Finally, the Essentials content applies to the nursing care of persons with substance use disorders as well as those who have medical or surgical conditions that are accompanied by psychosocial stressors. The PMH nursing scope and standards as revised (ANA, 2014) are consonant with ANA’s (2010) directives and serve to enhance the specialty’s understanding of current and future expectations for the knowledge, skills, and abilities of the various roles and levels of practice. The next section describes the factors for consideration in the revision process. The ANA production schedule aims to publish revisions of each volume every five years. This perception has prevented the service system, healthcare providers, and consumers from envisioning a healthy future for persons with mental health problems. Nurses are trained to protect private health information in nursing school and throughout their career by their employer. Environmental health (Standard 16) is the final set of competencies addressed within the revised document. The NPA is located in the California Business and Professions Code starting with Section 2700. President’s New Freedom Commission on Mental Health. These competencies also describe the ongoing feedback process inherent in the evaluation process as the healthcare consumer recovers, necessitating revaluation and revision of treatment goals and plans. Guidelines related to ethical behaviors and standards of practice had multiple changes; the scope of practice changes were targeted to address current trends and priorities in healthcare environment. The Substance Abuse and Mental Health Services Administration (SAMHSA, 2006) validated the resulting consumer driven framework of a person-centered, recovery-orientation for assessment and treatment. This emphasis on consumer participation goes beyond earlier efforts to include the consumer in treatment planning. Each set presents the competencies of the psychiatric-mental health registered nurse (PMH-RN) and additional competencies of the psychiatric-mental health advanced practice registered nurse (PMH-APRN). Diploma, Associate Degree and Baccalaureate degree nursing programs should include content areas and skill sets presented and elaborated in this document. Catherine F. Kane is an Associate Professor of Nursing at University of Virginia School of Nursing in Charlottesville, VA. Dr. Kane co-chaired the APNA and ISPN Joint Taskforce to revise and update the ANA Psychiatric-Mental Health Nursing: Scope and Standards of Practice (2007) with Kris A. McLoughlin, DNP, APRN, FAAN. Scope and Standards publications serve as a reference document for the relevant specialty, nursing in general, and across roles, including education, research and practice. The design, implementation and evaluation of quality improvement initiatives is expected of the PMH-APRN. © 2015 OJIN: The Online Journal of Issues in Nursing The recent revision of the PMH Scope and Standards (ANA, 2014) has several implications in the realm of nursing education. Professional practice evaluation (Standard 14) specifies competencies necessary to ensure that knowledge and skills are adequate to engage in clinical practice, including self-reflection, action planning, and assessment of goal achievement. The work of the task force to revise the PMH Scope and Standards carefully considered the existing document and other key factors in the current context of healthcare to craft a document with specifics to guide both dedicated PMH nurses and generalist nurses in all settings. The American Nurses Association (ANA) Code of Ethics (ANA, 2015) is a good example of incorporating virtue ethics into the ethical and legal obligations of the nursing profession (Exhibit 12.1). The PMH Scope and Standards support this initiative in a number of ways. The Foundation does not engage in political campaign activities or communications. This erosion has been driven by the reduction of psychiatric nursing content in the National Council Licensure Examination (NCLEX) exam (Kane, 2012). The Essentials describes the basic PMH Nursing knowledge and skill base in a format familiar to educators to clarify the linkage to essential general nursing skills and inform the development of entry level nursing education, continuing education, and clinical orientation curricula (Kane & Brackley, 2012). Practice evaluation. HIPAA laws protect healthcare consumers from having their personal health information shared inappropriately. Environmental health. Disclose to others, including sponsors, clients or colleagues, significant circumstances that could be construed as a potential or real conflict of interest, or any having an appearance of impropriety. Standard 5F: Milieu Therapy emphasizes the PMH-RN’s role to provide an orientation for healthcare consumers to their treatment environment. To evaluate the actions as being intrinsically right or wrong. APRN practice varies across states due to licensure regulations determined by state legislation. Psychiatric mental health substance abuse essential competencies taskforce of the American academy of nursing psychiatric mental health substance abuse expert panel. NBCC publishes specific and enforceable ethics policies. Specialized graduate education applied to a focused population is required for certification. The intent is to ensure that the consumer is integrated into all aspects of planning for treatment with the goal of treatment being recovery. New York, NY: Putnam. 20, No. This report summarized the literature on symptom onset and environmental risks leading to the conclusion that prevention of mental disorder is possible when protective contexts are fortified and risk factors are decreased. Archives of Psychiatric Nursing, 26, 77–79. This document exceeds competencies required to practice as an entry level graduate to address the scope of the foundational knowledge base necessary to practice nursing across settings and beyond entry level expectations. Catherine F. Kane, PhD, RN, FAAN The task force member authors of The Essentials (Kane & Brackley, 2012) undertook the charge of articulating the essential foundational PMH nursing competencies that any registered nurse must have in order to provide quality nursing care. Retrieved from www.ncsbn.org/08_Linking_the_NCLEX_to_Practice_Vol36.pdf, National Council of State Boards of Nursing (NCSBN). Substance Abuse and Mental Health Services Administration. 