Professional boundaries are integral to these values. 2. This sub-category is foundational to both PMH-RN and PMH-APRN practice and thus has no advanced competencies for the PMH-APRN. INTRODUCTION In 1970 the American Psychiatric Association, for the first time, appointed a committee to develop a code of ethics. These competencies also describe the ongoing feedback process inherent in the evaluation process as the healthcare consumer recovers, necessitating revaluation and revision of treatment goals and plans. Supporting and encouraging colleagues to engage in self-care practices and to seek appropriate help to cope with mental, emotional and behavioral problems contributes to maintaining a therapeutic environment for healthcare consumers. The 2014 scope and standards attest to the enduring principles of nursing inherent in registered nursing and advance nursing practice that can evolve incrementally over time to ensure the development and maintenance of an appropriate, meaningful and responsive healthcare environment. Each standard is tailored to psychiatric and mental health nursing practice. A survey of nursing faculty needs for training in use of new technologies for education and practice. Several key changes are described briefly below (ANA, 2014). APRN practice varies across states due to licensure regulations determined by state legislation. Ethics in Psychiatric Mental Health Practice. The recovery orientation supports investing in efforts to truly achieve higher and higher levels of wellness for the consumer. Retrieved from The American Nurses Association (ANA) Code of Ethics (ANA, 2015) is a good example of incorporating virtue ethics into the ethical and legal obligations of the nursing profession (Exhibit 12.1). 119, 318-319.(2010). American Nurses Association. Standard 5G: Therapeutic Relationship and Counseling emphasizes the competency base necessary to promote symptom stabilization and recovery. Scope and Standards publications serve as a reference document for the relevant specialty, nursing in general, and across roles, including education, research and practice. Wisconsin Administrative Code. Finally, the prospect of integrated care is emerging across the nation (Manderscheid, 2010). APNA is not responsible for the content of external websites. The recent revision of the PMH Scope and Standards (ANA, 2014) has several implications in the realm of nursing education. Positive Mental Health Outcomes in Individuals with Dementia: The Essential Role of Cultural Competence, Mental Illness and Prisoners: Concerns for Communities and Healthcare Providers, Military Culture Implications for Mental Health and Nursing Care. Nurses shall conduct themselves in accordance with the code of ethics adopted by the board in regulation. Retrieved from, National Council of State Boards of Nursing (NCSBN). Board of Nursing. Professional performance. NPs assess, diagnose, treat and manage acute episodic and chronic illnesses. Confidentiality in the treatment of adolescents. PMH nurses are ethically obligated to keep their knowledge of evidence base practice current and their skills and abilities appropriate to the population they care for. Rockville, MD: Author. Environmental health. The Essentials document was informed by and supports the PMH Scope and Standards and focuses on PMH nursing competencies relevant to general registered nursing practice. ... attention to the behavior and function of colleagues is within the particular expertise of the PMH nurse. Indian Psychiatric Society adopted its ethical code … Commitment to the recognition and advancement of the nursing profession involves knowledgeable contributions to policy development and implementation. 225, Section 1. Article published January 31, 2015, Substance Use Disorders and Related Concerns, The 200th Birthday of Florence Nightingale, Addressing Social Determinants of Health: Progress and Opportunities, Translational Research: From Knowledge to Practice, President’s New Freedom Commission on Mental Health, 2003,,,,, One advanced practice examination is offered by the American Nurses Credentialing Center for both roles. (2011). The PMH Scope and Standards support this initiative in a number of ways. PMH-APRNs are expected to engage in practices that are environmentally sound and to form professional relationships that promote policies to develop environmentally sustainable conditions. This portion of the document has been revised from the first edition to present specific sets of competencies for each standard. The PMH Scope and Standards emphasized the concept of a public health care model as a framework for service delivery and research based on the IOM report, Preventing Mental Emotional and Behavioral Disorders among Young People; Progress and Possibilities (O’Connell, Boat, & Warner, 2009). Achieving the promise: Transforming mental health care in America. This was the question posed in one of our classes at the Johns Hopkins School of Nursing. Establishing a trusting and understanding relationship with each patient is a key factor in providing the right care for the situation. 