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PowerPoint.pptxPsychiatric Management 1| NUR 620
Legal Aspects of Psychiatry and the Role of the Psychiatric Mental Health Nurse Practitioner (PMHNP)
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Scope and Standards of Psychiatric Mental Health Nursing
Laws that guide care and treatment of the mentally ill
Cultural Issues
Major Concepts
History of the NP Role
1952 Hildegard Peplau
Published her Theory of Interpersonal Relations
1965 Loretta C. Ford and Henry Silver
Registered Nurses with advanced education
Perform clinical duties traditionally performed by MDs
1965 The first NP program opened at the University of Colorado.
1967 Hildegard Peplau
Developed the clinical nurse specialist role with the ANA in the document “Statement of Psychiatric Nursing Practice.”
1973 ANA
Development of scope and standards of Psychiatric-Mental Health Practice
NURSING THEORIES SPECIFIC TO PSYCHIATRIC NURSING
Hildegard Peplau
Considered founder of psychiatric nursing
Developed theory of interpersonal relationships in early 1950s
Described six roles for the nurse
Four phases of the interpersonal nursing process
1. Orientation
2. Identification
3. Exploitation
4. Resolution
1.14 Copyright © Springer Publishing Company, LLC. All Rights Reserved.
History of the NP Role
2008 The License, Accreditation, Certification and Education consensus Model finalized four Advanced practice roles
Certified Registered Nurse Anesthetist (CRNA)
Certified Nurse Midwife (CNM)
Clinical Nurse Specialist (CNS)
Certified Nurse Practitioner (CNP)
2011 Psychiatric Mental Health Nurse Practitioner (PMHNP) prepared across the lifespan.
2015 All other PMH advanced roles retired.
ADVANCED PSYCHIATRIC-MENTAL HEALTH NURSING PRACTICE
United States
American Nurses Association
National Organization of Nurse Practioner Faculties (NONPF)
United Kingdom
No universal advanced nursing role equivalent to that in the United States
Nursing and Midwifery Council (NMC)
1. Teaching
2. Specialist practice
3. Prescribing
Latter, S., Maben, J., Myall, M., & Young, A. (2007). Perceptions and practice of concordance in nurses prescribing consultations: Findings from a national questionnaire survey and case studies of practice in England. International Journal of Nursing Studies, 44, 9–18. doi: 10.1016/j.ijnurstu.2005.11.005
Concordance
Working together with people
Not a synonym of compliance or adherence
Often used interchangeably in literature
Study by Latter, Maben, Myall, and Young (2007)
Degreed nurses were practicing concordance principles
CONCORDANCE
Roles of the PMHNP
Scholarly Activities
Publishing
Lecturing
Presenting
Preceptorship
Continuing Education
Mentoring
Works with a junior colleague
Mutual respect by both mentor and mentee
Client Advocacy
Reduce mental health stigma
Empower and advocate for patients
Support advocacy through professional organizations
Roles of the PMHNP
Health Policy
Participate in activities that promote health care policy
Actively contribute with
Presenting
Preceptorship
Continuing Education
Case Management
Coordinating and monitoring care
Promoting quality and cost effective outcomes
Risk Assessment
Continuously monitor for risk
Risk Management
Interventions to reduce the risk of injury
Advance Directives
Durable Power of Attorney for Health Care
Living Will
Scope and Standards of Practice
State laws
Grant legal authority of NP in the state
Decides who can be called an NP
Defines the role of the NP
Restrictions
Permissions
Collaborative agreement
Define disciplinary actions
Scope and Standards of Practice
Scientific Foundations
Leadership
Quality
Practice Inquiry
Technology and Information Literacy
Policy
Health Delivery System
Ethics
Independent Practice
Scope and Standards of Practice
Licensing
Process used by an agency to grant permission to practice
Credentialing
Ensure minimum level of competency
Certification-
ANCC
Provides protection of using the title
Grant legal authority of NP in the state
Scope of practice
Gives assurance to the public of minimum level of mastery
Psychotherapy
Psychopharmacological Interventions
Case Management
Consultation-Liaison
Clinical Supervision
Scope and Standards ARNP
The APN Therapist
Types of Therapeutic Interventions
Individual
Group
Family
Couples
Examples of Modalities
Psychodynamic
Interpersonal
CBT
Insight Oriented
Motivational Interviewing
Mindfulness
PSYCHOTHERAPY: Builds trust and develops a therapeutic alliance
Role of the PMHNP
Psychopharmacology
Prescribing medications
Ordering lab work and Diagnostic tests
Collaborative with the Patient/Family/Group
Considering genetics, current research and technology
Case Management
Organizes and coordinates care
Population
Legal and ethical considerations
Collaborative with the Patient/Family/Group
Identifies real or potential problems then intervenes
Role of the PMHNP
