A New Approach Reflective Journaling€¦ · Walt Disney Pictures, Pixar AnimationStudios •...

A Toolkit for Innovative Teaching Strategies in Psychiatric Mental Health Nursing

• Grace Saidel Wlasowicz, RN, Ph.D., PMHNP‐BC, University of Rochester School of Nursing

• David Sharp, RN, PhD, Louisiana College

• Todd Hastings MS, RN, PhD(c), Misericordia University• Barbara Buxton, PhD, PMHCNS‐BC, RN, University of Scranton

• Arleen Briggs, MSN, RN‐BC, APRN

• Undergraduate Subcommittee Group #3

Conflict of Interest

• The presenters have no conflict of interest to report.

By the end of the session the attendees will be

• Describe various strategies including: reflective journaling, simulation, case studies/problem based learning, movie clips, and lesson planning.

• Compare/contrast different approaches to student centered learning.

• Utilize innovative teaching strategies in future lesson planning

A New Approach to Reflective Journaling

Grace Saidel Wlasowicz, RN, Ph.D., PMHNP‐BC

University of Rochester School of Nursing

Reflective Journaling/Practice

• A heuristic process which involves a progressive movement from rational‐emotive operations to new insights and perspectives (Penny & Lund, 2004).

Reflective Journaling: What is it supposed to accomplish?

• Improve clinical competence

• Develop diagnostic reasoning

• Expand clinical decision‐making

• Engage in critical analysis

• Support self‐examination

APNA 27th Annual Conference Session 1034: October 9, 2013

Wlasowicz, Sharp, Hastings, Buxton 1

The Traditional Approach

• Spend the day in clinical

• Tell you what they did

• Report on their patient, the milieu, their thoughts and feelings

• Useful as a communication tool with instructor

• What is this approach lacking?

Kolb’s Experiential Model

Reflective practice: Questions to reflect upon

• What did you learn about psychiatric mental health nursing today?

• What did you learn about psychiatric mental health today? • What did you learn about care delivery?• What did you learn about the symptoms of schizophrenia? • What did you learn about therapeutic communication or

the 1:1 relationship?• What did you learn about psychotropics?• What did you learn about the therapeutic milieu?• What did you learn about your role as a student nurse?• What did you learn about inter professional collaboration?

References

• Hampton, S.E. & Morrow, C. (2003). Reflective journaling and assessment. Journal of Professional Issues in Engineering Education and Practice, 186‐189.

• Hubbs, D.L. & Brand, C.F. (2005), The paper mirror: Understanding reflective journaling. Journal of Experiential Education, 28(1), 60‐71.

• Kessler, P.D. & Lund, C.H. (2004). Reflective journaling: Developing an online journal for distance eduction. Nurse Educator, 29(1), 20‐24.

• Kolb, D. (1984). Experiential learning: Experience as the source of learning and development. New Jersey: Prentice‐Hall.

• Kolb, D. (1976). Management and learning process. California Management Review, 15 (3), 20‐3.

• Lasater, K. & Nielsen, A. (2009). Reflective journaling for clinical judgment development and evaluation. Journal of Nursing Education, 48(1), 40‐44.

• Lauterbach, S.S. & Hentz, P.B. (2005). Journaling to learn: A strategy in nursing eduation for developing the nurse as person and person as nurse. International Journal of Human Caring, 9(1), 29‐35.



Revision on planning a teaching session

Dr David Sharp

Teaching Plan should include

• Timeline

• Content matched to time line

• Resources required by teacher

• Teaching activity

• Student activity

Example of a lesson plan

Time

Class begins

Content Teacher activity Teaching method, aids

Student activity

Time11am Class begins

ContentSchizophrenia

Teacher activity Teaching method, aids Student activity

4 mins (11.04am)

Advance organizer

Show DVD clip ‘The Passion of Joan of Arc” DVD Settle down in classPay attention.Watch DVD clip and reflect on content

2 mins(11.06am)

Introduce topic Welcome class Talk Listen

2 mins(11.08am)

Define ‘normality’

Explain concepts Draw diagram on whiteboard Reflect on concepts explained

5 mins(11.13am)

Demographics of schizophrenia

Explain Powerpoint slides # 1- 9

Powerpoint slides Reflect on concepts explainedWrite notes

5mins (11.18am)

Causes of schizophrenia

Explain Powerpoint slides # 10- 16


6 mins (11.24am)

