Copyright © 2014 American Nurses Association, American Psychiatric Nurses Association and International Society of Psychiatric-Mental Health Nurses. Standards for Psychiatric-Psychiatric Nursing 43 Standards of Practice for Psychiatric-Psychiatric Nursing 44.
Psychiatric-Mental Health Nursing
Introduction
History and Evolution of Psychiatric-Mental Health Nursing
Funding from the NMHA led to a rapid expansion of graduate programs and the start of psychiatric-psychiatric-psychiatric nursing research. Psychiatric-psychiatric nursing education began to include more content on psychopharmacology and the pathophysiology of psychiatric disorders.
Origins of the Psychiatric-Mental Health Advanced Practice Nursing Role
Similarly, preparation for prescriptive privileges became an integral part of advanced practice psychiatric-psychiatric-psychiatric nursing graduate programs (Kaas & Markley, 1998). A shift in National Institute of Mental Health (NIMH) funding from education to research, leading to a dramatic decline in enrollment in psychiatric nursing programs (Taylor, 1999);
Current Issues and Trends
In 2010, less than 40% of the 45.9 million adults with mental disorders received any mental health services. These comorbidities significantly increase health care costs (Melek & Norris, 2008), with only a small fraction of those costs (16%) attributable to mental health services.
Definition of Psychiatric-Mental Health Nursing
Over the course of their practice, it is critical that PMH nurses consider the specific vision of mental health care that informs their practice. These reports agree on several points, but most crucially, a transformed mental health system focuses on the person.
Phenomena of Concern for Psychiatric-Mental Health Nurses
Psychiatric-Mental Health Nursing Clinical Practice Settings
Psychiatric-mental health registered nurses provide care within the community as an effective method of responding to the mental health needs of individuals, families and groups. Schools and colleges are an important site of mental health promotion, primary prevention and early intervention programs for children and youth involving psychiatric-mental health registered nurses.
Psychiatric-mental health advanced practice nurses (PMH-APRNs) include both nurse practitioners (PMH-NP) and clinical nurse specialists (PMH-CNS). Psychiatric-mental health nursing is necessarily holistic and takes into account the needs and strengths of the individual, family, group and community.
Other Specialized Areas of Practice
PMH-RN and the PMH-APRN levels of practice are found in forensic mental health settings. Psychiatric mental health nurses care for people with psychiatric, behavioral, and comorbid conditions across the lifespan and continuum of care.
Ethical Issues in Psychiatric-Mental Health Nursing
PMH nurses are in key roles to change prevailing negative perceptions and attitudes towards individuals with PMH disorders. PMH nurses have an ethical obligation to report observations or concerns of colleagues to their nurse manager.
Practice
- Assessment
- Diagnosis
- Outcomes Identification
- Planning
- Implementation
The psychiatric-mental nurse identifies the expected outcomes and goals of the healthcare consumer for a plan tailored to the healthcare consumer or situation. Modifies the plan (goals/outcomes and interventions) based on ongoing assessment of healthcare consumer achievement of goals and responses to interventions.
Standard 5A. Coordination of Care
Standard 5B. Health Teaching and Health Promotion The psychiatric-mental health registered nurse employs
Synthesizes empirical evidence on risk behavior, learning theories, theories of behavior change, motivational theories, epidemiology, and other related theories and frameworks in the design of health information and health care consumer education. Provides education for individuals, families and groups to promote knowledge, understanding and effective management of general health maintenance, mental health and psychiatric and drug problems. Uses knowledge of health beliefs, practices, evidence-based findings, and epidemiological principles, along with social, cultural, and political issues affecting community mental health, to develop health promotion strategies.
Designs health information and health care consumer education appropriate to the health care consumer's developmental level, learning needs, willingness to learn, and cultural values and beliefs. Evaluates real-world health information sources, such as the Internet, for accuracy, readability, and understandability to help health care consumers access quality health information. Assists the PMH-RN in the development of curricula and programs in health education and health promotion.
Standard 5C. Consultation
Standard 5D. Prescriptive Authority and Treatment The psychiatric-mental health advanced practice registered
The psychiatric-mental health registered nurse incorporates knowledge of pharmacological, biological and complementary interventions with applied clinical skills to restore the. Apply current research findings to guide nursing actions related to pharmacology, other biological therapies, and integrative therapies. Evaluate the health care consumer's response to biological interventions based on current knowledge of pharmacologic agents' intended actions, interactive effects, potential adverse effects, and therapeutic doses.
Includes medication management health education to support healthcare consumers in managing their own medication and adhering to a prescribed regimen. Provides health education about mechanism of action, intended effects, potential adverse effects of the proposed prescription, ways to manage transitional side effects, and other treatment options, including choosing a non-treatment option.
Standard 5F. Milieu Therapy
Provides support and validation to healthcare consumers when discussing their illness experience and seeks to prevent complications of illness. Therapeutic Relationships and Counseling The Psychiatric-Mental Health Registered Nurse (PHM-RN) uses The Psychiatric-Mental Health Registered Nurse (PHM-RN) uses therapeutic relationships and counseling interventions to assist health care consumers in their individual journeys of recovery by improving and regaining previous coping skills, promoting mental health and preventing mental disorders and disabilities. Utilizes therapeutic relationship and counseling techniques to promote stabilization of health care consumer's symptoms and personal recovery goals.
