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133 Cards in this Set

  • Front
  • Back
Nurse Practice act
defines advanced practice
prevailing state law defines scope
sets np credentialing requirements
states grounds for disciplinary action
collaborative agreement requirements
Stat grounds for disciplinary action
Practicing w/o valid license
falsification of records
medicare fraud
failure to use appropriate; nursing judgement, accepted nursing standards, accurate nursing documentation
Statutory law
differ for q state
may further define scope & requirements
may put more restrictions
Grants legal authority for NP practice
State legislative statutes which are the Nurse practice act of every state
state gov. grants permission to practice the profession
prohibits all other from legally doing protected practice
used to protect the public by ensuring a minimum level of professional competence
~a credential that provides title protection
~determines scope
~process where organization certifies licensed HCP has met certain predetermined standards specified by that HCP specialty
Scope of practice
Who Nps can see and what they can treat
Certification assures
that the HCP has acquired the skills and mastery of a body of knowledge
Primary certifying body for Psych Nursing is
American Nurses Association
Scope of Practice
defines who NP can see & what they can treat, roles & actions
~Identifies competencies assumed to be held by all NPs whe function in a particular role
~vary alot state to state
PMHNP standards (general scope of practice) are identified in
Scope and standards of Psychiatric-Mental health clinical nursing Practice (ANA, 2000)
Standards of Practice
~give authoritative statement about the quality and type of practice that should be provided
~Gives a way to judge the nature (good/bad) of care provided
~shows what kind of care pt should expect w/ various illnesses
~focused on the minimum levels of acceptable care
~can be used legally to show standard of care that has to be met
What can be used legally to describe the standard of care that must be met by a provider
Standards of practice
These may be precise protocols that must be followed or more general guidelines that recommend actions
Standards of practice
is the patients right to assume that information given to the HCP will not be disclosed
~ includes oral and written pt info
~requires provider discuss issues w/ pt estb consent, clarify questions about disclosure of info
Confidentiality is protected under federal statute through
The medical record confidentiality Act of 1996
Health Insurance Portability and Accountability act

1st national comprehensive privacy protection act

guarantees pt 4 fundamental rights
4 guaranteed fundamental rights of HIPPA
1) to be educated about HIPPA privacy protection
2)to have access to their own medical records
3)to request amendment to those aspects of their health info they object to
4) to require their permission for disclosure of their personal info
Exceptions to guaranteed confidentiality
If pt reveals an intent to harm self or others
~to attorneys involved in litigation
~when records are released to insurance companies
~When answering court orders, subpoenas or summons
~when meeting state reqs for mandatory reporting of diseases or conditions
~Tarasoff principle
~child or elder abuse
Tarasoff principle
1976 duty to warn potential victim of imminent danger of homicidal pts
Informed Consent
the communication process between the provider and the pt that results in the pt's acceptance or rejection of the proposed tx

~ an explanation of relevant info that enables the pt to make an appropriate and INFORMED DECISION

Who has a right to informed consent?
All competent adults or emancipated minors
Emancipated minor
individual ages 18 or younger who are :
~self-sufficiently living away from the family domicile
Elements of Informed Consent:
What do you have to tell them
~Nature in purpose of proposed tx/procedure
~risks/discomforts & benefits of tx
~risks & benefits of NOT undergoing tx
~Alternative procedures or tx
What must PROVIDER do with regard to informed consent?
Give pts all the elements of informed consent: ~Nature in purpose of proposed tx/procedure
~risks/discomforts & benefits of tx
~risks & benefits of NOT undergoing tx
~Alternative procedures or tx
MUST document in med record that informed consent has been given
Who is responsible for ensuring the the pt is cognitively capable of giving informed consent?
Doing what is fair

Fairness in All aspects of care
the duty to do good (promoting well-being):

Beneficence will ALWAYS trump autonomy this is the rationale for involuntary hospitalization ethically
Doing no harm
Being true and loyal
Doing for self
Telling the truth
treating everyone with equal respect
NP ethical behavior is defined where?
ANA policy statement on ethics that provides guidelines r/t delivering care that preserves pt's
3 Important ethical principles in Psychiatry
*Mutual decision making
*Right to tx in LEAST restrictive setting
*Right to refuse tx unless a legal process resulting in a mandatory court order for tx has been obtained
Mutual decision making
Pt must be involved in decision making to the FULL EXTENT of their capacity

