with your usual amount of sleep ….............................


0

1

2

3

4





68. Y
ou suffer from severe nervous exhaustion …...........


0

1

2

3

4




41





HAVE YOU NOTICED:





69. Worrying about your health ….....................................


0

1

2

3

4





70. Stuttering or stammering ….....................
.....................


0

1

2

3

4





71. Shaking or trembling …................................................


0

1

2

3

4





72. Being keyed up and jittery …........................................


0

1

2

3

4





73. Feeling weak and faint ….............................................


0

1

2

3

4





74. Frightening dreams …...................................................


0

1

2

3

4





75. Being uneasy and apprehensive ….......
........................


0

1

2

3

4



76. You get nervous or shaky when approached by a




superior …......................................................................


0

1

2

3

4





77. You become so afraid you can't move …......................


0

1

2

3

4



78. You are fearful of strangers and/or strange places


make you afraid …........................................
.................


0

1

2

3

4





79. Sudden noises make you jump or shake …...................


0

1

2

3

4


DOES IT SEEM:





80. That little things get on your nerves ….........................


0

1

2

3

4





81.

You are easily annoyed and irritated ….........................


0

1

2

3

4



82. When you feel angry, you act angrily toward most


everything …...............................................
....................


0

1

2

3

4



83. Angry thoughts about an irritating event keep


bothering you …..............................................................


0

1

2

3

4





84. You become mad or angry easily …...............................


0

1

2

3

4



85. Your anger is so great that you want to strike


something ….............................................
........................


0

1

2

3

4



86. You let little annoyances build up until you just


explode ….........................................................................


0

1

2

3

4






87. You become so upset that you hit something ….............


0

1

2

3

4


IN YOUR DAY
-
TO
-
DAY LIVING DO YOU FIND:



88. Your thinking gets completely mixed up when you


have to do things quickly …
............................................


0

1

2

3

4



89. You must do things very slowly to do them without


mistakes ….....................................................................
...


0

1

2

3

4





90. You get directions and orders wrong …...........................


0

1

2

3

4





91. You are unable to keep thoughts from running through




your mind …......................
...............................................


0

1

2

3

4

42









92. Frightening thoughts keep coming back ….....................


0

1

2

3

4





93. You become suddenly frightened for no good reason …...

0

1

2

3

4





94. You have difficulty in concentrating …............................


0

1

2

3

4


95.


What other ways do you experience stress, tension or


anxiety?



___________________________________________________________
___________________________


______________________________________________________________________________________


______________________________________________________________________________________



______________________________________________________________________________________






The following section is for WOMEN ONLY:



AROUND THE TIME OF YOUR PERIOD DO YOU FEEL:





96. Tense or jumpy …...........
.................................................


0

1

2

3

4




97. Mildly depressed …..........................................................


0

1

2

3

4
.




98. Moderately depress….......
...............................................


0

1

2

3

4



99. Severely depressed ….......................................................


0

1

2

3

4





100. Have you been pregnant within the last
year …....................................................


yes


no



101. Did you experience any complications during this pregnancy …..........................


yes


no



102. Did you experience any

complications during or after delivery …........................


yes


no



103. Have you had a hysterectomy …............................................................................


yes


no



104.
Have you had both ovaries removed ….................................................................


yes


no



105. In the last year have you experienced any symptoms due to this surgery …........


yes


no




106, Have you experienced menopause …....................................................................


yes


no



107. In the last year have you experienced any symptoms related to menopause …...


yes


no



This questionna
ire is adapted in part from

the Cornell Medical Index,

1949. It may not be copied

or reproduced without permission from

Elaine A. Thompson or Helen Nakagawa
-
Kogan.


Department of Psychosocial Nursing

University of Washington

Seattle, Washington 98195




43





S
TRESS LOG


STRESSOR

(DATE)

REACTION TO STRESS

(PHYSICAL, EMOTIONAL &
COGNITIVE)

STRESS MANAGEMENT
TECHNIQUES USED

EFFECTIVENESS

















































Disk#1Mangino

44






45





Nursing Network News, Winter 2000/01


IS STRESS INTERFERIN
G WITH THE


WELLNESS OF YOUR LIFE?


“10 TOP TIPS AND TECHNIQUES”


1.

SIX
-
SECOND MINI
-
RELAXATION

This exercise relieves tight muscles, clenched jaws and other physical signs of stress.



Become aware of what is annoying you.



Repeat to yourself, “alert mind, calm

body”



Smile inwardly. This will stop any angry expression. An inward smile is more a feeling than it is
noticeable to the people around you.



