgeries: minor or major? What, where, when, any complications? Family History: psychiatric or mood disorder or drug and alcohol? Find out FH for above in ach member (include parents,siblings, grandparents,aunts,uncles,cousins,offspring) Health problems in family members Genogram of family Relationship with family members? Suicides in family Developmental History: Normal delivery? Complications? Milestones on time? Problems with learning? Peer relationships? Activities in school? Special classes? Compare with others? How many jobs? Relationship with co-workers? Lost any family members or friends? Abuse history (physical, psychological,sexual)
  32. 32. 32 Social History: Current health habits/ADLs: Laundry? Cooking? Perform hygiene and grooming? Take care of self? Responsibilities? Difficulty doing chores? Educational History: Highest degree? School? Grades? Truancy? Hobbies, talents, interests: What kinds? What did for fun past week? Legal History: Any charges pending? Current Living Situation: Where? How long? Who? Marital and Relationship History: Live together? More arguments or disagreements? Able to work out problems? Relationships: Friends? How many? How often see? Getting along? Work History: Where? How long? How many hours? Job- calling in sick or poor performance (fired or quit) Able to concentrate? How feel doing?
  33. 33. 33 Financial Status: Support self? Family? Any stressors? Military History: if yes,combat? Religion/Spirituality: Attend church? Religion? Have spiritual beliefs ? Social network/support system: Who? How? Who can you talk to? Sexual History: Focused Review of Systems: General: Weight. Dizzy or light headed? Sleep? Fever. Chills, sweats? Skin/hair/nails: hair thinning? Dry skin? Color change? HEENT: head: dizzy? Headaches? Eyes: vision changes? Ears: ringing? Pain? Mouth/Throat:sores? Changes in teeth? Cardiac: Chest pain? Palpitations? Diaphoresis? GI: Change in habit? Diarrhea or constipation? N/V, abdominal pain? GU: frequency? Pain? LMP? Respiratory: SOB? DOE? MS: Weakness? Falls? Joint pain?
  34. 34. 34 Psych: How long? Change in personality? The following may or may not be helpful Disorder Symptoms Yes No Psychosis Hallucination Delusions Disorganized speech GAD Restlessness Worry too much Fatigue Irritability Muscle tension Anxiety Insomnia Panic SOB Palpitations Fainting Sweating Trembling Choking Depersonalization Numbness/tingling Chest pain Fear of losing sanity Getting out Fear of being in crowds Excessive worry OCD Obsessions Compulsive
  35. 35. 35 Anorexia Failure to maintain weight Fear of fat Body distortion Amenorrhea Bulimia Binge eating/2 x’s/wk for 3 mo Use of laxatives, diuretics, enemas Vigorous exercise OBJECTIVE Do memory test. 3 objects – ball, car, dog. Repeat now and later. Mental Status Exam: Appearance: Appears stated age tattoos,piercings Body build: thin obese cachetic muscular frail medium Position: lying sitting standing kneeling Posture; Slumped rigid slouched threatening comfortable Eye contact: Good Fair poor Dress: appropriate neatness clean
  36. 36. 36 Grooming: malodorous perfumed dirty unshaven makeup clean jewelry Manner/attitude: cooperative angry evasive Attentiveness: disinterested preoccupied distractible attentive Alertness: alert drowsy stupor comatose Behavior and psychomotoractivity: Slow retarded calm restless tremor lip smacking pacing picking at skin or clothing agitated Attitude toward examiner/reliability: Cooperative guarded suspicious hostile apathetic defensive uncooperative Mood: Euthymic depressed sad tearful hopeless angry hostile suspicious sullen anxious belligerent Affect: Bright constricted blunted (some reaction) flat labile anxious Speech: slow long pauses hesitant rapid pressured Monotonous stuttering Loud soft whispered monosyllabic hypertalkative Clear mumbled slurred pressured foul language
  37. 37. 37 Perceptual disturbance: Hallucinations (auditory, visual, tactile, gustatory) illusions depersonalization Thought processes: Clear coherent goal directed flight of ideas circumstantial loose associations word salad preservation tangential Thought content: Normal obsessions compulsions preoccupations phobias delusions paranoia religious somatic grandiose Alertness and level of consciousness: alert and oriented Do Glascow Coma Scale and score if not alert Orientation: time, person,place (do entire MMSE and score 1-30 for over 65 for baseline and anyone with alteration in consciousness) Memory: Recall objects at 1 min 3 min . Can you name the last 3 presidents What did you have for supperlast night? When did WWII end (for LT memory in older adult); When was Kennedy shot? (older than 50) What was your major in college? Do clock test,ask to name all animals can in 30 seconds; askfor digit span forward and back (4 numbers ) Concentration and attention:Spell world forward backward serial 7’s Praxis: Ask patient to follow a three-stage command: "Take a paper in your right hand, fold it in half, and put it on the floor." Ask patient to read and obey the following sentence which you have written on a piece of paper: "Close your eyes Capacity to read and write: Ask patient to write a sentence
