NR548 - Comprehensive Study Guide for Psychiatric Assessment in Psychiatric-Mental Health Nurse Practitioner Education questions with complete verified solutions

What does the competency about “anticipatory guidance” mean?

ANA Standards and Scope: Standard 5B: Health Teaching & Promotion - An educated professional nurse is aware of normal developmental and situational threats to wellness and can educate healthcare consumers to avoid them. Example: Moving a toddler from a crib to a bed can prevent injury associated with climbing out of the crib at that developmental age (ANA, 2015a, p. 65).

What does the ANA Standards explain the art of nursing is based on?

ANA Standards and Scope: Scope of Nursing Practice

The art of nursing is based on caring and respect for human dignity (ANA, 2015a, p. 11).

What is the fundamental principle of and attitude that the professional nurse must have as outlined in Provision 1?

ANA Code of Ethics: Provision 1Provision 1 explains, "the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person" (ANA, 2015b, p. 1).

How should the nurse respond to the discovery of human trafficking in his or her practice?

ANA Code of Ethics: Provision 8

Nurses must "bring attention to human rights violations in all settings and contexts. . . . The nursing profession must respond when these violations are encountered" (ANA, 2015b, p. 33).

Healthy People 2030

focuses on the prevention, screening, assessment, and treatment of mental disorders and behavioral conditions.

The Mental Health and Mental Disorders objectives

aim to improve health and quality of life for people affected by these conditions.

Standard of Practice PMHNP: Assessment

The PMHNP must be able to perform a comprehensive, person-centered psychiatric and mental health diagnostic evaluation, using relevant diagnostic tests and procedures. Evidence-based clinical practice guidelines inform screening and diagnostic activities when appropriate. Assessment may include a multigenerational family assessment as well as the assessment of interactions between the individual, family, community, and social systems as they relate to mental health.

Standard of Practice PMHNP: Diagnosis

The PMHNP must be able to use data obtained during the interview, examination, and diagnostic procedures to develop standard psychiatric and substance use diagnoses. The PMHNP evaluates the effects of psychiatric disorders on recovery, quality of life, and functional status and may examine the impact of stressors, trauma, and situational crisis in the context of the family cycle. The PMHNP may assist other staff in developing competence in the diagnostic process.

Standard of Practice PMHNP: Outcomes Identification

The PMHNP assists the PMH-RN to identify expected outcomes based on scientific evidence. Outcomes identification includes consideration of costs, clinical effectiveness, satisfaction, consistency, and continuity among providers. The PMHNP develops and applies clinical guidelines associated with positive clinical outcomes.

Standard of Practice PMHNP: Planning

The PMHNP applies current evidence and expert clinical knowledge to the identification of assessment and diagnostic strategies and therapeutic interventions. Individualized plans of care incorporate the client's beliefs and values and may include treatment modalities such as psychopharmacology and psychodynamic, cognitive behavioral, and supportive interpersonal therapies.

Standard of Practice PMHNP: Implementation

PMHNPs facilitate the use of system and community resources to implement the plan of care. The implementation standard incorporates coordination of care across disciplines; health teaching and health promotion; consultation; prescriptive authority and treatment; pharmacological, biological, and integrative therapies; milieu therapy, therapeutic relationships and counseling, and psychotherapy. The PMHNP functions as the single point of accountability for all medical and psychiatric services.

Standard of Practice PMHNP:Evaluation

PMHNPs evaluate the accuracy of diagnosis and effectiveness of interventions in reaching the client's desired outcomes. Evaluation includes consideration of the impact of the plan of care on the client, family, group, community, and institutions. Results of evaluations may lead to recommendations for process, protocol, or policy changes.

Standard of Practice PMHNP: Ethics

PMHNPs use the ANA Code of Ethics with Interpretive Statements to guide practice including informing the client of risks, benefits, and outcomes associated with care; participation in interprofessional teams to address ethical concerns; promotion of environments that support ethical care; and use of ethical principles to engage in advocacy for those with mental health problems, psychiatric disorders, and addiction services.

Standard of Practice PMHNP: Cultural Humanity

PMHNPs engage in self-reflection to assess for personal biases when working with culturally diverse individuals, groups, and communities. They strive to cultivate curiosity about the experience and treatment desires of clients from diverse backgrounds. They promote an inclusive work environment and participate in lifelong learning to develop and reinforce working effectively and inclusively with diverse populations.