Inhale slowly as you count to three, imagining your breath coming in through your feet. Exhale slowly
letting

the muscles throughout your body go limp.



Practiced regularly, these steps will become automatic.


2.

BELLY BREATHING

Focusing on breathing helps to settle the mind and encourage relaxation.



Lay down on your back. Loosen any constrictive clothes.



Put your h
ands on your lower belly, close your eyes, and imagine a balloon inside your abdomen.



As you breathe in and out, imagine the balloon filling and deflating.



Focus on the sound and sensation of breathing as you become increasingly relaxed.


3.

VISUALIZATION

Foc
us your imagination on an image to produce calm and increase energy. Imagination using multi
-
sensory
images can trigger a physiological response and can be used to develop control over bodily functions.



Close your eyes and imagine yourself standing in the

kitchen.



Notice the smells, sights and sounds of the kitchen.



See a large, juicy orange lying on the cutting board. Imagine picking it up and feeling its texture and
weight, then cutting a large slice.



As you cut the orange, notice the rich, fragrant jui
ce and color and texture of the pulp.



Imagine bringing this luscious orange slice toward your mouth and notice your mouth begin to water.


4.

SELF
-
HYPNOSIS

Use the natural ability to concentrate to benefit health.



Get into a relaxed position and take slow, de
ep breaths.



Fix your eyes on an object such as a candle or a picture while telling yourself to let you eyes gently close.



As you count slowly from 10 to 1 tell yourself to become increasingly relaxed.



Repeat phrases like, “My body is becoming more relaxed
and calm.”



In this relaxed state give yourself suggestions to improve some aspect of yourself. For example to
improve motivation you can repeat, “I am confident that I will achieve my goals. As I work toward them,
my enthusiasm and confidence grow.”


Nur
sing Network News, Winter 2000/01



5.

CREATE YOUR INNER ADVISOR

This exercise can develop conversation between your mind and body.



Start with your favorite relaxation technique to develop calm relaxation.



Invite your inner advisor to visit you. This advisor

may be a person, voice or symbol.

46







When comfortable with your advisor ask questions like, “How can I relax?” or “What is causing my
pain?” or “Who can help me?”



Patiently wait for answers. If the answer seems unclear, be patient and give yourself time to

develop
understanding.



6.

LAUGH



Laughter can reduce pain and stress and boost the immune system.



Expose yourself to humor


books, movies and cartoons.



Keep a humor journal listing amusing remarks and funny sayings. Notice the funny

things that happen,
write it all down and read it from time to time.



Tell a joke and share it with five people.



Laugh at yourself. Look for the funny side of life. People who can laugh at themselves have a stronger
sense of self worth and higher self
-
es
teem.



7.

AVOID BURNOUT

Balancing the many demands of life can prevent the health consequences of spreading one’s self too thin.



Set limits. Learn to say no. Schedule time to relax, put your feet up and play.



Envision the many facets of who YOU are


artis
t or gardener.



Keep lists of your priorities: focus on what is most important.



Ask for help and learn to share responsibilities.



Be willing to accept less than perfection in household tasks.



Celebrate the pleasures of connecting with your spouse and childr
en.



8.

HALTING THE TIME PRESSURE

Develop a healthier sense of time.



Break the habit of rushing by driving 5

10 miles per hour slower, choosing to stand in the longest grocery
checkout line or letting the phone ring several times before answering it.



Focus o
n what is important and get rid of less important things on the to
-
do list.



Establish your rhythm. Pay attention to your peaks and valleys in concentration, energy and alertness.



Be flexible. Take advantage of spontaneous events.



Practice living in the m
oment. Being totally absorbed in what you are doing can be exhilarating and
creates timeless moments in which pressures, fears and tension disappears.



Nursing Network News, Winter 2000/01




9.

COMMUNICATION

Effective communication can enhance health, nurt
ure relationships and help us cope with stress.



Learn to listen, openly and without judgment



Watch your body language. Avoid scowling and develop a relaxed confident posture.



Learn to be assertive, standing up for your rights in a friendly way.



Learn to s
ay “no” and prevent feeling overwhelmed.



Respect conversational styles. Recognizing that people of different ages and cultures express themselves
differently can prevent misunderstanding.



Practice praising. Express appreciation of people’s efforts and ac
hievements.



47






10.

HEALTH THINKING

Our emotions are determined by how we think about events. Use the questions below to learn to identify and
change negative thinking patterns and improve mood and health.



What is really bothering me?



Am I thinking in “all

or nothing” terms?



Am I assuming that every situation is the same?



Am I assuming the worst?



Am I making unfair comparisons?



Am I jumping to conclusions?



