Chapter Ten: Mental Health
Practical Application: Book Activity
Practical Application
Setting the Scene
Stop the Stigma: Why it’s important to talk about Mental Health (Heather Sarkis)
Watch this video by visiting https://youtu.be/gy1iH_Gxn0Q
Think About It
Drawing from Ms. Sarkis’s TED talk, consider:
- Did you find any facts she shared surprising?
- Why do you think mental health is so stigmatized into today’s society? What is the impact of such stigmatization?
- How have you encountered mental illness in your life? How did it impact your experience with others?
- What is one thing you can do to help reduce or eliminate stigma related to mental illness?
- As a nurse
- what can you do to help your patients avoid being treated like “it’s all in their heads”?
- how can you incorporate acceptance and treatment of mental health into your practice, especially if this is not your area of focus?
Practical Application: Additional Guidance
Exercise Title
“Living with Schizophrenia an Exercise in Self-Reflection”
VIDEO: https://www.youtube.com/watch?v=48YJMOcykvc
Objectives
This exercise aims to immerse learners to critically reflect on their own attitudes and behaviors related to mental health.
Preparing for the Exercise
- Introduction: Introduce the concept of self-reflection. Provide background information on the exercise and its objectives. Use information from American Psychiatric Nurses Association
- Video Viewing: Direct students to watch the provided video “Living with Schizophrenia.” Encourage active engagement and note-taking.
- If you have access to technology in your courses, you might explore VoiceThread or Perusall to encourage students recording their thoughts in real time.
Exercise Components
After watching the assigned video address the following areas:
- Define the word stigma.
- Describe an experience you have in mental health or with someone with mental illness
- What is your view of mental illness and persons with mental illness?
- Do you believe there is a stigma associated with mental illness? Why or why not.
- Discuss any concerns you have regarding working with persons with mental illness?
- Identify strategies to address these concerns regarding working with persons with mental illness
Evaluation and Assessment
- Assessment Criteria: Establish clear criteria for evaluating student performance:
- thoroughness of their analysis and self-awareness as to their preconceptions and assumptions
- identification of personal action items
- Assessment Method: Written reflection
Integration into Curriculum
- Alignment with Course Objectives: nsure that the exercise aligns with course objectives related to community health nursing, health promotion, advocacy, and program planning.
- Sequencing: Determine the appropriate timing and sequencing of the exercise within the course curriculum to complement other content and activities.
Resources and Support
- Learning Resources: Provide students with access to relevant literature, articles, and resources on mental health
- Faculty Support: Offer guidance, feedback, and support to students as they engage in the exercise, addressing any questions or concerns they may have about the scenario or related topics.
Content for this exercise comes from the American Psychiatric Nurses Associations (APNA) Undergraduate Education Toolkit:
American Psychiatric Nurses Association Education Council, Undergraduate Branch. (2022). Crosswalk toolkit: Defining and using psychiatric-mental health nursing skills in undergraduate nursing education. Retrieved from https://www.apna.org/resources/undergraduate-education-toolkit/
Conclusion
By following these guidelines, nurse educators can facilitate a dynamic and engaging practice application exercise that empowers nursing students to explore their attitudes and beliefs regarding mental health and how these attitudes may influence patient care and interactions.
Additional Activities
Role-playing/Communication Exercise
Scenario Title
Understanding Bipolar Disorder
Objective
To enhance nurses’ understanding of bipolar disorder and practice effective communication strategies when interacting with patients diagnosed with this condition.
Materials Needed
- Information handouts or slides about bipolar disorder
- Scenario cards depicting common patient interactions
- Flipchart or whiteboard
- Markers
Role-Playing Activity
- Introduction (15 minutes)
- Welcome and Introduction:
- Start the session by welcoming participants and explaining the objectives of the communication activity.
- Overview of Bipolar Disorder:
- Provide a brief overview of bipolar disorder, including its types (bipolar I, bipolar II, cyclothymic disorder), symptoms, and common treatment approaches.
- Discuss the impact of bipolar disorder on patients’ lives, emphasizing the importance of holistic care and understanding.
- Welcome and Introduction:
- Scenario Exploration (30 minutes)
- Scenario Cards:
- Distribute scenario cards depicting various situations involving patients with bipolar disorder.
- Each scenario should include details about the patient’s behavior, mood changes, and communication challenges.
- Small Group Discussion:
- Divide participants into small groups.
- Assign each group a scenario card and ask them to discuss:
- How they would approach the patient in the scenario.
- Effective communication strategies to use based on the patient’s current mood (manic, depressive, mixed).
- Ways to build rapport and trust with the patient.
- Role-Playing:
- After discussion, invite groups to role-play their scenarios.
- Encourage participants to practice using the communication strategies they discussed.
- Rotate roles so that each participant has the opportunity to play the nurse, patient, or observer.
