Module 5 Study Notes

In regard to health policy, what should be done before meeting the key players?

Assess/address organizational barriers and facilitators Meet/brainstorm with stake holders

Health policies are developed through __________ and __________.

law regulations

What are the exceptions to confidentiality? (8)

-Answering court orders, subpoenas, or summonses -If a client reveals an intent to harm self or others -In cases of child or elder abuse -Information given to attorneys involved in litigation -Meeting state requirements for mandatory reporting of diseases or conditions -Releasing records to insurance companies -Tarasoff principle -When appropriate persons or organizations determine that the need for information outweighs the principle of confidentiality

What does the PMHNP use to provide education?

A key part of the PMHNP's work is to use empirical evidence in educating their clients, clients' families, and the community about mental health, psychiatric illness, and effective management of illness. *If question is about stigma, answer that reaches the most people is usually correct!

What are the Social Determinants of Mental Health? (9)

Adverse early life experiences Food insecurity Housing instability Low education/educational inequality Poor access to and quality of healthcare Poor neighborhoods/built environments Poverty/low income/income inequality Social exclusion/social isolation Under employment/Unemployment

What are the ethical principles that all PMHNPs should employ? (7)

Autonomy: Doing for self Beneficence: Promoting well-being and doing good Fidelity: Being true and loyal Justice: Doing what is fair; fairness in all aspects of care Nonmaleficence: Doing no harm Respect: Treating everyone with equal respect Veracity: Telling the truth

Define the concept: -Stand up for client's rights and empower them to become their own advocates -Reduce the stigma of mental illness -Help clients receive available services -Promote mental health by participating in one or more professional organizations

Client advocacy

What are the 6 Institute of Medicine's quality aims (IOM, 2001)?

Client-centered Effective Efficient Equitable Safe Timely

What are the elements of informed consent? (5)

Comprehension: The patient should be able to comprehend the relevant information. Decision capacity: Patient should have the capacity (or ability) to make the decision. Documentation: Provider must document in medical record that informed consent has been obtained from client. Full Disclosure: The provider should disclose information on the treatment, test, or procedure in question, including the expected benefits and risks, and the likelihood (or probability) that the benefits and risks will occur. Voluntariness: The patient should voluntarily grant consent, without coercion.

Define: A diagram that illustrates the relationship between concepts.

Concept map

Define: The client's right to assume that information given to the healthcare provider will not be disclosed.

Confidentiality

What are the 3 rights of clients?

Confidentiality Give consent for treatment and withdraw consent at any time Least restrictive treatment

Define: The ability to practice nursing that meets the needs of clients care by using logical thinking and accurate nursing skills.

Core Competency

Who determines the standards of practice?

Determined by the American Nurses Association (ANA)

Define: This popular theory encourages learners to build on past experiences and knowledge, use their intuition, imagination and creativity, and search for new information to discover facts, correlations, and new truths.

Discovery Learning

Define: Persons younger than 18-years-old who are married, parents, or self-sufficiently living away from the family domicile.

Emancipated minors

What are the branches of law? (3)

Executive (implement law) Legislative (initial formulation) Judicial (interpret law)

Define the concept: -The view that humans define their own meaning in life and try to make rational decisions despite existing in an irrational universe (a philosophy based on the belief that the universe is irrational and meaningless and that the search for order brings the individual into conflict with the universe) -Focuses on the question of human existence, and the feeling that there is no purpose or explanation at the core of existence -Believes that individuals are entirely free and must take personal responsibility for themselves -Emphasizes accepting freedom, taking action, and believes that individuals must take personal responsibility for themselves

Existentialism

Define: A philosophy that emphasizes individual existence, freedom, and choice.

Existentialism

Define: A systematic, proactive method for evaluating a process to identify where and how it might fail and to assess the relative impact of different failures, in order to identify the parts of the process that are most in need of change.

Failure Modes and Effects Analysis (FMEA)

The word "fidelity" comes from what Latin word, and what does it mean?

Fidelity comes from the Latin "fides" meaning faithfulness. It is concerned with promise keeping, integrity, and honesty. It also involves meeting the patient's reasonable expectations (role fidelity) such as being respectful, competent, and professional.

Define: It looks at forces that are either driving movement toward a goal (helping forces) or blocking movement toward a goal (hindering forces).

Forced Field Analysis

Does HIPAA allow the PMHNP to disclose psychotherapy notes about a patient's condition?

HIPAA does not allow the PMHNP to make most disclosures about psychotherapy notes for a patient's condition without their authorization.

Define: Decisions, actions, and plans to achieve specific healthcare goals.

Health policy

If patients are not able to give informed consent, can someone else give it for them?

If patients are not able to give informed consent, family members, court-appointed guardians, or others (determined by state law) may act as "surrogate decision-makers" and make decisions for them.

Define: The communication process between the provider and the client that results in the client's acceptance or rejection of the proposed treatment.

