ANCC PMHNP chapter 2 forensic and health promotion questions with answers 2023, Exams of Nursing

Download ANCC PMHNP chapter 2 forensic and health promotion questions with answers 2023 and more Exams Nursing in PDF only on Docsity!

ANCC PMHNP chapter 2 forensic and

health promotion questions with

answers 2023

Mental Health promotion and education ✔•Teaching about interventions and ways to cope with stressors.

• Validating "normalcy" of feelings, and ensuring patients that they are not "crazy"
• Helping patients recognize their feelings and behaviors •helping patients identify resources in the community ANA Code of Ethics ✔- Use Code of Ethics for Nurses with Interpretive Statements to guide practice
• Deliver care in a manner that preserves and protects patient autonomy, dignity, and rights
• Is aware of and avoids using the power inherent in the therapeutic relationship to influence the patient in ways not related to the treatment goals
• Maintains patient confidentiality within legal and regulatory parameters
• Serves as a patient advocate protecting patients' rights and assisting patients in developing skills for self advocacy
• Maintains a therapeutic and professional patient-nurse relationship with appropriate professional role boundaries

1. Management of health status ✔health assessment, health history, physical exam, screening and diagnostic testing, diagnosing, prescribing meds and other treatment modalities, evaluating core outcomes
2. Maintenance of nurse-client relationship ✔Displaying environment of trust and respect, maintaining healthy boundaries, engaging in therapeutic communication
3. Teaching/coaching ✔Health promotion/disease prevention, risk reduction, coaching toward behavioral change
4. Professional Role ✔Serving as client advocate, utilizing information and technology in health care, using interdisciplinary collaboration and consultation, practicing ethically, showing leadership, undertaking professional development, participating in policy making.
5. Managing/negotiating health cae delivery systems

✔Decision making with regard to cost, access, and efficacy; applying business strategies to practice; negotiating legislative change when needed.

6. Monitoring quality of care ✔Evaluating quality of care, incorporating continuous quality improvement into practice.
7. Providing culturally sensitive care ✔Remaining culturally sensitive when assessing client's symptoms and his or her perceptions of symptoms. History of NP Role ✔Introduced by Dr. Loretta Ford and Henry Silver MD @ University of Colorado in 1965 state legislative statutes ✔Grants legal authority for NP practice, are the nurse practice act of every state and define scope of practice. Provides title protection, set credentialing requirements, place restrictions on practice, set grounds for disciplinary actions and may require collaborative agreement. collaborative agreement ✔protocols that describes what types of drugs may be prescribed and form of oversight by nursing boards statutory law ✔rules and regulations differ for each state, further define scope of practice, practice requirements and restrictions unique to each state. licensure ✔process by which an agency of the state grants permission to individuals accountable for the practice of a profession to engage in the practice of the profession credentialing ✔process used to protect the pubic by ensuring minimum level of competence certification

✔Is the process by which a professional organization or association certifies that an individual has met pre-determined standards and skills to practice in a specialty area. scope of practice ✔defines NP roles and action, and identifies competencies assumed to be held by all NPs, varies from state to state. standards of practice ✔Gives authoritative statements regarding the quality and type of practice that should be provided, is a way to judge the nature of care provided, and reflects minimum level of acceptable performance. confidentiality ✔Knowing that information given will not be disclosed, protected under federal statute through Medical Record Confidentiality Act of 1996. Pertains to verbal and written information. Requires informed consent to release records to patient or other providers. Hippa ✔(Health Insurance Portability and Accountability Act) It protects the privacy of patients in health services by safeguarding patients' private information., An act that protects health insurance coverage for workers and their families when they change jobs. If confidentiality of a patient is breached, severe fines may be imposed Health Information Technology for Economic and Clinical Health Act 2009 ✔Incentive payments for sharing electronic health records (EHR): e-prescribing, computerized physician orders, avoid duplication of services. Exemptions to guaranteed confidentiality ✔Intent to harm self or others, attorneys involved in litigation, records released to insurance companies, when answering court orders, subponeas, or summons. State mandatory reporting. cases of child or elder abuse. Tarasoff principle. Tarasoff principle ✔1976 - duty to warn victims of potential harm from client Informed consent ✔Communication between provider and patient that enables and informed decision. Right of all adults and emancipated minors. Elements of informed consent

