NR548/ NR 548 Exam 1 (NEW 2026/ 2027) Psychiatric Assessment for the PMHNP |Complete with Questions and Verified Answers| 100% Correct- Chamberlain

NR548/ NR 548 Exam 1 (NEW 2026/ 2027) Psychiatric Assessment for the PMHNP |Complete with Questions and Verified Answers| 100% Correct- Chamberlain Q. Major milestone in the Late 19th Century for mental health ANSWER reform movements led to changes in beliefs about the role of mental asylums in the treatment of mental illness. Focus shifted from restrictive custodial care to treatment. Dr. Edward Cowles created the first organized training school within a hospital for the insane in 1882 Major milestone in the Late 19th Century for mental health Q. Major milestones in the Early 20th Century for mental health ANSWER Early psychiatric nurses were trained by physicians; however, in 1913, Effie Jane Taylor developed the first nurse-organized training course for psychiatric nursing at John's Hopkins Hospital Q. Major Milestones during WWI for mental health ANSWER expanded awareness of mental health disorders and the need for specialized nursing care. Following WWI, the national league for nursing education added "nursing in nervous and mental diseases" to curriculum guides. Q. Major Milestones during WWII ANSWER many potential military recruits deemed unfit for service due to psychiatric concerns, while many veterans experienced combat-related neuropsychiatric conditions. Laura Fitzsimmons recommended standards of training for psychiatric nurses, which led to improved education and standards of care. Q. What year did National Mental Health Act (NMHA) pass? ANSWER 1946 Q. What was the significance of the National Mental Health Act (NMHA) ANSWER psychiatric nursing was now recognized as one of the four core disciplines in psychiatric care and treatment. This act increased funding for psychiatric nursing education programs and contributed to a growth in university-based nursing education. Q. What year did the first graduate program in psychiatric nursing established at Rutgers University? ANSWER 1954 Q. What was the significance of establishing a psychiatric nursing graduate program? ANSWER To prepare nurse therapists. Q. What role was the first advanced nurse practice role? ANSWER Psychiatric mental health clinical nurse specialist (PMHCS) Q. What is the Community Mental Health Centers Act of 1963 ANSWER Allowed for the expansion of the PMHCNS role into community and ambulatory settings as they helped those who had been deinstitutionalized adapt. Q. Who introduced the nurse practitioner role? ANSWER Loretta Ford, RN and Henry Silver, MD. Q. What year was the nurse practitioner role introduced? ANSWER 1965 Q. What year did the ANA first publish the Standards of Psychiatric-Mental Health Nurse Practice? ANSWER 1973 Q. What year did the states grant prescriptive authority to advance practice registered nurse (APRN), adding medication prescribing and management to the traditional therapy role of the psychiatric mental health (PMH) APRN. ANSWER 1980s Q. What year were certification exams for adult and family psychiatric mental health nurse practitioners developed? ANSWER 2000s Q. What year were certification exams retired and why? ANSWER 2015- because psychiatric certification exams were combined to a single Psychiatric Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC). Q. ANA Definition of the PMHNP ANSWER Psychiatric mental health nursing employs the art and science of nursing to promote mental health and address mental disorders, behavioral issues, and comorbid conditions across the lifespan. Q. Professional Certification ANSWER Regulation through education, accreditation, certification, licensure in role and population (APRN, Role, and Population Foci), Q. Specialty ANSWER American Psychiatric Nurses Association-Professional organization Q. Population foci ANSWER Individuals, families, groups with psychiatric mental health problems Q. Role ANSWER Nurse Practitioner (NP) Certified Registered Nurse Anesthetist (CRNA), Certified Nurse Midwife (CNM), Clinical Nurse Specialist (CNS)- Core competencies in population context Q. APRN ANSWER 3 Ps (Advanced-Pathophysiology, pharmacology, and health assessment) Q. Graduate Core ANSWER 2021 American Association of Colleges of Nursing (AACN) Master's Essentials Q. Clinical Practice settings for PMHNP ANSWER Crisis Intervention and psychiatric emergency services Acute inpatient care Intermediate and long-term care facilities Partial hospitalizations Residential services Community based care Assertive Community Treatment (ACT) team Q. Crisis Intervention and Psychiatric Emergency Services ANSWER Occurs in a hospital, psychiatric facility, or community setting. These services focus on psychiatric and substance related emergencies Q. Acute psychiatric inpatient care ANSWER Short term treatment. Occurs in the inpatient setting providing care for acutely ill patients at risk for harming self or others or unable to meet basic needs due to impairment. The focus is crisis stabilization Q. Intermediate and long-term care facilities ANSWER admit clients directly or accept transfers from acute inpatient care. Provide intermediate or long-term care for patients at chronic risk to self or others or unable