Informed consent

Define the concept: -Supports collaboration efforts among state boards of nursing, professional organizations, patient safety centers, and health systems to develop applicable initiatives -Holds people accountable for their behaviors and investigates errors -Goal of creating open and fair learning environment to design safe systems and manage choices -Mindset that affects work environment to proactively look for system breakdowns and identify ways to improve systems

Just Culture of Safety

What level of evidence is from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or 3 or more RCTs of good quality that have similar results?

Level 1

What are the levels of evidence?

Level 1: Systematic reviews Level 2: Randomized controlled trials Level 3: Cohort studies Level 4: Case-Control studies Level 5: Case series, case reports Level 6: Editorials, expert opinion

What level of evidence is obtained from at least one well-designed RCT (e.g., large multi-site RCT)?

Level 2

If a patient has a cultural expected response to a stressor, should they still be diagnosed with a mental illness?

Not necessarily

What does PICOT stand for?

P: patient, population of patients, problem I: Intervention C: comparison (another treatment or therapy, placebo) O: outcome T: time

PMHNP interventions follow what type of guidelines and what do they take into account?

PMHNP interventions follow evidence-based practice guidelines, are always client, goal-directed and take into account the client's ethnicity and culture.

What are the 4 components of the process of quality improvement?

Plan: Plan the change Do: Carry out the plan Study: Examine the results Act: Decide what actions will improve the process

What do the Social Determinants of Mental Health lead to? (2)

Poor mental health Risk of mental illness

What is the difference between primary and secondary research?

Primary research: Original study Secondary research: Similar original studies, meta-analyses, meta-ethnography

Define: A student-centered approach in which students learn about a subject by working in groups to solve an open-ended problems.

Problem-Based Learning (PBL)

What are the 4 components of health policy?

Process: formulation, implementation, and evaluation Policy reform: changes in programs and practices Policy environment: arena the process takes place in (government, media, public) Policy makers: key players and stakeholders

Define: Agency-specific projects that aim to improve systems, decrease cost, and improve productivity. For example, a retrospective chart review.

Quality Improvement

Debriefing strategies are an example of what concept?

Reflective Practice

Define the concept: -Reflection uses a model or framework to systematically "make sense of experience" -Process to tell a story about self and others to gain insight into practice -Enhances critical thinking to problem-solve and enhance clinical reasoning and decision-making -Link theory to practice

Reflective Practice

Which court case: An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medication.

Rennie Vs. Klein

Define: It is an ongoing process that should provide an organization with a detailed understanding of its risks and information necessary to address those risks in a timely manner.

Risk Analysis

Define: A collective term that describes a wide range of approaches, tools, and techniques used to uncover causes of problems.

Root Cause Analysis (RCA)

The following characteristics are definitive of what: -Defines NP roles and actions -Identifies competencies assumed to be held by all NPs who function in a particular role -Varies broadly from state to state -Advanced practice PMHNP standards are identified in Psychiatric-Mental Health Nursing: Scope and Standards of Practice (ANA, 2014)

Scope of practice

Define: Understand and consider culture, economic and educational status, health literacy level, family patterns and situation, and traditions (including alternative and folk remedies); communicate in language and at a level that the client understands.

Sociocultural competence

The following statements are definitive of what: -Authoritative statements regarding the quality and type of practice that should be provided -Provide a way to judge the nature of care provided -Reflect the expectation for the care that should be provided to clients with various illnesses -Reflect professional agreement focused on the minimum levels of acceptable performance -Can be used to legally describe the standard of care that must be met by a provider -May be precise protocols that must be followed or more general guidelines that recommend actions

Standards of practice

Who determines the PMHNP's scope of practice?

State Board of Nursing (state legislative statutes) *If answer requires you to consult State Board of Nursing...usually correct answer!

Give an example of nonmaleficence.

Stopping a medication that is causing harmful side effects or discontinuing a treatment strategy that is not effective and may be harmful. Imminent danger.

In regard to quality improvements, what are the 3 components of the Donabedian model?

Structure Process Outcome

What is the Tarasoff principle?

Tarasoff principle (Tarasoff v. Regents at the University of California, 1976); Duty to warn potential victim of imminent danger of homicidal clients

What Act works to prevent discrimination by employers with 15 or more employees against qualified persons in hiring, firing, advancement, job training, compensation, and workplace conditions?

The Americans with Disabilities Act of 1990

Confidentiality is protected under which federal statute?

The Medical Record Confidentiality Act of 1995

Do standards of practice give nurses the opportunity to practice as they wish?

The PMHNP is required by law to carry out care in accordance with what other reasonably prudent nurses would do in the same or similar circumstances. Thus, provision of high-quality care consistent with established standards is critical.

How many release of informations are required to release information on patient's chemical and psychiatric status to a third party?

Two separate releases

Employers are required to make reasonable __________ for qualified applicants or employees with a disability.

accomodations