1, Manuscript 1. BCC Code of Ethics: Approved September 17, 2010 Page 4 of 4 1. Focuses on the consequences of actions; the end justifies the means. Given the complexities and stressors of 21st century living, psychiatric mental health and substance use knowledge, skills, and abilities are integral to provide quality, holistic care to populations in need of nursing care. Journal of Psychosocial Nursing and Mental Health Services. Substance Abuse and Mental Health Services Administration. Best known for the Essential documents of the profession on nursing ethics, scope and standards of practice, and social policy, Nursesbooks.org … The work of the task force to revise the PMH Scope and Standards (ANA, 2014) carefully considered the existing document and other key factors in the current context of healthcare to craft a document with specifics to guide both dedicated PMH nurses and generalist nurses in all settings. PMH-APRN competencies in leadership include the promotion of person-centered recovery oriented models of care for the benefit of the overall healthcare system. Whether it’s regarding culture, value systems, religion, or someone’s lifestyle, nurses are to remain impartial in order to avoid conflict. Therefore, the presentation of the scope of practice varies from specialty to specialty in the topics and contexts addressed. doi:10.1016/j.apnu.2011.12.010, Kane, C.F. The expectation of self-care, stress management, and sustaining supportive interpersonal relationships is foundational to ensuring that PMH nurses are capable of providing optimal care within the limits of their skills and abilities. Using the Code of Ethics for Nurses with Interpretive Statements (ANA, 2015) as a framework, the nine provisions of the code are discussed with clinical applications. 111-148, §2702, 124 Stat. Knowledge and skills are required to promote and maintain environmentally healthy work settings and communities. The American Nurses Foundation is a separate charitable organization under Section 501(c)(3) of the Internal Revenue Code. (2010). This sub-category is foundational to both PMH-RN and PMH-APRN practice and thus has no advanced competencies for the PMH-APRN. However, as states adopt more progressive PMH-APRN practice acts, prescriptive authority will eventually be available to PMH-CNS and PMH-NPs. Professional boundaries are integral to these values. Silver Spring, MD: Author. American Nurses Association (ANA) Code of Ethics is of course one such code. The 2014 scope and standards attest to the enduring principles of nursing inherent in registered nursing and advance nursing practice that can evolve incrementally over time to ensure the development and maintenance of an appropriate, meaningful and responsive healthcare environment. PMI’s Code of Ethics and Professional Conduct applies those values to the real-life practice of project management, where the best outcome is the most ethical one. Retrieved from nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html, Institute of Medicine. Retrieved at www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf. Consensus model for APRN regulation: Licensure, accreditation, certification and education. A paradigm shift toward prevention promotes an appreciation of the social determinants of health. ANA (2010) used the term ‘healthcare consumer’ throughout Scope and Standards to emphasize the orientation of nursing practice toward engaging individuals and families throughout the trajectory of involvement in healthcare services from promoting health and wellness to treating disease and illness. Retrieved from www.nami.org/Template.cfm?Section=New_Freedom_Commission&Template=/ContentManagement/ContentDisplay.cfm&ContentID=28335. Written by: ANA Center for Ethics and Human Rights Adopted by: ANA Board of Directors Purpose Discrimination in any form is harmful to society as a whole and in opposition to the values and ethical code of the nursing profession, which directs the nurse to “…respect the inherent dignity, worth, unique Psychiatric-mental health nursing: Scope and standards of practice. Barbara J. Limandri, PhD, PMHNP, BC. Nurse practitioners (NPs) are licensed, independent practitioners who practice in ambulatory, acute and long-term care as primary and/or specialty care providers. This document was produced through the collaborative efforts of members of the American Academy of Nursing Psychiatric Mental Health Substance Abuse Expert Panel. Nursing: Scope and standards of practice (2nd Edition). Citation: Kane, C., (January 31, 2015) \"The 2014 Scope and Standards of Practice for Psychiatric Mental Health Nursing: Key Updates\" OJIN: The Online Journal of Issues in Nursing Vol. This includes providing an orientation to rights and responsibilities in the treatment environment, assisting consumers to select and participate in meaningful treatment and activities that will promote their personal growth, and advocating for the least restrictive measures to maintain safety individually and collectively within the milieu. Professional boundaries. Right to refuse treatment, informed consent, Involuntary commitment and insanity defense, Rights of same-sex couples to adopt, insemination, Reproductive health for the intellectually disabled, Step 1- Assessment (condition/problem, prognosis, socio-demographic information, advance directives, conflict or competing interests), Step 2- Identifying ethical issue (different morally acceptable options, rank the ethical or relevant considerations), Step 3- Goal setting, decision making, and implementation. The six Standards of Practice follow the traditional nursing process, including assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. Resources such as the Psychiatric-Mental Health Nursing: Scope and Standards of Practice (ANA, 2014) and the Essential Psychiatric, Mental Health and Substance Use Competencies for the