Standard of Practice PMHNP: Communication

PMHNPs assess communication preferences of healthcare consumers, families, and colleagues. They seek to assess and improve personal communication skills, accurately conveying information, and thoroughly documenting care. They maintain communication with other members of the interprofessional and contribute their professional perspective.

Standard of Practice PMHNP: Professional Collaboration

PMHNPs partner with other disciplines to improve care through activities that include consultation, education, research, and technological development. They model expert practice, mentor colleagues, and facilitate interprofessional processes

Standard of Practice PMHNP: Leadership

PMHNPs provide leadership by influencing decision-making bodies and health policy to promote person-centered, recovery-oriented mental health services, and improvement of the practice environment. They provide direction to interprofessional teams and design innovations to improve practice and health outcomes. PMHNPs model expert practice and mentor colleagues.

Standard of Practice PMHNP: Education

PMHNPs seek current evidence to expand clinical knowledge, improve role performance, and increase understanding of professional issues. In the advanced role, they model expert practice; mentor RNs and other colleagues as appropriate; and participate in interprofessional teams that contribute to the promotion of interprofessional education, role development, advanced nursing practice, and health care.

Standard of Practice PMHNP: Evidence-Based Practice and Research

PMHNPs contribute to nursing knowledge by conducting, appraising, or synthesizing research to improve healthcare practice. PMHNPs engage in activities that promote research and clinical inquiry, including the dissemination of research findings and the integration of current evidence into practice.

Standard of Practice PMHNP: Quality of Practice

PMHNPs obtain and maintain professional certification at the advanced level. PMHNPs may evaluate the practice environment in relation to existing evidence, design quality improvement initiatives, and identify opportunities for the generation or use of research.

Standard of Practice PMHNP: Professional Practice Evaluation

PMHNPs formally seek feedback regarding their practice from healthcare consumers, colleagues, peers, and others. They reflect on and evaluate their practice and role performance to model self-improvement.

Standard of Practice PMHNP: Resource Utilization

PMHNPs effectively use organizational and community resources to create innovative, interprofessional plans of care that address healthcare consumers' concerns. Evaluation strategies demonstrate quality, cost-effectiveness, cost-benefit, and efficiency. PMHNPs build collaborative relationships to identify and meet resource needs.

Standard of Practice PMHNP: Environmental Health

PMHNPs work to analyze the impact of social, political, and economic influences on the environment and human health exposures, creating partnerships that promote sustainable environmental health policies.

In the late 19th century

Focus shifted from restrictive custodial care to treatment.

Dr. Edward Cowles created the first organized training school within a hospital for the insane​ in 1882.

Early 20th century

Early psychiatric nurses were trained by physicians; however, in 1913, Effie Jane Taylor developed the first nurse-organized training course for psychiatric nursing at Johns Hopkins Hospital.

World War I

expanded awareness of mental health disorders and the need for specialized nursing care. Following WWI, the National League for Nursing Education added "nursing in nervous and mental diseases" to curriculum guides.

World War II

In WWII,​ many potential military recruits deemed unfit for service due to psychiatric concerns, while many veterans experienced combat-related neuropsychiatric conditions. Laura Fitzsimmons recommended standards of training for psychiatric nurses, which led to improved education and standards of care.​

1946

With the passage of the National Mental Health Act (NMHA) of 1946, psychiatric nursing was recognized as one of the four core disciplines in psychiatric care and treatment (American Nurses Association [ANA] et al., 2022). The act increased funding for psychiatric nursing education programs and contributed to a growth in university-based nursing education.

1954

In 1954, the first graduate program in psychiatric nursing was established at Rutgers University by Hildegarde Peplau to prepare nurse therapists. The first advanced practice nursing role was the psychiatric-mental health clinical nurse specialist (PMHCNS) role.

1963

The 1950s brought a transition towards deinstitutionalization in care for those with mental illnesses, which led to an increase in the number of psychiatric clients receiving care in the community rather than hospitals. The Community Mental Health Centers Act of 1963 allowed for the expansion of the PMHCNS role into community and ambulatory settings as they helped those who had been deinstitutionalized adapt (ANA et al., 2022).

