Discussion Topics, Mohr

Chapter 1, Introduction to Psychiatric-Mental Health Nursing

1. After learning about mental illnesses in class, a classmate expresses her fear of developing a mental illness. She says to you, "I see a little bit of myself in every mental illness diagnosis we talk about. I am so afraid I may develop one of these diseases one day."

a.What are the elements of mental health? In what way do you meet these elements?

b.What are the influences on mental health? Which mental health influences can be controlled and which ones cannot?

2. Jane, a 43-year-old mother of two, was admitted to a mental health facility after a suicide attempt and was diagnosed with severe depression. After several weeks of antidepressant therapy, Jane's mood greatly improved. Jane's friend, who was unaware of her suicide attempt and diagnosis, noticed the difference in Jane. When asked about what caused the difference in her mood, Jane said she was just feeling a little down but she was feeling better now. Jane was ashamed to tell her friend about her suicide attempt and her mental health diagnosis.

a.What are the similarities and differences associated with the stigma of a physical illness and that of mental illness?

b.What stigmas about those with mental health conditions exist in society?

3. Sarah has been working the past 5 years on a telemetry unit. After several experiences with patients suffering from mental health conditions, Sarah becomes interested in mental health nursing and is considering looking for a job as a psychiatric nurse.

a.Describe the levels of practice for the psychiatric-mental health nurse.

b.Discuss the guiding principles or beliefs on which psychiatric-mental health nursing is built.

4. Your instructor mentions Mental Health: A Report of the Surgeon General in class.You are curious and decide to read the report at: http://profiles.nlm.nih.gov/ps/access/NNBBHS.pdfThe instructor asks you to share your findings with the class.

a.How does stigma affect individuals with mental illness?How can nurses seek to combat stigma in mental health care?

b.What are the risk factors in children, adults, and older adults that increase the development of a mental illness?

c.What issues associated with confidentiality does the report reveal? What do you believe could be done about these issues?

Discussion Topics, Mohr

Chapter 2, Neuroscience: Biology and Behavior

Discussion Topics

1. Mary is a 40-year-old woman who has been diagnosed with schizophrenia. Mary's 20-year-old daughter, Maria, expresses concern that her mother's mental health disorder is genetic.

a.What is the relationship between genetics and environment in the development of psychiatric disorders?

b.What deficiencies are associated with Mendel's theory?

2. James and Susan have just had their first child. James tells the nurse that he and his wife want to ensure that their new baby's brain develops to its fullest potential.

a.What determines brain development in infancy and childhood?

b.What would you include in a teaching plan for these parents to promote their child's brain development?

3. You and a friend are discussing mental health disorders at lunch one day. Your friend says, "I think people should be able to control any type of mental problems; they just need to have the will to feel better."

a.How would you respond to someone who believes that mental illness is related to a lack of willpower?

b.How are neurotransmitters involved in mental illness?

4.Your friend Marcia has been suffering from symptoms such as staring spells, confusion, and uncontrollable jerking of the arms and legs.Her general physician wants to perform an electroencephalogram (EEG).

a.Describe to Marcia the use and purpose of an EEG.

b.What are the advantages and disadvantages of this neuroimaging technique?

1. You and a fellow nursing student are discussing the different psychological theories. You find that you have differing opinions on which theories are the most accurate.

a.Select a theory that seems to be the most compatible with your personal beliefs. What were your reasons for selecting this theory?

b.Select a theory that seems least compatible with your personal beliefs. What were you reasons for selecting this theory?

2. You are receiving report from a psychiatric-mental health nurse. The nurse tells you that the patient you will be working with today is using defense mechanisms.

a.List and define one of the defense mechanisms that people use, and provide an example that would demonstrate use of that defense mechanism.

3. An individual is seeking assistance from a mental health professional due to issues he is having with problem solving. The mental health professional follows the cognitive-behavioral theory.

a.Describe a problem that someone may encounter in life. If a person was following rational problem solving, explain how the problem you identified would be evaluated in the five stages.

4.You are a nursing student working on the psychiatric unit.One of the new graduate nurses verbalizes not ever grasping the concepts of theory while she was in nursing school.

a.Explain to the new graduate nurse why theory is important in nursing practice.