389-400). Nursing: Scope and standards of practice (2nd Edition). The content, especially related to APRN scope of practice, serves as a framework to promote external priorities in healthcare delivered by the President’s New Freedom Commission on Mental Health (2003) , SAMHSA (2006), the IOM (2010), and the ACA (2010). As the healthcare delivery system experiences ongoing fundamental transformation, PMH nursing leadership is integral to delivering meaningful and responsive person-centered, consumer oriented services. She believes that nutrition, exercise, sleep, and a healthy living environment are fundamental to mental health, and works to support each individual in creating the healthiest lifestyle. This Code was promulgated through NAPOLCOM Resolution No. American Nurses Association (ANA) Code of Ethics is of course one such code. Guidelines related to ethical behaviors and standards of practice had multiple changes; the scope of practice changes were targeted to address current trends and priorities in healthcare environment. Archives of Psychiatric Nursing, 26, 77–79. Thus, nursing curricula represent to the low competency expectation for the psychiatric knowledge base of registered nurses practicing in the complex world of 21st century healthcare. Retrieved at (2010). NPs are experts in health promotion and disease prevention. National Academies Press: Washington, DC. Environmental health (Standard 16) is the final set of competencies addressed within the revised document. Investigation of complaints and violations. Standard 5F: Milieu Therapy emphasizes the PMH-RN’s role to provide an orientation for healthcare consumers to their treatment environment. Potential nurses and schools of nursing must have adequate funding to ensure a continuing stream of qualified PMH nurses to meet the growing need. The Psychiatric-Mental Health Nurse Practitioner (PMHNP) is a registered nurse practitioner specialized wit handling psychiatrist mental cases. With the growing expense in time and money to educate nurses, most programs are likely to use the NCLEX model to formulate nursing curricula. Diploma, Associate Degree and Baccalaureate degree nursing programs should include content areas and skill sets presented and elaborated in this document. New York, NY: Putnam. The work of the task force to revise the PMH Scope and Standards carefully considered the existing document and other key factors in the current context of healthcare to craft a document with specifics to guide both dedicated PMH nurses and generalist nurses in all settings. The document provides a thorough and strong foundation to see the PMH nursing specialty through the coming years as cultural and legislative evolution broadly impacts the nursing profession across education, practice, and research. The PMH-RN competencies emphasize collaboration with the healthcare consumer, significant others, and interprofessional collaboration in the assessment process. They are registered nurses with specialized, advanced education and clinical competency to provide health and medical care for diverse populations in a variety of primary care, acute and long-term care settings. Code of ethics help teachers create a safe, productive, and positive learning environment in their teaching career. Dynamic and recent changes in the United States healthcare system influenced the deliberations of the task force as review and analysis proceeded. - Use Code of Ethics for Nurses with Interpretive Statements t… health assessment, health history, physical exam, screening an… Displaying environment of trust and respect, maintaining healt… Dr. Kane represented the International Society of Psychiatric Nursing and Dr. McLouglin represented the American Psychiatric Nurses Association. 20, No. Risk or cost-benefit analysis for making ethical decisions. Nurses are trained to protect private health information in nursing school and throughout their career by their employer. In the instance of serious and persistent mental illness, recovery as an achievable goal has not been perceived by healthcare providers and, indeed, consumers themselves. Email: The second edition was published in June 2014. (2003). This document exceeds competencies required to practice as an entry level graduate to address the scope of the foundational knowledge base necessary to practice nursing across settings and beyond entry level expectations. Finally, the Essentials content applies to the nursing care of persons with substance use disorders as well as those who have medical or surgical conditions that are accompanied by psychosocial stressors. HHS Publication No. The revised PMH Scope and Standards (ANA, 2014) is essential to nursing education as a foundational document upon which to base curricular priorities and content. Teaching content related to psychiatric and mental health concerns has become increasingly challenging. Involvement in quality improvement processes (Standard 10) is expected of the PMH-RN. The dynamic nature of healthcare reform requires continual vigilance and adherence to principles of inclusion and acceptance of the consumer voice. Likewise, providing constructive feedback to peers and colleagues is expected to produce a mutually supportive and productive evaluation process involving and benefit oneself and colleagues. 