An important ethical principal in psych
Fiarness to everyone, sound reason, rightfulness of decisions and actions
Principle of Consistency
If everyone were to take the action being considered-would everyone benefit or not be harmed?
Principle of respect
Requires that everyone be treated with equal respect
Deontological theory
AKA Formalism

An action is either good or bad based upon THE ACT ITSELF regardless of the consequences of that act
Telological theory
Aka Utilitarinanism or Consequentialism

An action is judged as good or bad in relation to the CONSEQUENCES or OUTCOME
Virtue Ethics
Individuals actions are based upon INNATE MORAL VIRTUE OR CHARACTER

e.g. compassion, trustworthiness, moral integrity
An ethical dilemma
represents a situation in which a CHOICE must be made between tow or more potentially justifiable alternatives

Choice to promote good is made despite conflicting and contradictory choices
Right to refuse tx/meds
Right to refuse tx to extent permitted by law; right to be informed of the medical consequences of pt actions

In some emergency situations, a pt can be medicated or tx against their will but state laws vary

Have to document that a reasonable person would expect PMHNP to tx them, it you know otherwise may be breaking the law
APRNs should keep info confidential unless....
disclosure is required to prevent clear and imminent danger to others, or when legal requirement demand that confidential inf be revealed
~~~~~forensic, court cases
~~~~~Child & elder abuse
Ethical responsibilities of PMHNP
~Honor pt's confidentiality
~Practice w/in their area of expertise
~Maintain accurate records
~Clarify their responsibilities to pt & families
~Tradition ways of doing things need to be changed to accommodate new situations
Malpractice Insurance provides
financial protection against claims of malpractice
~coverage for negligent professional acts
~Coverage for highly technical or professional skills req by HCP
~NP's own legal representation to advocate for them
Malpractice Insurance does NOT protect NPs who are
practicing outside their legal scope of practice
4 Elements of negligence that MUST be established to prove malpractice
~Breach of Duty
~Proximate Cause
the NP had a duty to exercise reasonable care when undertaking and providing tx to the pt

Element of negligence that MUST be established to prove malpractice
Breach of Duty
The NP violated the applicable standard of care in treating the pt's condition
Proximate Cause
a causal relationship between the breach in the standard of care and the pt's injuries

Element of negligence that MUST be established to prove malpractice
Permanent and substantial damages to the pt as a result of the breach in the standard of care

Element of negligence that MUST be established to prove malpractice
This is a legal not a medical concept

a determination that a pt can make reasonable judgements and decisions regarding tx & other health concerns
An individual is considered competent until
a court rules the person to be incompetent.

If deemed incompetent, a court-appointed guardian will make health-related decisions for the individual
Involuntary COMMITMENT
process of involuntairly forcing an individual to receive evaluation or tx

process may differ from state to state
Basic criteria for commitment
~pt has a diagnosed Psych d/o
~pt is harmful to self or others as a consequence of the psych d/o
~pt is unaware or unwilling to accept the nature and severity of the d/o
~tx is likely to improve functioning
During an involuntary admission what liberties do the client maintain?
Pt maintain all civil liverties EXCEPT the ability to come and go as they please

Amount of time pt can be kept against their wishes varies by state
During a voluntary admission what liberties do the client maintain?
Client maintains ALL civil liberties

Client consents to potential confinement w/in the structure of a hospital setting (Almost q state allows for a brief period of detainment to assess a pt for dangerousness to self and others before allowing the pt to leave a hospital setting EVEN if the admission was voluntary
is a process where an APN who is more experienced and knowledgeable agrees to monitor and support a junior colleague in the role, competencies and skills necessary to provide effective care
Mentoring is most effective when?
the relationship is comprised of mutual respect
Mentoring requires?
~commitment to professional growth
~appropriate levels of expertise
~reciprocal investment in the relationship
~mutual respect
~an open attitude
~correct timing
~teaching learning process
~time duration of several yrs
~career development relationship
Functions of a good mentor....
~demonstrates role expertise and role modeling
~facilitates role socialization
~shares values and customs
Provides support, structure and challenges to the mentee
~helps facilitate contacts with significant people
Benefits to the mentor
~satisfaction in seeing achievements of mentee
~protege may assist mentor with research, ideas
~Learns new things
~expands clinical excellence through others
Patient advocacy requires
knowledge, skill and the ability to understand and move through systems

political knowledge & understanding of partnerships is necessary in working w/in the health care system

organized planning and actions to change "what is" to what "should be"
What is patient advocacy?
one of the primary roles of the APN

speak on a patient's behalf and help patients get any information or services they need.