  38. 38. 38 Visuospatial ability: correctly copy figure of intersecting pentagons Abstract thinking, proverbs,and similarities: Proverb: Have you heard the expression: A rolling stone gathers no moss? What does that mean to you? How are apples and oranges alike? How are a chair and a table alike? { Better for an older person} Abstract concrete impaired Fund of information and intelligence: level of education and intelligence Ask re current events,make change Judgment: If you found stamped letter what would you do? Insight: What kind of problem do you think that you are having? Good intact fair limited Assets/strengths:motivation? What good at? Liabilities: Areas you would like to work on? Other objective assessments: T: P: R: BP: Wt. Ht: Lab work. General: HEENT: Neck: Cardiac: Respiratory: Abdomen: Extremities: Neuro:
  39. 39. 39 ASSESSMENT Axis I: Axis II: 799.9 Deferred Axis III: Medical problems Axis IV: Problem with primary support group Problem related to social environment Educational problems Occupational problems Housing problems Economic problems Problems with access to health care Problems related to interaction with legal system/crime Other psychosocialand environmental problems (identify specific stressors forSOAPs, CDMs) Axis V: Current GAF: Highest GAF in past year: Plan: Labs and diagnostic tests Pharmacologic Teaching plan Counseling plan Referrals and consultation Follow up
  40. 40. 40 UTA School of Nursing Tips for Follow up Medication Management Visit and Documentation : 1. What has happened since the last visit-update on symptoms, list all medications, response to medication, worsening of symptoms or improvement, new symptoms, review of expected side effects and indication if present or not, new or continued stressors, hospitalizations, medical issues-new or continuing, always include suicide evaluation, include relevant quotes from patient . Include significant positives and negatives. Include duration and severity of symptoms/problems. 2. Objective data-focus on appearance, speech, eye contact, level of cooperation, agitation, thought processes, thought content, perception, mood, affect, judgment, insight, etc. (brief notation of each area- include significant positives and negatives-e.g. no reckless behavior (on judgment ) 3. Any screenings done (e.g. AIMS), recording of lab and VS e.g. what is most recent lithium level, date of level, last date of thyroid testing, etc. BMI, waist circumference, weight if applicable 4. Focus your thinking on “is this the correct diagnosis?” is this the correct medication(s), do we decrease the med, increase a med, change a med, stop a med, or change the dosing schedule of the med. 5. Write Axis I-V diagnosis for this patient, updating for this visit. Write plan for this patient including all areas. If continuing the same meds, write them down, with the doses and schedule for taking. “Continue Paxil 20 mg qHS.: If new med, write Start Wellbutrin 150mg. XL qam., etc. If giving samples, indicate how many, if given RX, indicate # of pills and # of refills
  41. 41. 41 GUIDELINES FOR CLINICAL EXPERIENCES 1. Documentation of Care: The UTA School of Nursing Nurse Practitioner Programs requires a wide variety of clinical hours which necessitates the studen t to obtain experiences in numerous settings. The student is expected to appropriately, thoroughly,and accurately document each client encounteron the client’s health record, i.e., SOAP notes,clinical summaries, etc. All entries made by the student in the client’s health record should be reviewed by the preceptor. Documentation will be co-signed by the preceptor as appropriate for the clinical site. 2. Clinical Preceptors: Students are encouraged to utilize several preceptors throughout their nurse practitioner coursework. Guidelines for the selection of preceptors are included in the “Preceptor Agreement Packet”. Please note that the “Letter of Agreement” in the packet MUST b e signed and on file at UTA BEFORE clinical experiences commence at the site. If using a new preceptor, the biographical form must be submitted to Vanessa Montgomery. Students are expected to negotiate their clinical objectives and number of hours with each preceptor. If for any reason, the primary preceptorand/or a secondary preceptoris absent,i.e., not physically in the practice setting,the student may not make any decisions requiring medical management. If a secondary preceptoris available in the absence of your primary preceptor, a preceptor agreement form must be completed prior to any medical management activity and faxed to the School of Nursing to your clinical advisor. Turn in your preceptor agreements to clinical advisor by 3rd week of class for ALL clinical experience for that semester. 3. Clinical Experiences: Clinical experiences should not occur at the student’s place of employment. Clinical experiences are strictly voluntary and are not to be reimbursed by any forms of payment (salary of any type). A BNE rule. All charting should be signed as your name followed by RN, UTA PMHNP student. 