PMH-APRN - a nurse with graduate-level training who provides psychiatric-mental health care and
promotes mental health across the lifespan
-assess, diagnose and treat individuals and families who have psychiatric and/or substance disorders
-work in a variety of health care settings and practices and are eligible for reimbursement through
private insurers, HMOs, PPOs, Medicare and Medicaid
ANA Code of Ethics: anticipatory guidance competency - ANA Standards and Scope: Standard 5B: Health
Teaching & Promotion
-An 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 Code of Ethics: the art of nursing is based on? - caring and respect for human dignity
ANA Code of Ethics: the fundamental principle of and attitude that the professional nurse must have as
outlined in Provision 1 - ANA Code of Ethics: Provision 1
-"the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes
of every person" (ANA, 2015b, p. 1).
ANA Code of Ethics: How should the nurse respond to the discovery of human trafficking in his or her
practice? - ANA Code of Ethics: Provision 8
-Nurses 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).
Dr. Edward Cowles created in 1882 - the first organized training school within a hospital for the insane
1913, Effie Jane Taylor developed - the first nurse-organized training course for psychiatric nursing at
Johns Hopkins Hospital
(before early psychiatric nurses were trained by physicians)
,Following WWI, the National League for Nursing Education added: - "nursing in nervous and mental
diseases" to curriculum guides
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.
National Mental Health Act (NMHA) of 1946 - -psychiatric nursing was recognized as one of the four core
disciplines in psychiatric care and treatment
-The act increased funding for psychiatric nursing education programs and contributed to a growth in
university-based nursing education.
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.
The Community Mental Health Centers Act of 1963 - (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
1965 - Loretta Ford, RN and Henry Silver MD introduce the nurse practitioner role.
1973 ANA first published: - Standards of Psychiatric-Mental Health Nursing Practice
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.
, 2000s these exams were developed: - Certification exams for adult and family psychiatric mental health
nurse practitioner (PMHNP) developed.
-These exams were retired in 2015 when psychiatric certification exams were combined to a single
Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC).
The 21st Century Cures Act of 2016: - -resulted in the creation of the U.S. Department of Health and
Human Services (HHS) Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC)
-group is charged with compiling a summary of advances in serious mental illness (SMI) and serious
emotional disturbance (SED) research, evaluating federal programs and treatment services related to
SMI and SED, and making specific recommendations to better coordinate the administration of mental
health services
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.
PMHNP scope of practice - broad and includes practice in a variety of possible roles and clinical settings
-Education
• A master's degree, post master's certificate, or doctoral degree is required for PMH APRN practice.
-Clinical Practice Settings
• Crisis intervention and psychiatric emergency services
• Acute inpatient care
• Intermediate and long-term care
• Partial hospitalization and intensive outpatient treatment (IOP)
• Residential services
• Community-based care
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