Psychiatric mental health nursing practice is one of the newest disciplines to be licensed to provide psychotherapy As such, the majority of psychotherapy research is centered on other disciplines such as psychology, social work, marriage/family therapy, art therapy, psychiatry, and mental health counseling.

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                              Applying Current Literature to Clinical Practice

Psychiatric mental health nursing practice is one of the newest disciplines to be licensed to provide psychotherapy As such, the majority of psychotherapy research is centered on other disciplines such as psychology, social work, marriage/family therapy, art therapy, psychiatry, and mental health counseling. This makes it essential for you to be able to translate current literature from other disciplines into your own clinical practice. For this Assignment, you practice this skill by examining literature on group work and group therapy and considering its applicability to your own clients.

                                                     Learning Objectives

Students will:

· Evaluate the application of current literature to clinical practice

To prepare:

· Review this week’s Learning Resources and reflect on the insights they provide

on group work and group therapy.

· Select one of the articles from the Learning Resources to evaluate for this

assignment.

Note: In nursing practice, it is not uncommon to review current literature and share findings with your colleagues. Approach this Assignment as though you were presenting the information to your colleagues.

 

                                                             Assignment

In a 5- to 10-slide PowerPoint presentation, address the following:

o  Provide an overview of the article you selected, including answers to the

following questions:

o What type of group was discussed?

o Who were the participants in the group? Why were they selected?

o What was the setting of the group?

o How often did the group meet?

o What was the duration of the group therapy?

o What curative factors might be important for this group and why?

o What “exclusion criteria” did the authors mention?

o Explain the findings/outcomes of the study in the article. Include whether this

will translate into practice with your own client groups. If so, how? If not, why?

o Explain whether the limitations of the study might impact your ability to use the

findings/outcomes presented in the article.

Note: The presentation should be 5–10 slides, not including the title and reference slides. Include presenter notes (no more than a half page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your presentation with evidence-based literature.

                                                                     Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

  • Chapter 11, “Group Therapy” (Review pp.      407–428.)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

Chapter 1, “The Therapeutic Factors” (pp. 1–18)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

Chapter 2, “Interpersonal Learning” (pp. 19–52)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

Chapter 3, “Group Cohesiveness” (pp. 53–76)

Leszcz, M., & Kobos, J. C. (2008). Evidence-based group psychotherapy: Using AGPA’s practice guidelines to enhance clinical effectiveness. Journal of Clinical Psychology, 64(11), 1238–1260. doi:10.1002/jclp.20531

Marmarosh, C. L. (2014). Empirical research on attachment in group psychotherapy: Moving the field forward. Psychotherapy, 51(1), 88–92. doi:10.1037/a0032523

Microsoft. (2017). Basic tasks for creating a PowerPoint presentation. Retrieved from https://support.office.com/en-us/article/Basic-tasks-for-creating-a-PowerPoint-2013-presentation-efbbc1cd-c5f1-4264-b48e-c8a7b0334e36

Tasca, G. A. (2014). Attachment and group psychotherapy: Introduction to a special section. Psychotherapy, 51(1), 53–56. doi:10.1037/a0033015.

Tasca, G. A., Francis, K., & Balfour, L. (2014). Group psychotherapy levels of interventions: A clinical process commentary. Psychotherapy, 51(1), 25–29. doi:10.1037/a0032520

You will select one of the following articles on group therapy to evaluate for this week’s Assignment.

Bélanger, C., Laporte, L., Sabourin, S., & Wright, J. (2015). The effect of cognitive-behavioral group marital therapy on marital happiness and problem solving self-appraisal. American Journal of Family Therapy, 43(2), 103–118. doi:10.1080/01926187.2014.956614

Himelhoch, S., Medoff, D., & Oyeniyi, G. (2007). Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: A systematic review and meta-analysis. AIDS Patient Care & Stds, 21(10), 732–739. doi:10.1089/apc.2007.0012

Pessagno, R. A., & Hunker, D. (2013). Using short-term group psychotherapy as an evidence-based intervention for first-time mothers at risk for postpartum depression. Perspectives in Psychiatric Care, 49(3), 202–209. doi:10.1111/j.1744-6163.2012.00350.x

