NR548 Psychiatric Assessment
Exam 1 week 1 and 2 study guide September- October Summer 2025
Scope of Psychiatric Mental Health Nursing Practice: Advanced Practice Competencies
Origins of the PMHNP Role
The field of psychiatric-mental health nursing began in the late 19th century when there was a
societal shift in the perception of the purpose of mental asylums from custodial care to medical
and social treatment for mental illness. In the 1950s, Rutgers University awarded its first
graduate degree in psychiatric-mental health nursing. The psychiatric mental health clinical
nurse specialist was the first master's prepared advanced practice nursing role. The role of the
psychiatric and mental health nurse practitioner (PMHNP) was introduced in the 1990s and has
evolved over time to incorporate a person-centered, biopsychosocial model of care.
1 Late 19th Century In the late 19th century, 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.
2 Early 20th CenturyEarly psychiatric nurses were trained by physicians; however, in 1913,
Effie Jane Taylor developed the first nurse-organized training course for psychiatric nursing
at Johns Hopkins Hospital.
3 World War I (WWI) The World Wars 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.
4 World War II (WWII) In WWII, 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.
5 1946 With the passage of the National Mental Health Act (NMHA) of 1946,
psychiatric nursing was recognized as one of the four core disciplines in psychiatric care
and treatment (American Nurses Association [ANA] et al., 2022). The act increased funding
for psychiatric nursing education programs and contributed to a growth in university-based
nursing education.
,6 1954 In 1954, the first graduate program in psychiatric nursing was established at
Rutgers University by Hildegarde Peplau to prepare nurse therapists. The first advanced
practice nursing role was the psychiatric-mental health clinical nurse specialist (PMHCNS)
role.
7 1963 The 1950s brought a transition towards deinstitutionalization in care for
those with mental illnesses, which led to an increase in the number of psychiatric clients
receiving care in the community rather than hospitals. The Community Mental Health Centers
Act of 1963 allowed for the expansion of the PMHCNS role into community and ambulatory
settings as they helped those who had been deinstitutionalized adapt (ANA et al., 2022).
8 1965 Loretta Ford, RN and Henry Silver MD introduce the nurse practitioner role.
9 1973 ANA first published Standards of Psychiatric-Mental Health Nursing Practice
in 1973.
10 1980s Over time, research turned towards the neurobiological basis for mental
illness. With advances in psychotropic medications, psychopharmacology has played an
increased role in treatment. In the 1980s, states began to grant prescriptive authority to
advanced practice registered nurse (APRN), adding medication prescribing and management
to the traditional therapy role of the psychiatric mental health (PMH) APRN.
11 2000 , Certification exams for adult and family psychiatric mental health nurse
practitioners (PMHNPs) were developed. These exams were retired in 2015 when psychiatric
certification exams were combined into a single Psychiatric-Mental Health Nurse
Practitioner (Across the Lifespan) Certification (PMHNP-BC).
12 Present Current trends in care focus on integrated treatment of those with co-
occurring medical and psychiatric diagnoses and co-occurring psychiatric and substance
use disorders, leading to a need to add content in advanced health assessment,
pharmacology, pathophysiology, and the diagnosis of psychiatric illness to graduate
psychiatric nursing curricula. Primary care has become the point of entry to psychiatric care
for many clients.
PMHNPs are helping to address the growing need for primary mental health services and
mental illness prevention. Though the number of advanced practice psychiatric nurses has
increased, there are still limitations in access for many clients, which has led to disparities in
mental health treatment.
ANA Definition of the PMHNP/Clinical Practice Settings/PMHNP Practice Focus
, 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. The American Nurses Association (ANA et al., 2022) provides further guidance for
advanced practice registered nurses practicing in the psychiatric-mental health specialty area.
According to the ANA (ANA et al., 2022), “Both PMHNPs and psychiatric mental health clinical
nurse specialists (PMH CNS)" are considered PMH APRNs. Their roles are essentially similar in
purpose, functions, settings, and qualifications. Both integrate physical and mental health and
work in inpatient and outpatient settings. Promoting mental health and collaborating with other
health professionals are key aspects of the PMH-APRN role.
The 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
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
Recommendations
According to the American Psychiatric Nurses Association (APNA, 2020) and ANCC (2019)
recommendations include:
• One entry educational focus: PMHNP with preparation across the lifespan,
addressing mental health promotion and mental illness diagnosis and
treatment.
• Currently licensed and certified PMHNPs who demonstrate competency by
continuing re-certification are permitted to continue practicing under their
current license and certification.