Discussion Topics

1. When talking to a friend, she reveals to you that she has been taking an over-the-counter herb to help treat depression, and she feels as if it is working for her.

a.What are your personal beliefs about unproved treatments?

b.Would you use a treatment or therapy that was not scientifically proven?

2. Two nurses are having a debate as to whether evidence-based care or pseudoscience should primarily be used in mental health care.

a.Compare and contrast evidence-based care and pseudoscience.

3. Health information based on pseudoscience, myths, and quackery is often advertised in the media.

a.Describe an example of a product seen on the television or heard about on the radio that suggests the possibility of quackery or fraud.

4.You have been chosen to do a presentation for the mental health nursing class on evidence-based practice.

a.Explain the importance of the psychiatric nurse using evidence-based practice in caring for the mental health client.

b.What is the difference between evidence-based practice (EBP) and empirically supported treatments (ESTs)?

1. You are conducting an interview with a client and he reveals to you that he abuses his wife. He asks you not to tell anyone.

a.Would you be required to keep this client's confidentiality or to share the information with someone?

b.How would you respond to the client?

c.How would you feel about a client sharing this information with you and what would you do with the information?

2. While giving report on a mental health client to another nurse, the nurse asks you, "What is the patient's admission status?"

a.What is the difference between voluntary admission, emergency admission, and involuntary commitment?

3. An ethical dilemma is a situation in which moral and ethical principles conflict with one another.

a.Provide an example of an ethical dilemma that you might be faced with as a nurse.

4.Your nursing instructor has been teaching the class about the Nurse Practice Act, Standards of Care, and the ANA Code of Ethics.

a.How will the Nurse Practice Act and the ANA Code of Ethics influence your nursing practice?

b.How do standards of care protect the mental health client?

5.Your nursing instructor has paired you with a peer group and asked you to analyze ethical principles of autonomy, beneficence, paternalism, veracity, fidelity, and justice in relation to the care of the mental health client.

a.Discuss each of these ethical principles.

b.How would your group incorporate each ethical principle into the care of the mental health client?

1. During her first semester of nursing school, Felecia was assigned to a patient belonging to the American Indian culture. Felicia began to compare her own cultural beliefs with that of her patient.

a.To what ethnic, socioeconomic class, and community do you feel a part of or belong?

b.What are the values of your cultural group?

c.What are your attitudes toward people who are different from you in appearance or behavior?

2. When caring for an individual who belongs to a different culture, there may be variations in health concept and promotion.

a.List a cultural group, what their concept of health may be, and discuss variations as well as potential health promotion beliefs.

3. Maria is a 26-year-old woman who lived in Mexico until the age of 20. She has been experiencing severe depression but is afraid to seek treatment.

a.List and explain one of the reasons why minority groups may display resistance to, and feel uncomfortable about, seeking mental health services.

b.What religious or spiritual influences may be affecting Maria's decision?

c.How could racial bias affect Maria?

d.Identify some cultural barriers to treatment Maria may face.

4. During your fourth semester of nursing school, you are peer mentoring a first-semester nursing student.You are discussing culturally competent nursing care.

a.Identify the four critical skills that nurses need in order to provide culturally sensitive and competent care for the mental health client.

b.Describe an example of how each of these skills could be incorporated into the care of a client of Asian descent.

1. While caring for a mental health client, the client begins to discuss issues he is having related to religion and spirituality. He says, "My parents go to church all the time and because I don't go, they think I am not a good person. I believe in God, I just don't believe in everything my parents' religion teaches."

a.In your opinion, what is the difference between spirituality and religion?

b.Would you feel comfortable talking with a client about religious or spiritual issues? Why or why not?

c.If you do not feel comfortable talking with a client about religion or spirituality, to whom would you refer the client?

2. You are having a conversation with a client about values. After the conversation, you begin to think about your own values and what they mean to you.

a.What values are important to you?

b.What influences your values?

c.Why is it important to be aware of your own values?