1965

Loretta Ford, RN and Henry Silver MD introduce the nurse practitioner role.

1973

ANA first published Standards of Psychiatric-Mental Health Nursing Practice in 1973.

1980s

Over time, research turned towards the neurobiological basis for mental illness. With advances in psychotropic medications, psychopharmacology has played an increased role in treatment. In the 1980s, states began to grant prescriptive authority to advanced practice registered nurse (APRN), adding medication prescribing and management to the traditional therapy role of the psychiatric mental health (PMH) APRN.

2000s

Certification exams for adult and family psychiatric mental health nurse practitioner (PMHNP) developed. These exams were retired in 2015​ when psychiatric certification exams were combined to a single Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC)​.

Present

Current trends in care focus on integrated treatment of those with co-occurring medical and psychiatric diagnoses and co-occurring psychiatric and substance use disorders, leading to a need to add content in advanced health assessment, pharmacology, pathophysiology, and the diagnosis of psychiatric illness to graduate psychiatric nursing curricula. Primary care has become the point of entry to psychiatric care for many clients. PMHNPs are helping to address the growing need for primary mental health services and mental illness prevention. Though the number of advanced practice psychiatric nurses has increased, there are still limitations in access for many clients, which has led to disparities in mental health treatment.​

The PMHNP scope of practice- Education

Education- A master's degree, post-master's certificate, or doctoral degree is required for PMH APRN practice.

The PMHNP scope of practice- Clinical Practice Settings

Crisis intervention and psychiatric emergency services occur in a hospital, psychiatric facility or community setting. These services focus on psychiatric and substance-related emergencies.

Acute inpatient care is a short-term treatment. It occurs in the inpatient setting providing care for acutely ill clients at risk for harming self or others or unable to meet basic needs due to impairment. The focus is crisis stabilization.

Intermediate and long-term care may admit clients directly or accept transfers from acute inpatient care. They provide intermediate or long-term care for clients at chronic risk to self or others or unable to function without supervision and support due to mental disorders. They include treatment, habilitation and rehabilitation and may be public, private, or state hospitals operated through the criminal justice system.

Partial hospitalization and intensive outpatient treatment (IOP) provide acute symptom management, intensive treatment, and safe housing for clients who do not require 24-hour medical management or nursing care. These programs can be free standing or step-down facilities.

Residential services provide 24-hour care and housing for an extended period. Services include psychoeducation, vocational rehabilitation, and training for activities of daily living.

Community-based care is provided in non-hospital community settings such as mental health clinics, homes, worksites, shelters, crisis centers, senior centers, group homes, or schools. It can also provide care in an integrative primary health care setting.

Assertive Community Treatment (ACT) is a team treatment approach to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with severe mental illness (SMI). It provides individualized service 24 hours a day, 7 days a week.

The PMHNP scope of practice-PMH APRN Specialty Areas

Integrative programs: The PMHNP functions as part of an interdisciplinary team, providing care and treatment for clients with mental disorders, including substance use disorders and co-occurring medical disorders. Integrative care helps improve care coordination between primary care providers and behavioral health.

Telehealth: The PMHNP utilizes telecommunication technology such as telephone consultation, interactive video sessions, and e-mail to deliver care and treatment to clients. Telehealth must be practiced following all applicable laws and regulations (ANA et al., 2022).

Forensic mental health: Forensic mental health involves the intersection of psychiatric nursing and the criminal justice system. Activities may include working with victims or offenders in settings including the community, jails, prisons, and state psychiatric hospitals. “Forensic PMH-APRNs perform psychiatric assessments, prescribe and administer psychiatric medications, educate correctional officers about mental health issues, and provide therapeutic services to witnesses and victims of crime” (ANA et al., 2022, p. 48).

Disaster psychiatric-mental health nursing: Disaster psychiatric-mental health nursing is a growing field. As first responders, PMHNPs provide psychological first aid and mental health clinical services in response to environmental and man-made disasters.