to function without supervision and support due to mental disorders. They include treatment, habilitation and rehabilitation and may be public, private, or state hospitals operated through the criminal justice system. Q. Partial Hospitalization or Intensive Outpatient Treatment (IOP) ANSWER Provide acute symptom management, intensive treatment, and safe housing for patients who do not require 24-hour medical management or nursing care. These programs can be free standing or step-down facilities. Q. Residential services ANSWER Provide 24-hour care and housing for an extended period. Services include psychoeducation, vocational rehabilitation, and training for activities of daily living. Q. Community-Based Care ANSWER Provided in non-hospital community settings such as mental health clinics, homes, worksites, shelters, crisis centers, senior centers, group homes, or schools. It can also provide care in an integrative primary health care setting. Q. Assertive Community Treatment (ACT) ANSWER team treatment approach to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with severe mental illness (SMI). It provides individualized service 24 hours a day, 7 days a week. Q. Code of Ethics ANSWER Respect for the individual Commitment to the healthcare consumer Advocacy for the healthcare consumer Responsibility and Accountability for Practice Duties to self and others Q. PMHNP APRN Roles ANSWER Primary Care Psychotherapy Psychopharmacological management Case Management Program, system, and policy development management Psychiatric Consultation-Liaison Nursing (PCLN) Clinical Supervision Self Employment Q. PMHNP in Primary Care ANSWER provide healthcare at a basic level rather thana specialized level. address a majority of personal healthcare needs. Healthcare consumers often seek care for mental health concerns at the primary care level for accessibility or to avoid the stigma associated with mental health services. At the primary level, PMHNPs may work in collaboration or consultation with primary care providers or independently provide behavioral health care in an integrated setting. Q. PMHNP in Psychotherapy Setting ANSWER involved formally structured relationship between the therapist (PMHNP) and the health care consumer that applies evidence-based methods to effect negotiated outcomes. PMHNP in Psychopharmacological Management Prescribes or recommends pharmacologic agents and may order and interpret diagnostic and lab tests to assess treatment response or monitor for adverse effects. PMHNP in Case Management Responsible for the coordination of care and related decision-making about mental health care for a client, family, group, or population. PMHNP in Program, system, and policy development management engages in the design, implementation, management, and evaluation of programs, systems, or policies to address the mental health needs of a population at risk for developing mental health problems through prevention, health promotion, identification and reduction of risk factors, screening, and early intervention. PMHNP in Psychiatric Consultation-Liaison Nursing (PCLN) role involves "the assessment, diagnosis, and treatment of behavioral, cognitive, developmental. emotional, and spiritual responses of individuals, families, and significant others with co-occurring physical illness(es) and/or dysfunction." The PCLN often works as a member of an interdisciplinary consultation liaison team. PMHNP as Clinical Supervision Assists other metal health clinicians to evaluate their practice, expand their skills, and meet standards for ongoing peer supervision. Clinical supervision focuses on growth and development rather than performance evaluation. May serves as administration, education, and researchers. PMHNP Self employed provide direct comprehensive mental health services in solo or group private practice setting through contracts with other entities. PMH APRN Specialty Areas Integrative Programs Telehealth Forensic Mental Health Disaster psychiatric mental health nursing Integrative Programs PMHNP functions as part of an interdisciplinary team, providing care and treatment for clients with mental disorders, including substance use disorders and co-occurring medical disorders. Helps improve care coordination between primary care providers and behavioral health. Telehealth PMHNP utilizes telecommunication technology such as telephone consultation, interactive video sessions, and email to deliver care and treatment to clients. Teleheath must be practiced following all applicable laws and regulations. Forensic Mental Health involves the intersection of psychiatric nursing and the criminal justice system. Activities may include working with victims or offenders in the settings including the community, jails, prisons, and state psychiatric hospitals. "Forensic PMH-APRNs perform psychiatric assessments, prescribe, and administer psychiatric medications, educate correctional officers about mental health issues, and provide therapeutic services to witnesses and victims of crimes" Disaster Psychiatric Mental Health Nursing a growing field. As first responders, PMHNPs provide psychological first aid and mental health clinical services in response to environmental and man-made disasters. The