3. Shandra is a 54-year-old woman who has severe clinical depression. She was diagnosed with breast cancer 5 years ago and went through chemotherapy. She describes the experience as "the worst time of my life." Six months ago, she was told that the cancer had returned. She has made the decision not to go through chemotherapy a second time. She has been overheard saying, "What did I do to deserve this?" and "God must really be mad at me for something." After talking with Shandra, the mental health nurse arrives at a nursing diagnosis of Readiness for Enhanced Spiritual Well-being.

a.What interventions may be implemented for Shandra?

b.When would spiritual interventions be contraindicated?

c.What ethical concerns need to be considered when developing nursing interventions related to religion and spirituality?

4.A mental health client presents to your psychiatric facility.You are the nurse conducting the spiritual assessment.

a.Why do you believe a spiritual assessment is important?

b.What are the components of a spiritual assessment?

c.What are some open-ended questions you could ask to facilitate better communication with the client?

1. It has been found that in a group setting, people may act in a way that is not within their typical character.

a.Read the information in the chapter about Zimbardo's "Stanford Prison Experiment." How do you think you would have acted as a prison guard or as a prisoner?

b.Have you ever been influenced by a group to behave in a manner that you normally would not have if you were alone? How do you feel about that behavior now?

2. Jessica is a 24-year-old woman who is suffering from depression. Her boyfriend of 2 years recently committed suicide, and she has been trying to figure out why.

a.What is the difference between dispositional and situational factors?

b.Jessica overhears someone say that Jessica has been a "psycho" ever since her boyfriend killed himself. Discuss the implications of labeling and social perception.

c.Discuss Rosenhan's study and how it relates to labeling.

3. Mark is a psychiatric nurse who has been working in a mental health facility for 15 years. At the end of his shift, the nurse to whom he needs to give report walks into the nurse's station. Mark says, "I can't wait to get out of here, I can't deal with these crazy people anymore." A patient overhears his statement and begins to cry.

a.What are the signs of professional burnout in the workplace?

b.What methods could Mark use to manage his stress/burnout?

4.You are a nursing student doing your clinical rotation in the local emergency department.You witness a case of horizontal violence between a nurse of 25 years' experience against a new graduate nurse.Your nursing instructor asks you to discuss in class what you witnessed.

a.What is horizontal violence?

b.From what you witnessed, how do you believe horizontal violence affects the nurse?

Discussion Topics, Mohr

Chapter 9, The Nursing Process in Psychiatric-Mental Health Care

Discussion Topics

Learning Objective

1. Wanda is a 34-year-old woman who was raped at the age of 17. She has never told anyone about her experience. Whenever she starts to think about the event, Wanda drinks heavily to forget about the emotional pain. She has been avoiding social situations because being in a crowd makes her very anxious. Two weeks ago while shopping, she suffered a panic attack and had to be taken to the hospital. She has pushed away all family members and has no one left in her immediate support system.

a.Develop a nursing diagnosis that would be appropriate for Wanda.

b.What assessment information from the case supports your diagnosis?

c.Create a list of at least three short-term and one long-term outcome for the nursing diagnosis.

2. You are conducting an admission interview with Linda, a 47-year-old woman whose husband died from a car accident 2 months ago. She was admitted due to a suicide attempt and states during the interview that she has "nothing to live for." She says that she has been drinking alcohol regularly to "numb the pain" and to help her sleep at night. After the interview, you develop a list of nursing diagnoses, which includes the following:

Dysfunctional Grieving related to lack of adequate support secondary to loss of spouse as evidenced by client's statement of having "nothing to live for."

Ineffective Individual Coping related to substance abuse and inappropriate coping mechanisms as evidenced by client's statement of using alcohol to "numb the pain."

Sleep Pattern Disturbance related to lifestyle disruption as evidenced by client's statement that alcohol is used to assist with sleeping.

a.For each nursing diagnosis, develop appropriate long-term and short-term goals.

b.For each nursing diagnosis, develop appropriate interventions.

c.How will you evaluate if these nursing diagnoses were effective?

d.Where will you document these nursing diagnosis and interventions and why?

3. After completing a care plan for a mental health client, you have been asked to document in the client's record.

a.Why is documenting in the care record necessary?

b.When documenting the nursing process, why key components and principles need to remain consistent?

c.Compare and contract narrative, SOAP, and PIE charting.