Sayın, A., Candansayar, S., & Welkin, L. (2013). Group psychotherapy in women with a history of sexual abuse: What did they find helpful? Journal of Clinical Nursing, 22(23/24), 3249–3258. doi:10.1111/jocn.12168

Yildiran, H., & Holt, R. R. (2015). Thematic analysis of the effectiveness of an inpatient mindfulness group for adults with intellectual disabilities. British Journal of Learning Disabilities, 43(1), 49–54. doi:10.1111/bld.12085

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Develop effective documentation skills for group therapy sessions

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                              Mental Health Practicum–Week 8 Journal  Entry

Students will:

· Develop effective documentation skills for group therapy sessions *

· Develop diagnoses for clients receiving group psychotherapy *

· Evaluate the efficacy of cognitive behavioral therapy for groups *

· Analyze legal and ethical implications of counseling clients with psychiatric

disorders *

                                                           ASSIGNMENT 

Select two clients you observed or counseled this week during a group therapy session. Note: The two clients you select must have attended the same group session.

Then, in your Practicum Journal, address the following:

· Using the Group Therapy Progress Note in this week’s Learning Resources,

document the group session.

· Describe each client (without violating HIPAA regulations), and identify any

pertinent history or medical information, including prescribed medications.

· Using the DSM-5, explain and justify your diagnosis for each client.

· Explain whether cognitive behavioral therapy would be effective with this group.

Include expected outcomes based on this therapeutic approach.

· Explain any legal and/or ethical implications related to counseling each client.

· Support your approach with evidence-based literature.

                                                   Learning Resources

Required Readings

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

  • Chapter      11, “In the Beginning” (pp. 309–344)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

  • Chapter      12, “The Advanced Group” (pp. 345–390)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Bjornsson, A. S., Bidwell, L. C., Brosse, A. L., Carey, G., Hauser, M., Mackiewicz Seghete, K. L., … Craighead, W. E. (2011). Cognitive-behavioral group therapy versus group psychotherapy for social anxiety disorder among college students: A randomized controlled trial. Depression and Anxiety, 28(11), 1034–1042. doi:10.1002/da.20877

Safak, Y., Karadere, M. E., Ozdel, K., Ozcan, T., Türkçapar, M. H., Kuru, E., & Yücens, B. (2014). The effectiveness of cognitive behavioral group psychotherapy for obsessive-compulsive disorder. Turkish Journal of Psychiatry, 25(4), 225–233. Retrieved from http://www.turkpsikiyatri.com/

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        Psychiatric Assessment of the Adult and Older Adult

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                             Psychiatric Assessment of the Adult and Older Adult

Many assessment principles are the same for children and adults; however, with adults/older adults, consent for participation in the assessment comes from the actual client and not parents or guardians. The exception to this is adults/older adults who have been determined incapacitated by a court of competent jurisdiction. Some adults may be easier to assess than children/adolescents as they are more psychologically minded. That is, they have better insights into themselves and their motivations than children/adolescents (although this is not universally true).

Older adults present some of their own unique assessment challenges in that they may have higher levels of stigma associated with seeking psychiatric care. Additionally, there are higher rates of neurocognitive disorders superimposed on other clinical conditions such as depression or anxiety, which creates additional diagnostic challenges.

This week, you will develop your own personal format for initial interviews of mental health clients. You also will explore the restrictions and limitations for practice as a PMHNP in your home state and create a plan for passing the national certification exam.

Week 1-developing skills in interviewing and diagnostic reasoning

As we begin Week 1, the module is focused on developing an interview format that provides you with questions/responses that you will use in your work-ups and diagnostic assessments or some call them Psychiatric H & P. By now, you have seen many different formats and ways that providers conduct interviews.

For this document, I encourage you to think of your personal style as well as assure that all relevant information is collected in the first interview. Do not use a template that you find online or that your preceptor uses in the office. The purpose of this assignment is for you to think through how you interview patients. There are many examples online to use as a guide. The key elements are similar to a medical H &P, HPI, PPH, PMH, FH, SH, ROS (psychiatric), MSE, Clinical Assessment and Formulation, Diagnosis, and Plan. This will be your ‘bread and butter’, so to speak for your entire career. It is worth spending some time and effort on this. If you put in a canned template, I will not accept your work.
My personal style is what I would call ‘conversational’. I try to engage in some social conversation to get the visit started and then as the patient talks, I make notes on follow-up questions. I keep a list of the basic things that I need for my write-up: HPI, PPH, PMH, Soc/Dev, Substance use, Medication history, Stressors, coping abilities, therapy history. At the end of what I consider ‘the interview’ I review my list to make sure that I have all the information and I sometimes say to patients, “let me make sure that I got all the information that I need to make an accurate diagnosis and develop a treatment plan”. Then, I will say to the patient, “do you have anything that you’d like to add?”