Exam 1 week 1 and 2 study guide September- October Summer 2025
Scope of Psychiatric Mental Health Nursing Practice: Advanced Practice Competencies
Origins of the PMHNP Role
The field of psychiatric-mental health nursing began in the late 19th century when there was a
societal shift in the perception of the purpose of mental asylums from custodial care to medical
and social treatment for mental illness. In the 1950s, Rutgers University awarded its first
graduate degree in psychiatric-mental health nursing. The psychiatric mental health clinical
nurse specialist was the first master's prepared advanced practice nursing role. The role of the
psychiatric and mental health nurse practitioner (PMHNP) was introduced in the 1990s and has
evolved over time to incorporate a person-centered, biopsychosocial model of care.
1 Late 19th Century In the late 19th century, 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.
2 Early 20th CenturyEarly psychiatric nurses were trained by physicians; however, in 1913,
Effie Jane Taylor developed the first nurse-organized training course for psychiatric nursing
at Johns Hopkins Hospital.
3 World War I (WWI) The World Wars 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.
4 World War II (WWII) In WWII, 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.
5 1946 With the passage of the National Mental Health Act (NMHA) of 1946,
psychiatric nursing was recognized as one of the four core disciplines in psychiatric care
and treatment (American Nurses Association [ANA] et al., 2022). The act increased funding
for psychiatric nursing education programs and contributed to a growth in university-based
nursing education.
,6 1954 In 1954, the first graduate program in psychiatric nursing was established at
Rutgers University by Hildegarde Peplau to prepare nurse therapists. The first advanced
practice nursing role was the psychiatric-mental health clinical nurse specialist (PMHCNS)
role.
7 1963 The 1950s brought a transition towards deinstitutionalization in care for
those with mental illnesses, which led to an increase in the number of psychiatric clients
receiving care in the community rather than hospitals. The Community Mental Health Centers
Act of 1963 allowed for the expansion of the PMHCNS role into community and ambulatory
settings as they helped those who had been deinstitutionalized adapt (ANA et al., 2022).
8 1965 Loretta Ford, RN and Henry Silver MD introduce the nurse practitioner role.
9 1973 ANA first published Standards of Psychiatric-Mental Health Nursing Practice
in 1973.
10 1980s Over time, research turned towards the neurobiological basis for mental
illness. With advances in psychotropic medications, psychopharmacology has played an
increased role in treatment. In the 1980s, states began to grant prescriptive authority to
advanced practice registered nurse (APRN), adding medication prescribing and management
to the traditional therapy role of the psychiatric mental health (PMH) APRN.
11 2000 , Certification exams for adult and family psychiatric mental health nurse
practitioners (PMHNPs) were developed. These exams were retired in 2015 when psychiatric
certification exams were combined into a single Psychiatric-Mental Health Nurse
Practitioner (Across the Lifespan) Certification (PMHNP-BC).
12 Present Current trends in care focus on integrated treatment of those with co-
occurring medical and psychiatric diagnoses and co-occurring psychiatric and substance
use disorders, leading to a need to add content in advanced health assessment,
pharmacology, pathophysiology, and the diagnosis of psychiatric illness to graduate
psychiatric nursing curricula. Primary care has become the point of entry to psychiatric care
for many clients.
PMHNPs are helping to address the growing need for primary mental health services and
mental illness prevention. Though the number of advanced practice psychiatric nurses has
increased, there are still limitations in access for many clients, which has led to disparities in
mental health treatment.
ANA Definition of the PMHNP/Clinical Practice Settings/PMHNP Practice Focus
, 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. The American Nurses Association (ANA et al., 2022) provides further guidance for
advanced practice registered nurses practicing in the psychiatric-mental health specialty area.
According to the ANA (ANA et al., 2022), “Both PMHNPs and psychiatric mental health clinical
nurse specialists (PMH CNS)" are considered PMH APRNs. Their roles are essentially similar in
purpose, functions, settings, and qualifications. Both integrate physical and mental health and
work in inpatient and outpatient settings. Promoting mental health and collaborating with other
health professionals are key aspects of the PMH-APRN role.
The 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
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
Recommendations
According to the American Psychiatric Nurses Association (APNA, 2020) and ANCC (2019)
recommendations include:
• One entry educational focus: PMHNP with preparation across the lifespan,
addressing mental health promotion and mental illness diagnosis and
treatment.
• Currently licensed and certified PMHNPs who demonstrate competency by
continuing re-certification are permitted to continue practicing under their
current license and certification.