- Scenario Cards:
- Debriefing and Discussion (15 minutes)
- Group Reflection:
- Facilitate a group discussion on the challenges encountered during the role-plays and the effectiveness of different communication approaches.
- Encourage participants to share insights and lessons learned from their experiences.
- Key Takeaways:
- Summarize key communication strategies for interacting with patients with bipolar disorder.
- Discuss the importance of empathy, active listening, and adapting communication styles to meet the patient’s needs.
- Group Reflection:
- Step 4: Wrap-Up (10 minutes)
- Q&A and Closing Remarks:
- Address any questions or concerns raised by participants.
- Provide additional resources or reading materials on bipolar disorder and trauma-informed care in nursing practice.
Debriefing and Feedback
After the role-play, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
- What symptoms indicated that the patient may have bipolar disorder?
- Why did you chose the communication strategies you used in the role play?
- What communication strategies seemed to be the most successful?
Reflective Practice
This activity could occur on a discussion board or by uploading a video using Flip or Canvas Studio.
What insights have you gained from your interactions with mental health clients as a nursing student, and how have these experiences influenced your approach to providing patient-centered care?
Interactive Module
Create an interactive escape room using Google Forms that challenges students to solve puzzles related to the chapter topic. These NCLEX-style questions can be a starting point.
- A nurse is caring for a client diagnosed with generalized anxiety disorder (GAD). Which intervention should the nurse prioritize to assist the client in managing anxiety?
- Administering lorazepam (Ativan) as prescribed by the healthcare provider.
- Restricting the client’s access to caffeine-containing beverages.
- Initiating cognitive-behavioral therapy sessions immediately.
- Encouraging deep-breathing exercises and progressive muscle relaxation techniques.
- A nurse is caring for a client diagnosed with major depressive disorder (MDD). Which assessment finding would the nurse prioritize as indicating a potential worsening of the client’s depression?
- Expressing feelings of worthlessness and guilt.
- Increased appetite and weight gain.
- Improved concentration and ability to make decisions.
- Increased interest in social activities.
- A nurse is caring for a client diagnosed with bipolar disorder who is experiencing a manic episode. Which intervention should the nurse prioritize to promote client safety?
- Encouraging participation in group therapy sessions.
- Implementing a strict bedtime routine to promote sleep.
- Monitoring fluid intake and output closely.
- Establishing limits on impulsive spending behaviors.
- A nurse is caring for a client diagnosed with obsessive-compulsive disorder (OCD). Which client behavior would the nurse prioritize for intervention?
- Spending excessive time organizing personal belongings.
- Engaging in ritualistic handwashing for 30 minutes before meals.
- Preferring to follow a daily routine without changes.
- Reporting occasional intrusive thoughts about harm to loved ones.
- A nurse is assessing a client diagnosed with schizophrenia who exhibits disorganized thinking and delusions of persecution. Which intervention should the nurse prioritize to promote therapeutic communication?
- Asking the client direct questions to clarify their delusional beliefs.
- Using non-verbal communication, such as nodding to show understanding.
- Encouraging the client to participate in group therapy sessions.
- Administering antipsychotic medication as prescribed.
Case Study: Mental Health in the Community
Patient Profile
Bella, a 38-year-old woman, resides in a suburban community. She works as a freelance graphic designer and lives alone in a small apartment. Bella has a history of depression and anxiety, managed with medication and occasional therapy sessions. Recently, she has been experiencing increased stress due to financial difficulties and isolation exacerbated by the COVID-19 pandemic. Bella has been feeling overwhelmed and expresses thoughts of hopelessness and worthlessness.
Presenting Issues
Bella presents to the community health clinic with complaints of persistent sadness, insomnia, and loss of interest in activities she once enjoyed. She reports feeling fatigued despite sleeping poorly and has experienced significant weight loss over the past month. Bella admits to having thoughts of ending her life, although she has not made any specific plans.
Assessment Findings
The nurse recognizes Mary’s signs of trauma and decides to implement trauma-informed care principles:
- Mental Status Examination: Bella appears withdrawn and tearful. She exhibits slowed speech and poor eye contact. She expresses feelings of guilt over being a burden to others.
- Physical Examination: Vital signs are within normal limits. Physical exam is unremarkable except for signs of poor self-care (e.g., unkempt appearance).
- Psychosocial Assessment: Bella reports limited social support and increased feelings of isolation since the pandemic began. She describes difficulty concentrating on work tasks and diminished motivation.
Nursing Diagnosis
Risk for Suicide related to feelings of hopelessness, social isolation, and recent stressors.
Plan of Care
- Immediate Safety Measures:
- Ensure Bella’s immediate safety by removing any potential means of self-harm (e.g., sharp objects, medications).
- Establish a suicide safety plan with Bella, including identifying supportive contacts and coping strategies.