- Features of Schizophrenia- Historical approaches to treatmnet

Show video clip “Beautiful Mind” video Watch video clip and reflect on content

1 min(11.25am)

Features of schizophrenia

Explain Powerpoint slides # 17


10 min (11.30am) Defining symptoms of schizophrenia(illusion v halluscination)

- Explain Powerpoint slides of illusions slides #18-22- Demonstration of hearing voices

PowerPoint slides Reflect on concepts explainedWrite notes

Participate in group exercise

5 mins(11.35am)

Symptoms of Schizophrenia

Explain PowerPoint slides #23-28


5 mins (11.40am)

Forms of schizophrenia

Explain Powerpoint slides # 29-32


7 mins (11.47am)

Dopamine and treatment issues

Show video clip Explain slides #33-35

‘Trouble in Mind” video Watch video clip and reflect on contentWrite notes from slides

3mins(11.52am)

Any questions from class

Ask if any question

Provide answers Ask questions. Reflect on answers given

2mins (11.55am)

Summary +Feedback

Summarise session

Talk and explain, listen ListenProvide feedback

5 mins (12.00am) Break Exit classroom Prepare for next session

Remember…• Time span for attention is about 13 minutes!

• Need to vary/break up content every 15 minutes

• Using student centered approaches promotes active learning

• You do not have to teach the whole content of a book chapter (students are usually able to read!)

• The teacher should inform and guide the learning process

• Have fun!



Using Movies Teaching PMH Nursing

Dr David Sharp

Harvey, 1950

One Flew Over the Cuckoo’s Nest, 1975

Can use movie clips to• Give example of a diagnosis

• Give example of problems faced by a client

• Give examples of approaches to treatment (including historical perspectives)

• Give examples of cultural variables in PMH

• Give example of societal reaction to PMH problem

Aviator, 2004

The Wrong Man,1956

Finding Nemo,2003

Joan of Arc,1999

Lars and the Real Girl,2007

Movie clips available from a range of sources

• CD ROMs professionally produced regarding PMH nursing

• Internet based sources

• Documentary films distributed via publishing houses

• Documentary/news programs produced for television

• “Hollywood” movies – produced by the entertainment industry but using PMH content

“Hollywood” movies

• Covered by the Educational Exemption for showing movies in class.

• Available in VHS or DVD format

• Bonus features in DVDs can often be used –especially the Theatre Trailer

• Students may or may not be familiar with the movie

• Movies with PMH content not just made in the USA

Horton Hears a Who!2008

Vertigo,1958

Examples of using “Hollywood” movies in class

• Joan of Arc – used to point out how definitions of mental health issues change over time and across cultures. Delusional thinking, auditory hallucinations

Joan of Arc,1999

The Passion of Joan of Arc,1928.

The Passion of Joan of Arc,1928

The Madness of King George

Historical perspectives on the treatment of PMH disorders, the power of physicians in dealing with clients. Porphyria.

The Madness of King George,1994

The Madness of King George,1994



12 Monkeys

• Trying to understand the “un‐understandability” of PMH problems. Delusional belief systems. Paranoia and aggression

12 Monkeys,1995

12 Monkeys,1995

A Beautiful Mind

Recent movies may be familiar to students. Historical perspectives, insulin therapy. Delusional beliefs. Paranoia, self harm.

A Beautiful Mind,2001

A Beautiful Mind,2001

Useful references

Wedding, D., Boyd, M.A., and Niemiec , R.M. (2010) Movies and Mental Illness: Using Films to Understand Psychopathology. (3rd Edition).

Blog for next edition : http://movies andmentalillness.blogspot.com

Movies and Mental Illness Filmography by Susan Nicosia. http://www.imagiscape.ca/research/art/Movies%20and%20Mental%20Illness%20Filmography.htm

Masters, Joan (2005) Hollywood in the Classroom: Using Feature Films to Teach. Nurse Educator May/June 2005 , Vol 30, Issue 3, p113‐116

Movie References• Aubrey, S., Cameron, J. and Kimmel, S. (Producers), & Gillespie, C. (Director). 2007. Lars and

the Real Girl [Motion picture]. USA: Metro‐Goldwyn‐Mayer.• Beck, J. (Producer), & Koster, H. (Director). 1950. Harvey. [Motion picture]. USA: Universal

International Pictures.• Deane, A., Friend, B. LeFaive, D., Gernon, E. and Flashner, G. (Producers), & Duguay, C.