COLLABORATION
Consensus Model: Licensing, Accreditation, Credentialing and Education
Collaborative physician
Primary Care
Collaboration with other healthcare providers
Integrated MH care in Primary Care Setting
MH Care in a co-location
Refers patients
Healthcare Policy
Advocates for patient and family rights
Role of the PMHNP
CLINICAL SUPERVISION
Individual or Group
Planned meetings
In-depth reflection on complex issues
Develops awareness, acceptance and impulse containment
Assessment
Performs comprehensive psychiatric examinations
Uses evidence based clinical practice guidelines
Orders and interprets diagnostic tests and procedures
Conducts a multigenerational family assessment
Diagnosis
Compares normal and abnormal findings to formulate a diagnosis
Evaluates the health impact on the individual and family
Standards of Practice
Outcomes Identification
Identifies outcomes that are achievable
Considers the cost and clinical effectiveness of the treatment plan
Orders and interprets diagnostic tests and procedures
Involves the client, family and other health providers in outcome
Planning
Provides individualized care including client’s values and belief system
Offers care in the least restrictive environment
Provides culturally relevant care
Standards of Practice
Implementation
Implements age appropriate, culturally and ethnically sensitive care
Collaborates with nursing colleagues and health providers
Manages psychiatric emergencies
Incorporates innovative strategies for care
Health Teaching and Promotion
Teaching based on situation, developmental stage, readiness, language
Includes intended effects and potential adverse effects
Uses health information resources to increase patient’s access to care
Standards of Practice
Areas of Practices
Psychiatric crisis
Acute in-patient
Intermediate and long term setting
Residential
Partial hospitalization
Community-based care
Assertive Community Treatment
Tele-psychiatry
Collaborative practice
Private practice
Florida Board of Nursing, Nurse Practice Act
American Psychiatric Nurses Association
American Nurses Credentialing Center
PMHNP Professional Links
Legal, Ethical and Cultural Issues in Psychiatric Mental Health Nursing
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Patient Rights-Civil
Vote
Civil service ranking
Driver’s license
Enter contractual relationships
Press charges
Human care and treatment-medical , dental, psychiatric
Religious freedom
Social interaction
Recreational opportunities
Confidentiality
Informed consent
Least restrictive setting
Visitation
Communication
Privacy
Inpatient Rights
Florida Mental Health Act aka Baker Act
Florida Alcohol and Other Drug Services Act aka Marchman Act
Involuntary Admissions
Ex parte order by a judge following petition from family or health care professional
Law enforcement officer deems behavior falls under danger to self and/or others
Psychiatric mental health care professional certifies need for admission due to danger to self or others
Law enforcement takes person to a Baker Act Facility
Involuntary Admission
Patient may be kept for observation for 72 hours excluding weekends and holidays
After 72 hours, patient is released or placed in front of court under Habeas Corpus
Judge makes decision on least restrictive setting
Involuntary Admission
Right to Refuse Treatment
Right to Treatment
Duty to Warn & to Protect
Major Legal Decisions
O’Connor v. Donaldson (1975) RIGHT TO LIBERTY
Supreme court ruling that harmlessly mentally ill cannot be confined against their will if they can survive outside.
Confined 15 years in Florida for paranoid delusions
Involuntary confinement must be based on danger to self or others
Right to Refuse Treatment
Rennie v. Klein (1979) New Jersey Supreme Court decision
Rogers v. Okin (1981) Massachusetts Supreme Court
Right to Refuse Medication Right to Guardianship
Rouse v. Cameron (1966) Washington D.C.
Treatment must be offered and in the LEAST RESTRICTIVE SETTING
Wyatt v. Stickney (1971) Alabama
Mental health patients must be offered adequate care and treatment at a minimum
* Most states a court order needed to administer medications and or electroconvulsive therapy
Right to Treatment
Tarasoff 1 (1976) THE DUTY TO WARN AND PROTECT
Tarasoff v. Regents of University of California. California Supreme Court A potential victim must be warned.
Tarasoff 2 (1982)
Tarasoff v. Regents of University of California. California Supreme Court A dangerous person must be reported to police.
Duty to Warn and to Protect
NP have moral duties, obligations and responsibilities to their patients:
Justice: Doing what’s fair
Beneficence: Promoting well being, doing good
Non-maleficence: Do no harm
Fidelity: Being true and loyal
Autonomy: Doing for self
Veracity: Telling the truth
Respect: Treating everyone with equal respect
Ethics
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