PMHNP is providing care to a 29-year-old client who presents with persistent sadness and hopelessness for the last two months. She is having difficulty sleeping and has a decreased appetite. This is the clients first contact with the health care system about her concerns. What practice setting describes this scenario? Primary Care The client is experiencing depressive symptoms. The PMHNP prescribes an SSRI. What Intervention does this describe? Pharmacological Intervention The PMHNP provides the clients with some mindfulness techniques to try at home. What intervention does this describe? Psychotherapy Two weeks after starting the SSRI, the client begins to experience SI and develops a plan to kill herself. A friend brings the clients to the emergency room. The PMHNP meets the client at the emergency room and collaborates with the physician to coordinate care. What practice setting does this describe? Crisis Intervention A client is admitted to the psychiatric and behavioral health unit at the local hospital for a 72-hour observation where the PMHNP works with her team providing treatment. The clients remain hospitalized for a week while her medications are managed. The client attends individual and group therapy sessions. What practice setting does this describe? Acute PMHNP Care Following hospitalization, the client returns home but commutes to a treatment center for 4 hours a day 5 days a week for ongoing therapy, medication management, and psychoeducation. What practice setting does this describe? Partial Hospitalization/Intensive Outpatient Treatment The PMHNP serves as the point of contact person, coordinating the treatment team, which consists of the PMHNP, a social worker, and possibly a psychologist and psychiatrist. What role does the PMHNP play in? Case Management Over the course 2 months, the clients condition improves. She is discharged from intensive outpatient treatment and begins weekly appointments with the PMHNP at the PMHNPs clinic. What practice setting does this describe? Community-Based Care A global pandemic limits face to face mental health visits, the PMHNP determines that the client requires ongoing mental health treatment. The PMHNP arranges to meet with the client via weekly interactive video sessions. What specialty practice setting does this describe? Telehealth The PMHNP owns the private practice that is providing services to the client. What practice setting does this describe? Self-Employment Respect for the Individual The PMHNP approaches professional relationships with compassion, caring, and respect, acknowledging the dignity and worth of each individual. Helps instill hope and empowers those with PMH disorders Affirms the worth and dignity of those with PMH disorders by advocating to overcome negative stigmas towards PMH diagnoses to ensure access to care. Commitment to the Healthcare Consumer The PMHNPs primary commitment is to the individual, family, group, or community who is the health care consumer. Recognizes and addresses personal attitudes and behaviors that could interfere with meeting ethical guidelines for care. Maintains proper boundaries. Participates in self, peer, and supervisory oversight of clinical skills and practice. Recognizes that hose with brain based mental health disorders may have maladaptive coping behaviors, which impact the individual, family, and society. Maladaptive behavior may continue in spite of negative consequences. Behavioral change may involve setbacks. Aware of the need to balance human rights with safety, including coercive measures or forced treatment when individuals are unable to maintain their own safety. Advocacy for the health care consumer PMHNP recognizes the vulnerability, complexity, and legal considerations associated with providing care to those with PMH disorders. Strives to protect the rights, health, and safety of clients. Maintains confidentiality according to HIPPA requirements and professional boundaries in all interactions. Recognizes the power differential in the therapeutic relationship and understands that any sort of sexual activity or intimacies with current clients, their close family members, guardians, or significant others is unethical. Responsibility and Accountability for Practice Must be responsible and accountable for their own practice. Must be able to articulate competencies and be aware of scope of practice and professional standards guiding their own practice. Must understand the cope of other team members' practice in order to delegate appropriately. Duties to self and others Owes the same duties to self as to others. Accords moral with and dignity to oneself and others, including colleagues. Is committed to practicing self-care, managing stress, and maintaining supportive relationships to meet personal needs outside of therapeutic relationships. Identifies and addresses moral distress. Contributions to Healthcare Environments Helps maintain and improve healthcare environments and conditions of employment Recognizes signs and symptoms of psychiatric disorders int he workplace and reports peer observations or concerns to leadership. Helps address problems faced by colleagues that may impact client safety or violate public trust, including substance abuse. Advancement