(Director). 1999. Joan of Arc [Motion picture]. USA: CBS.• Dreyer, C.T. (Producer and Director). 1928. The Passion of Joan of Arc [Motion picture].

France: Société générale des films• Evans, S. and Parfitt, D. (Producers), & Bennett, A. (Director). 1994. The Madness of King

George [Motion picture]. United Kingdom: Samuel Goldwyn Company. • Hitchcock, A. (Producer and Director). 1956. The Wrong Man [Motion picture]. USA:

Warner Bros.• Hitchcock, A. (Producer and Director). 1958. Vertigo [Motion picture]. USA: Paramount

Pictures.• Howard, R. Producer and Director). 2001. A Beautiful Mind [Motion Picture]. USA Universal

Pictures.• Gordon, B. and Anderson, B. (Producers), & Hayward, J, and Martino, S. (Directors). 2008.

Horton Hears a Who! [Motion picture]. USA: 20th Century Fox Animation. • Mann, M., Climan, S., King, G., and Evans, C. (Producers), & Scorsese, M. (Director). 2004.

The Aviator [Motion picture]. USA: Warner Bros. Pictures, Miramax Films.• Roven, C. (Producer) & Gilliam, T. (Director). 1995. 12 Monkeys [Motion picture]. USA:

Universal Pictures.• Walters, G. (Producer), & Stanton, A. (Director). 2003. Finding Nemo [Motion picture]. USA:

Walt Disney Pictures, Pixar Animation Studios• Zaentz, S. and Douglas, M. (Producers). 1975. One Flew over the Cuckoo’s Nest [Motion

picture]. USA: United Artists.



Drama and Role Play: Getting dramatic and going one on one (the original simulation)Barbara Buxton, PhD, PMH-CNSand

Todd Hastings, MS, RN

Use of Role Play and Drama Goals for Nurses

Examine human behavior Practice rapport-building with patients Practice therapeutic communication skills “simulate” the nurse-patient relationship Motivational interviewing Practice Nursing Process

Why role play and drama? To decrease students’ fear and anxiety related to those

with mental illness To increase empathy towards someone with mental

illness and develop a bond with the patient Students experience a “real life” patient in a controlled

setting and practice therapeutic communication skills To study behavior with real people To practice “reading people”

“Simulate” the nurse-patient relationship

Role play and drama as good (or better?) than simulation

(Lane & Rollnick, 2007)

Role Play Method

Students pair up and assume roles ◦ One student in role of provider◦ One student in role of patientBoth can use scripts or ad lib the role based on

their basic knowledge of expectations…

Onlookers could be used to critique?

Drama Method

Recruit a student volunteerto portray the student nursea week prior to presentation

Give a brief description of the client that will be the guest

Encourage the student to read the chapter on the chosen diagnosis (This is everyone’s homework, so encourage ALL students to read the chapter!)



For a student: An Example of a PMH client

– Role Play or DramaWoman with Schizophrenia:

Your patient is 24 years old with a disheveled appearance; she is quiet and withdrawn, but will interact with you. She appears preoccupied as if she is

hearing and seeing things that you aren't seeing and hearing. She is scared and maybe paranoid as well. She is in the hospital, came in last night, when the police

found her in the streets talking to herself and becoming agitated when they approached her. She attempted to strike one of them, so they brought her to the

ER and she was admitted to the unit where you work as a 302 admission (involuntary). She didn't sleep all night. She has layers of clothes on and she

smells. She hasn't bathed in several days. She refused medication when she was admitted and won't take any from you. You are her assigned nurse and need to

spend some time with her.Hints: know the positive and negative symptoms of schizophrenia. Consider the

importance of establishing a trusting, therapeutic relationship with this person, see your textbook regarding working with a person with delusions and

hallucinations. You may also want to consider suggestions to help her manage her symptoms. The guest will not be aggressive and her anxiety level will not be real

high, so you may be able to spend some time with her and offer her suggestions...we will see how she will respond!