✔Nature and purpose of propose treatment or procedure Risk and benefits of treatment Risk and benefits of not getting treatment Alternative procedures or treatments Diagnosis and prognosis. *Provider must document in the medical records that informed consent has been obtained and the PMHNP is responsible for ensuring that the pt is cognitively capable of giving informed consent. Ethics of disclosure by providers ✔Patients have the right to know whats happening during their treatment. Providers have an ethical responsibility to disclose medical errors, accidents, injuries, and negative results to patients, and as a result of the disclosure they may have legal rights to compensation. Beneficence ✔promoting well being and doing good nonmalfeasance ✔doing no harm fidelity ✔being true and loyal autonomy ✔doing for self veracity ✔telling the truth respect ✔treating everyone with equal respect deontological theory ✔action is judged based on the act itself teleological theory ✔action is judged based on the consequences virtue ethics

✔actions are chosen based on moral virtues of the person Four elements of negligence to prove malpractice ✔Duty: to exercise reasonable care when care for patient.Breach of duty: violation of standards of care, Proximate Cause: casual relationship, Damages: permanent and substantial damages a s a result of breach Ethical rights ✔To preserve client's dignity, autonomy, rights and confidentiality. Client's must be involved in decision making to the full extent of their capacity (Mutual Decision Making). Client's have a right to treatment in the least restrictive setting. Clients' have a right to refuse treatment unless a legal process resulting in a mandatory court order for treatment has been obtained. ethical dilema ✔Occurs in situations where there are two or more justifiable alternatives. Occurs when the choice is made to promote good. Which option sacrifices the fewest high- priority values (a harm-reduction approach) competency ✔A legal, not a medical concept. Determination that client can make reasonable judgments and decisions regarding treatment and health concerns. patients are competent until the court rules otherwise. A court appointed guardian makes health related decisissons Voluntary client rights ✔client maintains all civil liberties and consents to potential confinement Involuntary commitment criteria ✔1. diagnosed Psych disorder

2. harmful to self/other bc of d.o.
3. unaware/unwilling to accept severity/nature of d.o. 4.Tx likely to increase functioning Involuntary client rights ✔clients maintain all civil liberties except coming and going as they please; the amount of time varies by state Durable Power of attorney (health care proxy) ✔1. Designates in writing who is to act on pt's behalf if pt is incompetent.

2.Relates to all aspects of life including financial decisions.

3. Should be an aspect of relapse planning for clients with chronic psych d/o. Living Will ✔Document that gives specific instructions that a client makes when competent that providers must follow if he/she becomes incompetent. Scholarly activities ✔Publishing, Lecturing, Preceptorship, Continuing Education Patient advocacy ✔--Standing up for patient's rights and empowering them to become their own advocate. --Participating in professional organizations. --Helping patients receive available services. Health policy ✔Participation in local, national, and international health policy activity. testify at public meeting, lobby, or work with the media to bring awareness to an issue. Case management ✔System of controlled oversight and authorization of services and benefits provided to clients. -Coordinating Care, Ensuring Quality Outcomes, Monitoring Plan of Care, and Advocacy. Promote Quality Cost-Effective Outcomes. Health promotion and disease prevention ✔Preventive Care & Screening Practices. Screening for physical Health Problems in the Psych patient. Usually Guided by Healthy People 2010, which identifies national health objectives, incl. behavioral health. Mental health promotion and education ✔Teaching about Ways to Cope with Specific stressors. -Validating "normalcy" of feelings; ensuring clients they are not "crazy". Helping clients recognize and identify their feelings or behaviors. Helping clients identify resources in the community. primary prevention ✔Aimed at decreasing incidence (number of new cases) of mental disorders. ie: by helping people avoid stressors or cope with them more adaptively (Stress Management Classes, Smoking Prevention Classes, Drug Abuse Resistance Education (DARE). secondary prevention