This conversational style is not for everyone and I know many providers that use more of a ‘checklist’ style. Think about what you want and how you will feel most comfortable. Feel free to provide feedback to your colleagues –there are no right or wrong styles.

Instructions- Week 1:

Despite what you may believe (or may have been told), there is no such thing as one “right” way to do an interview. In fact, there are numerous books written about the various ways of conducting the clinical interview. In actual clinical practice, you will find the format that “works” best for you and addresses your unique strengths and the needs of the client.

In this Discussion, you will practice finding the interview format that works for you and share those ideas with your colleagues for feedback.

Learning Objectives

Students will:

  • Develop formats for initial interviews of mental health clients

To prepare for this Discussion:

  • Review  the Learning Resources.
  • Develop an interview format you would use for an initial interview of a client.

                                                           ASSIGNMENT

  • Attach  the interview format document you would use for an initial interview of a client.
  • Describe      what interview format your preceptor uses for the initial interview of a  client.
  • Describe      which element of your interview format is most helpful in your practice.

                                               Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

  • Section 5.1, “Psychiatric Interview, Mental Status      Examination” (pp. 192–211)
  • Section 5.2, “The Psychiatric Report and Medical      Record” (pp. 211–217)
  • Section 5.3, “Psychiatric Rating Scales” (pp. 217–236)
  • Section 5.5, “Personality Assessment: Adults and      Children” (pp. 246–257)
  • Section 5.7, “Medical Assessment and Laboratory Testing      in Psychiatry” (pp. 266–275)
  • Chapter      6, “Classification in Psychiatry” (pp. 290–308)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

  • “Cautionary Statement for Forensic Use of DSM-5”
  • “Assessment Measures”
  • “Cultural Formulation”
  • “Glossary of Technical Terms”
  • “Glossary of Cultural Concepts of Distress”

Barton Associates. (2017). Nurse practitioner scope of practice laws. Retrieved from https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws/

American Psychiatric Association. (2016). Practice guidelines for the psychiatric 

evaluation of adults. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Required Media

Laureate Education (Producer). (2017b). Working with Adults and Older Adults” [Video file]. Baltimore, MD: Author.

Hagen, B. (Producer). (n.d.-a). Conducting a mental status exam [Video file]. Mill Valley, CA: Psychotherapy.net.

Optional Resources

American Psychological Association. (2008). Assessment of older adults with diminished capacity. Retrieved from https://www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf 

Rosen, S. L., & Reuben, D. B. (2011). Geriatric assessment tools. Mount Sinai Journal of Medicine, 78(4), 489–497. doi:10.1002/msj.20277

Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). TIP 59: Improving cultural competence. Retrieved from http://store.samhsa.gov/product/TIP-59-Improving-Cultural-Competence/SMA15-4849

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I am a nurse and I became the first health care professional elected into the Delaware General Assembly, as well as the first registered nurse elected.

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Chapter 55

Taking Action: Nurse, Educator, and Legislator

My Journey to the Delaware General Assembly

Bethany Hall-Long

“I have come to the conclusion that politics are too serious a matter to be left to the politicians.”

General Charles de Gaulle

My Political Roots

I am a nurse and I became the first health care professional elected into the Delaware General Assembly, as well as the first registered nurse elected. The roots of my public service began in a farming community where I volunteered to help others in my church and at neighborhood organizations. At the age of 12, I was a candy-striper in a local hospital and continued my civic work during my teen years. When I entered college I joined a political party. Though my parents were not politically active, my great-grandfather was a member of the Delaware House of Representatives in the 1920s and I am a descendent of Delaware’s 16th governor.