4.Your nursing instructor has just demonstrated a psychosocial assessment for you in the clinical setting.Your fellow nursing student did not see this demonstration, so you decide to enlighten her.

a.What is a psychosocial assessment?

b.Explain the components of the psychosocial assessment.

c.Provide an example question for each dimension.

5.You are doing your student nurse clinical rotation on the inpatient psychiatric unit when you hear the physician mention the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).This interests you and you decide to investigate.

a.What is the DSM-IV-TR? What is its purpose?

b.Why do you believe knowledge of the DSM-IV-TR is important for psychiatric nurses?

Discussion Topics, Mohr

Chapter 10, The Interview and Assessment Process

Discussion Topics

Learning Objective

1. You have been asked to conduct an interview for a psychiatric-mental health client.

a.What part of conducting an interview to obtain psychosocial data on a client is most difficult for you?

b.What part of conducting an interview to obtain psychosocial data on a client is relatively easy for you?

c.What are your strengths as an interviewer and what skills do you need to develop?

2. You are working at a psychiatric-mental health facility that uses the PERSONS acronym for collecting data in the initial patient assessment.

a.Choose one of the letters of this acronym and explain the data that would be collected under that letter.

b.For your chosen area, list five questions that you would ask to elicit information from a psychiatric-mental health client.

3. The nurse is caring for a 39-year-old American Indian psychiatric mental health client.

a.What is the importance of assessing cultural needs in a psychiatric-mental health client?

b.What is the importance of assessing spiritual needs in a psychiatric-mental health client?

4.Your nursing instructor lectured on standardized tools in class today.You took good notes and you are attempting to explain these tools for a fellow nursing student who was sick and missed class.

a.What are some of the standardized tools your instructor discussed? Which healthcare professional would use the tools discussed?What are the tools used for?

b.Why do healthcare professionals use standardized tools?

Discussion Topics, Mohr

Chapter 11, Therapeutic Relationships and Communication

Discussion Topics

Learning Objective

1. You are learning about therapeutic communication in your mental health nursing course and begin to evaluate your own communication techniques.

a.List two therapeutic communication techniques that you could use more often and how you would incorporate these techniques into your communication patters.

b.List a nontherapeutic communication technique that you use, explain why it is nontherapeutic, and tell how you can change it to a therapeutic technique.

2. Your nursing instructor tells you that therapeutic relationships are very important in mental healthcare to help clients solve problems, cope more effectively, and achieve developmental goals.

a.Choose one of the essential elements of a therapeutic relationship and describe how you can develop this element with a mental health client.

b.List one of the obstacles to establishing a therapeutic relationship and describe how you can prevent this obstacle in your own professional relationships.

3. You are working as a mental health nurse and you are caring for a patient suffering from anxiety and another suffering from psychoses.

a.What techniques would you use to therapeutically communicate with an individual suffering from anxiety?

b.What techniques would you use to therapeutically communicate with an individual suffering from psychoses?

4.You are working on the psychiatric nursing unit and the charge nurse assigns you a client with a depressive disorder.You must implement the phases of the therapeutic relationship.

a.What are the phases of the therapeutic relationship?Describe each phase.

b.What would you do at each phase to develop a relationship with the depressed client?

5. Your nursing instructor has just been lecturing in the mental health course about the importance of listening in the therapeutic nurse-client relationship.

a.Describe what active listening means to you.What are the components of active listening?

b.How will you incorporate active listening into your practice as a nurse?

Discussion Topics, Mohr

Chapter 12, Working With the Multidisciplinary Team

Discussion Topics

Learning Objective

1. As a nurse, you are a part of the multidisciplinary team. While working in a hospital, you are able to interact with individuals from several different specialties.

a.Describe your experience in coordinating services with occupational therapists, psychologists, psychiatrists, registered dietitians, and social workers. If you have not had this experience, describe the interactions that you have witnessed in the healthcare setting.

b.What do you believe the benefits are to working with individuals within these specialties?

