NURS6670 Walden Psychiatric Mental Health Nurse Practitioner Certification Plan Paper

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NURS6670

Walden University

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Part 1

Checkpoint for Psychiatric Mental Health Nurse Practitioner Certification Plan

Learning Objectives: Students will:

  • Evaluate progress on certification plans

Report your progress on the Certification Plan

  • What have you done to prepare for your certification?
  • Have you completed the scheduled tasks assigned on your timeline? If not, what are your plans to stay on schedule?

Part 2

State Practice Agreements

In many states, nurse practitioners are completely autonomous professionals. In other states, however, NPs have a wide range of “restrictive” practice ranging from requirements for a “supervising” physician to requirements for a “collaborative” agreement with a physician.

In this Practicum Journal Assignment, you will examine the requirements Texas state in order to prepare yourself for the realities of practice upon graduation.

Learning Objectives: Students will:

  • Analyze state PMHNP practice agreements
  • Analyze physician collaboration issues
  • Analyze barriers to PMHNP independent practice
  • Create plans for addressing state PMHNP practice issues

To Prepare for this Practicum Journal:

  • Review practice agreements in your state.
  • Identify at least two physician collaboration issues in your state.

ACTUAL ASSIGNMENT

PLEASE Addressed each of the bullets, use the resources or you can use other references within last five years only- from 2015 to 2019. Please do not begin a paragraph with author name(s) (PLEASE USE parenthetical/in-text citations)

  1. Briefly describe the practice agreements for PMHNPs in your state.
  2. Explain the two physician collaboration issues that you identified.
  3. Explain what you think are the barriers to PMHNPs practicing independently in your state.
  4. Outline a plan for how you might address PMHNP practice issues in your state.

Part 3

Decision Tree

For this Assignment, as you examine the client case study, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.

The Assignment:

Learning Objectives: Students will:

  • Evaluate clients for treatment of mental health disorders
  • Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders

Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment. https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/08/mm/decision_tree/index.html

At each Decision Point, stop to complete the following:

  • Decision #1: Differential Diagnosis
    • Which Decision did you select?
    • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
  • Decision #2: Treatment Plan for Psychotherapy
    • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
  • Decision #3: Treatment Plan for Psychopharmacology
    • Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
  • Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

Note: Support your rationale with academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Case #3 Neurocognitive Disorders

BACKGROUND

Mr. Charles Wingate is a 76-year-old Caucasian male who presents to your office for an initial psychiatric evaluation. He is accompanied by his eldest son, Mark, who lives with Mr. Wingate. Mr. Wingate was referred to you by his primary care provider who has performed an extensive diagnostic workup to rule out an organic basis for his changes in cognition. Mr. Wingate’s son Mark has verbalized a concern that Mr. Wingate may have Alzheimer’s disease. When questioned, Mr. Wingate states that he is unaware of anyone in his family ever having been diagnosed with Alzheimer’s disease.

SUBJECTIVE

Mr. Wingate states that he has always been “a little bit forgetful,” but he noticed that in his 60s and 70s, it got worse. Mark states that “for the past 2 years, it has been getting worse. He doesn’t even notice how bad his memory has become.” On at least two occasions, Mr. Wingate has gotten lost when he was driving to the grocery store. Mr. Wingate protested his disagreement with this accusation stating, “but they were doing road construction, anyone could have gotten mixed up!” While his son conceded to this, he pointed out that Mr. Wingate’s memory has caused some other problems, such as errors with paying his monthly utility bills (at one point, the electric company threatened to shut off his electricity due to his nonpayment of the bill).

His son Mark also pointed out that the family is concerned for Mr. Wingate’s safety as he twice left his keys hanging in the door and just two evenings ago, put food in oven and forgot about it until the smoke detector in the kitchen began to alarm.

Mr. Wingate also has had a few issues with managing his medications. Specifically, he took too many Norvasc tablets a few months ago, which resulted in hypotension and a fall. Since that time, Mark’s wife has been setting up Mr. Wingate’s pills in pill boxes, but recently, multiple “missed doses” have been noted.

Mr. Wingate states: “but those are my night pills that I miss—I’m always better at remembering things in the morning.” Mark agrees, stating that Mr. Wingate’s cognition does vary throughout the course of the day and appears to worsen in the evening. He also reports that his father seems much less alert in the evenings, and more alert in the mornings.

Mr. Wingate reports that he has had poor sleep for “a long time now.” He does report that over the past few months, he has been having what he describes as “very vivid nightmares.” His son states that sometimes he is awakened by his father’s yelling during nightmares, and enters his father’s room, and sees his father swinging or kicking in his sleep.

He reports that his appetite is “alright” and that his energy levels do fluctuate throughout the course of the day. He states: “sometimes, I can concentrate really well; other times I can’t … it is very frustrating!” Specific to substance use, Mr. Wingate notes that he used to enjoy a glass of wine or two with dinner, but states that it just doesn’t interest him, anymore. Plus, he stated that he notices that when he does drink, he develops slow muscle contractions.

Mr. Wingate’s son also shares a concern about his father’s abnormal movements. He states that for about the last 6 months, his father has had problems with coordination. He states that he raised these concerns with the family doctor who suggested it may be “late onset Parkinson’s disease.” However, he was not treated because the symptoms were “not that bad.”

