Clinical  portfolio     Mental  Health  Nursing  Practice  

   

Paper:  168.242/168.243  (2nd  year)   Paper:  168.341/168.342  (3rd  year)  

 

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Mental Health in the Bachelor of Nursing at Massey University Information for preceptors and clinical agencies Introduction 168.242 and 168.243 (Year Two) and 168.341 and 168.342 (Year Three) are integrated papers of theoretical perspectives, applied knowledge and praxis. We will be working and learning alongside consumers as individuals within the context of a family and community. Delineating the difference between mental health and mental illness is important. As part of their learning, students will need to consider the many factors that affect an individual’s ability to establish and maintain wellbeing. Alongside this is the service users’ experiences and coping skills, as they relate to their perception of self and their relationships. The term service user is used throughout this portfolio. This incorporates other names such as client, patient, or resident or consumer (depending on the agency setting). The mental health component of this paper is organised around and supported by four tenants of practice. These are: • The therapeutic relationship • The lived experience of distress/illness • Recovery philosophy • Nursing competency In the second year paper the perspective is broad and considers the long-term or enduring nature of coping ability and mental distress and how you might develop your interpersonal skills and ability to undertake assessments. In Year Three, that focus is sharpened to the acute nature of distress, risk and interventions from a nursing perspective. In Year Three students are expected to consolidate learning in regard to interpersonal skill development, undertake clinical interviewing and risk assessment and develop therapeutic partnerships with service users within the clinical environment. The experience of coping and problem solving as an individual within relationships and a community will be considered across both years. The approach to nursing must be underpinned by a philosophical stance of partnership, recovery and working in a culturally safe manner with people. While the above are considered cornerstones of both the second and third year mental health theory and clinical placements, they are not exclusive of many other important principles and theories of illness, care and healing.

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The relationship The goal of a therapeutic interpersonal relationship is to enable the service user to identify and explore strengths and limitations of their coping ability. As nurses we utilise a contracted relationship with service users, negotiate boundaries and work in partnership to explore thoughts, feelings and responses to everyday self perception, relationships and choices. Nurses are required to develop a level of congruence between what they say and how they act toward the person with whom they work. Nursing by its nature should symbolise healthy communication and personal competence. It is useful for us to recognise and be careful about how we express our views, our language, our own behaviour and expression of feelings (Wilson & Carryer, 2008). Being authentic, realistic and hopeful are key ingredients for outcomes of the relationships, in which we participate as nurses. Reflection on our own unique capabilities and limitations can assist us to recognise this in others. The lived experience of distress/illness Working with people experiencing mental illness in partnership (Barker, 2009) enables the nurse to bring to the relationship a willingness to engage and trust with a genuine desire to help, respect and empathise. The service user, on the other hand, brings an array of experiences, ideas and expectations that may be very different and sometimes unusual, to the relationship. The experience of illness is always unique, sometimes disabling, but always ‘real’ for the service user and their family. Nurses should endeavour to empathise and seek to improve their understanding of the service user’s experiences whilst communicating a willingness to assist them in making sense of their experience. Recovery Philosophy The principles of recovery and working within the context of an individual’s life experiences, developmental stage, personal resources and potential underpin partnership and a therapeutic relationship (Barker, 2009). Developing an awareness of these principles and conveying unconditional positive regard and hope with the service users you will work alongside in practice can make a significant difference in advancing the recovery process for someone. The principles of recovery apply within all our relationships as nurses. Nursing Competency As we individually expand our awareness of how we manage our relationships with others, and the types of communication processes we use, we begin to recognise the differences between the everyday person we are and the professional person we are becoming. Your development of a ‘whole person approach’ (Barker, 2009) alongside the increasing awareness of how society and communities value vulnerability and wellbeing in relation to metal health will develop during your practicum. This means you need to be alert, conscious and reflective of the factors, both obvious and hidden at times, which affect the development of distress and recovery. Reflective practice and peer support will be processes used to critically consider your own developing competency as a nurse. Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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The clinical experience The School acknowledges the key role clinical agency staff fulfils in supporting our students in their clinical practice. Good clinical experiences with enthusiastic mentors and preceptors, as well as support and encouragement from Massey University, will attract our future nurses into mental health nursing. The students learn their practical skills and knowledge whilst they are out gaining experience with you, and the support of our Clinical Teaching Associates. Students are expected to know, before commencing their clinical experience, the signs and symptoms of major mental health problems, an approach to assessment, and how to formulate a care plan. However, putting this into practice and gaining confidence in their first mental health practice experience requires your support and that of their CTA. Year Two clinical experiences require students to work with people in recovery, whereas Year Three students work with people experiencing acute mental health problems. The curriculum at Massey University is recovery and social inclusion focused. In Year Two, students write an assignment about the principles of recovery and social inclusion and how they may incorporate that learning into their nursing approach. The topics covered during Year Two include medications, care planning, assessment and symptom spotting, the ethics of care, mental health law, recovery and social inclusion, stress and distress. In Year Three, students are encouraged to apply these principles in acute care settings, assessing different groups of people such as older adults, young people, and alcohol and other drug use. Students are required to focus on mental health risk assessment, and especially assessment of suicidal intention. Students learn to implement therapeutic relationship skills and to know the purpose of the therapeutic relationship. Students also complete individual learning outcomes which are mental health specific. It is necessary for meeting competencies, that students demonstrate their knowledge and application in practice. The competency assessment is undertaken by the CTA with input from you as mentor/preceptor. On the following page is a summarized list of mental health-related topics that is taught over the 3 years of the programme. It is not all inclusive but intended to provide agency staff with an overview of mental health teaching.