2. A child is experiencing unusually high activity and is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The child is admitted to a mental health facility that incorporates a multidisciplinary approach. When the child returns to school, an individualized education program (IEP) is developed.

a.Describe the role that a school psychologist, occupational therapist, social worker, and a registered dietitian would play in the care of this child.

b.Explain the purpose of the IEP and what is included in an IEP.

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3. After being assessed by an occupational therapist, it is determined that Katie, a 38-year-old woman, would benefit from sensory integration.

a.Describe the systems, components, purpose, and dysfunction manifestations identified in sensory integration.

Discussion Topics, Mohr

Chapter 13, Individual Therapies and Nursing Interventions

Discussion Topics

Learning Objective

1.After a conflict with a coworker, you are feeling upset and stressed. You begin to doubt your abilities as a nurse and are engaging in self-defeating thinking.

a.When you are upset and stressed, in whom do you confide? Does talking about your experience help? If you were caring for a patient who felt as if he or she had no one to confide in, what would you suggest?

b.How can you use the techniques of rational-emotive behavior therapy to confront self-defeating thinking?

2. An individual has decided to seek psychotherapy but is not sure which approach would be best.

a.What is psychotherapy?

b.Compare and contrast cognitive-behavioral therapy, solution-focused therapy, and client-centered therapy.

c.In your opinion, which type of psychotherapy do you believe would be most effective in changing behavior? Why?

3. After spending several days as a nursing student in a mental health facility, you become interested in the role of the psychiatric nurse.

a.Compare and contrast the role of the basic-level psychiatric-mental health registered nurse and the advanced-level psychiatric-mental health advanced practice registered nurse.

b.What nursing interventions can be implemented by the basic-level psychiatric-mental health registered nurse?

4.You are caring for a mental health client.The client expresses to you that he does not understand the need for or goals of therapy.

a.Explain the purpose and goals of therapy to the client.

Discussion Topics, Mohr

Chapter 14, Groups and Group Interventions

Discussion Topics

Learning Objective

1. As a nursing student and as an individual, there are various groups in which you have the opportunity to participate.

a.Identify which groups you find personally satisfying and enriching and which groups you find difficult and problematic. What is different about each kind of group?

b.How do you feel about sharing personal feelings in a group setting? Does the kind of group make any difference? If so, describe how.

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2. You have been asked to lead a support group for people who have been diagnosed with breast cancer.

a.List and describe the different leadership styles. Which style do you believe that you would use for this support group?

b.After the first group meeting, you are asked to analyze the different roles that the group members assumed. What are the different roles that group members can assume? Which ones can interfere with group functioning?

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3. A psychologist refers a patient with depression to group therapy.

a.What are the advantages and disadvantages of group therapy?

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4.Your mental health nursing instructor has just lectured on types of group therapy.

a.What are the different types of group therapy?

b.Compare and contrast the various types of group therapy.

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5.Your nursing instructor has assigned you to lead a group activity for the mental health class on the stages of group development.

a.Describe the stages of group development.

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Discussion Topics, Mohr

Chapter 15, Families and Family Interventions

Discussion Topics

Learning Objective

1. Mark is a 22-year-old college student and is the primary caregiver for his 15-year-old brother. Mark's younger brother was just diagnosed with a mental illness.

a.If you were in Mark's place, what effect would the mental illness have on you?

b.Think of a time when a family member was suffering from an illness or when stress was occurring in your family. What were your needs during this time? What kind of nursing support would have been helpful?

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2. Sam and Joan have been married for 25 years and have three children: Max, who is 23; Janet, who is 19; and Sarah, who is 15. Janet has just been diagnosed with a mental illness.

a.Describe the objective and subjective burdens each family member may experience.

b.Describe the meaning this diagnosis may have to Janet's parents, younger sibling, and older sibling.

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3. Bobbie is a 54-year-old woman who has been diagnosed with bipolar disorder. Her husband, Larry, has been very supportive and accepting of the mental illness diagnosis. Her two children, ages 15 and 17 are worried that they might also develop bipolar disorder but are also very supportive of their mother. The family feels that they do not have the knowledge and skills to handle the condition and decide to enroll in family consultation.

a.Why do you believe it is important to involve the family in the treatment of clients?

b.Describe family consultation.How is it different from family therapy?

c.Describe the components of family consultation.

d.Describe the role of the nurse as a family consultant.

