PART I

I. Foundations of Psychiatric Mental Health Nursing

1. Describe characteristics of mental health and mental illness.

2. Discuss the purpose and use of Diagnostic and Statistical manual of mental disorders (DSM IV- TR)

3. Identify historical landmarks in psychiatric care.

4. Discuss the current trends in the treatment of people with mental illness.

5. Discuss the American Nurses Association standards of practice for psychiatric mental health nursing.

6. Describe common student concerns about psychiatric nursing.

Critical thinking questions:

1. In your own words, describe mental health. Describe the characteristics, behavior, and abilities of
someone who is mentally healthy.

2. When you think of mental illness, what images or ideas come into your mind? Where do these ideas
come from- movies, television, personal experience?

3. What personal characteristics do you have that indicate good mental health?

II. Neurobiologic Theories and Psychopharmacology

1. Discuss the structure, processes, and functions of the brain.

2. Describe the current neurobiologic research and theories that are the basis for current
psychopharmacologic treatment of mental disorders.

3. Discuss the nurse’s role in educating the clients and families about current neurobiologic theories and
medication management.

4. Identify pertinent teaching for clients and families about brain imaging techniques.

5. Discuss the categories of drugs used to treat mental illness and their mechanism of action, side effects
and special nursing considerations.

6. Identify client responses that indicate treatment effectiveness.

7. Discuss common barriers to maintaining the medication regimen.

8. Develop a teaching plan for clients and families for implementation of the prescribed therapeutic
regimen.

Critical thinking questions:

1. It is possible to identify a gene associated with increased risk for the late onset of Alzheimer’s disease.
Should this test be available to anyone who requests it? Why or why not? What dilemmas might arise
from having such knowledge?
2. What are the implications for nursing if it becomes possible to predict certain illnesses such as
Schizophrenia, through the identification of genes responsible for or linked to the disease? Should this
influence whether people who carry such genes should have children? Who should make that decision,
given that many peoplewith chronic mental illness depend on government programs for financial
support?

3. Drug companies research and develop new drugs. Much more money and effort is expended to
produce new drugs for common disorders rather than drugs needed to treat rare disorders, such as
Tourette syndrome. What are the ethical and financial dilemmas associated with research designed to
produce new drugs?

III. Psychosocial theories and therapy

1. Explain the basic beliefs and approaches of the following psychosocial theories: psychoanalytic,
developmental, interpersonal, humanistic, behavioral, existential, and crisis intervention.

2. Describe the following psychosocial treatment modalities: individual psychotherapy, group

psychotherapy, family therapy, behavior modification, systematic desensitization, token economy,self-
help groups, support groups, education groups, cognitive therapy, milieu therapy, and psychiatric
rehabilitation.

3. Identify psychosocial theory on which each treatment strategy is based.

4. Identify how several of the theoretical perspectives have influenced current nursing practice.

Critical thinking questions:

1. Can sound parenting and nurturing in a loving environment overcome a genetic or biologic
predisposition to mental illness?

2. Can children raised in a hostile environment without parental love, support, and consistency avoid
mental health problems as adults? If so, how, or what factors could help a person overcome a neglected
or traumatic childhood?

IV. Treatment Settings and therapeutic programs

1. Discuss traditional treatment settings.

2. Describe different types of residential treatment settings and the services they provide.

3. Describe community treatment programs that provide services to people with mental illness.

4. Identify barriers to effective treatment to homeless people with mental illness.

5. Discuss the issues related to people with mental illness in the criminal justice system.

6. Describe the roles of different members of a multidisciplinary mental health care team.

7. Identify the different roles of the nurses in varied treatment settings and programs.

Critical thinking questions:

1. Discuss the role of the nurse in advocating for social or legislative policy changes needed to provide
psychiatric rehabilitation services for clients in all settings.

2. When are programs for special populations, such as mentally ill adults who are offenders or homeless,
considered successful?

3. How can the nurse reconcile the trend for shorti inpatient hospitalization with the long term needs of
some clients with severe and persistent mental illness?

V. Therapeutic Relationship

1. Describe how the nurse uses the necessary components involved in building and enhancing the nurse-
client relationship.