54 professional code of ethics, and professional practice standards. The concept of recovery is integrated throughout the document. Implications for nursing education and a companion resource are discussed. American Nurses Association. The NCSBN Joint Dialogue Group developed the licensure, accreditation, certification, and education (LACE) model to provide guidance to state boards of nursing and state legislative bodies regarding APRN scope of practice. The recovery concept (SAMHSA, 2006) has promoted change in many aspects of psychiatric mental health care. These documents are also used by regulators, payors, policy makers and other stakeholders. In B. Levin, K. Hennessy, & J. Petrila (Eds. Am I doing what is in the best interest of my client? Privacy screens help reduce the visibility of patient charts, and passwords are required … Dr. Kane most recently served as program coordinator for the UVA School of Nursing’s PMH Nursing program, was the recipient of the ANA’s 2012 Hildegard Peplau Award, and is a member of the American Academy of Nursing’s Psychiatric Mental Health and Substance Use Expert Panel. Catherine F. Kane, PhD, RN, FAAN Code of Medical Ethics Opinion 1.2.1 Treating oneself or a member of one’s own family poses several challenges for physicians, including concerns about professional objectivity, patient autonomy, and informed consent. Professional boundaries. Interpersonal relations in nursing. Retrieved from, NCSBN Joint Dialogue Group Report. Substance Abuse and Mental Health Services Administration. Archives of Psychiatric Nursing, 26(2), 80–110. (SMA) 12-4681. (SAMHSA, 2006). An important companion document to the PMH Scope and Standards is the Essential Psychiatric, Mental Health and Substance Use Competencies for the Registered Nurse (Kane & Brackley, 2012). Specialized graduate education applied to a focused population is required for certification. PMH nursing has a long tradition of relationship-based care, first conceptualized and defined for nursing by Peplau (1952). Citation: Kane, C., (January 31, 2015) "The 2014 Scope and Standards of Practice for Psychiatric Mental Health Nursing: Key Updates" OJIN: The Online Journal of Issues in Nursing Vol. Presently, there are over twenty specialties for which ANA produces a dedicated Scope and Standards of Practice. 92-4 entitled, “Approving the Philippine National Police Code of Professional Conduct and Ethical Standards” with the end view of This erosion has been driven by the reduction of psychiatric nursing content in the National Council Licensure Examination (NCLEX) exam (Kane, 2012). The nurse’s role may be focused on clinical practice, administration, Several key factors that emerged for review in the revision process included external documents and priorities currently influencing the United States (U.S.) healthcare system; the current emphasis on consumer participation in the recovery process; workforce requirements and challenges for PMH nursing; and regulatory concerns for advanced practice nurses. Given the complexities and stressors of 21st century living, psychiatric mental health and substance use knowledge, skills, and abilities are integral to provide quality, holistic care to populations in need of nursing care. She tries to limit the amount of psychiatric medications needed by addressing mental health needs in a holistic fashion. Collaboration with other professionals, agencies, organizations and the public is essential to holistic care delivery. Washington, DC: The National Academies Press, Kane, C.F & Brackley, M.A (2012). It’s easy to see how pairing this moral standard with knowledge of a family member or friend’s background could present difficulties should you find yourself as their nurse. (2012). Consensus model for APRN regulation: Licensure, accreditation, certification and education. A paradigm shift toward prevention promotes an appreciation of the social determinants of health. The President’s New Freedom Commission Report on Mental Health (President’s New Freedom Commission on Mental Health, 2003) launched a review and revision of the structure of mental health care delivery in the United States. PMH-APRN competencies in leadership include the promotion of person-centered recovery oriented models of care for the benefit of the overall healthcare system. Scope and Standards publications serve as a reference document for the relevant specialty, nursing in general, and across roles, including education, research and practice. Evolution and integration of primary care services with specialty services. 20, No. The need to evaluate the outcomes of the intervention using standardized empirical methods is also stressed. HIPAA laws protect healthcare consumers from having their personal health information shared inappropriately. HISTORY: 2004 Act No. The 10 Standards of Professional Performance address all the standards presented in the ANA Scope and Standards of Practice (2010) in the same order in terms of appropriate competencies for the PMH-RN and the PMH-APRN (ANA, 2014). Participation in self-assessment processes (including peer and supervisory levels) is essential to ensuring the ethical integrity of the professional interpersonal process. Journal of Psychosocial Nursing and Mental Health Services. Emphasizing the use of evidence-based psychotherapeutic frameworks, this sub-category presents competencies that are applicable only within PMH-APRN practice. AMA PRINCIPLES OF MEDICAL ETHICS 5.05 Confidential Care for Minors Practitioners have a duty to promote the autonomy of minor … ), Mental health services: A public health perspective (3rd Edition, pp. Communication competencies go hand in hand with leadership competencies (Standard 12) to effect progressive and positive developments in treatment, the discipline, and healthcare systems. A recovery orientation is integral to PMH nursing practice. NCSBN (2009) reported that the majority of newly licensed RNs were working in medical/surgical (39.5%) and critical care (34.5%) settings, whereas the remainder were employed in pediatrics (6.1% ), nursing homes (5.0%), and nurseries (3.0%). Mental health, United States, 2010. This appreciation directs PMH nurses to contribute to the scientific basis of prevention