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4.You are caring for a patient with an anxiety disorder on the psychiatric unit.The family is present with the patient.Your instructor talked in the mental health course about cognitive, affective, and behavioral psychiatric nursing interventions.

a.What are cognitive, affective, and behavioral psychiatric nursing interventions?

b.Give some examples of cognitive, affective, and behavioral psychiatric nursing interventions you could apply to the care of this family.

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Discussion Topics, Mohr

Chapter 16, Psychopharmacology

Discussion Topics Learning

Objective

1. You are caring for a 52-year- old woman who has been prescribed a major antipsychotic (neuroleptic) agent. After explaining the potential side effect, the client refuses to take the medication.

a. How would you feel about taking a major antipsychotic (neuroleptic) agent, realizing the many side effects that these medications can cause?

b. For psychoactive medications to be effective, client adherence is essential. How would you respond to a client who continually fails to follow his or her medication regimen?

2. Carmen is a 40-year- old woman who suffers from severe depression. Her physician has tried several different antidepressants that have been unsuccessful in treating her condition. The physician is now considering placing Carmen on a tricyclic antidepressant or a monoamine oxidase inhibitor.

a. What type of client education would you want to provide to a client who is prescribed a tricyclic antidepressant?

b. What type of client education would you want to provide to a client who is prescribed a monoamine oxidase inhibitor?

3. Lenny is a 53-year- old man who has been diagnosed with bipolar disorder. He is seeing a psychiatric nurse practitioner, who has prescribed lithium.

a. What type of client education would you want to provide to a client who is prescribed lithium?

b. What are the therapeutic and toxic blood levels of lithium?

4. A client in your care is very anxious about taking his newly prescribed medication for depression, Pristiq. You attempt to alleviate his concerns about taking a new drug through medication education.

a. Explain the FDA's process of approving new drugs.

b. Discuss the principles of adherence and efficacy in relation to psychotropic medications.

c. Identify the classification, neurotransmitters involved, and the disorders for which the client's medication is prescribed.

d. What is the action, recommended dosage, and route of administration, side effects, potential adverse effects, contraindications, and nursing implications for the client's medication, Pristiq?

Discussion Topics, Mohr

Chapter 17, Integrative Therapies

Discussion Topics

Learning Objective

1. One of your family members is diagnosed with a medical condition and chooses to use both traditional Western treatments and complementary and alternative medicine (CAM) therapies.

a.What are your personal feelings and beliefs about CAM approaches to healing? Have you ever sought treatment with an alternative approach? If so, what were the results? How has this affected your role as a nurse?

b.How do you feel about the client who rejects traditional medicine and seeks alternative measures for a health problem?

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2. While caring for a client with depression, he tells you that when his sister was suffering from the same condition, she used herbs and acupuncture. He tells you that he would like to know more about CAM therapies.

a.What is the difference between complementary and alternative treatments?

b.Identify and describe one type of CAM therapy for each category of the National Center for Complementary and Alternative Medicine classifications.

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3. During your psychiatric-mental health rotation at a hospital, you are asked to give the other nurses a presentation about CAM treatments for psychiatric conditions.

a.Choose one of the following conditions: anxiety disorders, mood disorders, addictive disorders, or cognitive disorders. Identify and explain at least one CAM treatment that can be used for your chosen condition. Also list any potential side effects, if any.

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Discussion Topics, Mohr

Chapter 18, Somatic Therapies

Discussion Topics

Learning Objective

1. Electroconvulsive therapy (ECT) has been found to be an effective treatment for mental health disorders.

a.What is the indication for ECT?

b.How has your perception of ECT changed after learning more about the procedure?

c.Describe the potential side effects of ECT and the nurse's role in caring for a client receiving ECT.

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2. Jackson has been diagnosed with seasonal affective disorder after suffering from depression over the fall and winter months for the past 3 years.

a.List the information that you would provide Jackson about phototherapy.

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3. A client wishes to know more about nonpharmacological somatic therapies.

a.Compare and contract transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation, and psychosurgery.

