Psychiatric-Mental Health Nursing: Scope and Standards of Practice
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While this foundational volume is primarily for those directly involved with psychiatric–mental health nursing practice, education and research, other nursing and allied health care providers, researchers and scholars will find value in this content.
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Psychiatric-Mental Health Nursing - American Nurses Association
American Nurses Association
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Published by Nursesbooks.org
The Publishing Program of ANA
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The American Psychiatric Nurses Association (APNA), the International Society of Psychiatric-Mental Health Nurses (ISPN), and the American Nurses Association (ANA) are national professional associations. This joint publication, Psychiatric Mental Health Nursing: Scope and Standards of Practice, 2nd Edition, reflects the thinking of the practice specialty of psychiatric-mental health nursing on various issues and should be reviewed in conjunction with state board of nursing policies and practices. State law, rules, and regulations govern the practice of nursing, while Psychiatric Mental Health Nursing: Scope and Standards of Practice, 2nd Edition guides psychiatric-mental health nurses in the application of their professional skills and responsibilities.
The American Psychiatric Nurses Association (APNA) is your resource for psychiatric-mental health nursing. A professional organization with more than 9,000 members, we are committed to the practice of psychiatric mental health (PMH) nursing, health and wellness promotion through identification of mental health issues, prevention of mental health problems and the care and treatment of persons with psychiatric disorders. To facilitate professional advancement, APNA provides quality psychiatric-mental health nursing continuing education; a wealth of resources for established, emerging, and prospective PMH nurses; and a community of dynamic collaboration. APNA champions psychiatric-mental health nursing and advocates for mental health care through the development of positions on key issues, the widespread dissemination of current knowledge and developments in PMH nursing, and collaboration with consumer groups, to promote evidence-based advances in recovery-focused assessment, diagnosis, treatment, and evaluation of persons with mental illness and substance use disorders. For more information: www.apna.org.
The International Society of Psychiatric-Mental Health Nurses exists to unite and strengthen the presence and the voice of specialty psychiatric-mental health nursing while influencing healthcare policy to promote equitable, evidence-based and effective treatment and care for individuals, families, and communities. http://www.ispn-psych.org
The American Nurses Association is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent/state nurses associations and its organizational affiliates. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on healthcare issues affecting nurses and the public.
Copyright © 2014 American Nurses Association, American Psychiatric Nurses Association and International Society of Psychiatric-Mental Health Nurses. All rights reserved. Reproduction or transmission in any form is not permitted without written permission of the American Nurses Association (ANA). This publication may not be translated without written permission of ANA. For inquiries or to report unauthorized use, email copyright@ana.org
ISBN-13: 978-1-55810-557-7 SAN: 851-3481 06/2014
First printing: June 2014
Contents
Contributors
Preface
Scope of Practice of Psychiatric-Mental Health Nursing
Origins of the Psychiatric-Mental Health Advanced Practice Nursing Role
Current Issues and Trends
Prevalence of Mental Disorders across the Lifespan: Critical Facts
Substance Abuse Disorders: Prevalence and Comorbidities
Children and Older Adults
Disparities in Mental Health Treatment
Opportunities to Partner with Consumers for Recovery and Wellness
Structure of a Person-Centered, Recovery-Oriented Public Health Care Model: Unifying Efforts
Prevention: The Promise of Building Resiliency
Screening and Early Intervention
Integrated Care
Technology of a Public Health Model of Mental Health Care
Emerging Models of Acute Care
Workforce Requirements for a Public Health Model of Mental Health Care
Psychiatric-Mental Health Nursing Leadership in Transforming the Mental Health System
Definition of Psychiatric-Mental Health Nursing
Phenomena of Concern for Psychiatric-Mental Health Nurses
Psychiatric-Mental Health Nursing Clinical Practice Settings
Crisis Intervention and Psychiatric Emergency Services
Acute Inpatient Care
Intermediate and Long-Term Care
Partial Hospitalization and Intensive Outpatient Treatment
Residential Services
Community-Based Care
Assertive Community Treatment (ACT)
Levels of Psychiatric-Mental Health Nursing Practice
Psychiatric-Mental Health Registered Nurse (PMH-RN)
Psychiatric-Mental Health Advanced Practice Registered Nurse (PMH-APRN)
Consensus Model: LACE (Licensure, Accreditation, Certification and Education) and APRN Roles
Primary Care
Psychotherapy
Psychopharmacological Interventions
Case Management
Program, System, and Policy Development and Management
Psychiatric Consultation–Liaison Nursing (PCLN)
Clinical Supervision
Administration, Education, and Research Practice
Self-Employment
Other Specialized Areas of Practice
Integrative Programs
Telehealth
Forensic Mental Health
Disaster Psychiatric-Mental Health Nursing
Ethical Issues in Psychiatric-Mental Health Nursing
Respect for the Individual
Commitment to the Healthcare Consumer
Advocacy for the Healthcare Consumer
Responsibility and Accountability for Practice
Duties to Self and Others