✔Aimed at reducing prevalence or number of existing cases of mental disorders. Early Case Finding, screening, Prompt and effective treatment (Hotlines, Crisis Intervention, Disaster Responses) tertiary prevention ✔Aimed at reducing disability and severity of a mental disorder. Rehabilitative Services.--Avoidance or postponement of complications (day treatment programs, Case management for physical, housing, or vocational needs; social skills training.) biological risk factors ✔hx of mental illness, poor nutrition, poor health psychological risk factors ✔poor self concept, external locus of control, poor ego defenses social risk factors ✔stressful occupation, low socioeconomic status, poor level of social integration Risk Assessment ✔The continuous monitoring for high-risk situations. Assessing individuals for non- healthy behaviors. Risk Management ✔Activities or systems designed to recognize and intervene to decrease the risk of injury to clients. Appropriate interventions that are implemented to reduce unhealthy behaviors in clients and high-risk situations. Functions to recognize and intervene to decrease subsequent claims against health care providers. Culture ✔Learned beliefs and behaviors or the socially inherited characteristics common among all member of a group--may be racial, social, ethnic or religious grouping. Culture bound syndrome ✔Specific behaviors related to a person-s culture and not linked to a psychiatric disorder. Be cognizant of inaccurately judging a client's behavior as psychopathology when it is really related to his culture. Ethnicity ✔Self-identified race, tribe, or nation with which a person or group identifies and which greatly influences beliefs and behavior.

Family ✔Group of adults and children who are usually related and whose adults participate in carrying out the essential functions of providing food, clothing, shelter, safety, and education of children. Initially teaches the belief patterns, religion, culture, and mores of a society. Concept broadened beyond the traditional husband-wife-children pattern. Community ✔A group of families often sharing the same race, tribe, or culture and who have beliefs or behavior not shared by others. Environment ✔Includes both physical and psychosocial factors; the general circumstances of an individual's life: Social contacts, housing, climate, altitude, pollution, fluoride in water, crime, poverty, transportation, water contamination. Homeless individuals ✔People who do not have stable or consistent nighttime housing or who maintain permanent residence at shelters, hotels, transitional housing, or public places in which it is not appropriate for human beings to live. Persons intended to be institutionalized who are in institutions for transitory residence. Homeless families ✔Majority are headed by a single parent, usually a woman. Risk factors for homelessness ✔Female-headed households: limited education or employment skills; low-paying employment with little or no benefits and limited access to affordable housing. Teen mothers: lack of education and incomes that older parents possess. Other Reasons: Mental Illness Addictive Disorders, Poverty, Unemployment Inadequate Public Assistance, Domestic Violence, Lifestyle Choice Facts regarding homeless population ✔50% have co-occurring substance use disorders and serious mental illness. Schizophrenia accounts for 15-45% of the US homeless pop. Symptoms are often active and untreated. This results in paranoia, hallucinations, mania, anxiety, and depression, making it difficult to maintain employment, relationships, and other ADL's. These people are at greater risk for violence, medication noncompliance, and treatment resistance.

Strategies for reducing homelessness ✔Outreach Services: in various settings; building an empathetic, consistent, and caring relationship to provide treatment. Integrated Care: Combining mental health and medical care to improve overall functioning in the community; also may include access to dental care and pharmacy services with co-location. Supporting services to people in housing: effective in moving homeless individuals with serious mental illness directly to independent housing with support and intensive attention. Prevention: Beginning with discharge planning in inpatient settings, provide resources for mental health care, housing, transitioning service, and follow-up. Migrant and seasonal farm workers ✔Estimated between 3 and 5 million in the US (difficult to estimate because they are moving around) High incidence of depression, anxiety and substance abuse. Poor working conditions, problems with the process of acculturation, isolation, discrimination, and impaired access to health care play a role in the high prevalence of mental illness among this population. Physical and emotional abuse of women is harder to address because of frequent changes of location. Displaying an empathetic, understanding, and culturally sensitive attitude is imperative when promoting care due to the ways specific cultures perceive mental illness. Forensics ✔The application of scientific knowledge to legal problems and legal proceedings, such as forensic anthropology, dentistry, pathology, science, etc. Forensic risk assessment ✔Protects the public from individuals with known mental disorders having dangerous, violent and criminal histories Risk assessment (different from forensic risk assessment) ✔Psychiatric evaluation performed in emergency department after arrest and before individual is confined to a correctional facility Forensic Nursing ✔Practice of nursing when health and legal systems intersect; the forensic nurse provides direct services to individual clients; consultation services to nursing, medical, and legal agencies; and expert court testimony in areas dealing with trauma and/or investigations of questioned deaths, adequacy of services delivery, and specialized diagnoses of specific conditions as related to nursing. Forensic vs correction nursing