of the Nursing Profession Contributes to advancing the profession through practice, education, administration, and knowledge development. Maintains knowledge of and applies evidence-based practice guidelines, including risk assessment and management Participates in continuous quality improvement. Pursues continuing education Collaboration to Meet Health Needs Promotes community, national, and international efforts to meet health needs through collaboration with other healthcare professionals. Engages in partnerships with other specialty nurses, government agencies, professional nursing organizations, and mental health organizations to promote prevention, treatment, and recovery. Promotion of the Nursing Profession Advocates for environments that respect human rights, customs, and spiritual beliefs of individuals, families, and communities. Engages in interactions and collaborations to articulate nursing values and maintain the integrity of the profession Participates in policy development and implementation that recognizes PMH disorders as treatable and ensures that nursing care is delivered with respect to human needs and values without prejudice. Strategies to eliminate disparities in behavioral health include: Increasing the number minority providers. Improving access to services through telehealth and other technologies Examining and understanding the social determinants of health in underserved communities. Using cultural humility to enhance the communication in populations served Increasing the use of Primary Care Behavioral Health (PCBH) integrative practice clinics that provide medical and behavioral health services in one location. What does the competency about "anticipatory guidance" mean? Explore: ANA Standards and Scope: Standard 5B: Health Teaching & PromotionAn educated professional nurse is aware of normal developmental and situational threats to wellness and can educate healthcare consumers to avoid them. Example: Moving a toddler from a crib to a bed can prevent injury associated with climbing out of the crib at that developmental age (ANA, 2015a, p. 65). What do the Standards explain the art of nursing is based on? Explore: ANA Standards and Scope: Scope of Nursing PracticeThe art of nursing is based on caring and respect for human dignity (ANA, 2015a, p. 11). What is the fundamental principle of and attitude that the professional nurse must have as outlined in Provision 1? Explore: ANA Code of Ethics: Provision 1Provision 1 explains, "the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person" (ANA, 2015b, p. 1). How should the nurse respond to the discovery of human trafficking in his or her practice? Explore: ANA Code of Ethics: Provision 8Nurses must "bring attention to human rights violations in all settings and contexts. . . . The nursing profession must respond when these violations are encountered" (ANA, 2015b, p. 33). Psychiatric-mental health nursing employs the art and science of nursing to promote mental health and address mental disorders, behavioral issues, and comorbid conditions across the lifespan PMHNP & PMH CNS are considered PMH APRNs. Their roles are essentially synonymous in purpose, essential functions, settings, and qualifications. Both APRN roles have essential roles in integrating physical and mental health needs; and both APRNS work in inpatient and outpatient settings. The promotion of mental health in society is a crucial element of the PMH-APRN role, as is collaboration with and referral to other health professionals as appropriate. (LACE) Consensus Model for APRN Regulation has provided recommendations for licensure, accreditation, certification, and education (LACE) pertaining to all APRN practice. PMHNP certification exam criteria is set by the American Nurses Credentialing Center (ANCC). APRN Recommendations Pyramid Pyramid (Top to bottom) Specialty Population foci Role APRN Graduate Core Professional Certification Regulation through education, accreditation, certification, licensure in role and population (APRN, Role, and Population foci) Competencies [Specialty] American Psychiatric Nurses Association - Professional Organization [Population foci] Individuals, families, groups with psychiatric-mental health problems [Role] Nurse Practitioner (NP), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse Midwife (CNM), Clinical Nurse Specialist (CNS) - Core competencies in population context [APRN] 3 Ps (Advanced - Pathophysiology, Pharmacology, and Health Assessment) [Graduate Core] 2021 American Association of Colleges of Nursing (AACN) Master's Essentials American Psychiatric Nurses Association (APNA, 2020) and ANCC (2019) recommendations One entry educational focus: PMHNP with preparation across the lifespan, addressing mental health promotion and mental illness diagnosis and treatment. American Psychiatric Nurses Association (APNA, 2020) and ANCC (2019) recommendations Currently licensed and certified PMHNPs who demonstrate competency by continuing re-certification are permitted to continue practicing under their current license and certification. American Psychiatric Nurses Association (APNA, 2020) and ANCC (2019) recommendations Didactic curriculum content to address assessment and diagnosis, age-specific