The PMHNP scope of practice:- PMHNP APRN Roles

Primary care: Primary care settings provide healthcare at a basic level rather than a specialized level. Primary care providers address a majority of personal healthcare needs. Healthcare consumers often seek care for mental health concerns at the primary care level for accessibility or to avoid the stigma associated with mental health services. At the primary care level, PMHNPs may work in collaboration or consultation with a primary care provider or independently provide behavioral health care in an integrated setting.

Psychotherapy: Psychotherapy involves a formally structured relationship between the therapist (PMHNP) and the healthcare consumer that applies evidence-based methods to effect negotiated outcomes.

Psychopharmacological management: The PMHNP prescribes or recommends pharmacologic agents and may order and interpret diagnostic and lab tests to assess treatment response or monitor for adverse effects.

The PMHNP scope of practice:- PMHNP APRN Roles Cont'd

Case management: The PMHNP is responsible for the coordination of care and related decision-making about mental health care for a client, family, group, or population.

Program, system, and policy development management: The PMHNP engages in the design, implementation, management, and evaluation of programs, systems, or policies to address the mental health needs of a population at risk for developing mental health problems through prevention, health promotion, identification and reduction of risk factors, screening, and early intervention.

Psychiatric Consultation-Liaison Nursing (PCLN): The role involves "the assessment, diagnosis, and treatment of behavioral, cognitive, developmental, emotional, and spiritual responses of individuals, families, and significant others with co-occurring [actual or potential] physical illness(es) and/or dysfunction" (ANA et al., 2022, p.42). The PCLN often works as a member of an interdisciplinary consultation-liaison team.

Clinical Supervision: The PMHNP assists other mental health clinicians to evaluate their practice, expand their skills, and meet standards for ongoing peer supervision. Clinical supervision focuses on growth and development rather than performance evaluation.Administration, Education, and Research Practice: PMHNP may serve as administrators, educators, and researchers.

Self-Employment: PMHNPs provide direct comprehensive mental health services in solo or group private practice settings or through contracts with other entities.

The PMHNP scope of practice-Works with:

Individuals

Families

Groups

Communities

Organizations

The PMHNP scope of practice-Collaborates with:

Physicians and other advanced practiced providers

Psychiatrists

Psychologists

RNs

Social Workers

Spiritual Care

Therapists

Counselors

True/ False: PMHNPs are expected to adhere to all ethical standards as provided by the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements

True: - PMHNPs are expected to adhere to all ethical standards as provided by the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements

What doe the code of ethics serve as / mandates for the PHMNP?

The Code of Ethics provides guidance to nurses about ethical behavior and mandates a minimum standard of practice. There are nine provisions within the Code for which specific applications have been developed for PMHNP practice

Code of Ethics:- Respect for the Individual

The PMHNP

approaches professional relationships with compassion, caring, and respect, acknowledging the dignity and worth of each individual.

helps instill hope and empowers those with PMH disorders.

affirms the worth and dignity of those with PMH disorders by advocating to overcome negative stigmas towards PMH diagnoses to ensure access to care.

Code of Ethics:-Commitment to the Healthcare Consumer

The PMHNP's primary commitment is to the individual, family, group, or community who is the healthcare consumer.

Recognizes and addresses personal attitudes and behaviors that could interfere with meeting ethical guidelines for care.

maintains proper boundaries.

Participates in self, peer, and supervisory oversight of clinical skills and practice.

Recognizes that those with brain-based mental health disorders may have maladaptive coping behaviors, which impact the individual, family, and society. Maladaptive behavior may continue in spite of negative consequences. Behavioral change may involve setbacks.

Is aware of the need to balance human rights with safety, including coercive measures or forced treatment when individuals are unable to maintain their own safety.

Code of Ethics:- Advocacy for the Healthcare Consumer

The PMHNP recognizes the vulnerability, complexity, and legal considerations associated with providing care to those with PMH disorders.

Strives to protect the rights, health, and safety of clients.

maintains confidentiality according to Health Insurance Portability and Accountability Act of 1996 (HIPAA) Requirements and professional boundaries in all interactions (face-to-face, telehealth, electronic record, social media).

recognizes the power differential in the therapeutic Relationship and understands that any sort of sexual activity or intimacies (physical, verbal, electronic, social media) with current clients, their close family members, guardians, or significant others is unethical.

