Psychiatric Diagnosis and Management: Child Essay

Psychiatric Diagnosis and Management: Child Essay

Kimberly Response

It is good that you are transitioning from Family Nurse Practitioner to Psychiatric Nurse Practitioner. However, the fact that the transition does not worry you means that you are prepared to deal with the changes and challenges you might face. Transitioning from one specialty to the other brings about changes in roles. As one transitions to a higher position, they are expected to be more responsible and responsive to issues (Urbanowicz, 2019). Besides, the roles and responsibilities change; hence it is vital to adhere to the set morals and ethics of the new roles. The fear of improperly diagnosing a patient affects people from all levels. In this case, you need to have a strong support system. This can be done by ensuring that you have a great relationship with your colleagues. In addition, you must work towards ensuring that you achieve all the set goals and objectives.

It is good that you have included some of the functions of the Psychiatric Nurse Practitioner. It is essential to understand these functions since they are the basis of what you will be handling daily. According to Kumar et al. (2020), PMHNP diagnoses and treats common acute psychiatric problems, illnesses, and crises. The roles must be overwhelming. However, with your FNP experiences, it will be easy to adjust and deliver the best. One of the standards of practice for the PMHNP is to identify expected outcomes and individualized plans for individuals depending on their unique situations (Chapman et al., 2019). This helps in giving individualized care since each patient has their own needs. It becomes easy to develop a suitable treatment plan if the requirements are identified. It is also vital to ensure that you work well with other professionals in the same department. As a result, it will be easy to provide the optimal outcome for all the patients.

References

Chapman, S. A., Toretsky, C., & Phoenix, B. J. (2019). Enhancing Psychiatric Mental health Nurse Practitioner Practice: Impact of State Scope of Practice Regulations. Journal of Nursing Regulation, 10(1), 35-43. https://doi.org/10.1016/s2155-8256(19)30081-x

Kumar, A., Kearney, A., Hoskins, K., & Iyengar, A. (2020). The Role of Psychiatric Mental health Nurse Practitioners in Improving Mental and Behavioral Health Care Delivery for Children and Adolescents in Multiple Settings. Archives of Psychiatric Nursing, 34(5), 275-280. https://doi.org/10.1016/j.apnu.2020.07.022

Urbanowicz, J. (2019). APRN Transition to Practice. The Nurse Practitioner, 44(12), 50-55. https://doi.org/10.1097/01.npr.0000605520.88939.d1

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Kimberly Bernacki
RE: Discussion Question #4 – Prompt
COLLAPSE
Certificate Students – As an APRN, you successfully navigated the transition from the RN scope of practice at the generalist and specialist levels to the advanced level of practice. But moving to a new specialty, you are once again somewhat of a novice. What worries you about this transition? Please talk about issues from various perspectives, especially scope, professional relationships, legal, and ethical perspectives.

The transition from Family Nurse Practitioner (FNP) to Psychiatric Nurse Practitioner (PMHNP) doesn’t worry me as much as it did when I made the transition from the Registered Nurse (RN) role to the FNP role. As an RN, I would follow the orders of the physician and treat the patient, however once I became an APRN, my position completely changed to the provider role. I was assessing, diagnosing, prescribing medications, and collaborating with other providers. Transitioning from the FNP to PMHNP role will create its own challenges. Until I gain my confidence, I am concerned that I may not provide the correct diagnosis or prescribe the best possible medication for that patient. What if I improperly diagnosis the patient because I’m not getting all the input I need from the psychiatric intake exam or will the class of medication I prescribe work for the patient and will I have to continue to search and try different medications until I find one that works best for that patient? I feel like every provider eventually creates their own algorithm for every scenario, however, until you have a few years under your belt you tend to second guess yourself. Another concern is transitioning from the traditional brick-and-mortar outpatient clinic to delivering care through telemedicine. Several PMHNP’s I have talked to recently who are in an outpatient clinic are switching over to telehealth for their outpatient clinic patients. I worry that it may be difficult to perform a thorough psychiatric exam on a patient without being face-to-face. Older patients may have difficulty utilizing telemedicine due to being unfamiliar with technology, living in rural areas, and not having access to the internet. These are all legitimate concerns for any new PMHNP in the first year of clinic practice.

