Download PMHNP Role, Scope, and Regulatory Process and more Exams Nursing in PDF only on Docsity!
ANCC PMHNP CHAPTER 2 PSYCHIATRIC-
MENTAL HEALTH NURSE PRACTITIONER ROLE,
SCOPE OF PRACTICE, AND REGULATORY
PROCESS
All nurse practitioners upon graduation are expected to meet - ANSWER NURSE PRACTITIONER ADVANCED PRACTICE CORE CONTENT a set of core competencies Specialty competencies, such as the Psychiatric-Mental Health Nurse Practitioner Competencies, are then built upon these core competencies (NONPF, 2013). Nurse Practitioner Core Competencies are based on "THE Q SLIPP" - ANSWER *Technology and Information Literacy *Health Delivery System *Ethics *Quality
- Scientific Foundations *Leadership *Practice Inquiry *Independent Practice *Policy What are the 3) MHNP Leadership Competencies - ANSWER Leadership Competencies
- Participates in and evaluate community/population-focused programs that: promote mental health prevent or reduce risk of mental health problems
- Advocates for complex client and family medicolegal rights and issues
- Collaborates with colleagues about advocacy, policy to reduce health disparities and improve outcomes for populations Quality Competencies - ANSWER Quality Competencies Evaluates the appropriate uses of seclusion and restraints in the care process
Policy Competencies - ANSWER Policy Competencies
Provides consultation to healthcare providers and others to enhance quality and cost Guides the client in evaluating the appropriate use of complementary and alternative treatment Uses individualized outcome measure to evaluate psychiatric care Manages psychiatric emergencies Refers clients appropriately Facilitates the transition of clients across levels of care Uses outcomes to evaluate care Attends to the client-NP relationship as a vehicle for change Maintains a therapeutic relationship over time with individuals and groups Therapeutically concludes the client-NP relationship Demonstrates ability to address sexual and physical abuse, substance abuse, sexuality, and spiritual conflicts Applies therapeutic relationship strategies based on theory and research Applies principles of self-efficacy, empowerment, and others to effect change Identifies and maintains professional boundaries Teaches clients, families, and groups Provides psychoeducation Modifies the treatment approach based on client readiness Considers motivation and readiness to improve self-care
Demonstrates knowledge of appropriate use of seclusion and restraint Documents appropriate use of seclusion and restraint The NP role was introduced in what year by whom? discuss HX - ANSWER HISTORY OF THE NP ROLE introduced in 1965 by Loretta C. Ford, EdD, and Henry K. Silver, MD, at the University of Colorado (Mirr Jansen & Zwygart-Stauffacher, 2006). They identified new roles in which experienced registered nurses (RNs) with advanced education and skills were performing clinical duties traditionally reserved for physicians. Universities were slow to implement NP programs at the master's level. However, RNs embraced the new role and rushed into continuing education programs of varying length, quality, and focus to accomplish the necessary educational preparation for this new role. As part of the LACE model, Psychiatric-Mental Health was identified as a population focus. The American Psychiatric Nurses Association (APNA) and International Society of Psychiatric Nurses (ISPN) recommendation was for psychiatric-mental health nurse practitioners (PMHNPs) to be prepared across the life span (APNA, 2011). As of 2015 APRNs in psychiatric-mental health nursing have one certification examination, PMHNP-Life Span, with the American Nurses Credentialing Center (ANCC, 2015). All previous psychiatric-mental health advanced practice certification examinations have been retired as of December 2015 (ANCC, 2015). Proven competence brought an acceptance of the NP role in the healthcare system, with acceptance and recognition of the title and role by consumers and other health professionals. NP programs are accredited by one of two organizations to achieve standardization and control over quality: the Commission on Collegiate Nursing Education (CCNE, 2016) and the Accreditation Commission for Education in Nursing (ACEN, 2016). NPs are recognized providers under many third-party insurance coverage plans (e.g., Medicare, Medicaid, CHAMPUS, federal programs funding school-based clinics, U.S. military, Veterans Administration).
- Places restrictions on practice
- Sets NP credentialing requirements (e.g., educational requirements, certification)
- States grounds for disciplinary action: ** Practicing without 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
- May specifically require that an NP develop a collaborative agreement with a physician ** Collaborative agreement: Also known as a protocol that describes what types of drugs might be prescribed and defines some form of oversight for NP practice Regulatory and Statutory Dimensions of the NP Role Statutory law, Licensure, Credentialing, Certification - ANSWER Regulatory and Statutory Dimensions of the NP Role Statutory law
- Rules and regulations differ for each state
- May further define scope of practice and practice requirements
- May provide restrictions in practice unique to specific state 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
- A credential that provides title protection
- Determines scope of practice (i.e., whom NPs can see and what NPs can treat)
- The process by which a professional organization or association certifies that a person licensed to practice as a professional has met certain predetermined standards specified by that profession for specialty practice
- Assures the public that a person has mastery of a specified body of
knowledge
- Protected under federal statute through the Medical Record Confidentiality Act of 1995 (S. 1360)
- Pertains to verbal and written client information
- Requires that the provider discuss confidentiality issues with clients, establish consent, and clarify any questions about disclosure of information
- Requires that provider obtain a signed medical authorization and consent form to release medical records and information when requested by the client or another healthcare provider PROFESSIONAL ROLE RESPONSIBILITIES HIPAA - ANSWER PROFESSIONAL ROLE RESPONSIBILITIES HIPAA
- The first national comprehensive privacy protection act
- Guarantees clients four fundamental rights:
- To be educated about HIPAA privacy protection, 2. To have access to their own medical records,
- To request amendment of their health information to which they object, and 4. To require their permission for disclosure of their personal information. PROFESSIONAL ROLE RESPONSIBILITIES The Health Information Technology for Economic and Clinical Health Act (HITECH) - ANSWER PROFESSIONAL ROLE RESPONSIBILITIES The Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 (Health Resources and Services Administration [HRSA],
- Incentive payments for sharing specific electronic health record (EHR) data
- Meaningful use incentives
- Electronic health records can improve both individual and population- based health outcomes (Friedman, Parrish, & Ross, 2013).