Uses a therapeutic relationship and counseling techniques, in both individual and group settings, to reinforce healthy behaviors and patterns of interaction and to help the health care user discover individualized health behaviors that replace unhealthy ones. It documents counseling interventions including, but not limited to, communication and interviewing techniques, problem-solving activities, crisis interventions, stress management, supportive skill-building and educational groups, relaxation techniques, assertiveness training, and conflict resolution.
Standard 5H. Psychotherapy
Evaluation
It carries out a systematic, ongoing and criterion-referenced evaluation of results and goals according to the prescribed interventions with a plan and a marked timeline. It evaluates the effectiveness of planned strategies in terms of the responses of health care consumers and the achievement of expected results. It evaluates the accuracy of diagnosis and the effectiveness of interventions in achieving the expected outcomes of the health care consumer.
Synthesizes the results of the evaluation analyzes to determine the impact of the plan on affected healthcare consumers, families, groups, communities and institutions. Uses the results of the evaluation analyzes to make or recommend process or structural changes, including policy, procedure or protocol documentation, as appropriate. Assists the PMH-RN in the evaluation and reformulation of the plan in complex situations.
Ethics
Promotes advance care planning regarding behavioral health issues, which may include behavioral health advance directives. Uses ethical principles to advocate for access and equity of services for mental health, psychiatric, and substance abuse disorders.
Education
Participates in interprofessional teams contributing to role development and advanced nursing practice and health care.
Evidence-Based Practice and Research The psychiatric-mental health registered nurse integrates
Quality of Practice
Communication
Leadership
Collaboration
Professional Practice Evaluation
Resource Utilization
Environmental Health
Retrieved from http://www.actassociation.org/actModel/. The tidal model: Developing a person-centered approach to psychiatric and mental health nursing. Essentials of psychiatric-mental health nursing in the BSN curriculum: Collaboratively by ISPN and APNA Available at: http://www.ispn-psych.org/. Task Force on Essential Competencies for Substance Abuse in Psychiatric Mental Health American Academy of Nursing Psychiatric Expert Panel on Substance Abuse in Mental Health.
Mental Health: Culture, Race, and Ethnicity - A Supplement to Mental Health: A Report of the Surgeon General. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. PMH-APRN Psychiatric-mental health advanced practice registered nurse PMH-CNS Psychiatric-mental health clinical nurse specialist.
Psychiatric-Mental Health
Nursing: Scope and Standards of Practice (2007)
S ILVER S PRING , M ARYLAND
P SYCHIATRIC -M ENTAL H EALTH N URSING
S COPE AND S TANDARDS
OF P RACTICE
The International Society of Psychiatric-Mental Health Nurses (ISPN) exists to unify and strengthen the presence and voice of specialty psychiatric-mental health nurses while influencing health policy to promote equitable, evidence-based, and effective treatment and care for individuals, families, and communities. Definition of Psychiatric-Psychiatric Nursing 13 Phenomena of Concern for Psychiatric-Psychiatric Nurses 15 Levels of Psychiatric-Psychiatric Nursing 16 Psychiatric-Psychiatric Nurse (RN-PMH) 16 Advanced Psychiatric-Mental Early Registered. In 2004, the American Psychiatric Nurses Association and the International Society of Psychiatric-Mental Health Nurses appointed a joint task force to begin the review and revision of the Scope and Standards of Psychiatric-Mental Health Nursing Practice published in 2000 by the American Nurses Association (ANA, 2000) .
In August 2005, a group of ANA psychiatric mental health care experts and policy leaders met to review initial drafts and make recommendations. Panel members represented psychiatric nursing clinical administrators, nurses, and psychiatric advanced practice nurses working in acute psychiatric care settings. In addition, the introduction was revised to emphasize the leadership role of psychiatric mental health nurses in the transformation of the mental health system, as described in the 2003 report of the President's New Freedom Commission (New Freedom Commission, 2003).
P SYCHIATRIC -M ENTAL H EALTH N URSING : S COPE OF P RACTICE
Similarly, preparation for prescribed privileges was embedded in advanced practice psychiatric and mental health graduate programs ( Kaas & Markley, 1998 ). This is reflected in the core curriculum of graduate psychiatric nursing programs. Psychiatric-Mental Health Care: Scope of Practice 7 Alzheimer's disease is common (New Freedom Commission on Mental Health, 2003).
10 Psychiatric-Mental Health Nursing: Scope and Standards of Practice Management systems require team leaders who are experienced, trained mental health professionals (Rapp, 1998), and that psychiatric nurses are a key agent in achieving positive patient outcomes in case management teams (McGrew & Bond, 1995). 20 Psychiatric-Mental Health Nursing: Scope and Standards of Practice holistic care, and develop the various scientific and nursing knowledge bases. In the community, the APRN-PMH can focus on the mental health needs of the population as a whole.
S TANDARDS OF P RACTICE
S TANDARD 1. A SSESSMENT
Evidence-Based Practice and Research
The PMH registered nurse communicates effectively in various forms in all areas of practice. The PMH registered nurse collaborates with nursing consumers, the family, the interprofessional health care team, and others in the implementation of nursing practice. The PMH registered nurse evaluates their own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations.
The PMH registered nurse considers factors related to safety, effectiveness, cost, and impact on practice when planning and implementing nursing services. All registered psychiatric and mental health nurses (PMHs) and APRNs are expected to participate in professional activities, including leadership, appropriate to their education and position. PMH and APRN registered nurses are accountable for their professional actions to themselves, their patients, their peers, and ultimately society.