interventions, and mental health needs and issues across the lifespan, including includes the three Ps (pathophysiology, pharmacology, and physical assessment) and PMHNP-specific content, including psychotherapeutic modalities (the fourth P). American Psychiatric Nurses Association (APNA, 2020) and ANCC (2019) recommendations During supervised practice, students provide psychiatric mental health services across the lifespan, including: Clinical experience in various settings encouraged to promote integrated and collaborative healthcare. Minimum number of clinical hours sufficient for entry-level competence across the lifespan. Graduates who meet exam eligibility criteria register for the certification examination for Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC) which is offered by the ANCC. After certification and state credentialing, graduates will be able to provide psychiatric mental health advanced practice services across the lifespan. Clinical Practice Settings Crisis intervention and psychiatric emergency services occur in a hospital, psychiatric facility or community setting. These services focus on psychiatric and substance-related emergencies. Acute inpatient care is a short-term treatment. It occurs in the inpatient setting providing care for acutely ill clients at risk for harming self or others or unable to meet basic needs due to impairment. The focus is crisis stabilization. Intermediate and long-term care may admit clients directly or accept transfers from acute inpatient care. They provide intermediate or long-term care for clients at chronic risk to self or others or unable to function without supervision and support due to mental disorders. They include treatment, habilitation and rehabilitation and may be public, private, or state hospitals operated through the criminal justice system. Partial hospitalization and intensive outpatient treatment (IOP) provide acute symptom management, intensive treatment, and safe housing for clients who do not require 24-hour medical management or nursing care. These programs can be free standing or step-down facilities. Residential services provide 24-hour care and housing for an extended period. Services include psychoeducation, vocational rehabilitation, and training for activities of daily living. Community-based care is provided in non-hospital community settings such as mental health clinics, homes, worksites, shelters, crisis centers, senior centers, group homes, or schools. It can also provide care in an integrative primary health care setting. Assertive Community Treatment (ACT) team treatment approach to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with severe mental illness (SMI). It provides individualized service 24 hours a day, 7 days a week. Primary care Primary care settings provide healthcare at a basic level rather than a specialized level. Primary care providers address a majority of personal healthcare needs. Healthcare consumers often seek care for mental health concerns at the primary care level for accessibility or to avoid the stigma associated with mental health services. At the primary care level, PMHNPs may work in collaboration or consultation with a primary care provider or independently provide behavioral health care in an integrated setting. Psychotherapy Psychotherapy involves a formally structured relationship between the therapist (PMHNP) and the healthcare consumer that applies evidence-based methods to effect negotiated outcomes. Psychopharmacological management The PMHNP prescribes or recommends pharmacologic agents and may order and interpret diagnostic and lab tests to assess treatment response or monitor for adverse effects. Case management The PMHNP is responsible for the coordination of care and related decision-making about mental health care for a client, family, group, or population. Program, system, and policy development management: The PMHNP engages in the design, implementation, management, and evaluation of programs, systems, or policies to address the mental health needs of a population at risk for developing mental health problems through prevention, health promotion, identification and reduction of risk factors, screening, and early intervention. Psychiatric Consultation-Liaison Nursing (PCLN) The role involves "the assessment, diagnosis, and treatment of behavioral, cognitive, developmental, emotional, and spiritual responses of individuals, families, and significant others with co-occurring [actual or potential] physical illness(es) and/or dysfunction" (ANA et al., 2022, p.42). The PCLN often works as a member of an interdisciplinary consultation-liaison team. Clinical Supervision The PMHNP assists other mental health clinicians to evaluate their practice, expand their skills, and meet standards for ongoing peer supervision. Clinical supervision focuses on growth and development rather than performance evaluation.Administration, Education, and Research Practice: PMHNP may serve as administrators, educators, and researchers. Self-Employment PMHNPs provide direct comprehensive mental health services in solo or group private practice settings or through contracts with other entities. Integrative programs The PMHNP functions as part of an interdisciplinary