Scope of Practice for PMHNP’s

Functions performed by the PMHNP are to diagnose and treat common acute psychiatric problems, illness, and crises. PMHNP’s provide psychopharmacologic management, individual, group, and family psychotherapy, and counsel clients on common identified chronic psychiatric conditions across the life span (Vanderbilt University,2022). PMHNP’s also coordinate and integrate multidisciplinary services for clients with complex psychiatric problems and provide comprehensive family psychiatric mental health patient’s diagnoses (VU, 2022). I feel confident with my educational background coupled with my FNP experiences that I will be able to diagnose and recommend an evidenced based practice modality for my patients.

16 Standards of Practice for the PMHNP (American Psychiatric Nurses Association (APNA), 2014).

I. The PMHNP collects and synthesizes comprehensive health data that are pertinent to the healthcare consumer’s health and/or situation.
II. The PMHNP analyzes the assessment data to determine diagnoses, problems, and areas of focus for care and treatment, including level of risk.
III. The PMHNP identifies expected outcomes and individualized plans for individuals depending on their unique situation.
IV. The PMHNP develops a plan that prescribes strategies to assist the patient with optimal clinical outcomes.
V. The PMHNP implements the identified individualized plan. The PMHNP coordinates care delivery. The PMHNP develops strategies to promote a safe delivery of healthcare. The PMHNP collaborates with other providers to identify a plan of care that will produce the best possible outcome for that patient. The PMHNP uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations. The PMHNP incorporates his/her knowledge of pharmacological, biological, and complementary interventions to restore health and prevent future disability of the patient. The PMHNP maintains a safe and recovery-oriented environment in collaboration with the patient, family, and other healthcare providers. The PMHNP uses psychotherapy interventions to assist patients in their recovery journeys by helping the patient better cope with their individual mental health disability. The PMHNP conducts individual, couples, and family psychotherapy.
VI. The PMHNP evaluates progress toward attainment of goals.
VII. The PMHNP integrates ethical provisions in all areas of practice.
VIII. The PMHNP maintains knowledge and competency through continuing education.
IX. The PMHNP integrates evidence-based guidelines into his/her practice.
X. The PMHNP enhances the quality and effectiveness of nursing care by being responsible, accountable, and ethical.
XI. The PMHNP communicates effectively in a variety of settings.
XII. The PMHNP provides leadership in the professional practice setting.
XIII. The PMHNP collaborates with the patient, family, and interprofessional healthcare team to provide the most holistic care possible.
XIV. The PMHNP’s practice is guided by professional practice standards, rules, and regulations.
XV. The PMHNP considers safety, effectiveness, and cost in the planning and delivery of psychiatric care.
XVI. The PMHNP practices in an environmentally safe and healthy manner.

Professional Relationships

The role transition for the PMHNP should include collaborating with other professionals to provide optimal outcomes for the patient. For example, when working with the child and adolescent population, the PMHNP might locate their practice where children are located (Kumar et al., 2020). It would be important for the PMHNP to develop professional relationships with school personnel to evaluate and treat children with emerging symptoms such as anxiety, depression, or suicidality (Kumar et al. 2020). The World Health Organization (WHO) states that PMHNP’s should work toward partnering and collaborating with people outside the health sphere such as schoolteachers, religious leaders, faith healers, police officers, and local nongovernmental organizations to effectively expand their services and bring more awareness to mental health illness within the community (Kumar et al., 2020). The field of psychiatric nursing has the ability to capitalize on his history by reaching more mentally ill patients through collaboration with others outside the healthcare field (Kumar et al., 2020).

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Legal Implications and Risks for the PMHNP in Telehealth
Psychiatric Mental Health Nurse Practitioners should be aware of some of the liability issues that are created with telemedicine. For example, PMHNP’s typically are licensed only in the state in which they practice but with the use of telehealth technologies, this would allow these providers to assess patients remotely and across state borders, making single state license uneconomical (Balestra, 2018). PMHNP’s would need a license for every state in which they planned to provide telehealth visits (Balestra, 2018). Currently, the National Council of State Boards of Nursing (NCSBN), is planning an Advanced Practice Registered Nurse (APRN) Compact that would allow an APRN to hold one multistate license with a privilege to practice in other compact states (Balestra, 2018). The APRN Compact does not include all the states and only the states who participate would allow this capability for the PMHNP (Balestra, 2018). There is a lot of variation in telehealth rules and regulation that NP’s working in telemedicine need to be aware of. There is a risk for legal action from regulatory authorities if they do not have proper certifications, licenses, and training in every state they are required to practice (Balestra, 2018).