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4.Your nursing instructor has been teaching on somatic therapies in the mental health class today.Your client has an order for a somatic therapy the following day, so you go in to provide client education.

a.What are somatic therapies?

b.Discuss the different types included in this classification.

c.Which somatic therapy do you believe is most effective and why?

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Discussion Topics, Mohr

Chapter 19, Inpatient Care Settings

Discussion Topics

Learning Objective

1. While doing a clinical rotation in a psychiatric-mental health facility, a client is involuntarily committed.

a.Would you feel differently caring for a client who was voluntarily or involuntarily committed?

b.Have you ever witnessed a client be involuntarily committed inappropriately? If yes, how did that make you feel? If not, how would that make you feel?

c.Do you believe that involuntary commitment orders are necessary? Why or why not?

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2. You are caring for a psychiatric-mental health client who would like more information on different mental health care settings.

a.What are the different levels of care for inpatient settings?

b.Define and explain the different types of inpatient settings.

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3. You are working for a psychiatric-mental health facility that uses traditional milieu therapy.

a.Explain the five steps of milieu therapy.

b.Explain one of the roles of the nurse in milieu therapy (fostering self-care; providing client education; conducting community meetings or life skills groups; administering medications; or working with support groups).

c.Do you believe milieu therapy is effective?Why or why not?

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Discussion Topics, Mohr

Chapter 20, Community and Home Psychiatric Care

Discussion Topics

Learning Objective

1. During your psychiatric-mental health nursing rotation, you have been asked to spend several days with a home health nurse.

a.How would you feel about caring for someone in his or her home?

b.What are some reasons that you would prefer to have a family member treated in your home rather than in an institutional setting?

c.What difficulties do you think a psychiatric home care nurse might encounter in the home compared with the hospital setting?

d.What would you find challenging and rewarding about working in the home setting?

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2. Jeremy is a 42-year old man who suffers from severe and persistent mental illness. His family is interested in finding out more about preventative services.

a.What is the difference between primary, secondary, and tertiary prevention services?

b.Provide a list of community services available in your local area. Identify the services as primary, secondary, or tertiary.

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3. Your local community is looking to increase the mental health services available to citizens. A community support system is being developed and will be run by the health department.

a.List and explain the three tenets of community support systems.

b.List one of the principles that are basic to psychiatric rehabilitation. Explain how an institution could strive to achieve this principle.

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Discussion Topics, Mohr

Chapter 21, Forensic Psychiatric Nursing

Discussion Topics

Learning Objective

1. You have just graduated from nursing school and you are considering working in forensic nursing.

a.Explain the psychiatric nurse's role in the forensic milieu.

b.What are your fears in dealing with people in correctional facilities?

c.What do you think would be most difficult about working with the forensic client?

d.Have you ever witnessed acting-out behavior in a client? What happened? How did it make you feel? What do you think about this situation now? Were there any clues that this behavior was imminent? Looking at this situation now, could it have been prevented?

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2. You are interviewing a forensic nurse who works in a correctional facility. The nurse begins to discuss the issues associated with special populations.

a.Choose one of the special populations that forensic nurses may interact with (juvenile offenders, female offenders, older adult offenders, offenders with HIV/AIDS or hepatitis, or offenders with terminal illness). Discuss some of the issues that a forensic nurse faces when dealing with these special populations.

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3. While performing a clinical rotation in a hospital, you are assigned to a client that has been admitted from a local correctional facility. He was admitted with severe chest pain and it was confirmed that the client had a myocardial infarction. When assessing the client, you must be accompanied by a police officer and he must un-cuff the client from the bed so that you can perform a complete assessment. When you read the client's chart, you find out that he is incarcerated for the attempted murder of a child.

a.Would you treat this client differently than any other client who was admitted with a myocardial infarction?

b.How is security for the forensic nurse incorporated into client care and what type of challenges does this present?

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4.You have just graduated from nursing school and started a job at the local correctional facility in the health clinic.Your first client is a female who has just been transferred to the correctional facility today.She has a diagnosis of terminal cancer.You learn she has three children and a husband that are devastated about her incarceration.The client reports being extremely worried about her family.

a.What are the potential blocks to the assessment process with this client?

b.What are potential nursing diagnoses for this client?What interventions could be used for each diagnosis (use the textbook for support)?

c.What strategies would you adopt when working with the client's family?Provide examples of how you could implement these strategies.