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Year 1 – all papers Mental health assessment Self care and stress management Mental health across the lifespan Malignant social psychology in practice

Lecture Lecture Lecture Lab

Year 2 – paper 168242/3 Long term conditions Interpersonal skills development Recovery workshop Mental health nursing and recovery Recovery, social inclusion and citizenship Care ethics and cultural safety Connection and emotional competence Biopsychosocial approaches Disability in Aotearoa New Zealand Strengths based approaches Medication Whole person approach De-escalation Two or three week placement

Labs Lab Lecture Lecture Lecture Lecture Lecture Lecture Tutorial Tutorial Tutorial Tutorial Placement

Year 3 168341/2 semester 1 Hearing voices workshop Interpersonal skill development Biopsychosocial approaches Acute nursing and recovery Safety and risk assessment – including suicidal intent Psychopharmacology Crisis intervention Brief interventions Challenging personality and overwhelming distress Acute assessment and interventions consolidation Three week placement

Lab Labs Lecture Lecture Lecture Lecture Lecture Lecture Lecture Tutorials Placement

Year 3 168344/3 semester 2 Preparation for elective placement Alcohol and drug assessment Mental health liaison Older people and mental health Parental ambivalence Young people and mental health Mental health assessment and interventions II consolidation Nine week placement

Lab Lecture Lecture Lecture Lecture Lecture Tutorials Placement

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Useful literature during practice to reflect on: Barker, P. (2009). Psychiatric and mental health nursing: The craft of caring (2nd. ed). London: Arnold. Muir-Cochrane, E., Barkway, P., & Nizette, D. (2014) Mosby’s pocketbook of mental health, (2nd.ed). Sydney: Elsevier. Procter, N., Hamer, H., McGarry, D., Wilson, R. & Froggett, T. (2014). Mental Health: A person centred approach. Sydney, Australia: Cambridge. Te Ao Maramatunga New Zealand College of Mental Health Nurses Inc. (2012). Standards of practice for mental health nursing in New Zealand (3rd. ed.) Retrieved from: www.nzcmhn.org.nz These texts are useful resources for students to reflect on in relation to process, assessment, perspectives and critical thinking. Students are expected to search and review literature to support their leaning in practice (praxis). This includes finding readings, and discussing nursing literature (in particular mental health nursing and New Zealand nursing literature).

Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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COMPETENCY BASED ASSESSMENT Summative assessment Portfolio completion: • Objectives (2) Self-Assessment • Exemplars (2) • Case study which is a write up of your whole person assessment and a plan to fit with the person’s current goals Passed competency assessment

