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ANCC PMHNP EXAM C
HAPTERS 2-
Nurse Practitioner Core Competencies - all nurse practitioners upon graduation are expected to meet these. These include scientific foundations, leadership, quality, practice inquiry, technology and information literacy, policy, health delivery system, ethics, and independent practice history of NP role - the NP role was introduced in 1965 by Loretta Ford and Henry Silver, MD at the University of Colorado. They identified new roles in which experienced RNs with advanced education and skills were performing clinical duties traditionally reserved for physicians. License, Accreditation, Certification, and Education Consensus Model - adopted by many nursing organizations, this provides guidance for states to adopt uniformity in the regulation of APRN roles; finalized in 2008 state legislative statutes - grant legal authority for NP practice Nurse Practice Act - every state has one; provides title protection (who may be called a nurse practitioner), defines advanced practice, prevailing state laws that define scope of practice, places restrictions on practice, sets NP credentialing requirements, states grounds for disciplinary action, and may specifically require that an NP develop a collaborative agreement with a physician States grounds for disciplinary action - practicing without a valid license, falsification of records, medicare fraud, failure to use appropriate nursing judgment, failure to follow accepted nursing standards, failure to complete accurate nursing documentation collaborative agreement - a protocol that describes what types of drugs might be prescribed and defines some form of oversight for NP practice licensure - a process by which an agency of state government grants permission to persons to engage in the practice of that profession; also prohibits all others from legally doing protected practice credentialing - process used to protect the public by ensuring a minimum level of professional competence certification - credential that provides title protection; determines scope of practice; process by which a professional organization or association certifies that a person licensed to practice as a professional meets set standards, assures public of mastery, assures person has acquired necessary skills
scope of practice - defines NP roles and actions; identifies competencies assumed to be held by all NPs who function in a particular role; varies broadly from state to state standards of practice - authoritative statements regarding the quality and type of practice that should be provided; provide a way to judge nature of care provided; can be used to legally describe standard of care that must be met by a provider; may be precise protocols or more general guidelines confidentiality - client's right to assume that info given to provider will not be disclosed, protected under federal stature through the Medical Record Confidentiality Act of 1995; pertains to written and verbal info; requires provider obtain signed medical authorization and consent forms to release medical records and info when requested by client or another healthcare provider HIPAA - guarantees clients four fundamental rights: to be educated about privacy protection, to have access to their own medical records, to request amendment of their health info to which they object, and to require their permission for disclosure of their personal info HITECH - health information technology for economic and clinical health act of 2009; incentive payments for sharing specific EHR data, meaningful use incentives exceptions to guaranteed confidentiality - when appropriate person or organizations determine that the need for info outweighs principle of confidentiality, if a client reveals an intent to harm self or others, info given to attorneys involved in litigation, releasing records to insurance companies, answering court orders, subpoenas, or summons, meeting state requirements for mandatory reporting of diseases or conditions, Tarasoff principle, in cases of elder or child abuse informed consent - communication process between provider and client that results in client's acceptance or rejection of proposed treatment; right of all competent adults and emancipated minors emancipated minor - persons younger than 18 who are married, parents, or self- sufficiently living away from the family domicile elements of informed consent - must include nature/purpose of tx, risks/benefits of tx, risks/benefits of NOT doing tx, alternative tx, diagnosis and prognosis. Provider must document in medical record that informed consent has been obtained from client justice - doing what is fair; fairness in all aspects of care beneficence - promoting well-being and doing good nonmaleficence - doing no harm
voluntary admission - admission to a hospital or other treatment facility willfully; clients maintain all civil liberties risk assessment - continuous monitoring for high risk situations, assessing persons for non-healthy behaviors healthcare proxy - durable power of attorney durable power of attorney - legally binding in all 50 states, designates in writing an agent to act on behalf of a person should he or she be unable to make healthcare decisions; includes financial decision making; should be considered as an aspect of relapse planning for clients with chronic psychiatric disorders living will - not legally binding in all states, document prepared while client is mentally competent to designate preferences for care if client becomes incompetent or terminally ill culture-bound syndromes - specific behaviors related to a person's culture and not linked to a psychiatric disorder colocation - providing mental health and primary care services at a single site forensic risk assessment - protect the public from persons with known mental disorders having dangerous, violent, and criminal histories transference - displacement of feelings for significant people in the client's past onto the PMHNP in the present relationship countertransference - nurse's emotional reaction to the client based on her or his past experiences introduction phase - also known as orientation phase of therapeutic nurse-client relationship; nurse creates trusting environment, establishes professional boundaries, establishes length of interaction, provides diagnostic evaluation, sets mutually agreed upon tx objectives. Client has initial hesitancy (approach avoidance) working phase - also known as the Identification and Exploitation phase of therapeutic nurse-client relationship; nurse clarifies client expectations/goals, implements tx plan, monitors health, undertakes preventative health, measures/evaluates outcomes of care, reprioritizes plans/objectives as needed. Transference/countertransference may occur. Client may have resistance to care practices/change termination phase - also known as the resolution phase of therapeutic nurse-client relationship; nurse reviews client's progress toward objectives, establishes plan for long term care, focuses on self-management strategies, disengages from relationship, refers
to other services. Client may resist termination, regress, and have reemergence of symptoms/problems trust vs mistrust - birth-1 year; mastery includes ability to form meaningful relationships, hope about the future, trust in others. Indications of failure include poor relationships, lack of future hope, suspiciousness of others autonomy vs shame and doubt - 1-3 years; mastery indications include self-control, self- esteem, willpower. Indications of failure include poor self-control, low self esteem, self doubt, lack of independence initiative vs guilt - 3-6 years; mastery indications include self-directed behavior, goal formation, sense of purpose. Failure indications include lack of self-initiated behavior, lack of goal orientation industry vs inferiority - 6-12 years; mastery indications include ability to work, sense of competency and achievement. Failure includes sense of inferiority, difficulty learning, working identity vs role confusion - 12-20 years; mastery includes personal sense of identity; failure includes identity confusion, poor self-identification in group settings intimacy vs isolation - 20-35 years; mastery includes committed relationships, capacity to love; failure includes emotional isolation and egocentrism generativity vs stagnation - 35-65 years; mastery includes ability to give time and talents to others, ability to care for others. Failure includes self-absorption, inability to grow and change as a person, inability to care for others integrity vs despair - 65+; mastery includes fulfillment and comfort with life, willingness to face death, insight and balanced perspective on life's events; failure includes bitterness, sense of dissatisfaction with life, despair over impending death psychodynamic theory - developed by Freud, focus is on concepts of intrapsychic conflict among the structures of the mind; assumes behavior is purposeful and meaningful principle of psychic determinism - tenet of psychodynamic theory that states that even apparently meaningless, random, or accidental behavior is actually motivated by underlying unconscious mental content age of onset for intellectual disability - infancy- usually evident at birth age of onset for ADHD - early childhood; per DSM-5 by age 12 age of onset for schizophrenia - 18-25 for men; 25-35 for women
preoperational stage - 2-7 years; more extensive use of language and symbolism; magical thinking concrete operations stage - 7-12 years; child begin to use logic; develop concepts of reversibility and conservation formal operations stage - 12-adulthood; ability to think abstractly; thinking operates in a formal, logical manner reversibility - realization that one thing can turn into another and back again; part of cognitive theory conservation - ability to recognize that although the shape of an object may change, it will still maintain characteristic that enable it to be recognized as that object (e.g. clay); part of cognitive theory denial - defense mechanism of avoidance of unpleasant realities by unconsciously ignoring their existence projection - defense mechanism of unconscious rejection of emotionally unacceptable personal attributes, beliefs, or actions by attributing them to other people, situations, or events regression - defense mechanism of returning to more comfortable thoughts, behaviors, or feelings used in earlier stages of development in response to current conflict, stress, or threat repression - defense mechanism of unconscious exclusion of unwanted, disturbing emotions, thoughts, or impulses from conscious awareness reaction formation - defense mechanism of overcompensation; unacceptable feelings, thoughts, or behaviors are pushed from conscious awareness by displaying and acting on the opposite feeling, thought, or behavior rationalization - defense mechanism of justifying illogical, unreasonable ideas, feelings, or actions by developing an acceptable explanation that satisfies the person undoing - defense mechanism of attempting behaviors that make up for or undo an unacceptable action, feeling, or impulse intellectualization - defense mechanism of attempting to master current stressor or conflict by expansion of knowledge, explanation, or understanding suppression - defense mechanism; conscious analog of repression; conscious denial of a disturbing situation, feeling or event
