Chap. 1 - role, scope, regulatory Flashcards
Two seminal psych nurses (1950’s)
Hildegard Peplau
Jane Mellow
Maintenance of the nurse-client relationship (3 factors)
Trust and respect
Healthy boundaries
Therapeutic communication
Teaching and coaching roles (3)
Health promotion/disease prevention
Risk reduction
Coaching toward behavioral change
Participation in policy making
Negotiating legislation
Do we care about these?
Yes
Competencies (7)
Health promotion, health protection, disease prevention, and treatment
NP-Client relationship
Teaching/coaching
Professional role
Managing and negotiating health care delivery systems
Monitoring and ensuring quality
Cultural competence
Health promotion and protection, disease prevention, and treatment: the three competencies within
Assessment
Diagnosis of health status
Plan of care and implementation of treatment
Assessment (4 subsets)
Physical and mental health
Psych eval (including MSE)
Family system
Differentiation of normal/abnormal symptomology
Why conduct a physical assessment? (4 reasons)
Assess general health status
Differential dx
To screen for general/non-psych disorders
To identify the primary psych dx
Diagnosis of health status - 4 areas
Ordering/interpreting dx tests
Differential dx
Dx of psych disorders
Applying taxonomy
Taxonomy
The science of defining groups of biological organisms on the basis of shared characteristics and giving names to those groups.
6 taxonomies
International Classification of Diseases (ICD)
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Health Insurance Portability and Accountability Act (HIPAA) code sets
Nursing Interventions Classification (NIC)
Nursing Outcomes Classification (NOC)
North American Nursing Diagnosis Association (NANDA)
Plan of care is always….
Evidence based
Are collaboration, consultation, and coordination of referrals important?
Yes they are.
Should we stay involved in professional organizations and research?
Yes we should.
Are education, policy, and research important.
You betcha.
NP role was introduced when, where, and by whom?
1965
The University of Colorado
Dr Loretta C Ford and Henry K Silver, MD
Why are NP programs accredited?
To achieve standardization and quality control.
Who or what grants the legal authority for NP practice?
State legislative statutes
State legislative statutes governing nursing are called…
Nurse Practice Acts
Nurse Practice Acts define what? (6)
Title protection (who can be styled an NP)
Advance practice
Scope of practice (what an NP does)
Restrictions on practice
Credentialing requirements (education and certification)
Grounds for disciplinary action
Are all Nurse Practice Acts the same?
No, they vary from state to state
Collaborative Agreement
A protocol that describes what types of drugs might be prescribed and defines some form of oversight board for NP practice.
Licensure
A process by which an agency of state government grants permission to individuals accountable for the practice of a profession to engage in the practice of that profession.
Credentialing
Process used to protect the public by ensuring a minimum level of professional competence.
Certification
Determines scope of practice
Assurance that the licensee has met predetermined standards specified by the profession
Assures the public that the licensee has mastery of a body of knowledge
Primary certifying body of psych nursing
American Nurses Association
Scope of practice: defined at state or national level?
State level.
Scope of practice: what is it?
Defines NP roles and actions.
Standards of practice define what?
Minimum levels of acceptable performance
Legally, the standard of care that must be met by a provider
The quality and type of practice to be provided
In layman’s terms, scope is ______ and standards are ______
scope is what we do
standards are how we do it
Confidentiality is protected under what federal statute?
The Medical Record Confidentiality Act of 1996
HIPAA is the first national comprehensive ______ act
Privacy
HIPAA guarantees four rights:
To be educated about HIPAA
To have access to our own medical records
To request amendment to aspects of our health info to which we object
To require permission for disclosure of personal information
When does the need for information outweigh the principle of confidentiality? (7 categories)
Intent to harm self or others
Release to attorneys involved in litigation
Release to insurance companies
In response to court orders, summons, or subpoenas
Mandatory reporting of certain diseases or conditions
Child abuse/elder abuse
Tarasoff principle
What is the Tarasoff (1976) principle?
Duty to warn potential victim of imminent danger of homicidal clients
Informed consent
A right of all competent adults and emancipated minors. An explanation of the proposed treatment allowing the client to make an informed decision as to whether to accept or decline the treatment.
Emancipated minors
Individuals aged 18 or under who are married, parents, or self-sufficiently living away from their family domicile
Five elements of informed consent:
Nature and purpose of proposed treatment Risks and benefits treatment Risks and benefits of non-treatment Alternative procedures or treatments Diagnosis and prognosis
Must you document provision of informed consent?