Formative assessment

•

Interim

You may also want to complete the: • •

Mental Health Act worksheets Medication worksheets

These are self-directed and won’t be reviewed by your CTA. •

Participation in peer review

Expectation of practice The clinical experience is always organised by the School, and allows students to observe and be involved with service users and mental health agencies which provide assessment, treatment, rehabilitation and support to service users experiencing mental illness. It is envisaged that practice will enable students to: • Understand people experiencing ill health • Develop understanding a practice of the nursing process as a framework within nursing relationships • Explore and begin to develop a therapeutic caring approach • Develop confidence in, and refine therapeutic communication with consumers and family • Explore the unique role of the nurse within the mental health care setting Furthermore, students will learn how to: • Self-assess, using reflective skills and critical thinking processes • Seek feedback from service users, peers, agency staff and lecturers • Use critical reflection and the principles of clinical supervision through peer review groups Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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There is an expectation that students complete the Mental Health Act (1992) worksheets prior to the first day of practice (in Year Two, and again in Year Three as a refresher if required). The medication worksheets may be completed before or during practice (in Years Two & Three). Students meet their CTA during the clinical preparation day, or on the first day of their clinical experience. The allocated CTA will meet to discuss portfolio requirements and learning objectives. It is the students’ responsibility to maintain and complete the required learning for competency-based assessments. Toward the end of the first week of practice the CTA will meet with the students to discuss their learning progress, and an interim assessment will be undertaken. Toward the end of the final week completion of the portfolio is required and a summative assessment will be completed by the CTA. Access to clients’ notes and documentation Students have a right and responsibility to avail themselves of all relevant information which pertains to the agency and the service users they will be working alongside. Knowledge of documentation and records is a key aspect of the assessment and careplanning process. Looking at current and old notes which pertain to the service users must be negotiated with the agency staff. It is preferable that students meet the service users and establish rapport and communication with them prior to reading their notes. Issues of safety and need for prior knowledge must be discussed between the allocated preceptor and the student. Students are not permitted to photocopy notes and records, or remove these from the agency’s premises. Students must ensure that the privacy and confidentiality of service users, and the agency in which they reside, are maintained at all times. In summary, students have been reminded that: 1. 2. 3. 4.

5. 6. 7.

All service user information is to be treated as strictly confidential, and students must not disclose the identity of any service user; They need to be discrete and not give out personal information about themselves e.g. their home phone number etc, to any service users in any mental health setting; If a service user becomes overfriendly and intrudes into their personal space, the agency staff and the CTA need to be informed of this, so the situation can be managed in a supportive way; If there are any requests made by service users, to advise them that they need to obtain permission from the Registered Nurse in charge before they can meet the request. Students can also consult with their lecturer/CTA if they have any concerns; There is no smoking in all agencies, although there may be a designated smoking area in accordance with agency guidelines; In the event of a student not meeting safety requirements or professional standards, the student will be withdrawn from the placement; If they are going to be late or absent, they must inform the agency and the CTA prior to the expected starting time;

Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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8.

In many mental health settings they are not required to wear a Massey University uniform. However, on such occasions they are expected to wear smart, casual clothing. 9. They are required to wear their Massey University name badge at all times whilst in practice at the agency. 10. That it is important to consult with, and reflect on their learning with their preceptors/mentors on a regular basis. This includes seeking and receiving feedback on their learning and competence. Learning objectives and exemplars The purpose of setting learning objective is to assist students with structuring their learning and reflective skills. During clinical practicum students are required to set two learning objectives which enable you to reflect in depth on some specific concepts important to understand within this paper. Year Two: Learning objectives should be related to gaining a greater understanding of the knowledge, skills and attitudes required to work alongside service users experiencing adaptation to long-term or enduring illness or disability. The objectives should fit with the setting the student is in. One objective will be set out for the student while the second objective requires the student to negotiate with their CTA. Year Three: Learning objectives should incorporate Year Two understanding and extend into consolidating practice, exploration of relational nursing care and examine the nature of distress, acuity and assessment. Learning objectives include: 1. A statement which captures your learning intention 2. Criteria that you intend to pursue to structure the process of your learning 3. A written exemplar at the completion of your learning which summarises the learning which take place for you e.g.: My goal is to explore the use of the therapeutic communication whilst working with service users within this clinical setting • I will explore the nursing literature on therapeutic relationships and choose one particular article that will guide my approach. • Using a framework I will utilise the suggested process and roles within to work alongside a service user within my agency • I will complete a whole person assessment and a series of mental state examinations to practice the assessment process and clinical decision making • I will discuss the assessment and construct a care plan in partnership with the service user based on their required needs • I will complete an exemplar which will show reflection on what I have learnt and how this learning will contribute to my own nursing practice in the future

Learning objectives should relate to the overall objectives for this paper. Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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Other suggestions to construct learning goals around can include: establishing professional communication, recovery, interpersonal skill development; social exclusion; a unique treatment such as ECT (if the treatment is undertaken in the setting and you are directly involved), multi-professional perspectives, crisis intervention, culturally specific approaches; family interventions and various other concepts or frameworks which would be useful and relevant to explore during the context of your clinical practicum. The student’s exemplar (or written reflection of praxis) in relation to their learning objective needs to be completed prior to the last day of their clinical experience. The CTA will read the exemplar and provide written as well as verbal feedback to the student. The exemplar and the content of the clinical portfolio will contribute to the student’s overall summative assessment and report. Clinical case study Whist in practice students are expected to negotiate with a service user and gain their consent to complete a clinical case study ensuring that they utilise the whole person approach assessment, undertake a mental state examination, and construct a care plan in partnership with the chosen client. This case study must be written up and given to the lecturer prior to the end of placement. The purpose of undertaking a case study is to assist students to structure communication and interviewing skills, and practice these skills in order to gain confidence in the assessment, planning, and intervention processes of the nursing process. The case study should show evidence of permission obtained from the client. Students are required to use a pseudonym to maintain confidentiality of the service user. It is useful if the student can discuss the progress of their case study with the agency staff and CTA to ensure they are on the right track. It will be an opportunity to gain feedback around areas of nursing competence which relate to management of nursing care, professional judgement and relational ability.