sublimation - defense mechanism; unconscious process of substitution of socially acceptable, constructive activity for strong unacceptable impulse altruism - defense mechanism; meeting the needs of others in order to discharge drives, conflicts, or stressors interpersonal theory - developed by Sullivan; behavior occurs because of interpersonal dynamics; interpersonal relationships and experiences influence ones personality development, which is called the self-system health belief model - developed by Becker; explains that healthy people do not always take advantage of screening or preventative programs because of perception of susceptibility, seriousness of illness, perceived benefits of treatment, perceived barriers to change, expectations of efficacy precontemplation - person has no intention to change contemplation - person is thinking about changing; is aware that there is a problem but not committed to changing preparation - person has made the decision to change; is ready for action action - the person is engaging in specific overt actions to change maintenance - the person is engaging in behaviors to prevent relapse self-efficacy - perception of one's ability to perform a certain task at a certain level of accomplishment theory of cultural care - nursing theory by Leininger that states regardless of the culture, care is the unifying focus and the essence of nursing; health and well being can be predicted through cultural care theory of self-care - nursing theory by Dorothy Orem that states that self-care includes activities that maintain life, health, and well-being therapeutic nurse-client relationship theory - also known as interpersonal theory, developed by Peplau, first significant psychiatric nursing theory, based on Sullivan's work, sees nursing as an interpersonal process in which all interventions occur within the context of the nurse-client relationship; orientation phase, working phase, and termination phase caring theory - nursing theory by Jean Watson that states that caring is a an essential component of nursing; carative factors guide the core of nursing and should be
quantitative hierarchy - 1. Evidence from systematic reviews of descriptive and qualitative studies
- Evidence from a single descriptive or qualitative study
- Evidence from expert opinion/committee
- Evidence-based guideline based on systematic review of RCTs
- Evidence from well-designed controlled trials w/o randomization
- Systematic reviews or meta-analysis
- Evidence from at least one well-designed RCT internal validity - the independent variable (the treatment) caused a change in the dependent variable (outcome) external validity - the sample is representative of the population and the results can be generalized descriptive statistics - use to summarize the basic features of the data in the study; numerical values that summarize, organize, and describe observations mean - average of scores standard deviation - indication of the possible deviations from the mean variance - how the values are dispersed around the mean 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 - tests the differences 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 p value - also known as level of significance; describes the probability of a particular result occurring by chance alone (if it is .01 there is a 1% probability of obtaining a result by chance alone) quality improvement - agency-specific projects that aim to improve systems, decrease cost, and improve productivity; provides standardized method to identify gaps in practice and systems to evaluate ways to improve structure, function, and resources in care PDSA cycle - plan, do, study, act; process of quality improvement
donabedian model - structure, process, outcome HEDIS - the national committee for quality assurance developed the Health Effectiveness Data Information Sets to measure health outcomes. 8 for mental health: antidepressant management, follow-up after hosp, follow-up for children with ADHD, diabetes screening in schizophrenia/bipolar, cardiovascular monitoring in schizophrenia, adherence to antipsychotics in schizophrenia, and initiation of engagement in alcohol and other drug treatment patient-centered care model - model in which providers provide care that is patient- centered with the following: a welcoming environment, respect for clients' values and expressed needs, client empowerment or "activation", sociocultural competence, coordination/integration of care, comfort/support, access and navigation skills, and community outreach health care home - defined in the ACA as an approach to primary care that provides coordinated care to persons with multiple chronic health conditions, including mental health and substance use; offers team-based care; builds on community supports conflict of interest - situation in which a person's financial, professional or personal situation may affect or appear to affect the person's judgment in his or her professional responsibilities types of conflict of interest - relationships with pharmaceutical, medical supply, or insurance companies; money/gifts in kind; referrals; fee splitting rights of clients - confidentiality, least restrictive environment, give consent for treatment and withdraw consent at any time health policy - decisions, actions, and plans to achieve specific healthcare goals; developed through law and regulations four components of health policy - 1. process: formulation, implementation, and evaluation
- policy reform: changes in programs and practices
- policy environment: arena the process takes place in (government, media, public)
- policy makers: key players and stake holders