team, providing care and treatment for clients with mental disorders, including substance use disorders and co-occurring medical disorders. Integrative care helps improve care coordination between primary care providers and behavioral health. Telehealth The PMHNP utilizes telecommunication technology such as telephone consultation, interactive video sessions, and e-mail to deliver care and treatment to clients. Telehealth must be practiced following all applicable laws and regulations (ANA et al., 2022). Forensic mental health Forensic mental health involves the intersection of psychiatric nursing and the criminal justice system. Activities may include working with victims or offenders in settings including the community, jails, prisons, and state psychiatric hospitals. "Forensic PMH-APRNs perform psychiatric assessments, prescribe and administer psychiatric medications, educate correctional officers about mental health issues, and provide therapeutic services to witnesses and victims of crime" (ANA et al., 2022, p. 48) Disaster psychiatric-mental health nursing Disaster psychiatric-mental health nursing is a growing field. As first responders, PMHNPs provide psychological first aid and mental health clinical services in response to environmental and man-made disasters. The PMHNP Works with Individuals Families Groups Communities Organizations The PMHNP Collaborates with Physicians and other advanced practiced providers Psychiatrists Psychologists RNs Social Workers Spiritual Care Therapists Counselors Primary Care The PMHNP (Psychiatric Mental Health Nurse Practitioner) is providing care to a 29-year-old client who presents with persistent sadness and hopelessness for the last two months. She is having difficulty sleeping and has a decreased appetite. This is the client's first contact with the healthcare system about her concerns. [Rationale: This is the client's initial contact with the healthcare system about her concerns]. Pharmacologic Intervention The client has experienced depressive symptoms. The PMHNP prescribes a selective serotonin reuptake inhibitor (SSRI). [Rationale: The PMHNP is prescribing psychopharmacotherapy for the client]. Psychotherapy The PMHNP provides the client with some mindfulness techniques to try at home. [Rationale: The PMHNP is utilizing a psychotherapeutic approach to help the client gain insight]. Crisis Intervention Two weeks after starting on the SSRI, the client begins to experience suicidal ideations and develops a plan to kill herself. A friend brings the client to the emergency room. The PMHNP meets the client at the emergency room and collaborates with the physician to coordinate care. [Rationale: Suicidal ideation with a plan is a psychiatric emergency requiring immediate intervention]. Acute PMHNP Care The client is admitted to the psychiatric and behavioral health unit at the local hospital for a 72-hour observation where the PMHNP works with her team providing treatment. The client remains hospitalized for a week while her medications are managed. The client attends individual and group therapy sessions. [Rationale: Acute inpatient care occurs in an intensive hospital or psychiatric facility setting]. Partial Hospitalization/Intensive Outpatient Treatment Following hospitalization, the client returns home but commutes to a treatment center for 4 hours a day 5 days per week for ongoing therapy, medication management, and psychoeducation [Rationale: Partial Hospitalization/Intensive Outpatient Treatment occurs when a client receives intensive therapy on an outpatient basis, often used when a client does not require 24-hour care but still require intense treatment]. Case Management The PMHNP serves as the point of contact person, coordinating the treatment team, which consists of the PMHNP, a social worker, and possibly a psychologist and psychiatrist [Rationale: Case management involves oversight and/or coordination of care]. Community-Based Care Over the course of 2 months, the client's condition improves. She is discharged from intensive outpatient treatment and begins weekly appointments with the PMHNP at the PMHNP's clinic [Rationale: Community-based care is provided in a non-hospital community setting]. Telehealth A global pandemic limits face-to-face mental health visits, the PMHNP determines that the client requires ongoing mental health treatment. The PMHNP arranges to meet with the client via weekly interactive video sessions [Rationale: Telehealth services utilize telecommunication technology to deliver treatment to clients]. Self-Employment The PMHNP owns the private practice that is providing services to the client [Rationale: The PMHNP is providing direct services through private practice]. Code of Ethics provides guidance to nurses about ethical behavior and mandates a minimum standard of practice. There are nine provisions within the Code for which specific applications have been developed for PMHNP practice Code of Ethics for PMHNP fundamental values commitments boundaries pertaining to duty and loyalty beyond the relationship with the healthcare consumer to explore collaboration and duties to the profession. Respect for the Individual approaches professional relationships with compassion, caring, and