2. Explain the importance of values, beliefs and attitudes in the development of nurse- client
relationship.

3. Describe the importance of self – awareness and therapeutic use of self in the nurse- client
relationship.

4. Identify self-awareness issues that can enhance or hinder nurse- client relationship.

5. Define carper’s 4 patterns of knowing and give example of each.

6. Describe the differences between social, intimate, and theraqpeutic relationship.

7. Describe and implement the phases of the nurse- client relationship as outlined by Hildegard Peplau.

8. Explain the negative behaviors that can hinder or diminish the nurse-client relationship.

9. Explain the various possible roles of the nurse.

Critical thinking questions:

1. When it is possible to accept a gift from a client? What types of gifts are acceptable? Under what
circumstances should the nurse accept gifts from a client?

2. What relationship- building behaviors would the nurse use with a client who is very distrustful of the
health care system?

3. What preconceptions do you have about mental health clients?

PART II

I. Therapeutic communication

1. Describe the goals of therapeutic communication.

2. Identify therapeutic and non-therapeutic verbal communication skills.

3. Discuss verbal communication skills such as facial expression, body language, vocal cues, eye contact,
and understanding of levels of meaning and context.
4. Discuss boundaries in therapeutic communication with respect to distance and use of touch.

5. Distinguish between abstract and concrete messages.

6. Tabulate Therapeutic communication techniques with the following format:

Therapeutic communication techniques Examples: (in English and Visayan language) Rationale 1- 25

7. Tabulate Non- therapeutic communication techniques with the following format:

Non- therapeutic communication techniques Examples: (in English and Visayan language) Rationale 1-19

Critical thinking questions:

1. Explain why the nurse’s attempt to solve the client’s problem is less effective than guiding the client
to identify his or her own ways to resolve the issue.

2. The nurse is working with a client whose culture includes honoring one’s parents and being obedient,
keeping private matters within the family only, and not talking with strangers about family matters.
Given this client’s belief system, how will the nurse use therapeutic communication effectively?

II. Client’s Response to illness

1. Discuss the influences of age, growth and development on a client’s response to illness.

2. Identify the roles that physical health and biologic make up play in a client’s emotional responses.

3. Explain the importance of personal characteristics, such as self- efficacy, hardiness, resilience,
resourcefulness, and spirituality, in a client’s response to stressors.

4. Explain the influence of interpersonal factors, such as sense of belonging, social networks, and family
support, on a client’s response to illness.

5. Describe various cultural beliefs and practices that can affect mental health or illness.

6. Explain the cultural factors that the nurse must assess and consider when working with the clients of
different cultural backgrounds.

7. Explain the nurse’s role in assessing and working with clients of different cultural backgrounds.

Critical thinking skills:

1. What is the cultural and ethnic background of your family? How does it affect your mental illness?

2. How would you describe yourself in terms of the individual characteristics that affect one’s response
to illness such as growth and development, biologic factors, self- efficacy, hardiness, hardiness,
resilience and resourcefulness, and spirituality?

3. Which of these categories of factors that influence the client’s response to illness- individual,
interpersonal, and cultural- do you think is most influential? Why?
PART III

Chapter VIII. ASSESSMENT

1. Define assessment

2. Factors influencing assessment:

a. Client participation and feedback

b. Client’s health status

c. Client’s previous experiences/ misconceptions about health care

d. Client’s ability to understand

e. Nurse’s attitude and approach

3. How to conduct an interview? (Psychiatric nursing approach)

a. Environment

b. Input from family and friends

c. How to phrase questions

4. Content of the assessment:

a. Describe the following components:

• History

• General appearance

• Mood and affect (include the definition of the common terms in assessing mood and affect)

• Thought process and content (include the definition of the common terms r/t thought process and
content)

• Sensorium and intellectual processes

• Judgment and insight

• Self- concept

• Roles and relationships

• Physiologic and self- concerns

5. How to analyze data?

6. Psychological tests used in the planning of care for the clients

7. Psychiatric Diagnoses

CRITICAL THINKING QUESTIONS:

1. The nurse is preparing to do a psychosocial assessment for a client who is seeking help because she
has been physically abusive to her children. What feeling might the nurse experience?How the nurse
view this client?

2. The nurse has discovered through the assessment process that the client drinks quart of vodka every
2 days. The client states this is not a problem. How does the nurse proceed? What could the nurse say to
this client?

3. The nurse is assessing a client who is illiterate. How will the nurse assess the intellectual functioning
of this client? What other areas of a psychosocial assessment might be impaired by the client’s inability
to read and write?

CLINICAL EXAMPLE:

4. The nurse at a mental health clinic is meeting a new client for the first time and plans to do
psychosocial assessment. When the client arrives, the nurse finds a young woman who looks somewhat
apprehensive and is crying and twisting tissues in her hands. The client can tell the nurse her name and
age but begins crying before she can provide any other information. The nurse knows it is essential to
obtain information from this young woman, but it is clear she will have trouble answering all interview
questions at this time.