Empowering clients to become their own advocates and make decisions on their own behalf is essential to client health
Patient advocacy what you DO
participate as a member of professional and community organizations and advisory groups to promote the mental health of people at risk for mental d/o

coordinates referrals and acts to promote access to quality, cost-effective mental health care

advocates for the pt to make sure all health needs are met
In health care arenas advocates for mental health care practices that are
culturally sensitive to patients and families' needs
In health care community and public policy arenas advocates for public practices that
Reduce environmental risks to the mental health of patients and their families
Simplest ways to advocate for a client
standing up for clients' rights empowering them to become their own advocate

helping clients receive available services

coordinating quality and cost effective care

Promoting mental health by participating in a professional org (APNA, ISPN)
Case Management
is a system of controlled oversight and authorization of services and benefits provided to clients
Case mgmt overall goal
to promote quality cost effective outcomes
Case mgmt consist of
~coordinating care
~ensuring quality outcomes
~monitoring plan of care
~doing advocacy
Primary Prevention is aimed at
decreasing the incidence (# of new cases) of mental d/o

Measure to prevent onset of condition (e.g. routine immunizations)

~helping people avoid stessors or cope with them more adaptively

E.g. Stess MGMT, classes for graduate students, smoking prevention classes, DARE
Secondary Prevention aimed at
Decreasing the prevalence (# of existing cases of mental disorders
~early case finding
~prompt and effective tx
~~~~~Telephone hotlines, crisis interventio, disaster responses

Measures to identify and treat asymptomatic persons with risk factors (e.g. Pap smear, BP screening)
Tertiary prevention aimed at
decreasing the disability and severity of a mental d/o
~~rehabilitative services
~~avoidance or postponement of complications
(E.g. tx programs; case MGMT for physical, housing, or vocational needs; social skills training

Measures that are part of tx & MGMT of persons w/ clinical illnesses
(e.g. Rx to lower BP & cholesterol in persons with HTN, CAD
Primary prevention does what?
maintain and promote health
Secondary prevention does what?
screening for subclinical manifestation

Tertiary prevention does what?
if you already have the problem tertiary prevention limits progression
Risk factors
Perdisposing characteristics that make it more likely that a person will develop a disorder

Scholarly activities toward rectification requirements
Publishing : 1 article
Lecturing/presentations: 5 different presentations
Continuing education: 75 CEs per specialty per certification period
College courses: 5 semester hours
Preceptorship: 120hrs, 2 out of each of the 5 categories needed per certification period (5 yrs)
Biological risk & preventative factors
genetic backgrounds
Nutritional status
general health
Psychological risk factors
poor self-concept,
external locus of control,
poor ego defenses
Social risk factors
stressful occupation, low socioeconomic status,
poor level of social integration,
define Risk factor
predisposing characteristics that make it more likely that a person will develop a certain d/o
ANA collaboration definition
Physicians and nurses working together as colleagues, working interdependently within the boundaries of of their scope of practice
Describes a written, mandatory relationship between 2 providers
Collaborative agreement

~Generally a physician and an NP in many states required for NP practice.
~The structure of this regulatory relationship varies greatly from state to state
__________ is still the most common model of regulatory requirement for NPs practice
Federal funded insurance program for elderly or disabled
~NP authorized HCP
~NP reimbursed @ 85% m.d. rate
4 parts A,B,C,D
a jointly funded, federal-state health insurance program for certain poor ppl

~managed by the individual state

~NPs are eligible to apply for a Medicaid Provider #
Medicare part A
Medicare Part B
Medicare Part C
Managed care
Medicare Part D
Preventive factors
~factors that prevent or protect the individual from the d/o

~coping mechanisms or resources that facilitate a healthy response
Biological preventive factors
~without a hx of mental illness in family,
~healthy nutritional status,
~good general health
Psychological preventive factors
~good self-esteem or self-concept
~internal locus of control
~healthy ego-defenses
Social preventative factors
~low-stress occupation
~higher socioeconomic status
~higher level of education
Advance Directives
~Legally binding in all 50 states
~Living will
~Durable power of attorney for health care
Living will
Document giving specific instructions while pt is mentally competent that providers must follow if client becomes incompetent

~designates preferences for care if pt becomes incompetent or terminally ill
Durable power of attorney for health care
aka health care proxy
~Designates in writing an agent to act on behalf of an individual should they become unable to make health care decisions
~Not limited to terminal illness, and also covers other aspects of illness, such as making financial decisions during an individual's illness
~should be considered as an aspect of relapse planning for pts with chronic psych d/o
The learned beliefs & behaviors or the socially inherited characteristics that are common among all members of a group: may be a racial, social, ethnic, or religious grouping
Culturally competent care
treating pt from diverse cultures, viewing each pt as a unique individual and noting a potential relationship between the pt's cultural experiences and their sx presentation and perceptions
Assumes that if the NP becomes more sensitive to cultural issues surrounding sx and tx more comprehensive health care can be provided
culturally competent care
Culture-bound syndromes
Specific behaviors r/t a person's culture and not linked to a psych d/o

~be cognizant of inaccurately judging a pt's behavior as psychopathology when it is really r/t their culture

e.g cupping in Asian cultures
Cultural influences
Environment cultural influences
includes both physical & psychosocial factors
~the general circumstances of an individuals life
*social contacts
*housing surrounding
*air pollution
*fluoride in water
water contamination
Community cultural influences
A group of families often sharing the same race, tribe, or culture and who have beliefs or behavior not shared by others
Family cultural influences
concept broadened beyond the traditional husband-wife children pattern
~Family initially teaches the belief patterns, religion, culture, and more of a society
Research utilization process
~Critique research
~synthesize the findings
~apply the findings
~measure the outcomes
Evidence-Based Practice model
~Develop a clinical question using the PICO method
Systematically search for relevant research evidence
~critique the research evidence
~make an evidence-base decision regarding implementation
~implement the change depending on the decision
~evaluate the change
Research utilization
Process of synthesizing
using research-generated knowledge to make a change in practices: a subset of the broader evidence-based practice
What are the 2 models for reducing the gap between research finding and application to practice?
Evidence-based practice & research utilization
Evidence based practice
the integration of best research evidence with clinical expertise an pt values and needs
P=Patient, population of patients, problem
C=comparison (another tx or therapy, placebo)
O= 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 stats
~used to describe the basic features of the data in the study
~numerical values that summarize
*describe observations
~can be generated by either quantitative or qualitative studies