My interest in politics began while working with underserved residents at the same time I was completing my master’s degree in community health nursing in the late 1980s. I used an earlier edition of this book in my graduate program and vividly recall reading the chapters about becoming involved in politics. I began working with my local city government, the League of Women Voters, and a federal health clinic that served the homeless. Before these experiences, I had thought that public policy was remote to nursing and somewhat dry. These experiences changed my perspective.

Volunteering and Campaigning

I went on to volunteer with nonprofit and civic organizations, join professional associations, and to complete my doctoral degree in nursing administration and public policy. During this time, I served as a United States Senate Fellow and as a U.S. Department of Health and Human Services policy analyst for the Secretary’s Commission on Nursing. These experiences exposed me to national policy work, federal officials, leaders in the nation’s health associations, and international researchers. I became actively involved with veteran’s organizations because my husband was on active duty in the military. I also became a volunteer on political campaigns with the Democratic Party. I had excellent mentors to assist me with both my nursing and political career paths. All of these experiences helped me to understand the policy process and the importance of building relationships.

I began my work in politics to make a difference in the lives of many citizens who lack life’s necessary resources. As a public health nurse, I had an interest in improving the services available to vulnerable populations. I continue to work to advance issues important to the residents I represent. These include health care, the environment, land preservation, education, and economic development.

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There’s a Reason It is Called “Running” for Office

A number of factors influenced my decision to run for public office in 2000, including my desire to make a significant contribution to the public’s health. As a university faculty member, I assigned students to various public health and health policy assignments. During these experiences, I witnessed the need for expert health knowledge in the Delaware General Assembly. The time was ripe within the political party and within my district to run for the Delaware legislature. I ran for office for the first time in 2000 and lost by a mere 1%. I had run against a long-term, male incumbent and learned some important political lessons. In 2002, political redistricting left a vacant seat and I ran again. This time I won in a tough election against the president of the local school board. After serving 6 years in the House, I campaigned for, and won, a state senate race in 2008 (Figure 55-1).

 

FIGURE 55-1 Dr. Hall-Long’s campaign literature identifies her as a nurse and educator.

A Day in the Life of a Nurse-Legislator

No two days in politics are alike. Each elected official’s experiences and perceptions are linked to his or her beliefs, the district’s beliefs, the state’s legislative rules, and external economic or social pressures. In Delaware, serving as a legislator is a part-time job. Delaware’s bicameral legislative session is active for a total of 45 days per year. Session convenes each January, and the legislature must pass the budget bill and recess by July 1. We meet three days a week: Tuesday, Wednesday, and Thursday. I spend the remaining days on

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constituent work, in meetings, delivering speeches, and conducting my job as a nursing faculty member. Between July and January, my days are filled with at least 8 to 12 hours of meetings, community work, and, in election years, campaign activities. On occasion, there are Special Sessions in the fall when the senate convenes.

Much of a state legislator’s time is spent on the capital and operating budgets of the state, as well as handling senate confirmations. These activities need to be completed by the end of the state’s fiscal year: July 1. My most important role is to represent my constituents at committee meetings, public hearings, on task forces, and as a sponsor or cosponsor of relevant bills. My district is both rural and suburban and has numerous policy needs: smart growth, transportation, education, health care, and economic development.

I juggle caring for my family, legislative work, and nursing education. I’m up at 5 AM to exercise and then I have breakfast meetings with constituents or campaign committee members. Following the meetings, I usually put on my other hat and spend time with my nursing students. I return phone calls in my car as I head into the state capital. When I arrive in my office, I’m greeted with phone messages, e-mail, and the pressing issues of the day. I share one staff member with another senator. Session begins around 2 PM when we enter caucus for 30 to 45 minutes to discuss the legislative agenda and bills to be voted upon. One day a week there are committee hearings. In the afternoons, I squeeze in more phone calls, RSVPs, research with the lawyers, and then head back to the floor for votes.

After each legislative day, there are usually receptions sponsored by interest groups. These provide time for lobbyists and members to review issues and concerns and highlight state funding efforts or programs. Typically, I attend several civic or association meetings each evening after the session in my district (I balance these with my son’s sporting and school events.). These meetings are important for gathering community input, staying current on issues, and letting my constituents know that I am concerned about their issues. It all takes a lot of time, energy, and a few cups of coffee.