- Psychiatric Assessment:
- Arrange for a comprehensive psychiatric assessment to evaluate Bella’s current mental health status, suicidal ideation severity, and need for medication adjustment or additional therapy.
- Therapeutic Communication and Support:
- Engage in therapeutic communication to validate Bella’s feelings and provide emotional support.
- Encourage Bella to express her emotions and concerns in a safe and non-judgmental environment.
- Collaborative Care:
- Coordinate care with Bella’s psychiatrist and therapist to ensure continuity of care and appropriate follow-up.
- Involve community resources such as local mental health support groups or crisis intervention services.
- Health Promotion and Education:
- Educate Bella about the importance of adhering to her prescribed medications and attending therapy sessions regularly.
- Provide information on stress management techniques, relaxation exercises, and healthy coping strategies.
Evaluation
Monitor Bella’s progress closely, assessing for changes in mood, suicidal ideation, and overall well-being. Evaluate the effectiveness of interventions implemented in reducing Bella’s risk for suicide and improving her mental health status.
Outcome
The goal is for Bella to feel supported, safe, and empowered to manage her depression effectively with the help of appropriate treatment and community resources. Long-term objectives include improving Bella’s coping skills, enhancing social support networks, and promoting overall mental health wellness in the community.
Simulation
Scenario
Managing Depression in a Community Setting
Setting
You are a community health nurse assigned to provide care for Abraham, a 45-year-old man who lives alone in an apartment complex. Abraham has a history of depression and recently experienced a significant loss—he was laid off from his job of 15 years due to company downsizing. He has been feeling increasingly hopeless and withdrawn, neglecting his personal hygiene and skipping meals. Today, you are visiting Abraham to assess his current mental health status and provide necessary interventions.
Objective
- Conduct a thorough assessment of Abraham’s mental health, including his current mood, suicidal ideation, and functional status.
- Develop a plan of care to address Abraham’s depression and promote his mental well-being in the community setting.
- Implement therapeutic interventions to support Abraham and enhance his coping skills.
- Evaluate the effectiveness of interventions and adjust the plan of care as needed based on Abraham’s response.
Simulation Outline
- Preparation:
- Review Abraham’s medical history and any recent assessments or notes.
- Gather assessment tools, such as scales for depression severity and suicide risk assessment.
- Initial Assessment:
- Approach Abraham in a calm and non-threatening manner.
- Conduct a mental status examination, assessing his mood, affect, thought content, and cognitive function.
- Use validated screening tools (e.g., PHQ-9) to assess the severity of Abraham’s depression.
- Therapeutic Communication:
- Establish rapport with Abraham and create a supportive environment.
- Encourage open communication and active listening to understand Abraham’s concerns and emotions.
- Validate Abraham’s feelings of sadness and hopelessness without judgment.
- Safety Assessment:
- Assess Abraham’s risk of suicide using a standardized suicide risk assessment tool.
- Implement safety measures as needed to ensure Abraham’s immediate safety.
- Development of Plan of Care:
- Collaborate with Abraham to develop a personalized care plan based on assessment findings and his preferences.
- Include goals related to symptom management, social support enhancement, and daily routine establishment.
- Intervention Implementation:
- Educate Abraham about depression, its symptoms, and the importance of treatment adherence.
- Discuss coping strategies and relaxation techniques (e.g., deep breathing exercises, mindfulness) to help manage stress and negative emotions.
- Provide information on community resources, such as support groups or counseling services, available to Abraham.
- Evaluation and Follow-Up:
- Evaluate Abraham’s response to interventions and monitor changes in his mood and functional status.
- Schedule follow-up visits or phone calls to assess ongoing needs and provide additional support.
- Document all assessments, interventions, and outcomes in Abraham’s health record.
Debriefing and Feedback
After the simulation, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
- Challenges encountered during the simulation and strategies for overcoming them.
- Effectiveness of interventions and areas for improvement in providing care to individuals with depression in community settings.
- Reflect on the importance of holistic care and multidisciplinary collaboration in managing mental health issues.
Competency Assessment
Demonstration
Assessment and Care Planning: Developing individualized care plans based on assessment findings, incorporating evidence-based interventions and patient preferences.
Crisis Intervention and Safety Measures: Apply protocols for assessing and managing suicidal ideation, aggression, and other psychiatric emergencies.
Family and Community Education: Educate patients, families, and communities about mental health disorders, treatment options, and strategies for promoting mental wellness.
Clinical Activities/Opportunities
- Crisis Intervention Teams:
- Respond to mental health crises in the community, participate in de-escalation techniques and safety protocols.
- School-Based Mental Health Programs:
- Screening and Assessment: Assist in conducting mental health screenings or assessments for students, identifying early signs of mental health issues and facilitating referrals.
- Education and Support Groups: Facilitate or co-facilitate educational sessions or support groups for students focusing on mental health awareness, coping skills, and stress management.