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Nursing and Mental Health

Although patients may stop in an emergency room or doctor's office for a medical issue, an underlying mental health need might be interfering with their wellbeing as well. The Nursing School retooled its curriculum to ensure all of its students are ready to treat such patients.
Business & Community  |  May 12, 2014  |  By Kevin Dunegan
Michelle Giddings, psychiatric nurse practitioner and assistant professor with the UNLV School of Nursing. (R Marsh Starks/UNLV Photo Services)

An ambulance siren wailed. It's a sound the two nurses had heard many times. A sound the patient they were speaking with had also heard throughout his life. Now the sound, usually just part of the day's background noises, forced the patient from the exam table to cower in a far corner of the room, yelling for everyone to take cover.

The stunned nurses approached him, assuring him all was well. That's when he screamed, "It's a bomb. Get down before it goes off."

The patient's diagnosis is post traumatic stress disorder, more commonly known as PTSD. The scenario is similar to dozens of reactions by those suffering from the condition. Fortunately for the nurses and the patient, this scenario is a simulation.

In the last two years, the School of Nursing has bolstered the mental health portion of its curriculum with the introduction of standardized patient simulations, which take place at the Clinical Simulation Center Las Vegas. The "patient" is a professional actor specially trained to portray aspects of PTSD and the nurses are fourth-semester students of the nursing program.

Students also work with patients diagnosed with psychiatric and mental health conditions under the supervision of clinical faculty. The psychiatric nursing experience gained by students includes observing courtroom cases involving juvenile behavioral and mental health issues, visiting psychiatric hospitals and substance abuse treatment facilities, and attending group sessions with those suffering from mental health issues.

According to Dr. Michelle Giddings, psychiatric nurse practitioner and assistant professor with the School of Nursing, the enhanced curriculum focuses on changes in mental health policy, trends in mental health care, and evidence-based practice for treating patients -- including pharmacological and nonpharmacological options.

"The increase in hands-on learning furthers the students' understanding about what mental illness actually entails," Giddings said. "A majority of people learn by exposure, and during these experiences many students discover the human side of mental illness, which helps demystify the concept for them."

Giddings pushed for and co-wrote the PTSD scenario with nursing professor Jessica Doolen, a simulation expert, because the condition is prevalent in society and is severely underserved. The goals are to help nursing students become more aware of the disorder and strengthen their assessment, intervention, and treatment skills for these patients. The students face three other mental health simulations, each focusing on a person who has bipolar disorder, schizophrenia, and generalized anxiety disorder.

Groups of eight students are present during the scenarios, enabling two to interact with the different patient actors. During a simulation, the two students speaking with the patient are observed by their instructors and peers from another room.

When the simulated encounter concludes, the instructors host a debriefing session during which all students discuss what transpired, identify what actions were appropriate, and suggest alternative approaches. The actor relays feedback to the students from the simulated patient's perspective.

"We stress that psychiatric and mental health needs are not limited to psychiatric hospitals. They can be present in any unit, facility, and work area," Giddings said. "The students, as new nurses, must be prepared to identify the disorders and their immediate needs. In certain circumstances, they may be the only person in the room who can de-escalate a potentially dangerous situation."

Since 2012, Giddings has seen interest in a mental health specialization rise to nearly 10 percent of each year's graduating class.

According course evaluations and comments, students appreciate the hands-on opportunities the mental health section affords them. Many note the shift in their thinking about mental illness and develop empathy for those afflicted by the various disorders. As one student summarized, "I no longer link mental illness with 'crazy' and want to do more to help these patients."