Are my worries worth worrying about?



Am I blaming myself for something that is out of my control?



Do I

expect perfection?



What difference will this make in one week or one year?





Developing a healthy perspective on life requires persistence and creativity. According to Drs. Kraft and Catanzaro, living
creatively means “challenging
assumptions, recogni
zing patterns, seeing things in new ways, making connection, taking risks, taking advantage of chance, and constructing netwo
rks.



Reference: Kraft, George H., M.D.; Catanzaro, Marci, R.N., PH.D.; Living with Multiple Sclerosis: A Wellness Approach; Sobel
, Davis, M.D., Ornstein, Robert, Ph.D.; “10
Top Tips and Techniques” from Mind/Body Health Newsletter as it appeared in the MS Matters, April, 2000.










Health Promotion Groups



Many of the current health problems in the United States are due to unh
ealthy
personal behavior and unwise choices.
Individuals with psychiatric/mental illness are
not immune from the consequences of unhealthy lifestyle choices, numerous studies
have determined that they may even have an increased incidence of physical ailme
nts.
Health teaching is an expected intervention for a professional nurse providing standard
psychiatric
-
mental health care. As students in mental health clinical, you will be
expected to provide health teaching for your clients by conducting a Health Pr
omotion
group and/or Health Fair.

General Guidelines:


Prior to leading your Health Promotion Group it is necessary to do some
preparation.

Students should assess the needs of the clients and create a group that will
address these needs.

Always remember
that even though the clients have a mental
illness and may be functioning at a very regressed level, they still are adults. It is
important that you do some research on the topic prior to leading the group, so you
have current, accurate information and co
uld answer questions if asked during the
group.


Participation in the group can be facilitated if the health information is
presented in an interactive format. Possible interactive activities include practicing
new health behaviors, doing a puzzle, and pl
aying a game, reading information, or
participating in a discussion. When you do all the talking or activity in the Health
Promotion group, client involvement is not facilitated. Sometimes, clients who are
taking psychotropic medications have problems wi
th their eyes, so it is important to
have reading material that is easy to read, with larger print. Also, don't forget the age
of the clients, is this an activity that you and your peers would do.


Health Promotion groups are best conducted in small room
s, if no rooms are
av
ai
lable

a corner of the dayroom

will do
. It is important to have to have enough
chairs for all the participants, sometimes a table is useful but it is not always
necessary.
Ask/
Inform the ward staff and the patients when you are goi
ng to have
your health group, and solicit their participation during the group and cooperation with
turning off the TV, radio, or anything else that is noisy and distracting. You can make
a sign advertising your group and post it on the wall prior to your

group if you like,
but it is not necessary. You can invite specific clients to your group, or you can have
an informal group and invite anyone on the unit to attend. The group can last between
30 minutes to an hour. After you have conducted your group,

you could complete the
group form and give it to the ward staff, or you could document the client's
participation in their charts if you are doing that at your facility.








49








Here are some possible topics that you could h
ave a Health Promotion group
on, if
you have ideas on other topics run it by your instructor before doing
.


Nutrition

-

food pyramid; serving sizes; fiber intake; vitamins; decreasing fat
intake; special diets; cholesterol; effects of taking psychotropic drugs on your
diet; etc. When

you are discussing diet remember where your clients currently
are, what kinds of actual dietary choices can they make, how much are they
going to be able to spend on food when they leave and what types of stores or
food preparation tools will they have.

E
xercise

-

benefits; pulse rates; back exercises; etc. Easy exercise videos are
useful, but remember where you are.

Hygiene

-

foot care; oral hygiene; hair care; skin care; the importance of extra
protection due to their sun sensitivity from the psychotrop
ic medications; etc.
Again, remember what they have available for personal hygiene, many
successful student groups have focused on cutting, cleaning and polishing nails.

General Health

-

Hypertension; diabetes; headaches; "cold"; "flue"; gastric
distress
(mention the problems with diarrhea and lithium); sleeping; smoking;
cancer prevention; safety; relaxation; visualization; stress management; feeling
recognition; etc.


Self
-
esteem promoting groups

-

make
-
up groups for women.


Relaxation groups



guided i
magery, yoga, music etc.

Some of the chronic clients are sometimes a little reluctant to attend groups, or
have been conditioned that if they attend an activity they will be given a reward.
In the past clients have been given such things as coffee or ciga
rettes, however
you are running a
Health Promotion

group so only give things that are of some
benefit or minimal negative consequence, sugar
-
free gum works.


Please use the Health Promotion resources available in the computer room.

















50





SUFFOLK
COUNTY COMMUNITY COLLEGE

NUR136 Reminiscence Project


What is Reminiscence?