to assist children and families to promote healthy interactions and environments and to develop resilience and optimism. Ethical decisions should be based on duty/obligation to others, principles that are fixed and not subject to change. The Nursing Practice Act (NPA) is the body of California law that mandates the Board to set out the scope of practice and responsibilities for RNs. This perception has prevented the service system, healthcare providers, and consumers from envisioning a healthy future for persons with mental health problems. Therapeutic relationship and counseling. The Substance Abuse and Mental Health Services Administration (SAMHSA, 2006) validated the resulting consumer driven framework of a person-centered, recovery-orientation for assessment and treatment. The PMH-APRN competencies demonstrate the higher level of nursing practice requiring preparation in graduate education programs, including clinical supervision by APRNs to ensure an advanced set of knowledge, skills, and abilities. Code of Ethics ANA resource listing the Code of Ethics for Nurses with Interpretive Statements. Kate believes healing can happen in many ways and that wellness has different meanings to each individual. Available at:, Nguyen, D.N., Zierler, B., & Nguyen, H.Q. Psychiatric-mental health nursing: Scope and standards of practice (2nd Edition). Finally, the PMH nurse engages in advancing the profession; actively collaborates inter-professionally in assessment, treatment, and evaluation; and demonstrates leadership to develop informed policy and improve healthcare systems. Emerging from the Nuremberg trials was a code of ethics setting out ‘standards to which physicians must conform when carrying out experiments on human subjects’. Nursing education is incorporating informational and educational technologies and telehealth modalities into curricula as the demand for services grows. The department shall investigate complaints and violations of this chapter as provided in Section 40-1-80. Milieu therapy has always had a prominent place in PMH nursing practice due to the importance of structure and safety for persons experiencing acute mental disorders. This includes providing an orientation to rights and responsibilities in the treatment environment, assisting consumers to select and participate in meaningful treatment and activities that will promote their personal growth, and advocating for the least restrictive measures to maintain safety individually and collectively within the milieu. O’Connell, M.E., Boat, T., & Warner, K.E. This care incorporates compassion and instills hope and empowerment, while respecting the dignity and worth of the individual. Several key factors that emerged for review in the revision process included external documents and priorities currently influencing the United States healthcare system... As with any process to revise, there were many considerations to discuss. A concerted effort is being made to integrate the consumer into policy and program development, which in turn emphasizes consumer participation in all aspects of care-planning and treatment. A concerted effort is being made to integrate the consumer into policy and program development, which in turn emphasizes consumer participation in all aspects of care-planning and treatment. Key words: Nursing, scope and standards, advanced practice, psychiatry, mental health, competency, essentials, substance use, treatment, nursing curricula, NCLEX. Right to refuse treatment, informed consent, Involuntary commitment and insanity defense, Rights of same-sex couples to adopt, insemination, Reproductive health for the intellectually disabled, Step 1- Assessment (condition/problem, prognosis, socio-demographic information, advance directives, conflict or competing interests), Step 2- Identifying ethical issue (different morally acceptable options, rank the ethical or relevant considerations), Step 3- Goal setting, decision making, and implementation. PMI’s Code of Ethics and Professional Conduct applies those values to the real-life practice of project management, where the best outcome is the most ethical one. (2010). Catherine F. Kane is an Associate Professor of Nursing at University of Virginia School of Nursing in Charlottesville, VA. Dr. Kane co-chaired the APNA and ISPN Joint Taskforce to revise and update the ANA Psychiatric-Mental Health Nursing: Scope and Standards of Practice (2007) with Kris A. McLoughlin, DNP, APRN, FAAN. This article begins with a brief overview of the revision process. This standard is integral to promoting appropriate resource utilization (Standard 15) within the healthcare environment. These factors informed and influenced the review and revision of the PMH Scope and Standards. 