NP core competencies
Scientific foundations.
Leadership.
Quality.
Practice Inquiry.
Technology and information literacy.
Policy.
Health Delivery system.
Ethics.
Independent Practice.
Leadership competencies
Participates, advocates and collaborates.
Quality competencies
Evaluates the appropriate uses of seclusion and restraints in the care process.
Policy competencies
Employs opportunities to influence health policy to reduce the impact of stigma on services for prevention and treatment of mental health problems.
History of NP role
Introduced in 1965 by Loretta Ford and Henry Sliver , University of Colorado.
Consensus model. Four types
CRNA, Mid wife, clinical specialist and NP.
Who grants legal authority for NP practice ?
State legislative statutes.
State legislative statutes authorizes..
The Nurse Practice Act of every state.
What does the Nurse Practice Act do?
Provides title protection (who may be called NP).
Defines advanced practice.
Prevailing state laws that define scope of practice (what NP may do).
Places restrictions on practice.
Sets NP credentialing requirements (e.g. Educational requirements, certific
States grounds for disciplinary actions.
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.
Collaborative agreement
Protocol that describes what types of drugs might be prescribed and defines some form of oversight for NP practice.
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 person to engage in the practice of the profession.
Also prohibit 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).
A process by which a professional organization or association certifies that a person licensed to practice as a professional has met
Certifying body for APNA
American Nurses Credentialing Center (ANCC).
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.
PMHNP standards are identified in
Psychiatric-Mental Health Nursing: Scope and Standards of Practice.
Standards of practices
Authoritative statements regarding the quality and type of practice that should be provided.
Provide a way to judge the nature of care provided.
Reflect the expectation for the care that should be provided to clients with various illnesses.
Reflect profes
Professional Role responsibilities
Confidentiality.
HIPPA.
The Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009.
Telehealth.
Exceptions to guaranteed confidentiality.
Informed consent.
Ethics.
Confidentiality
Protected under federal statute through the Medical Record Confidentiality Act of 1995.
HIPPA guarantees client four fundamental rights
Educated about HIPPA privacy protection.
Access to their own medical records.
Request amend to their health information.
Require permission for disclosure of their personal information.
HITECH
Incentives payment for sharing specific electronic health records data.
Electronic health records - E prescribing, computerized physician order sets, tracking care and avoiding duplication of services.
Telehealth
Same standards of care delivered in person.
Must include provisions for emergency care of the client.
Exceptions to guaranteed confidentiality
When appropriate organizations determine that the need for information outweigh the principle of confidentiality.
Client reveals an intent to harm others or self.
Information given to attorneys, insurance companies, court orders, meet state requirement fo
Tarasoff principle
Duty to warn potential victim of imminent danger of homicidal clients.
Informed consent
Communication process between the provider and the client that results in the client's acceptance or rejection of the proposed treatment.
Must document informed consent.
Must ensure client is cognitively capable of giving informed consent.
Ethics
Ethics principles Justice - fairness.
Beneficence: promote doing good.
Nonmalificence: Doing no harm.
Fidelity: being true and loyal.
Autonomy: Doing for self.
Veracity: telling the truth.
Respect .Treating everyone with equal respect.
Important ethical principles in psychiatry
Client 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 ma
Ethical dilemma
Two or more justifiable alternatives.
Which option sacrifices the fewest high-priority values ( a harm reduction approach).
Theoretical approaches to ethical decision-making
Deontological , teleological, and virtue .
Deontological theory
An action is judged as good or bad based on the act itself regardless of the consequences.
Teleological theory
An action is judged as good or bad based on the consequence or outcome .
Virtue ethics
Actions are chosen based on the moral virtues (e.g. Honesty, courage,) or the character of person making the decisions.
Ethics of Disclosure by providers
Client have a right to know what is happening during the course of their treatment.
Providers have an ethical responsibility to disclose medical errors, accidents.
Client has a right for compensation for harm.
Legal consideration
All NPs should get malpractice insurance.
Malpractice insurance
Provides financial protection against claims of malpractice.
Does not protect NPs from charges of practicing outside their legal scope of practice.
Four elements of negligence must be established to prove malpractice
Duty, breach of duty, proximate cause, damages.
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 clients condition.
Proximate cause
There is a casual 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
A legal, not a medical concept.
A determination that a client can make reasonable judgments and decisions regarding treatment and other health concerns.
A person is considered competent until a court rules the person to be incompetent.
If a person is deem
Commitment
Process of forcing a person to receive involuntarily evaluation or treatment.
Basic criteria include
Having a diagnosed psychiatric disorder.
Person is harmful to self or others.
Person is unaware or unwilling to accept the nature and severity of the disorder.
Treatment is likely to improve functioning.
Involuntary admission
Client maintain all civil liberties except the ability to come and go as they please.
Voluntary admission
Client maintains all civil liberties.
Roles of the PMHNP
scholarly activities.
mentoring.
Client advocacy.
Health policy.
Case management.
Risk assessment.
Risk management.
Advance directives.
Phases of policy-making
Formulation, implementation , and evaluation.
Advance directives
Durable power of attorney for health care.
Also known as health care proxy.
Designates, in writing, an agent to act on behalf of a person should he become unable to make healthcare decisions.
Culturally competent
Treating clients from diverse cultures, viewing each client as a unique person, and noting a personal relationship between client's cultural experience and their symptoms .
Culture-bound syndromes
Specific behaviors related to a person's culture and not linked to a psychiatric disorder.
Strategies for reducing homelessness
Outreach, integrated care, supporting services in persons in housing, and prevention.
Sexual identity
how people identify psychologically on a continuum between female and male and to whom they are sexually or affectionately attracted to.
Gender identity
A person's identity along a continuum between normative constructs of masculinity and femininity .
Influenced by biological (pre and post natal hormone levels and gene expression) and social factors (gender messages from family, mass media, and cultural a
Sexual orientation
THe direction of sexual attraction .
Preferred over sexual preference or lifestyle .
Asexual
Not attracted to either sex.
Transgender
Umbrella term describing persons whose gender identity does not conform to gender norms associated with the gender they were assigned at birth.
Transsexual
Persons who identify as the opposite gender from the one they were assigned at birth. Some change their bodies hormonally and/or surgically to conform to their gender identity.
Sexual behavior
The manner in which humans experience and express their sexuality, including attracting partners, sexual interactions, and social interactions.
Forensic
Nurse-client relationship based on crime committed and investigational aspect of the interaction.
Correctional
Nurse-client relationship based on offender's current mental health and medical conditions.
Forensic risk assessment
Protect the public from persons with known mental disorders having violent, dangerous histories.