Drama Presentation Faculty will greet students and announce that a

“guest” will be joining class that day Faculty will leave to greet the “guest” and student

volunteer will accompany faculty Faculty will dress the part, student will introduce

the “guest”, and the drama will begin There is no script…”Guest” and student will

interact with each other Initially the other students may laugh or gigglewhen drama begins, but they will settle down and watch closely Presentation lasts 10 to 15 minutes

Role Play Presentation Faculty will assign students to the nurse or the

client role Students will engage in a role play interview for

assessing the client “status”, symptoms, and ability to engage in a therapeutic relationship

Again, there is no script…students will interact with each other for several minutes

Initially students may find it challenging to seriously assume roles but express how they learn to better assess and care for PMH clients

Presentation lasts 5-10 min

Role Play and Drama…learn to better understand the patient

Participants get the benefit of clarifying “what to say” when being clinician

Participants develop a better appreciation for “how it feels” to be the patient

Challenging psychiatric scenarios with “difficult patients” should be embraced!

(Joyner & Young, 2006)

Post Presentation

Come back…definitely come back as yourself

Begin by asking students what they observed about the “client”

Work through the nursing process Praise the students who assumed

roles…point out what they did well in the role play or drama scenario

Let’s do one of each!

Observe the scenario presented and debrief Then do role play – you are either a nurse or

a patient Assume the role! 10 minutes What did you learn from both? Benefits…



ReferencesBuxton, B. (2011) Interaction unscripted. Journal of Psychosocial Nursing and Mental Health Services,

49(5), 28-32.Feely, M. (1997). Using peplau's theory in nurse-patient relations. International Nursing Review, 44(4),

115-120.Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=1998021038&site=ehost-live

Joyner, B., & Young, L. (2006). Teaching medical students using role play: Twelve tips for successful role plays. Medical Teacher, 28(3), 225-229.Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=16753719&site=ehost-live

Lane, C., Hood, K., & Rollnick, S. (2008). Teaching motivational interviewing: Using role play is as effective as using simulated patients. Medical Education, 42(6), 637-644. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009923184&site=ehost-live

Lane, C., & Rollnick, S. (2007). The use of simulated patients and role-play in communication skills training: A review of the literature to august 2005. Patient education and counseling, 67(1), 13-20.Retrieved from http://linkinghub.elsevier.com/retrieve/pii/S0738399107000912?showall=true

Lowenstein, A. J. (2011). Role play. In M. J. Bradshaw & A. J. Lowenstein (Eds.), Innovative teaching strategies in nursing and related health professions (5th ed.). Sudbury, MA: Jones and Bartlett.

McCarthy, B., O'Donovan, M., & Twomey, A. (2008). Person-centred communication: Design, implementation and evaluation of a communication skills module for undergraduate nursing students -- an irish context. Contemporary Nurse: A Journal for the Australian Nursing Profession, 27(2), 207-222. doi:http://dx.doi.org/10.5172/conu.2008.27.2.207

All clip art downloaded from Microsoft PowerPoint program



Case StudiesProblem Solving Learning

Provide a story based situation to which students can pin their classroom learning.

Any learning need can be included in this activity

Students enjoy playing detective in order to solve the situation.

Contains the need to utilize the Nursing Process

Care Plans can be developed from case studies.

Emphasizes the ability to succeed in a safe environment

Illustrative Case Studies

Exploratory (or pilot) Case Studies

Cumulative Case Studies

Critical Instance Case Studies

Individual Theories

Organizational Theories

Social Theories

An obvious advantage to this mode of instruction is that it allows students the exposure to settings and contexts that they might not otherwise experience.

The case study method also incorporates the idea that students can learn from one another "byengaging with each other and with each other's ideas, by asserting something and then having it questioned, challenged and thrown back at them so that they can reflect on what they hear, and then refine what they say" (Boehrer1990).

Creating Publicity Case Studies Dentist giving patients HIV: Murder by Dental Drill

Whitney Houston: A Death Day Coming!

Dan Blocker: Death of a TV Western Pioneer.

Casey Anthony: Mental Illness or Murder?

Jodi Arias: Murder or Insanity?

Pick anything in the news.

Government: Paranoid Schizophrenia and the Conspiracy Theory with the privacy issues.

Resources: Evolve text books have case studies in each chapter

Evolve has “unfolding case studies” with the text on the web site.

http://sciencecases.lib.buffalo.edu/cs/collection/detail.asp?case_id=673&id=673

http://writing.colostate.edu/guides/guide.cfm?guideid=60

APNA has teaching tools on the member bridge.

http://www.ncbi.nlm.nih.gov/books/NBK2248/

http://www.nso.com/case-studies/casestudy-article/325.jsp



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