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Medication worksheet Antidepressants: MEDICATION NAME (Generic and trade): What type of medication is this and how does it work?

What is the drug prescribed for and what are the expected therapeutic effects?

What is the nursing role when working alongside a person who is taking this drug?

What are some of the potential side effects and adverse effects of this drug?

What would be seen as an adverse reaction with this drug and when is it contraindicated?

Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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Medication worksheet Antipsychotics: MEDICATION NAME (Generic and trade): What type of medication is this and how does it work?

What is the drug prescribed for and what are the expected therapeutic effects?

What is the nursing role when working alongside a person who is taking this drug?

What are some of the potential side effects and adverse effects of this drug?

What would be seen as an adverse reaction with this drug and when is it contraindicated?

Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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Medication worksheet Mood stabilisers: MEDICATION NAME (Generic and trade): What type of medication is this and how does it work?

What is the drug prescribed for and what are the expected therapeutic effects?

What is the nursing role when working alongside a person who is taking this drug?

What are some of the potential side effects and adverse effects of this drug?

What would be seen as an adverse reaction with this drug and when is it contraindicated?

Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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Medication worksheet Anti-anxiety: MEDICATION NAME (Generic and trade): What type of medication is this and how does it work?

What is the drug prescribed for and what are the expected therapeutic effects?

What is the nursing role when working alongside a person who is taking this drug?

What are some of the potential side effects and adverse effects of this drug?

What would be seen as an adverse reaction with this drug and when is it contraindicated?

Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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Medication worksheet Hypnosedatives: MEDICATION NAME (Generic and trade): What type of medication is this and how does it work?

What is the drug prescribed for and what are the expected therapeutic effects?

What is the nursing role when working alongside a person who is taking this drug?

What are some of the potential side effects and adverse effects of this drug?

What would be seen as an adverse reaction with this drug and when is it contraindicated?

Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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Medication worksheets Antiparkinsonians: MEDICATION NAME (Generic and trade): What type of medication is this and how does it work?

What is the drug prescribed for and what are the expected therapeutic effects?

What is the nursing role when working alongside a person who is taking this drug?

What are some of the potential side effects and adverse effects of this drug?

What would be seen as an adverse reaction with this drug and when is it contraindicated?

Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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Peer review (student instructions) As part of your learning and reflection within the mental health setting you will attend and take part in peer review. Each student will attend a weekly session for 1 hour with their group of peers. This group will be structured for the purpose of peer review and clinical supervision. Mental Health Nurses use clinical supervision within their practice to critically reflect, discuss and problem solve issues which occur when working alongside consumers experiencing mental health issues. Clinical supervision also provides a venue in which to discus the environmental, political and social context of nursing practice. The purpose of clinical supervision is to promote reflective practice, peer support and to provide nurses with a venue in which to explore the dynamics of relationships taking place within their practice. Self awareness, emotional competence and managing ones own emotions are required skills of all nurses. How you are managing these aspects of your nursing competence will also be discussed within peer review. Peer review will be facilitated by your lecturer/CTA. The venue will be: _______________________________________________________ Day of the week: ________________________________________________________ If you are unable to attend peer review, you must inform your lecturer/CTA. Peer review is also another opportunity for you to develop and demonstrate your competence according to the requirements of a nursing student at this level within your assessment. My clinical lecturers contact details: Name: ______________________________ Contact details: __________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ . Agency details: ___________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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Reflection and self-assessment (instructions for students) Right from the beginning of the practicum it is your responsibility to make the most of all opportunities to seek learning experiences and gain skills in relationship building, self direction, self awareness, knowledge, skills and attitudes which will build your confidence and competence toward becoming a professional nurse. Many students find it useful to write down their experiences on a daily or regular basis to keep a record of events that take place during the placement. Your are encouraged to keep a diary during your placement, this will provide you with a prompt for your own self assessment and when you spend time with your lecturer who is undertaking your competency based assessment. Use the following pages for your own reflection. You can also ask agency staff and clients to contribute in the form of written feedback as to your progress and contribution to relationships and care you are demonstrating. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ____________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

Copyright ©Massey University 2015 All rights to this document are reserved. No part may be reproduced, transmitted, transcribed, stored in a non-retrieval system, or translated into any language, in any from or by any means, electronic, mechanical, optical, chemical, manual or in any other manner, without prior permission from Massey University.

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