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Discussion Topics, Mohr

Chapter 22, Sleep Disorders

Discussion Topics

Learning Objective

1. After you've worked the 7 am to 7 pm day shift for three years, your place of employment requires that you work the night shift for one year.

a.Define the term sleep.Have you ever experienced sleep deprivation? If so, how did you feel physically? Emotionally?

b.How well do you feel you sleep at night? Do you feel rested when you awaken in the morning?

c.Do you participate in any routines or rituals before going to bed? If so, why?

d.Do you believe that your abilities as a nurse would be compromised if you were working with sleep deprivation? Why or why not?

1, 3, 4

2. Timothy is 52 years old and has just developed problems with sleeping. After conducting an interview with Timothy, it is determined that the use of alcohol, tobacco, and caffeine may be interfering with his sleep.

a.List the changes in sleep patterns that occur from infancy through the elderly years.

b.How does the use of alcohol, tobacco, and caffeine interfere with sleep?

2, 4

3. After feeling down for several months and having difficulty sleeping, Chris decided to seek help from a healthcare provider. Chris was diagnosed with major depression and was placed on an antidepressant.

a.What effect does major depression have on sleep?

b.How can the different types of medications used to treat depression effect sleep?

3, 6, 7

4.Your 69 year old female patient is admitted for a sleep study.She complains of sleep difficulty nightly.

a.Explain the normal changes in sleep across the lifespan to the patient.

b.What diagnostic testing would you anticipate this patient having?

c.How can the nurse assess for sleep difficulty?

d.What are some recommendations you can make for good sleep hygiene?

e.What is an appropriate nursing diagnosis for this patient?What interventions would you use to assist the patient and why?

2, 5, 6, 8

Discussion Topics, Mohr

Chapter 23, Anxiety Disorders

Discussion Topics

Learning Objective

1. You are caring for a client who is experiencing severe anxiety. Think about a time in your life when you have experienced anxiety.

a.Define anxiety.

b.What are your common symptoms when anxious? Pay attention to your body response and connect the response to the feeling of anxiety. Classify these as cognitive, affective, physiologic, or behavioral.

c.How is your response to anxiety similar and different when the anxiety is related to your personal life and to your experience as a nursing student?

d.What techniques do you use to reduce your own anxiety? Do they work? Do you use several techniques or only a few? Do you smoke, drink, or use food to reduce your anxiety?

1, 5

2. Alex is a 54-year-old man who has been suffering from extreme anxiety after being robbed by a man at gun point. He does not understand how anxiety results from being robbed.

a.Discuss the proposed etiology for Anxiety Disorders (PTSD) with Alex.

b.Compare and contrast acute stress disorder and post-traumatic stress disorder.

c.Describe the effects anxiety can have on sensation, cognition, and verbal ability.

4, 5, 6

3. Marsha is a 38-year-old woman who has been diagnosed with an anxiety disorder. She has little knowledge about anxiety and believes she is alone in her diagnosis.She is also curious about the different treatment options available to treat anxiety.

a.Explain to Marsha what is meant by the term anxiety disorder.

b.To help her understand she is not alone, discuss the prevalence of anxiety disorders with Marsha.

c.Explain one of the cognitive-behavioral therapies used to treat anxiety.

d.Marsha's psychiatrist has decided to place her on medication. What types of medications can be used to treat anxiety? Choose one of these medications and list client education you would want to provide to a client.

2, 3, 7

Discussion Topics, Mohr

Chapter 24, Somatoform, Dissociative, and Sexual Disorders

Discussion Topics

Learning Objective

1. Mary is a 64-year-old woman who complains of chronic pain in her left arm, shoulder, and back. She has been through many diagnostic tests and no physical cause for the source of her pain can be found.

a.How do you feel about clients who constantly complain about various physical symptoms? How do you react when a client constantly complains about such symptoms? Do you think that your reaction to the clients interferes with developing a therapeutic relationship?

b.What do you believe about clients who have physical complaints but no demonstrated physiologic reason for them?