Code of Ethics:-Responsibility and Accountability for Practice

Must be responsible and accountable for their own practice.

must be able to articulate competencies and be aware of Scope of practice and professional standards guiding their own practice.

Must understand the scope of other team members' practice in order to delegate appropriately.

Code of Ethics:-Duties to Self and Others

Owes the same duties to self as to others.

Accords moral worth and dignity to oneself and others, including colleagues.

Is committed to practicing self-care, managing stress, and maintaining supportive relationships to meet personal needs outside of therapeutic relationships.

Identifies and addresses moral distress.

Code of Ethics:-Contributions to Healthcare Environments

Helps maintain and improve healthcare environments and conditions of employment.

Recognizes signs and symptoms of psychiatric disorders in the workplace and reports peer observations or concerns to leadership.

Helps address problems faced by colleagues that may impact client safety or violate public trust, including substance abuse.

Code of Ethics:- Advancement of the Nursing Profession

Contributes to advancing the profession through practice, education, administration, and knowledge development.

Maintains knowledge of and applies evidence-based practice guidelines, including risk assessment and management.

Participates in continuous quality improvement.

pursues continuing education.

Code of Ethics:-Collaboration to Meet Health Needs

Promotes community, national, and international efforts to meet health needs through collaboration with other healthcare professionals.

Engages in partnerships with other specialty nurses, government agencies, professional nursing organizations, and mental health organizations to promote prevention, treatment, and recovery.

Code of Ethics:-Promotion of the Nursing Profession

Advocates for environments that respect human rights, customs, and spiritual beliefs of individuals, families, and communities.

Engages in interactions and collaborations to articulate nursing values and maintain the integrity of the profession.

participates in policy development and implementation that Recognizes PMH disorders as treatable and ensures that nursing care is delivered with respect to human needs and values without prejudice.

Respect for the Individual

Scenario

Person A: "I can't believe you deal with these people every day. Schizophrenics would drive ME crazy!"

PMHNP: "Actually, schizophrenia is a chronic treatable disease, much like diabetes or other physical illnesses. Clients who have mental illness deserve compassion and care."

Rationale

Respect for the individual affirms the worth and dignity of those with PMH disorders by advocating to overcome negative stigmas towards PMH diagnoses to ensure access to care.

Commitment to the Healthcare Consumer

Scenario

The client presents to the emergency department with hallucinations and is threatening self-harm. The PMHNP signs an involuntary admission order for emergent psychiatric care.

Rationale

The PMHNP demonstrates a commitment to the healthcare consumer by balancing the client's human rights with safety, including coercive measures when the client was unable to maintain their own safety.

Advocacy for the Healthcare Consumer

Scenario

The PMHNP is sharing sexually explicit memes with a client that she saw earlier today in a group session.

Rationale

This is an unethical scenario. The PMHNP recognizes the power differential in the therapeutic relationship and understands that any sort of sexual activity or intimacies with current clients, their close family members, guardians, or significant others is unethical.

Responsibility and Accountability for Practice

Scenario

The PMHNP has overbooked her sessions today, so she asks the RN who works in her office to conduct one of her phone therapy sessions today.

Rationale

This is an unethical scenario. The PMHNP must understand the scope of other team members' practice in order to delegate appropriately. Conducting a counseling session is outside of the RN's scope of practice.

Duties to Self and Others

Scenario

The PMHNP takes time for daily meditation to improve mindfulness and ease stress.

Rationale

The PMHNP is committed to practicing self-care, managing stress, and maintaining supportive relationships to meet personal needs outside of therapeutic relationships.

Contributions to Healthcare Environments

Scenario

A PMHNP discovers her colleague is diverting scheduled medications to self-medicate anxiety. The PMHNP reports the concerns to the colleague’s supervisor.

Rationale

The PMHNP recognizes signs/symptoms of psychiatric disorders in the workplace reporting peer observations to leadership. The PMHNP helps address problems faced by colleagues that impact client safety or violate public trust, including substance abuse.

Advancement of the Nursing Profession

Scenario

The PMHNP gives a presentation at a national conference on best practices in depression treatment.

Rationale

The PMHNP contributes to advancing the profession through practice, education, administration, and knowledge development.