Fraud and abuse should also be considered when implementing a telemedicine program. Business arrangements involving telemedicine visits should not violate federal anti-kickback and Stark Law Statutes (Balestra, 2018). Anti-kickback law prohibits providers from receiving compensation involving federal payor dollars for referrals and prohibits referrals to another entity in which the referring provider has a financial interest (Balestra, 2018). Penalties can include fines, imprisonment, and exclusion from the Medicare and Medicaid program (Balestra, 2018). Stark Law is a healthcare fraud and abuse law that prohibits providers from referring patients for certain designated health services paid for by Medicare to any entity in which they have a financial relationship (Balestra, 2018). Violations include denial of payment and exclusion from the Medicare and Medicaid programs (Balestra, 2018).

Ethical Considerations for PMHNP’s in Telemedicine
Most telehealth devices if used appropriately have the potential to provide benefit to the patient and or family living in communities with limited access to healthcare, however, if used inappropriately ethical issues arise. There are four features of telehealth ethics to be considered: beneficence, autonomy, non-maleficence, and justice (Spahn, 2017). Beneficence in telehealth has the potential to increase access to healthcare, improve quality of medical care, and decrease cost (Spahn, 2017). Through the use of telemedicine technology, patients avoid inconveniences of traveling to large cities and benefit from consulting with a specialty provider they may not otherwise have access to living in distant, underserved communities. In today’s society of electronic medical records and storage of patient data and health information, it is easy for that information to get exposed to the wrong people, affecting one’s autonomy. Telehealth can either restrict autonomy by exposing one’s personal health information or promote autonomy by enabling a patient to give informed consent or provide advanced directives for one’s health. Non-maleficence means doing no harm to someone, a balance between ensuring safety and invading privacy (Spahn, 2017). Healthcare providers need to be extremely careful in maintaining confidentiality of patient data and be aware of the risk associated with unauthorized access. The ethical framework of justice is to be fair, honest, and transparent with all patients (Spahn, 2017). Increased access to healthcare for patients living in rural communities through the use of telemedicine, can create justice for patients with these inequalities.

References
American Psychiatric Nurses Association. (2014). Psychiatric mental health nursing. 2nd ed. American Nurses Association. Silver Spring: MD.
Balestra, M. (2018). Telehealth and legal implications for nurse practitioners. The Journal for Nurse Practitioners, 14(1), 33-39. https://doi.org/10.1016/j.nurpra.2017.10.003
Birch, K., Ling, A., & Phoenix, B. (2021). Psychiatric Nurse Practitioners as Leaders in

Behavioral Health Integration. The journal for nurse practitioners. JNP, 17(1), 112–115.

https://doi.org/10.1016/j.nurpra.2020.09.001

Kumar, A., Kearney, A., Hoskins, K., & Iyengar, A. (2020). The role of psychiatric mental

health nurse practitioners in improving mental and behavioral health care delivery for

children and adolescents in multiple settings. Archives of psychiatric nursing, 34(5), 275–

280. https://doi.org/10.1016/j.apnu.2020.07.022
Spahn, K. (2017). A nurse practitioner’s view on telehealth. Journal of the American Psychiatric Nurses Association, 23(3), 92. https://doi.org/10.1177/10783903
Vanderbilt University. (2022). Psychiatric mental health nurse practitioner scope of practice. Retrieved from https://nursing.vanderbilt.edu/msn/pmhnp/pmhnp_scope.php

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Appendix C1 & C2: Discussion Question Response #1 and #2 15 points per response

 Assignment Description

Each student submits a response to the Discussion Board question. This is done in the appropriate module discussion board in Blackboard (Course Objectives 1-8).

Assignment Objectives

The student will:

1. Synthesize the evidence-based literature for the week (learning opportunities, other identified resources);
2. Apply synthesized knowledge to understand the posted question;
3. Demonstrate understanding by developing a written response to the question; and
4. Demonstrate appropriate application of technology for communication and learning.

 Assignment Steps

To complete this assignment:

1. Read the posted question.
2. Use the assigned readings and other resources to develop a written response to the question.
3. Post the developed response to the appropriate week discussion board in Blackboard by the date assigned in the course calendar.
   

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 Assignment Evaluation

Each Discussion Board Response will be evaluated according the to the following rubric:

Criterion	Possible
Relevance	4	Response addresses the prompt.
Evidence Based	4	Response identifies and synthesizes the evidence in the literature, including DSM 5.
Critical Thinking	5	Review demonstrates critical thinking.
Mechanics	2	Writing is logical, APA 7th used; no errors in spelling, grammar, citations or references.

Required text book

Yalom, I. (2017). The gift of therapy: An open letter to a new generation of therapists and their patients. Harper Perennial.