Contributions to Healthcare Environments
Advancement of the Nursing Profession
Collaboration to Meet Health Needs
Promotion of the Nursing Profession
Standards of Psychiatric-Mental Health Nursing Practice
Standards of Practice for Psychiatric-Mental Health Nursing
Standard 1. Assessment
Standard 2. Diagnosis
Standard 3. Outcomes Identification
Standard 4. Planning
Standard 5. Implementation
Standard 5A. Coordination of Care
Standard 5B. Health Teaching and Health Promotion
Standard 5C. Consultation
Standard 5D. Prescriptive Authority and Treatment
Standard 5E. Pharmacological, Biological, and Integrative Therapies
Standard 5F. Milieu Therapy
Standard 5G. Therapeutic Relationship and Counseling
Standard 5H. Psychotherapy
Standard 6. Evaluation
Standards of Professional Performance for Psychiatric-Mental Health Nursing
Standard 7. Ethics
Standard 8. Education
Standard 9 Evidence-Based Practice and Research
Standard 10. Quality of Practice
Standard 11. Communication
Standard 12. Leadership
Standard 13. Collaboration
Standard 14. Professional Practice Evaluation
Standard 15. Resource Utilization
Standard 16. Environmental Health
Glossary
References
Abbreviations
Appendix A. Psychiatric-Mental Health Nursing: Scope and Standards of Practice (2007)
Index
Contributors
APNA and ISPN Joint Task Force Members
Kris A. McLoughlin, DNP, APRN, PMHCNS-BC, CADC-II, FAAN—APNA Co-Chair
Catherine F. Kane, PhD, RN, FAAN—ISPN Co-Chair
Kathleen Delaney, PhD, PMH-NP, FAAN
Sara Horton-Deutsch, PhD, APRN, PMHCNS, RN, ANEF
Amanda Du Wick, BSN, RN-BC
Kay Foland, PhD, RN, PMHNP-BC, PMHCNS-BC, CNP
Susan L.W. Krupnick MSN, PMHCNS-BC, ANP-BC, C-PREP
Sue M. Odegarden, MA, MS, BSN
Bethany J. Phoenix, PhD, RN, CNS
Peggy Plunkett, MSN, APRN, PMHCNS-BC
Diane Snow, PhD, RN, PMHNP-BC, CARN, FAANP
Victoria Soltis-Jarrett, PhD, PMHCNS/NP-BC
Christine Tebaldi, MSN, APRN, PMHNP-BC
Edilma L. Yearwood, PhD, PMHCNS-BC, FAAN
ANA Staff
Carol J. Bickford, PhD, RN-BC, CPHIMS—Content editor
Maureen E. Cones, Esq.—Legal counsel
Yvonne Daley Humes, MSA—Project coordinator
Eric Wurzbacher, BA—Project editor
About the American Psychiatric Nurses Association
The American Psychiatric Nurses Association (APNA) is your resource for psychiatric-mental health nursing. A professional organization with more than 9,000 members, we are committed to the practice of psychiatric-mental health (PMH) nursing, health and wellness promotion through identification of mental health issues, prevention of mental health problems and the care and treatment of persons with psychiatric disorders. To facilitate professional advancement, APNA provides quality psychiatric-mental health nursing continuing education; a wealth of resources for established, emerging, and prospective PMH nurses; and a community of dynamic collaboration. APNA champions psychiatric-mental health nursing and advocates for mental health care through the development of positions on key issues, the widespread dissemination of current knowledge and developments in PMH nursing, and collaboration with consumer groups, to promote evidence-based advances in recovery-focused assessment, diagnosis, treatment, and evaluation of persons with mental illness and substance use disorders. For more information: www.apna.org.
About the International Society of Psychiatric-Mental Health Nurses
The International Society of Psychiatric-Mental Health Nurses (ISPN) exists to unite and strengthen the presence and the voice of specialty psychiatric-mental health nursing while influencing healthcare policy to promote equitable, evidence-based and effective treatment and care for individuals, families, and communities. http://www.ispn-psych.org
About the American Nurses Association
The American Nurses Association (ANA) is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent/state nurses associations and its organizational affiliates. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.
About Nursesbooks.org, The Publishing Program of ANA
Nursesbooks.org publishes books on ANA core issues and programs, including ethics, leadership, quality, specialty practice, advanced practice, and the profession’s enduring legacy. Best known for the foundational documents of the profession on nursing ethics, scope and standards of practice, and social policy, Nursesbooks.org is the publisher for the professional, career-oriented nurse, reaching and serving nurse educators, administrators, managers, and researchers as well as staff nurses in the course of their professional development.
Preface
In 2011, the American Psychiatric Nurses Association (APNA) and the International Society of Psychiatric-Mental Health Nurses (ISPN) appointed a joint task force to begin the review and revision of Psychiatric-Mental Health Nursing: Scope and Standards of Practice, published in 2007 by the American Nurses Association (ANA07). The taskforce members were comprised of psychiatric-mental health nursing clinical administrators, staff nurses, nursing faculty, and psychiatric advanced practice registered nurses working in psychiatric facilities and the community. This taskforce convened in July 2011 to conduct an analysis of the existing document and begin crafting sections incorporating the results of the analysis.
In accordance with ANA recommendations, this document reflects the template language of the most recent publication of ANA nursing standards, Nursing: Scope and Standards of Practice, Second Edition (ANA10). In addition, the introduction has been revised to highlight the leadership role of psychiatric-mental health nurses in the transformation of the mental health system as outlined in Achieving the Promise, the President’s New Freedom Commission Report on Mental Health (United States Department of Health and Human Services03) and the Institute of Medicine’s Report (IOM) The Future of