respect, acknowledging the dignity and worth of each individual. helps instill hope and empowers those with PMH disorders. affirms the worth and dignity of those with PMH disorders by advocating to overcome negative stigmas towards PMH diagnoses to ensure access to care. Commitment to the Healthcare Consumer recognizes and addresses personal attitudes and behaviors that could interfere with meeting ethical guidelines for care. maintains proper boundaries. participates in self, peer, and supervisory oversight of clinical skills and practice. recognizes that those with brain-based mental health disorders may have maladaptive coping behaviors, which impact the individual, family, and society. Maladaptive behavior may continue in spite of negative consequences. Behavioral change may involve setbacks. is aware of the need to balance human rights with safety, including coercive measures or forced treatment when individuals are unable to maintain their own safety. Advocacy for the Healthcare Consumer strives to protect the rights, health, and safety of clients. maintains confidentiality according to Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements and professional boundaries in all interactions (face-to-face, telehealth, electronic record, social media). recognizes the power differential in the therapeutic relationship and understands that any sort of sexual activity or intimacies (physical, verbal, electronic, social media) with current clients, their close family members, guardians, or significant others is unethical. Responsibility and Accountability for Practice must be responsible and accountable for their own practice. must be able to articulate competencies and be aware of scope of practice and professional standards guiding their own practice. must understand the scope of other team members' practice in order to delegate appropriately. Duties to Self and Others owes the same duties to self as to others. accords moral worth and dignity to oneself and others, including colleagues. is committed to practicing self-care, managing stress, and maintaining supportive relationships to meet personal needs outside of therapeutic relationships. identifies and addresses moral distress. Contributions to Healthcare Environments helps maintain and improve healthcare environments and conditions of employment. recognizes signs and symptoms of psychiatric disorders in the workplace and reports peer observations or concerns to leadership. helps address problems faced by colleagues that may impact client safety or violate public trust, including substance abuse. Advancement of the Nursing Profession contributes to advancing the profession through practice, education, administration, and knowledge development. maintains knowledge of and applies evidence-based practice guidelines, including risk assessment and management. participates in continuous quality improvement. pursues continuing education. Collaboration to Meet Health Needs promotes community, national, and international efforts to meet health needs through collaboration with other healthcare professionals. engages in partnerships with other specialty nurses, government agencies, professional nursing organizations, and mental health organizations to promote prevention, treatment, and recovery. Promotion of the Nursing Profession advocates for environments that respect human rights, customs, and spiritual beliefs of individuals, families, and communities. engages in interactions and collaborations to articulate nursing values and maintain the integrity of the profession. participates in policy development and implementation that recognizes PMH disorders as treatable and ensures that nursing care is delivered with respect to human needs and values without prejudice. Ethical Principle 1 Tile: Respect for the Individual Scenario Person A: "I can't believe you deal with these people every day. Schizophrenics would drive ME crazy!" PMHNP: "Actually, schizophrenia is a chronic treatable disease, much like diabetes or other physical illnesses. Clients who have mental illness deserve compassion and care." Rationale Respect for the individual affirms the worth and dignity of those with PMH disorders by advocating to overcome negative stigmas towards PMH diagnoses to ensure access to care. Ethical Principle 2 Tile: Commitment to the Healthcare Consumer Scenario The client presents to the emergency department with hallucinations and is threatening self-harm. The PMHNP signs an involuntary admission order for emergent psychiatric care. Rationale The PMHNP demonstrates a commitment to the healthcare consumer by balancing the client's human rights with safety, including coercive measures when the client was unable to maintain their own safety. Ethical Principle 3 Tile: Responsibility and Accountability for Practice Scenario The PMHNP has overbooked her sessions today, so she asks the RN who works in her office to conduct one of her phone therapy sessions today. Rationale This is an unethical scenario. The PMHNP must understand the scope of other team members' practice in order to delegate appropriately. Conducting a counseling session is outside of the RN's scope of practice. Ethical Principle 5 Tile: Duties to Self and Others Scenario The PMHNP takes