2008 RN practice analysis: Linking the NCLEX-RN® examination to practice, NCSBN Research Brief, 36. Evaluation. Nursing, like most professions, has a code of ethics, but the code … To deliver preventive and treatment services in integrated service systems, PMH nursing requires a well-educated and clinically competent workforce. (SAMHSA, 2012). The ANA Joint Task Force convened in April 2012, with the objective to review and revise the first edition of the Psychiatric-Mental Health Nursing: Scope and Standards of Practice for publication in 2013. The 2014 Psychiatric-Mental Health Nursing: Scope and Standards of Practice is the specialty’s description of competent nursing practice. Standards are statements that identify the duties and obligations for which specialty nurses are held accountable, including general registered nurses and advanced practice nurses. It outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse. State practice acts define the scope of practice and PMH-APRNs are held responsible for practicing within the boundaries of their educational preparation. Understanding the NCLEX® examination through the core values of NCSBN. Written by: ANA Center for Ethics and Human Rights Adopted by: ANA Board of Directors Purpose Discrimination in any form is harmful to society as a whole and in opposition to the values and ethical code of the nursing profession, which directs the nurse to “…respect the inherent dignity, worth, unique As new models of service delivery are developed, PMH nurses must work to ensure that person-centered, recovery oriented principles are incorporated through the inclusion of healthcare consumers in the process of designing and implementing these services. Teachers are expected to maintain challenging expectations that will improve the potential of all learners through meaningful and inclusive participation in … The NBCC Code of Ethics is also published in an online version to assist counselors and members of the public. Some sections of this Code include comments. Standard 13: Collaboration is based directly on the principles of communication and leadership ensuring that the PMH-RN shares knowledge, engages in healthy interpersonal and professional processes, and contributes to the formation and maintenance of healthy learning and practice environments. Though the size of the mental health workforce in general has been deemed adequate, a shortage of clinicians exists in rural areas (SAMHSA, 2012). The American Nurses Foundation is a separate charitable organization under Section 501(c)(3) of the Internal Revenue Code. BCC Code of Ethics: Approved September 17, 2010 Page 4 of 4 1. Silver Spring, MD: Author. Sources of expertise were drawn from national nursing organizations and members of the previous task force. Significant changes to the second edition of the PMH Scope and Standards (ANA, 2014) included content related to nursing ethics, scope of practice, and standards of practice. Suicide Assessment and Nurses: What Does the Evidence Show? New York, NY: Oxford University Press. The Essentials describes the basic PMH Nursing knowledge and skill base in a format familiar to educators to clarify the linkage to essential general nursing skills and inform the development of entry level nursing education, continuing education, and clinical orientation curricula (Kane & Brackley, 2012). In the course, Philosophical, Theoretical, & Ethical Basis of Advanced… 55 Levels of nursing practice are differentiated according to the nurse’s educational 56 preparation. In a state where FNPs can independently practice and prescribe, the major complication would focus on what is best for the patient and whether local boards of ethics have opinions on the matter. Retrieved from, National Council of State Boards of Nursing. Disclose to others, including sponsors, clients or colleagues, significant circumstances that could be construed as a potential or real conflict of interest, or any having an appearance of impropriety. This even further limits consumer access to services from PMH Advanced Practice Registered Nurses (PMH-APRN). The least amount of time was reportedly spent on psychosocial integrity activities (10%), even though the unstandardized data revealed that these new nurses reported the average number of work hours spent in Psychosocial Integrity as 2.95 hours per work day, which computes to an unstandardized proportion of work hours being 0.27. You are pointing out a very important and interesting effect of our “blindedness” to racial injustices toward our minority nurse colleagues. Psychiatric mental health substance abuse essential competencies taskforce of the American academy of nursing psychiatric mental health substance abuse expert panel. The task force member authors of The Essentials (Kane & Brackley, 2012) undertook the charge of articulating the essential foundational PMH nursing competencies that any registered nurse must have in order to provide quality nursing care. This process directs the nurse to form interpersonal relationships with individuals in their care to understand, as fully as possible, circumstances, emotional responses, beliefs, motivations, and potential for action on their own behalf. Best known for the Essential documents of the profession on nursing ethics, scope and standards of practice, and social policy, … This report summarized the literature on symptom onset and environmental risks leading to the conclusion that prevention of mental disorder is possible when protective contexts are fortified and risk factors are decreased. The IOM report (2010) on the Future of Nursing provides the evidence and rationale for removal of these barriers. (2009). Standard 6: Evaluation provides competencies for the PMH-RN and advanced competencies for the PMH-APRN. The American Nurses Association (ANA) established a formal process in the late 1990s to recognize specialty areas of nursing practice as they develop and evolve with advancements in healthcare. NBCC has also developed specific guidelines regarding the provision of distance professional services. Likewise, attention to the behavior and function of colleagues is within the particular expertise of the PMH nurse. The six Standards of Practice follow the traditional nursing process, including assessment, diagnosis, outcomes identification, planning, implementation, and evaluation.