Incorporating Mental Health into the NP CurriculaMelissa Woods MSN, RN, PMHNP

Clemson University

STAGGERING STATISTICS

850,00 people die every year from ______.1

50% of patients seeking treatment in Primary Care for _____ dropout due to suboptimal treatment.2

More than 60% of those treated in Primary care are diagnosed with ___________.3

By 2020 _____ will be the second most serious medical condition contributing to burden resulting from disease.4

____ is the third most common reason for people seeking treatment in Primary Care.5

LET’S LOOK AT WHAT WE ARE DOING

How about let’s ask the questions “Are we doing enough?” “Are we doing all we can do?” “Are we teaching our students evidence based

practice?”

LET’S LOOK AT WHAT WE ARE DOING

Now let’s ask the questionsHow many hours do our programs devote to

diagnosing and treating depression?How many hours do we devote to correct initiating

and titrating psychotropic medications? Are we failing our students and in turn the patients

they treat?

STRATEGIES

Utilize current Mental Health (MH) faculty by having them lecture in: Advance Pharmacology class Adult, Geriatric, Frail Elder Practicum class “Worried Well” Any class where there is a Mental Health topicUtilizing current MH faculty is essential in

incorporating MH issues, topics and medications

STRATEGIES: THINKING OUTSIDE THE BOX

Incorporating a Mental Health class into the current curriculum. This can by done by: Lecture with a clinical component Lecture class only

STRATEGIES: THINKING OUTSIDE THE BOX

Lecture includes: Diagnosing using the DSM-IV-TR &

psychopharmacology for each disorder covered Application activities

Each student conducts a psychiatric history and physical Prepare template history and physicals in which each

student must read and make differential diagnosis, justify the diagnosis, prepare a plan of care, choose medication and justify the reasoning with each, address any laboratory work, address other health issues, and plan of care must include non-pharmacological treatments

APPLICATION ACTIVITIES

Diagnostic reasoning paper Section I: Select from 1 of the 3 symptoms Fatigue Insomnia Anxiety For each of the systems listed with the symptom you selected, develop 2 or 3

hypotheses concerning the etiology of the phenomenon. Present your rationale for each hypothesis. This involves a brief explanation of the pathophysiology of the hypothesized etiology.

Fatigue-Respiratory, Immunological, Psychiatric Insomnia-Endocrine, Musculoskeletal, Psychiatric Anxiety-Pulmonary, Cardiovascular, Psychiatric Section II: Choice one of the (2 or 3) psychiatric hypothesis and describe the

additional subjective and objective data you would collect to test one of these hypotheses. Explain how you would use the data to support this hypothesis and reject the others in so far as rejection may be possible.

Section III: For your supported hypothesis, develop a plan of care that includes medications and anything necessary to treat including community referrals.

STRATEGIES: THINKING OUTSIDE THE BOX

Clinical component includes experiences in: Primary care sites Sleep study clinic ER Evaluations and screenings Acute inpatient Outpatient- VA Clinic, OCD/unit at MUSC ECT observation, Electromagnetic Therapy observation AA/NA, Overeater’s Anonymous, Gambler’s Anonymous

meetings National Alliance on Mental Illness (NAMI)

STRATEGIES: THINKING OUTSIDE THE BOX

Encouraging graduate students to focus their research project, research paper or thesis, within Mental Health

STRATEGIES: THINKING OUTSIDE THE BOX

How about changing the current Advanced Pharmacology class hours? If it’s 3 hours total, lets make 1 hour of it

PsychopharmacologyOr change it to a 4 hour class and 1-2 hours in

Psychopharmacology

STRATEGIES: THINKING OUTSIDE THE BOX

Have students do a presentation on a MH topic, such as depression in African Americans

This also threads cultural competence through the curriculum

NOW LET’S TALK!

REFERENCES

1&4. World Health Organization. (2011). Depression. Retrieved August 4, 2011, from http://www.who.int/mental_health/management/depression/definition/en/.

2. Carlat, D. (2010). 45,000 More psychiatrist, anyone? Psychiatrist Times, 27(8), 1-4.

3. Williams, J.W., Gerrity, M. Holsinger ,T., Dobscha S., Gaynes, B., & Dietrich, A. (2007). Systematic review of multifaceted interventions to improve depression care. General Hospital Psychiatry, 29, 91-116.

5. McIlrath, C., Kenney, S., McKenna, H., McLaughlin, D. (2009). Benchmarks for effective primary care-based nursing services for adults with depression: A Delphi study Journal of Advanced Nursing, 66(2), 269-281.