What I’ve Been Able to Accomplish as a Nurse-Legislator

I have sponsored or cosponsored a range of legislation as a member of the house and senate: health, education, transportation, veteran’s affairs, agriculture, natural resources and the environment, homeland security, community and county affairs, and insurance committees. As the only health care professional in the Delaware General Assembly, I have been the prime sponsor of some important health bills and on task forces such as the necessary code changes for the state’s Health Exchange as a result of the federal Affordable Care Act (www. heatlthcare.gov), Governor’s Cancer Council, and the Health Fund Advisory (Master Tobacco Settlement Committee). I have worked on many licensure/scope of practice and public health and environmental policies. These policy issues have included occupational health, substance abuse prevention and treatment, cancer, minority health, dental care access, health professions, environmental justice, chronic illness, mercury removal from the environment, school health, early childhood education, prescription assistance, and end-of-life care decisions. I have found that having a nursing background is extremely valuable in influencing a wide variety of policy issues.

I have worked very closely with the farmers in my district. I myself was raised on a farm, and my knowledge of farming has proved vital. I was pleased to sponsor, as my first piece of legislation, the farmland preservation license tag. In addition, I have sponsored land use legislation that helps with county, municipal, and state communication. Only 1% of the U.S. population consumes more than 20% of all health care expenditures, and 5% of the population accounts for more than 50% of the total expenditure (The National Institute for Health Care Management [NIHCM] Research and Educational Foundation Data Brief, 2012). Chronic illness is a major issue for Delaware, as it is for the nation. I sponsored legislation to establish a blue ribbon task force to analyze the problem of chronic illness in Delaware and to develop policy recommendations. The task force identified strategies including

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disease standards of care for health professions, improved communication between insurers and providers, outreach to the at-risk, and the use of a disease management approach with Medicaid patients and among the business community.

I was the prime sponsor of legislation creating a cancer consortium for Delaware. This group has completed a comprehensive assessment and plans to tackle our high cancer mortality rates. I am pleased to say that the cancer incidence and cancer rates have dropped since the creation of this body. The state has implemented the consortium’s many recommendations, including establishing a free treatment program for cancer patients who lack insurance, adding statewide caseworkers, and creating screening programs. Recently, I was pleased to update the state’s Indoor Tanning Laws to prohibit children under age 14 years from using tanning beds and for those aged 14 to 18 years to require parental consent.

HIV infection rates in Delaware are among the highest in the nation. Several years ago I cosponsored needle exchange legislation, and it has shown a positive impact on HIV infection rates. I was pleased to sponsor the legislation to create a state Office of Health and Safety for public programs. All these examples of sponsored legislation involve a team effort with other officials, individuals, lobbyists, and organizations or advocates.

Tips for Influencing Elected Officials’ Health Policy Decisions

What have I learned as a legislator who can help other nurses who are seeking to influence policy? You must communicate well to influence policy, and nurses are naturally gifted communicators and problem solvers. In a study of nurse leaders in federal politics, I found that the political strategies used most frequently by nursing organizations are direct contacts, grassroots efforts, and coalition formation (Hall-Long, 1995). Nurses should not be intimidated by the need to call, write, or visit their elected officials. It is important when meeting with elected officials that you are prepared. Have a one-page fact sheet to leave behind (as opposed to a binder of information), and be prepared to summarize your issue and offer solutions in less than 5 minutes.

If nurses don’t speak up on health care issues, who will? Physicians? Hospital associations? Insurers? If nurses don’t speak up, legislators will only hear from other groups. Given health reform and a push for a nursing consensus model, advanced practice nurses are expected to take on a broader scope of practice and must be engaged in state-level policy discussions. You have heard the expression, “It’s not whether you win or lose but how you play the game.” Well, in politics, how you play the game can determine whether you win or lose an issue. Increasing your influence by working in a group or coalition is an extremely effective strategy.

Is It Worth It?

Life as an elected official has been better than I could have imagined. Though it has taken some time away from my family and my scholarship, it has been worthwhile. I encourage other nurses to consider how they might serve the public, including running for elected office.

References

Hall-Long B. Nursing education at political crossroads. Journal of Professional Nursing. 1995;11(3):139–146.

The National Institute for Health Care Management [NIHCM] Research and Educational Foundation Data Brief. The concentration of health care spending. [Retrieved from] 2012 www.nihcm.org/pdf/DataBrief3%20Final.pdf.

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