4. Telephone/Clinical Practicum Site Visits: The NP Faculty will be available for telephone consultation and/oron-site visits to the student and preceptoras needed throughout the semester. Depending on faculty/student preference, clinical practicums may be performed at the student’s clinical site or other site selected by the faculty. In the event that the practicum is performed at the student’s clinical site, the student should be prepared to conduct a psychiatric evaluation with a new client, and have selected the “potential” client before the faculty arrives at the facility. The student will be evaluated according to the criteria on the “Clinical Practicum Form” for the appropriate level in the program. . A score of 83% or greater is required as a passing score for all clinical practicums. Failing performances may be re-evaluated one time. (see guidelines) 5. Preceptor Evaluations: Preceptor evaluations are required each semester and indicate the student’s clinical performance over time as opposed to the practicum evaluation which evaluates clinical performance on one or two clients. In order for a preceptor to evaluate the student’s performance, there must be a preceptoragreement on file at UTA. Evaluations can be obtained from those preceptors that spend 16 hours or more in clinical with the student. The student is encouraged to ask the preceptor to discuss the evaluation with them before mailing it to the student’s clinical advisor. Therapy evaluation forms will be provided. Provide a stamped self-addressed envelope for the preceptor to mail the student evaluation with clinical advisor’s name, etc. or it can be faxed 817-272-5006. 6. Professional Attire: Students should dress professionally and appropriately according to the clinical practice setting. Professional street clothes and a UTA name badge identifying the student as a UTA Nurse Practitioner Student should be worn in client encounters. In psychiatric settings, closed toe shoes are preferred (no backless shoes)and no scarves or necklaces should be worn (for safety purposes) See UTA dress code 7. Clinical Conferences with Faculty: At regular intervals throughout the semester, faculty advisors will communicate with students regarding progress towards obta ining clinical objectives,overall student performance, in the program and other areas of concern. Students are expected to share information with the clinical advisor that will help the advisor evaluate the quality and scope of the clinical experiences. This commun ication may be conducted via telephone,email, or other method at the convenience of the student and faculty advisor. Complete evaluation of preceptors by e log. .
  42. 42. 42 The University of Texas at Arlington School of Nursing Family PMHNP (post masters will be individualized) NAME:(WEEKLY) CLINICAL HOUR TALLY SHEET FALL 2009 TOTAL= 720 hr in program (585 psych clinical hours) TYPE OF HOURS (Required) 8/24 - 8/31 8/31- 9/06 9/07- 9/13 9/14- 9/20 9/21- 9/27 9/28- 10/04 10/05- 10/11 10/12- 10/18 10/19- 10/25 10/26- 11/01 11/02- 11/08 11/9 11/15 11/16- 11/22 11/23- 11/29 11/30- 12/06 12/07-12/13 Hrs. From Previo us Semes ters Fall 2009 Totals TOTAL ADVANCED ASSESS. 45 ADULT PSYCH MT. 180 Required CHILD & ADOL PSYCH MT. 175 Required GERIATRIC PSYCH MT. 20 Required ADULT MEDICAL MT. 45 Required ADDICTION 45 Required GROUP Therapy 50 Required FAMILY Therapy 40 Required INDIVIDUAL Therapy 50 Required SEMINARS Practicum (5631) 25 Ped. Med Mt. 45 Required Total Hours Preceptor signatures:_______________________ ___________________ _________________________ _ _______________________ _____________________ ________________________ _____________ _ __ __________________
  43. 43. 43 Adult PMHNP Program (Note: post masters will be individualized) NAME:(WEEKLY) CLINICAL HOUR TALLY SHEET FALL 2009 TOTAL=675 for program (585 psych focused hours) TYPE OF HOURS (Required) 8/24 - 8/30 8/31- 9/05 9/07- 9/12 9/14- 9/20 9/21- 9/28 9/28- 10/04 10/05- 10/11 10/12- 10/18 10/19- 10/25 10/26- 11/01 11/02 11/08 11/9- 11/15 11/16- 11/22 11/23- 11/29 11/30- 12/06 12/07-12/13 Hrs. From Previous Semesters Fall 2009 TOTAL ADVANCED ASSESS.45 ADULT PSYCH MT. 305 Required ADOL PSYCH MT. 20 Required GERIATRIC PSYCH MT. 50 Required ADULT MEDICAL MT. 45 Required ADDICTION 45 Required GROUP Therapy 50 Required FAMILY Therapy 40 Required INDIVIDUAL Therapy 50 Required SEMINARS Practicum 25 Required Total Hours Preceptor Signatures :____________________ ____________________ ____________________ ____________________________ ______________ ________ _________________ ____________ ________
  44. 44. 44 Elog Work Sheet Date: ______________________ Site: _________________________ Client # (DOB): ______________ Age: _______ Sex: ________ Ethnicity _________ Purpose: ____________________ Problem: ________________________________________ CPT: _______________________ Diagnostics: _____________________________________ Procedures: ____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Axis I – (med dx): ______________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Axis II: _______________________________________________________________________ Axis III: ______________________________________________________________________ Axis IV: ______________________________________________________________________ Axis V: _______________________________________________________________________ Interventions: __________________________________________________________________ Nursing Diagnosis: ______________________________________________________________ Client complexity: ______________________ Student function: _______________
  45. 45. 45 Date, number of hours Type of experience Preceptor Signature of preceptor

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