✔Forensic:Nurse-Patient relationship based on crime committed and investigational aspect of the interaction. Corrections: Nurse-patient relationship based on offender's current mental health and medical problems Sexual Identity ✔How people identify psychologically on a continuum between female and male and to whom they are sexually and/or affectionately attracted. Gender identity ✔An individual's identity along a continuum between normative constructs of masculinity and femininity Gender identity factors ✔Influences may consist of biological and social factors. Biological factors may include pre and postnatal hormone levels and gene expression. Social factors may include gender messages from family, mass media, and cultural attitudes. Gender Identity Disorder (GID) is the formal diagnosis to describe persons who experience significant gender dysphoria (discontent with their biological sex). It is a psychiatric classification in the DSM-IV. Transgender ✔Individuals whose gender identity does not conform to gender norms associated with the sex they were assigned at birth; does not imply a particular sexual orientation. Transsexual ✔Individuals who identify as the opposite gender from the one they were assigned at birth; some change their bodies hormonally and surgically to conform to their gender identity. Sexual Behavior ✔Manner in which humans experience and express their sexuality; includes attracting partners, sexual interactions, and social interactions between individuals. Evidence based practice ✔The integration of best research evidence with clinical expertise and patient values and needs. Research utilization

✔Process of synthesizing, disseminating, and using research-generated knowledge to make a change in practice; a subset of the broader evidence-based practice. Research utilization process ✔Critique Research Synthesize the Findings Apply the Findings Measure the Outcomes Develop clinical question (PICO) ✔P = Patient, population of patients, problem I = Intervention C = Comparison (Another treatment or therapy, placebo) O = Outcome. Search for relevant research evidence Critique the research evidence Make an evidence-based decision regarding implementation. Implement the change, depending on the above decision. Evaluate the change. Internal validity ✔When the Independent Variable (treatment) caused a change in the dependent variable (the outcome). External validity ✔When the sample is representative of the population, and the results can be generalized. Descriptive statistics ✔Describes the basic features of the data in the study; numerical values that summarize, organize, and describe observations; can be generated by either qualitative or quantitative studies. --Mean: Average of scores --Standard Deviation: Indication of the possible deviations from the mean. --Variance: How the values are dispersed around the mean; the larger the variance, the larger the dispersion of scores. Inferential statistics ✔Numerical values that enable one to reach conclusions that extend beyond the immediate data alone; generated by quantitative research designs. --t test: Assesses whether the means of two groups are statistically different from each other. --Analysis of variance (ANOVA): Tests the diference among three or more groups. --Pearson's r correlation: Tests the relationship between two variables.

--Probability: Likelihood of an event occurring; lies between 0 and 1; an impossible event has a probability of 0, and a certain event has a probability of 1. --p value: Also known as level of significance; describes the probability of a particular result occurring by chance alone (if p = .01, there is a 1% probabiity of obtaining a result by chance alone). Research Ethics Institutional Review Boards (IRB's) ✔--Ensures that risks to participants are minimized. --Participant selection is equitable. --Averse events are reported and risks/benefits are reevaluated. --Informed consent is obtained and documented. --Data and safety monitoring plans are implemented when indicated. --Overall, the IRB protects the rights and welfare of human research participants and has the authority to approve, require modifications, or disapprove of any research activities. --All investigators or persons involved in research must take and pass a test on protection of human participants--The Belmont Report What is the mean? ✔The average of scores What is standard deviation? ✔Inidication of the possible deviations from the mean What is variance? ✔How the values are dispersed around the mean; the larger the variance, the larger the dispersion of the scores t-test ✔Assesses whether the means of two groups are statistically different from each others Analysis of variance (ANOVA) ✔Tests the difference among 3 or more groups Pearson's r correlation ✔Tests the relationship between 2 variables Probability ✔Likelihood of an event occurring; lies between 0 and 1; an impossible event has a probability of 0, and a certain event has a probability of 1

p value or level of significance ✔Describes the probability of a particular results occurring by chance alone (if p=0.01, there is a 1% probability of obtaining a results by chance alone)