When we reminisce we recall memories, review them, and recapture the emotions that went with
them. All of us engage in this reflective process from time to time; it is a normal an
d vital part of
growing older. Reminiscence by the elderly has all too often been devalued, regarded as turning
away from reality, living in the past and even seen as mental dysfunction. We know now, however
that exploring the past is an enriching experie
nce which provides deep personal satisfaction as well
as many other important benefits.


Studies have supported the value of reminiscence as a means of validating existence, resolving past
conflicts and finding meaning in remaining life. It is a way for t
he older adult to reassess life
experiences and further develop a sense of accomplishment and reward in life. At a time when older
adults may feel vulnerable, isolated or lonely, recalling and communicating their experiences helps
to improve their mental,

emotional and sometimes physical well
-
being.


We will look at Erickson’s theories of aging and the desire to accomplish the developmental task of
ego integrity vs. despair. The client that can appreciate times in the past and come to the realization
that

they had a life well lived will foster their ego integrity development.


For this project, you will interview an elder using an abbreviated version of the
Haight’s Life Review
and Experience Form.

The Life Review Form

contains questions referring to the f
ollowing life stages;
Childhood, Adolescence, Family & Home, Adulthood and Summary. See questions to be asked
below.


Life Review Form

1. Introduction

The elder that is interviewed must be older than 65 years of age.

Include some biographical and backgro
und information about the elder you interview: age,
cultural heritage, country of birth, occupation, medical diagnoses etc... If you choose indicate
if the person is a relative, friend or a client.

2. Childhood


What is your earliest memory?


What things c
an you remember when you were very young?


Describe a typical day in your life as a child.


3. Adolescence


What is the first thing you remember about your life as a teenager?


Who were the important people for you during this time?


What activities were y
ou involved in?


4. Family & Home


Describe your family:

Identify each member’s role, strength and weaknesses.

Rules and routines.

Religion and cultural influences.


Identify who you were closest to in your family.


Describe your home’s physical features a
nd overall atmosphere.


51





SUFFOLK COUNTY COMMUNITY COLLEGE

NUR136 Reminiscence Project



5. Adulthood


What were the most important events that happened after the age 20?


Describe your occupation/role and degree of satisfaction.

Identify significant relatio
nships:



Partner/spouse



Children



Friends



Relatives

What were some difficulties you encountered during your adult years?


6.

Summary

What has been the hardest thing you had to face?

What was the happiest moment in your life?

Looking back now, what ki
nd of life do you think you’ve had?

If you were going to live your life over again is there anything you would change?

What are the best things about your age now?

What are the most important things to you in your life today?


Directions for Presentation


1.

Document your patient’s verbal and non
-
verbal responses to each question.


2.

Include the following:

a.

Identify the physiological and psychosocial needs of the elder

b.

Identify patient’s support system and compare past to present resources.

c.

Identify the patient’s

current problem solving skills.

d.

Identify an
y

possible areas of intervention.


Please include your opinions, feelings and interpretations of what the elder has shared with you. In
your opinion do you feel that the elder has reached ego integrity or is in

despair? Consider how you
would use what you learned in the clinical area.


3.

Summarize all the information you have gathered on index cards and be prepared
for a 10 minute presentation and discussion of your findings and interpretations on
the second day o
f the workshop








5/06

AK & DP




52





SUFFOLK COUNTY COMMUNITY COLLEGE

SCHOOL OF NURSING

CLINICAL EVALUATION

LEVEL I


Name:








Final



Mid Semester










NUR101 _____ NUR124 _____

Clinical Agency:






NUR133 _____ NUR
136 _____









# Of Absences: ______

Date: From:


To:



Per # Of Clinical Experiences _____

EVALUATION CRITERIA

All areas are critical. A minimum rating of 2 or better in each category must be ac
hieved on
the final evaluation to receive a passing grade.


I.

PROFESSIONAL BEHAVIOR

1

2

3

NA / NO


A. Identifies the standards of care for basic nursing process, and
d
emonstrates


accountability for nursing care given.





B. Shows initiative in

identifying own nursing competencies and begins to identify


resources for lifelong learning.





C. Begins to correlate and identify consequences of ethical, legal and regulatory


aspects of professional nursing practice.





D. Recogni
zes the necessity for and maintenance of client confidentiality.





E. Recognizes professional advocacy as a role of the nurse.





F. Reports errors of omission/commission in a timely manner.





G. Demonstrates non
-
judgmental/culturally sensi
tive behaviors.





H. Maintains appropriate professional boundaries in the nurse
-
client relationship.





I. Reports to clinical facility on time.





J. Submits written assignments on time.





K. Clinical absences do not exceed policy lim
it.





L. Presents a professional appearance.





M. Utilizes constructive criticism and changes behavior accordingly.





II.