Ethical Principle 8

Collaboration to meet health needs

Scenario

The PMHNP is a member of the ANA and NAMI and regularly participates in workgroups that seek to expand access to care for healthcare consumers with PMH disorders.

Rationale

The PMHNP promotes community, national, and international efforts to meet health needs through collaboration with other healthcare professionals to promote prevention, treatment, and recovery.

Promotion of the Nursing Profession

Scenario

A PMHNP speaks at a school board meeting about the need develop policies to expand mental health services for underserved students.

Rationale

The PMHNP participates in policy development and implementation that recognizes PMH disorders as treatable and ensures that nursing care is delivered with respect to human needs and values without prejudice.

Strategies to eliminate disparities in behavioral health are essential to meet the specific needs of racial and ethnic populations and include:

increasing the number of minority providers

improving access to services through telehealth and other technologies

examining and understanding the social determinants of health in underserved communities

using cultural humility to enhance communication in populations served

increasing the use of Primary Care Behavioral Health (PCBH) integrative practice clinics that provide medical and behavioral health services in one location

The World Health Organization (n.d., para. 1) defines Social Determinant of Health

SDOH as "the conditions in which people are born, grow, live, work, and age. These conditions are influenced by economics, political influence, and resources at the global, national, and local levels."

Examples od SDOH include

The environment, the cleanliness of the air, access to food and water, social networks, as well as education and employment opportunities all impact an individual's ability to maintain and sustain health.; as well as access to quality, affordable healthcare.

What factors determine/ contributes to health?

A sense of cohesion and interpersonal trust among community members determine health. Social cohesion, however, is influenced by racial discrimination and inequality—as discrimination and inequality increase, social cohesion decreases. These factors impact health, as does economic instability and unemployment, which lead to increased rates of depression, physical illness, substance abuse, and domestic violence.

what is healthy people 2030?

a national initiative for discerning individual and population risk factors and health indicators

The Healthy People initiative developed a "place-based" organizing framework to consider SDOH which highlights five key areas of SDOH and underlying factors that may contribute to disparities.

Health and Health Care- access to health services

Neighborhood and Built Environment- Crime & violence

Social and Community Context- Incarceration

Economic Stability- housing instability

Education- language and literacy

The U.S. Department of Health and Human Services (HHS) defined personal health literacy

the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others

Health literacy can manifest

as limited engagement or participation in care, miscommunication, or a lack of compliance with or inaccurate understanding of the treatment plan

Cultural humility

Cultural humility and respect are requisites for effective communication across all populations, and most especially with racial and ethnic minority groups.

Cultural humility emphasizes self-evaluation, openness, and sensitivity toward another

Cultural Competence

Is characterized by gaining knowledge about another culture to provide competent care (Stubbe, 2020).

Both are critical to developing a treatment plan that is client-centered and culturally sensitive.

Impact of Mental Illness- Individual

Reduced ability to maintain physical health

Increased risk of cardiovascular and metabolic disease

Increased risk for unemployment

Decreased life expectancy, 11-30 years.

Impact of Mental Illness- Family

Increased stress

Caregiver fatigue

Impact of Mental Illness- Community

Mental health and substance abuse disorders are involved in 1 of every 8 ED visits by adults in U.S.

Mood disorders are the most common cause of hospitalization for those under 45 years of age in U.S.

Over $190 billion lost earnings

Increased risk for homelessness, incarceration

Impact of Mental Illness- World

Depression and anxiety cost global economy $1 trillion in lost productivity each year

Depression is the leading cause of disability worldwide

(SAMHSA, 2022) strategy plan

According to the Substance Abuse and Mental Health Services Administration's (SAMHSA, 2022) strategic plan for 2019-2023, advancing recovery support services is essential for treating the opioid crisis and substance abuse disorders.

SAMHSA initiatives are impacted

by the broader federal policy agenda to improve the care experience and the overall health of populations while reducing per capita healthcare costs.

Recovery-oriented care model

A person-centered, recovery-oriented public health care model could help improve access to and quality of care, thereby reducing the burden of mental illness. PMHNPs have an important role to play in advocating for and leading in such a model.

Elements of a recovery-oriented public health care model.

Prevention

Screening

Early intervention

Integrated care

Innovative use of health information technology

Appropriate number and distribution of mental health professionals