time for daily meditation to improve mindfulness and ease stress. Rationale The PMHNP is committed to practicing self-care, managing stress, and maintaining supportive relationships to meet personal needs outside of therapeutic relationships. Ethical Principle 6 Tile: Contributions to Healthcare Environments Scenario A PMHNP discovers her colleague is diverting scheduled medications to self-medicate anxiety. The PMHNP reports the concerns to the colleague's supervisor. Rationale The PMHNP recognizes signs/symptoms of psychiatric disorders in the workplace reporting peer observations to leadership. The PMHNP helps address problems faced by colleagues that impact client safety or violate public trust, including substance abuse. Ethical Principle 7 Tile: Advancement of the Nursing Profession Scenario The PMHNP gives a presentation at a national conference on best practices in depression treatment. Rationale The PMHNP contributes to advancing the profession through practice, education, administration, and knowledge development. Ethical Principle 8 Tile: Collaboration to meet health needs Scenario The PMHNP is a member of the ANA and NAMI and regularly participates in workgroups that seek to expand access to care for healthcare consumers with PMH disorders. Rationale The PMHNP promotes community, national, and international efforts to meet health needs through collaboration with other healthcare professionals to promote prevention, treatment, and recovery. Ethical Principle 9 Tile: Promotion of the Nursing Profession Scenario A PMHNP speaks at a school board meeting about the need develop policies to expand mental health services for underserved students. Rationale The PMHNP participates in policy development and implementation that recognizes PMH disorders as treatable and ensures that nursing care is delivered with respect to human needs and values without prejudice. Disparities in Mental Health Treatment Minority populations, and most especially minority individuals with severe mental illness such as schizophrenia or bipolar disorder, face barriers to accessing healthcare, including behavioral health services. Additional health disparities or differences in mental health outcomes in racial and ethnic minorities include the reduced utilization of necessary mental healthcare, decreased quality of care, and a lack of adherence in treatment services Minorities and ethnic groups have also shown poorer outcomes related to delay or avoidance of care, due to a mistrust of providers. Strategies to eliminate disparities in behavioral health increasing the number of minority providers improving access to services through telehealth and other technologies examining and understanding the social determinants of health in underserved communities using cultural humility to enhance communication in populations served increasing the use of Primary Care Behavioral Health (PCBH) integrative practice clinics that provide medical and behavioral health services in one location (Hills & Hills, 2019) Social Determinants of Health the conditions in which people are born, grow, live, work, and age. These conditions are influenced by economics, political influence, and resources at the global, national, and local levels. Health literacy the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others Health literacy can manifest as limited engagement or participation in care, miscommunication, or a lack of compliance with or inaccurate understanding of the treatment plan Cultural humility and respect requisites for effective communication across all populations, and most especially with racial and ethnic minority groups Cultural humility emphasizes self-evaluation, openness, and sensitivity toward another cultural competence is characterized by gaining knowledge about another culture to provide competent care Person Reduced ability to maintain physical health Increased risk of cardiovascular and metabolic disease Increased risk for unemployment Decreased life expectancy, 11-30 years. Family Increased stress Caregiver fatigue Community Mental health and substance abuse disorders are involved in 1 of every 8 ED visits by adults in U.S. Mood disorders are the most common cause of hospitalization for those under 45 years of age in U.S. Over $190 billion lost earnings Increased risk for homelessness, incarceration World Depression and anxiety cost global economy $1 trillion in lost productivity each year Depression is the leading cause of disability worldwide Disparities in mental healthcare have existed for decades and result in poor outcomes and a lack of engagement in services. Strategies to decrease disparities in behavioral health include cultural competence and cultural humility, increased access to mental health services, and an increase in the number of minority providers Factors influencing health include social determinants including economics, education, access to healthcare services, environmental variables, as well as political influence and resources at global, national and local levels which contribute to health, functioning, and quality-of-life outcomes and risks. Health literacy, cultural competence, and cultural humility key to obtaining positive outcomes for ethnic and minority populations.