MENTAL HEALTH AGENCY PARTNERS WITH GRADUATE STUDENTS IN PHYSICAL EXAMINATION TRAINING
Background: The physical health of the mentally ill is often neglected in inpatient psychiatric units. There is an urgent need to integrate both physical and psychological care to improve the overall health of those with mental illness and to prevent the revolving door between inpatient mental health units and the emergency department.
Description: Training occurs over a two-day period with four case study modules presented four times. Sixty mental health nurses attend the sessions. Physical assessment is included in each training module and upon completion of the four case studies. The participants demonstrate in groups of three (with each taking turns being the patient, the observer, and the nurse) a complete physical exam with the following components: skin, neurological, respiratory, abdominal, genitourinary, cardiac, and pain. The four case studies are built around four patients: one is pregnant and the others have diagnoses of cirrhosis, respiratory distress, or cardiac issues. Other medical components are added as the cases unfold: electrolyte imbalance, wound care, diabetes, metabolic disorder, dialysis, fall risk, cognitive impairment, hypertensive crisis, rhabdomyoloysis, and neuroleptic malignant syndrome. Laboratory results and psychotrophic medications are included. Each case study starts with presenting symptoms and as the scenario worsens nurses are prompted to discuss what other issues and problems may be considered. Students develop learning objectives, participant learning outcomes, and an evaluation plan.
Outcomes: At the conclusion of this activity the students are able to implement the role of nurse educator through a learning experience in a mental health agency; apply principles of teaching and learning, curriculum development, assessment, and evaluation in a clinical setting; and utilize preceptor and participant feedback to evaluate personal teaching effectiveness. At the conclusion of this activity mental health nurses are able to care for the physical needs of a person having a mental health crisis, demonstrate how to perform physical assessments on inpatient mental health patients, and recognize symptoms that necessitate prompt intervention in order to reduce unnecessary hospital readmission.
Conclusion: Graduate student nurse educators are exposed to pedagogical strategies for teaching mental health nurses in a clinical setting. Mental health nurses learn how to identify physical problems in order to appropriately intervene and transfer inpatient psychiatric patients to the emergency department. Students share materials with the mental health agency, which allows repetition of the modules with nurses and staff who were unable to attend. Research is needed to test the efficacy and effectiveness of pedagogical approaches, such as the use of case studies and physical assessment skill development, in the continuing education of mental health nurses.
Implications: Mental health nurses often miss important physical details in the assessment of their inpatient mental health patients. In order to address the burden of physical illness in patients with mental illness, nurses must perform physical examinations in psychiatric inpatient settings.