- Electronic health records can improve quality, safety, efficiency, effectiveness, and outcomes (U.S. DHHS, Office for Civil Rights, 2013).
- E-prescribing
- Computerized physician order sets
- Tracking care and avoiding duplication of services PROFESSIONAL ROLE RESPONSIBILITIES Telehealth - ANSWER PROFESSIONAL ROLE RESPONSIBILITIES
Telehealth
- The use of telephone or videoconferencing tools to deliver mental health care to clients who reside in rural areas or who may otherwise not be able to access care
- Must follow the same standards as care delivered in person
- Must be practiced in accordance with international, federal, and state regulatory agency standards
- Must include provisions for emergency care of the client
- The PMHNP must assure that HIPAA regulations regarding confidentiality and maintenance of the health record are followed. PROFESSIONAL ROLE RESPONSIBILITIES Exceptions to guaranteed confidentiality - ANSWER PROFESSIONAL ROLE RESPONSIBILITIES Exceptions to guaranteed confidentiality
- When appropriate persons or organizations determine that the need for information outweighs the principle of confidentiality
- If a client reveals an intent to harm self or others
- Information given to attorneys involved in litigation
- Releasing records to insurance companies
- Answering court orders, subpoenas, or summonses
- Meeting state requirements for mandatory reporting of diseases or conditions
- Tarasoff principle (Tarasoff v. Regents at the University of California, 1976): Duty to warn potential victim of imminent danger of homicidal clients
- In cases of child or elder abuse PROFESSIONAL ROLE RESPONSIBILITIES Informed consent - ANSWER PROFESSIONAL ROLE RESPONSIBILITIES Informed consent
- The communication process between the provider and the client that results in the client's acceptance or rejection of the proposed treatment
- An explanation of relevant information that enables the client to make an appropriate and informed decision
- The right of all competent adults or emancipated minors
family, group, community, or population.
- The nurse promotes, advocates for, and protects the rights, health, and safety of the client.
- The nurse has the authority, accountability, and responsibility for nursing practice, makes decisions, and takes action consistent with the obligation to promote health and provide optimal care.
- The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
- The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
- The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
- The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
- The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. PROFESSIONAL ROLE RESPONSIBILITIES Ethics 2 - ANSWER PROFESSIONAL ROLE RESPONSIBILITIES Ethics 2 Important ethical principles in psychiatry
- Clients must be involved in decision-making to the full extent of their capacity (mutual decision-making).
- Clients 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 dilemma
- Occurs in a situation in which 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)?
- Labeling oneself as "disabled" may affect one's beliefs or self-image.
Benefits of Disclosure - ANSWER Benefits of Disclosure
- Able to request reasonable accommodations
- Opportunity to have a job coach come to the worksite and communicate directly with employer
- Employee can involve an employment service provider, employee assistance program, or other third party in the development of accommodations.
- Easier for employee to come to work during an exacerbation of symptoms
- May help with the recovery process
- Allows coworkers to offer personal support
- May empower another employee to disclose Legal Considerations - ANSWER Legal Considerations Malpractice insurance
- Provides financial protection against claims of malpractice ** Coverage for negligent professional acts ** Coverage for highly technical or professional skills required by health professionals, including NPs
- Recommended universally for all NPs
- Does not protect NPs from charges of practicing outside their legal scope of practice
- Provides NPs their own legal representation to advocate for them even if their agency also carries malpractice liability insurance protection
- Four elements of negligence that must be established to prove malpractice: 1. Duty: The NP had a duty to exercise reasonable care when undertaking and providing treatment to the client.
- Breach of duty: The NP violated the applicable standard of care in treating the client's condition.
- Proximate cause: There is a causal relationship between the breach in the standard of care and the client's injuries.
- Damages: The client experiences permanent and substantial damages as a result of the breach in the standard of care. Competency - ANSWER Competency *A legal, not a medical concept *A determination that a client can make reasonable judgments and decisions regarding treatment and other health concerns
Mentoring - ANSWER ROLES OF THE PMHNP
Mentoring
- A process in which a more experienced NP agrees to guide and support a junior colleague in the role, competencies, and skills
- Requires mutual respect and an interactive process of learning
- Needs involvement by both the mentor and the mentee in the relationship ROLES OF THE PMHNP Client Advocacy - ANSWER ROLES OF THE PMHNP Client Advocacy
- Stand up for clients' rights and empower them to become their own advocates
- Reduce the stigma of mental illness
- Help clients receive available services
- Promote mental health by participating in one or more of these professional organizations: ** American Nurses Association (ANA) ** American Psychiatric Nurses Association (APNA) ** International Society of Psychiatric Nurses (ISPN) ROLES OF THE PMHNP Health Policy - ANSWER ROLES OF THE PMHNP Health Policy
- Advanced practice nurses have a legal and ethical responsibility to be a client advocate.
- Participation in local, state, national, and international health policy activities (Buppert, 2012)
- Involvement: Testify at a public meeting, lobby, or work with the media to bring awareness to an issue
- Phases of policy-making: formulation, implementation, and evaluation (Abood, 2007) ROLES OF THE PMHNP Case Management - ANSWER ROLES OF THE PMHNP