1. How should the nurse approach the crying client? What should the nurse say and do?

2. Identify five questions that the nurse would choose to ask this client initially. Give a rationale for the
chosen question.

IX. Legal and Ethical Concerns

1. Patient’s Bill of Rights

2. Restraints and Seclusion Standards for Behavioral Health

3. Describe the rights of the client in a psychiatric setting.

4. Discuss the legal and ethical issues related to seclusion and restraint

5. Describe the components of malpractice.

6. Identify pertinent ethical issues in the practice of psychiatric nursing.

7. Describe the most common types of torts in the mental health setting.

X. Anger, Hostility and Aggression

1. Discuss anger, hostility and aggression.

2. Describe psychiatric disorders that may be associated with an increased risk of hostility and physical
aggression in clients.

3. Describe the signs and symptoms, and behaviors associated with the five phases of aggression.

4. Discuss appropriate nursing interventions for the client during the five phases of aggression.
5. Describe important issues for nurses to be aware of when working with angry, hostile, or aggressive
clients.

6. Formulate sample nursing care plan for a client with aggressive behavior (in table form)

CRITICAL THINKING QUESTIONS:

1. If an aggressive client injures another client or staff, should criminal charges be filed against the
client? Why or why not?

XI. Abuse and Violence

1. Discuss the characteristics, the risk factors, and family dynamics of abusive and violent behavior.

2. Examine the incidences of and trends in domestic violence, child and elder abuse and rape.

3. Describe responses to abuse, specifically PTSD and dissociative identity disorder.

4. Clinical picture of abuse and violence

5. Characteristics of violent families.

6. Intergenerational transmission process

7. Clinical picture of abuse and violence

8. Cycle of abuse and violence

9. Clinical picture of child abuse, elder abuse and treatment intervention.

10. Rape and sexual assault, dynamics of rape and treatment intervention.

11. Psychiatric disorders related to abuse and violence

12. Formulate a sample Nursing Care Plan for a client who is being abused (table form)

Critical thinking questions:

1. Is spanking a child an acceptable form of discipline, or is it abusive? What determines the

appropriateness of discipline? Who should make the decisions, and why?

2. How can the nurse continue to have a positive relationship with the client who returns to abusive
relationship?

XII. Grief and Loss

1. Define grief, grieving, anticipatory grieving and mourning.

2. Identify the types of losses for which people may grieve.

3. Discuss the various theories of understanding the grief process. Tabulate the comparison of the
different theories.

4. Discuss the five dimensions of grieving.

5. Discuss disenfranchised grief and vulnerability of nurses who experiences it.

6. Identify the factors that increase the person’s susceptibility to complications related to grieving.

7. Discuss factors that are critical to integrating loss into life.

8. Formulate a sample nursing care plan for a client experiencing grief. (Table form)

Critical thinking questions:

1. What issues of loss does the nurse deal with every day? What are the nurse’s most valuable tools for
dealing with losses? How might the nurse use these tools across health care setting?

2. How might the nurse maintain his or her professional responsibility toward the therapeutic
relationship with those who are grieving for a loss? What components of trustworthiness must the nurse
cultivate in relation to a client who is grieving?

XIII. Anxiety and Anxiety Disorders

1. Define anxiety and anxiety related disorders.

2. Discuss anxiety as a response to stress.

3. Identify the psychological and physiologic responses of different levels of anxiety( table form).

4. Discuss the use of defense mechanisms by people with anxiety disorders.

5. Describe the current theories regarding the etiologies of major anxiety disorders.

6. Drug Study of the following anxiolytics:

1. Diazepam

2. Chlorazepate

3. Alprazolam

4. Oxazepam

5. Buspirone

6. Meprobamate

7. Librium

8. Prozac

9. Equanil

10. Atarax

7. Discuss anxiety related disorders and their symptoms: (table form)

1. Agoraphobia

2. Panic disorder
3. Specific phobia

4. Social phobia

5. OCD

6. GAD

7. Acute stress disorder

8. PTSD

8. Formulate a sample nursing care plan for a client experiencing anxious behavior (table form)

Critical thinking questions:

1. Because all people occasionally have anxiety, it is important for nurses to be aware of their own
coping mechanisms. Do a self- assessment: What causes you anxiety? What physical, emotional and
cognitive responses occur when you are anxious? What coping mechanisms do you use? Are they
healthy?