OBJECTIVE

Mr. Wingate was overall calm and pleasant during the clinical interview. Throughout the clinical interview, you notice that Mr. Wingate is not really involved in the discussion. He seems somewhat indifferent to the assessment and does not seem very concerned with what is being discussed. He only protested when discussing how he got lost on his way to the supermarket and his evening medication dose.

Review of systems and screening physical assessment were unremarkable, with the exception of fine resting tremors noted in both of Mr. Wingate’s hands. The psychiatric/mental health nurse practitioner (PMHNP) also reviewed laboratory studies that were sent from Mr. Wingate’s primary care provider; they were within normal limits with the exception of a serum sodium level of 130 mEq/L.

MENTAL STATUS EXAM

Mr. Wingate is alert. He is oriented to person, place, and partially oriented to time (he knows that it is morning, but cannot tell the hour). His speech is clear, coherent, goal directed, and spontaneous. Mr. Wingate’s self-reported mood is “ok.” Affect is somewhat constricted. His eye contact is fleeting throughout the clinical interview. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes appreciated. Judgment seems well preserved, but insight appears impaired as he is having trouble understanding why his son brought him to this appointment. Concentration and attention also appear impaired, which prompts the PMHNP to perform a mini-mental status exam (MMSE) on Mr. Wingate.

RESULTS OF MMSE

Score of 17, with primary deficits in orientation; calculation; recall (he was unable to recall any of the three items presented after 5 minutes); and he was unable to perform serial 7’s or spell the word “WORD” in reverse, despite the fact that he is a high school graduate and attended 1 year of college. He also needed prompting with the three-step command. His score suggests severe cognitive impairment.

At this point, please discuss any additional diagnostic tests you would perform on Mr. Wingate.

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Explanation & Answer

Attached.

Running Head: PMHNP AGREEMENTS IN TEXAS

Psychiatric Mental Health Nursing Practitioner Agreements in Texas
Name
Institution

1

PMHNP AGREEMENTS IN TEXAS

2

In general, Nursing Practitioners are specialized in the provision of care to patients
suffering from a variety of diseases. However, Psychiatric-Mental Health Nurse Practitioners are
specifically specialized in assessment, diagnosis, treatment, and provision of care to patients
diagnosed with mental health illness (AANP, 2019). The PMHNPs are certified by the American
Nurses Credentialing Center that assesses the Nurses’ competency and knowledge in mental
patient care. PMHNPs can make a diagnosis for mental disorders, plan for treatment and
prescribe drugs when needed and can also assist patients who are at risk of getting mental
disorders due to genetics conducting a family background evaluation.
PMHNPs Practice Agreements in Texas
In Texas, practice agreements for PMHNPs require that the Nurses provide primary care
to mentally ill patients. However, a written agreement between the PMHNP and individual in
charge of supervision, such as a physician is required. The protocols of practice are developed
jointly and reviewed annually (Scope of Practice Policy, n.d).
Regulations in Texas allow PMHNPs to diagnose mental illness and treat patients with
psychological problems and psychiatric illnesses. However, the prescription of drugs by a nurse
practitioner is regulated by Texas’s Nurse Practice Act that requires the signing of the
prescription agreement. The agreement lists the drugs, devices, and other items that might be
required for treatment.
Under the current law, the PMHNPs may offer counseling and advice to patients with
psychiatric conditions and also act as educators for family members with a history of mental
health problems. PMHNPs can also recommend screening for mental health conditions to help
the clients get aware and initiate self-care measures that allow them to overcome the problems.

PMHNP AGREEMENTS IN TEXAS

3

However, they must do this in collaboration with other physicians and professionals. When a
physician is licensed in Texas, they get the freedom even to start private practice while PMHNPs
and physician assistants cannot operate independently and must be closely supervised by an
assigned Physician (Scope of Practice Policy, n.d).
Collaboration Issues
I identified physician domination and administration of pharmacological therapy as
collaborative issues. Under physician domination, lack of enough knowledge and
misunderstanding on the PMHNP’s scope of practice is the main barrier to collaboration.
PMHNPs and physicians work intending to provide best practice and quality care to mental
health patients. However, the traditional model of practice that is focused on hierarchy results in
ineffective teamwork between the NPs and physicians (Hain & Fleck, 2014). The reason is that
physicians show dominance over the rest of the team, which undermines the NPs ability to
practice to their level of knowledge.
In terms of administration of pharmacological therapy, the Psychiatric-Mental Health
Nursing Practitioner must collaborate with the physician to prescribe medication that enables the
patients to deal with the mental issue. In this case, the practice agreement makes it possible for
PMHNPs to liaise with the psychiatrist to offer the best care to patients. Also, the PMHNP must
ensure that the process of recovery for mental health patient follow the set milestones and goals
to ensure that the patients regain mental stability and health.
Barriers to PMHNP Independent Practice in Texas
Nurse Practitioners in Texas have tried to seek independence from the agreements that tie
them to physician supervision without success. The PMHNPs seek to have the freedom to

PMHNP AGREEMENTS IN TEXAS

4

prescribe and treat their patients without signing the contracts with doctors as required by the law
(Alfaro, 2017). However, PMHNP independence is faced by several barriers
Physician Barriers
Most of Physicians in Texas believe that PMHNPs cannot provide quality and safe care
like the physicians. This is because physicians go under rigorous and long...


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