Yes, you must
Must you ensure that the client is cognitively capable of giving informed consent?
Yes, you must
Justice
Doing what is fair; fairness in all aspects of care
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 all with equal respect
Does the ANA have a policy statement on NP ethics?
Yes, the Code of Ethics for Nurses (2005)
Three crucial client rights/ethical principles in psychiatry
Clients must be involved in decision making (to the full extent of their capacity)
The right to treatment in the least restrictive setting
The right to refuse treatment (unless court-ordered)
An ethical dilemma involves ___ or more _____ ______
two or more justifiable alternatives
Deontological theory
An action is judged as good or bad based on the act itself, regardless of consequences
Teleological theory
And action is judged as good or bad based on the consequence or outcome
Virtue ethics
Actions are chosen based on the moral virtues (honesty, courage, wisdom, compassion) or character of the person making the decision
What does malpractice not cover?
Charges of practicing outside their legal scope of practice
Four elements of negligence that must be established to prove malpractice
Duty
Breach of duty
Proximate cause
Damages
Duty defined (as relates to negligence/malpractice)
The NP had a duty to exercise reasonable care when providing treatment
Breach of duty defined (as relates to negligence/malpractice)
The NP violated the applicable standard of care in treating the client’s condition
Proximate cause defined (as relates to negligence/malpractice)
There is a causal relationship between the breach in the standard of care and the client’s injuries
Damages defined (as relates to negligence/malpractice)
There are permanent and substantial damages to the client as a result of the breach in the standard of care
Competency - a legal or medical concept?
Legal
What is competency?
A determination that client can make reasonable judgments and decisions regarding health and treatment
Commitment
Process of involuntarily forcing an individual to receive evaluation or treatment. Individual must have a psych do, be harmful to self or others, unaware of or unwilling to accept disorder, and be likely to benefit from treatment.
Involuntary admission retains all civil liberties except…
the ability to come and go as they please
Two professional organizations for the FPMHNP
APNA (American Psychiatric Nurses Association)
ISPN (International Society of Psychiatric Nurses)
The overall goal of case management:
To promote quality cost-effective outcomes
Primary prevention
Aimed at decreasing incidence (number of new cases) of mental disorders. Stress management classes, smoking prevention classes, DARE program.
Secondary prevention
Aimed at decreasing prevalence (number of existing cases) of mental disorders. Screening, telephone hotlines, crisis intervention, disaster response.
Tertiary prevention
Aimed at decreasing the disability and severity of a mental disorder. Rehab services, day treatment, social skills training, case management for housing or vocational needs.
Three categories of risk and preventive factors
Biological (family history, nutrition)
Psychological (self-esteem or self-concept, locus of control)
Social (occupation, SES, education level)
Living will
Document giving specific instructions while client is mentally competent that providers must follow if client becomes incompetent
Durable power of attorney for health care (health care proxy)
Designates in writing an agent to act of behalf of a client should they become unable to make health care decisions (including finances)
Culture
The learned beliefs and behaviors or socially inherited characteristics common to a members of a racial, social, ethnic, or religious group
Culture-bound syndromes
Specific behaviors related to a person’s culture and not linked to a psychiatric disorder
Ethnicity
Self-identified race, tribe, or nation with which a person or group identifies and which greatly influences behavior and beliefs
Research utilization process (4 steps)
Critique research
Synthesize the findings
Apply the findings
Measure the outcomes
PICO
Patient/population/problem
Intervention
Comparison (of another tx or placebo)
Outcome
Internal validity
When the independent variable (the 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
Used to describe, summarize, organize data or observations. May be qualitative or quantitative.
Variance
How values are dispersed around the mean - the larger the variance, the larger the dispersion of scores.
Inferential statistics
Quantitative research results that enable one to reach conclusions.
t test
Assesses whether the means of two groups are statistically different from each other.
ANOVA
Analysis of variance
What is analysis of variance (ANOVA)?
Tests the difference among 3 or more groups.
Pearson’s t correlation
Tests the relationship between two variables
Probability
Likelihood of an event occurring; lies between 0 and 1; impossible = 0 and certain = 1.
p value
Level of significance; describes the probability of a particular result occurring by chance alone. p = .01 means a 1% probability of obtaining a result by chance alone.
IRB
Institutional review board. Ensures that risks to participants are minimized, safety plans are in place, rights and welfare of human subjects are protected.
The Belmont Report (1979)
Requires that all investigators take and pass a test on protection of human participants.