~~~Mean, Standard deviation, Variance
average of scores
Standard deviation
indication of the possible deviations from the mean
The purpose of preventive services is _____________
to help people live longer
Rationale for NOT offering preventive service
!) the service causes net harm in the target population
2) the service benefits few or no people in the target population
3) the balance between benefits & harms in uncertain
Inferential stats
~Numerical values the enable one to reach conclusions that extend beyond the immediate data alone:
~generated by quantitative research designs
*t test
*Analysis of variance
*Pearson's r correlation
*p value
~a descriptive stats

~how the value are dispersed around the mean
~the larger the variance the larger the dispersion of scores
assesses whether the means of 2 groups are statistically different from each other
Analysis of Variance
~test the difference among 3 or more groups
Pearson's r correlation
tests the relationship between 2 variables
~Likelihood of an event occurring
~lies between 0 & 1
~an impossible event has a probability of 0 and a certain event has a probability of 1
p value
aka level of significance
~describes the probability of 1 particular result occurring by chance alone
(if p=0.01, there is 1% probability of obtaining a result by chance alone)
Institutional review boards (IRBs) ensure that
~risks to participants are minimized
~participant selection is equitable
~adverse events are reported and risks/benefits are reevaluated
~Informed consent is obtained & documented
~Data and safety monitoring plans are implemented when indicated
~Overall, the IRB protects the rights and welfare of human research participants and has the authority to approve, require modifications, or disapprove of any research activities
The Belmont report
Said all investigators or individuals involved in research studies must take & pass a test on protection of human participants
Critical thinking
~acquisition of knowledge w/ an attitude of deliberate inquiry
~making clinical decisions based on ebp
~decreases the difficulty of choosing from conflicting or multiple recs when dx & tx pts