Registered Nurse (Kane & Brackley, 2012) provide timely and relevant guidance for the psychiatric mental health knowledge, skills and abilities required for current general nursing practice which are foundational for advanced practice in any nursing specialty. PMH nursing has a long tradition of relationship-based care, first conceptualized and defined for nursing by Peplau (1952). Risk or cost-benefit analysis for making ethical decisions. Finally, the PMH nurse engages in advancing the profession; actively collaborates inter-professionally in assessment, treatment, and evaluation; and demonstrates leadership to develop informed policy and improve healthcare systems. Interpersonal relations in nursing. This even further limits consumer access to services from PMH Advanced Practice Registered Nurses (PMH-APRN). Several key factors that emerged for review in the revision process included external documents and priorities currently influencing the United States healthcare system... As with any process to revise, there were many considerations to discuss. The 2014 Psychiatric-Mental Health Nursing: Scope and Standards of Practice is the specialty’s description of competent nursing practice. Washington, DC: The National Academies Press, Kane, C.F & Brackley, M.A (2012). An important companion document to the PMH Scope and Standards is the Essential Psychiatric, Mental Health and Substance Use Competencies for the Registered Nurse (Kane & Brackley, 2012). (SAMHSA, 2006). She believes that nutrition, exercise, sleep, and a healthy living environment are fundamental to mental health, and works to support each individual in creating the healthiest lifestyle. An explicit statement on unethical behavior involving sexual intimacy or activities with consumers or their close associates is provided to denounce any perspective that such behavior would be in any way appropriate (ANA, 2014). The Essentials emphasizes the responsibilities of all registered nurses to promote the mental health of all persons in their care. Responsibility and accountability for self. Personal Relationships Between Group Members and Leaders (e.g., dual/multiple relationships) The National Council of State Boards of Nursing (NCSBN) convened the NCSBN Joint Dialogue Group to address APRN regulation across states. Silver Spring, MD: Author. APNA is not responsible for the content of external websites. Scope and Standards publications serve as a reference document for the relevant specialty, nursing in general, and across roles, including education, research and practice. The NCSBN Joint Dialogue Group developed the licensure, accreditation, certification, and education (LACE) model to provide guidance to state boards of nursing and state legislative bodies regarding APRN scope of practice. The PMH-RN competencies emphasize collaboration with the healthcare consumer, significant others, and interprofessional collaboration in the assessment process. PMH nursing experts have identified a high degree of commonality between the PMH-CNS and the PMH-NP roles. The Essentials document was informed by and supports the PMH Scope and Standards and focuses on PMH nursing competencies relevant to general registered nursing practice. (SMA) 12-4681. The Institute of Medicine (IOM, 2010) report on the future of nursing promoted the role of advanced practice nurses as leaders in policy and practice development and supported the premise that nurses should practice to the full extent of their education and training. Implications for nursing education and a companion resource are discussed. Likewise, attention to the behavior and function of colleagues is within the particular expertise of the PMH nurse. The need to select therapies that are grounded in the best available empirical evidence is paramount to this skill-set. The second edition was published in June 2014. This was the question posed in one of our classes at the Johns Hopkins School of Nursing. When healthcare consumers are unable to control their behavior to the point of being a serious threat to themselves or others, PMH nurses must intervene with the consciousness of the need to balance human rights with professional actions to prevent harm. New York, NY: Oxford University Press. Thank you for your thoughtful and enlightening letter. This document provides the framework for educational preparation of nurses to deliver appropriate and effective care for persons experiencing health challenges, health crises, psychiatric illnesses, and/or addictions. NPs are experts in health promotion and disease prevention. Responsibility and accountability to the consumer, self and healthcare environments are addressed (ANA, 2014). With the growing expense in time and money to educate nurses, most programs are likely to use the NCLEX model to formulate nursing curricula. Summary of Tarasoff Citation: Kane, C., (January 31, 2015) "The 2014 Scope and Standards of Practice for Psychiatric Mental Health Nursing: Key Updates" OJIN: The Online Journal of Issues in Nursing Vol. Essential psychiatric and substance use competencies for the registered nurse: Crucial and complex knowledge, skills, and abilities. (2003). The need to evaluate the outcomes of the intervention using standardized empirical methods is also stressed. Code of ethics. Presently, there are over twenty specialties for which ANA produces a dedicated Scope and Standards of Practice. The NBCC Code of Ethics is also published in an online version to assist counselors and members of the public. The future of nursing: Leading change, advancing health. Significant changes to the second edition of the PMH Scope and Standards included content related to nursing ethics, scope of practice, and standards of practice. Finally, the implementation of the Patient Protection and Affordable Care Act (ACA, 2010) has provided the foundation for universal healthcare coverage with concomitant expectations of improving the quality of care, improving population health and reducing healthcare costs. Regulations which specify the implementation of the law appear in the California Code of Regulations. 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