COMMUNICATION






A. Applies basic techniques of therapeutic communication when interacting with a


client.





B. Demonstrates beginning ability in documenting client status in nursing notes


and care plans.





C. Demonstrates beginning skills in oral presentations to a group of fellow


students.





D. Identifies and uses information tec
hnology to access current nursing literature.





E. Communicates therapeutically with significant others as well as clients and


members of the health care team.





F. Demonstrates increasing ability to communicate relevant, accurate, and



complete information verbally and in written documentation.





G. Utilizes appropriate verbal and non
-
verbal communication techniques to


interact with individuals and groups of clients with impaired communication


abilities.





H.

Utilizes effective communication techniques when interacting with peers and


members of the health care team.








53






III.

ASSESSMENT

1

2

3

NA / NO


A. Assesses clients' health status to identify stressors that interfere with


adaptation.





B. Assesses human responses to stress.





C. Identifies strengths, resources and health care needs of a community.





D. Completes a health history including a physical, cognitive, psychosocial and


functional assessment.





E. Ass
esses the client's response to actual and potential health problems.





F. Assesses the client's response to interventions.





G. Assesses personal stress and adaptation.





IV.

C
LINICAL DECISION MAKING






A. Identifies evidence
-
based pra
ctice as the foundation for nursing decisions.





B. Utilizes the nursing process to analyze data and as the basis for clinical


decisions.





C. Maintains accurate and safe care and an awareness of current National


Patient Safety Goa
ls.





D. Integrates prior knowledge and begins to question personal assumptions.





E. Develops critical thinking, effectively organizes information, and develops


problem
-
solving techniques as the foundation for appropriate clinical deci
sion


making.





F. Develops diagnoses and plans care that focuses on actual or potential health


problems, promotion, wellness and restoration.





G. Modifies client care as indicated by evaluation of outcomes.





H. Identifies and

reports problems in a timely manner.





V.

CARING INTERVENTIONS






A. Demonstrates caring behavior towards clients, significant other(s), peers, and
other members of the health team recognizing cultural and spiritual diversity.





B. Provid
es safe nursing care in all settings.





C. Performs nursing skills competently.





D. Identifies community resources to support clients in the promotion and


maintenance of health.





E. Supports the client and significant other when mak
ing healthcare and end
-
of
-



life decisions.





F. Provides individualized interventions that include self
-
esteem enhancement,


anxiety reduction, and coping enhancement.





G. Uses aseptic technique correctly.





H. Administers medica
tions accurately and in accordance with agency protocol.





VI.

TEACHING AND LEARNING






A. Identifies the role of the nurse as a teacher and develops awareness of the


principles of effective teaching and learning.





B. Applies teaching an
d learning concepts to assist clients and groups in


managing wellness and/or self
-
management of illness.





C. Evaluates the progress of the client/significant other toward achievement of


identified learning outcomes.





D. Advocates health promotion.





VII.

COLLABORATION






A. Identifies roles of members of the health care team.





B. Utilizes multiple resources available for the individual and family within the


community.





C. Establishes partners
hips with clients and collaborates with the nursing team


to achieve client outcomes.





54






VIII.

MANAGING CARE

1

2

3

NA / NO


A. Describes the qualities of effective leaders.






B. Utilizes self
-
assessment to begin to develop leadership skill
s.






C. Identifies the relationship between power and leadership and management.






D. Describes the role of the nurse in cost containment and implements nursing


strategies to provide cost effective care.






E. Demonstrates the ability
to prioritize client needs.






F. Identifies leadership/management skills necessary for the planning and


implementing of client care.






G. Utilizes team
-
building strategies.






H. Describes principles of successfully motivating others
.






I. Identifies key concepts underlying effective delegation.






J. Identifies and implements strategies of behavior change.









■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■


■ ■ ■ ■ ■ ■


KEY TO PERFORMANCE APPRAISAL


3 = Performance meets clinical objectives and exceeds requirements

2 = Performance meets clinical objectives

1 = Performance does not meet clinical objectives

N/A = Not applicable

N/O = Not observed




/hard drive Revised 2/02
/09

55





INSTRUCTOR'S COMMENTS:


Written Assignment



NCP Score


Other


________


























Instructor's Signature _____
_______________________________

Date ___________________




STUDENT'S COMMENTS:


















Student's Signature ______________
_________________________

Date __
_______________




Revised 2/02
/09