By Day 6 of Week 1 Respond?to at least?two?

Peer responses

Wilson Cruz

Discussion Week 1

The practitioner acquired essential questions about the mood, feelings, onset of the problem, the influence of drug/alcohol, and thought about hurting himself. Since the patient stated not wanting to be alive and had thoughts about hurting himself, my next question would be if he has suicidal thoughts (and plan).

The practitioner could take some time to establish boundaries of confidentiality instead of going straight to the questions. She could introduce herself and explain the nature of the interview, saying that she is used to helping young people with their problems (attitude to help); thus, she would like to do a few questions. The sequence of questions could be from broad and non-personal to a narrow direction; to ask "have you been crying a lot" at the beginning of the interview could intimidate the patient into talking about his feeling (ashamed to admit it). Not at the beginning of the interview, I would ask, "what you do when you are sad, stay in your room, don't talk to anyone, cry."

The practitioner listened to the patient's problems, such as anger, school grades going down, and the patient's girlfriend breaking up with him. Still, she did not demonstrate with few words an empathic or sensitivity to his condition, such as "you must have felt terrible not knowing the cause of she broke up with you." Being sensitive and empathic helps develop rapport-building with a patient (Carlat, 2017).

The practitioner could explain the symptom expectation that a behavior is in some way normal or expected, such as the pain he feels about the broke up, not feeling the energy to play basketball, and unwillingness to do homework.

It is important to have a child or adolescent who presents a condition that parents or caregivers suspect a mental condition to be assessed by a clinician because psychotherapeutic interventions can change neurodevelopment (Wheeler, 2022).

Standardized diagnostic interviews provide a better approach to classifying child disorders than checklists, but most diagnostic interviews demand a lot of time from respondents and are expensive to implement. Self‐completed problem checklists (i.e., questionnaires) and standardized diagnostic interviews are the two most common assessment instruments used to measure psychiatric disorders in children (Angold cited by Boyle et al., 2017)

A child or adolescent presenting symptoms that could be a mental health condition may go through a screening to help determine the need for a deeper evaluation by a trained clinician. A preliminary screening can be the Child/Adolescent Psychiatry Screen (CAPS). The screening contains 85 questions that indicate the frequency of symptoms as none, mild, moderate, severe, and past (the child used to have significant problems with this behavior, but not during the past six months). The symptoms are arranged in sections, such as anxiety, depression, substance abuse, and learning disability, to help identify areas, it is the case, for discussion with the clinician.

The Children’s Depression Rating Scale-Revised (CDRS-R) is used to diagnose depression in children aged 6 to 12 but has also been shown to effectively assess and monitor adolescent symptomatology. It rates individuals on seventeen symptom areas, including dysfunction relating to schoolwork, interpersonal relationships, psychosomatic complaints, and other thoughts and feelings commonly presenting in depressed children and adolescents. Each item is rated on a scale of 1 to 7, with one being least severe to 7 indicating severe clinical difficulties. A total score of 85 or higher indicates a depressive disorder.

Parents have attachment relationships with their children. They provide the environment for their children to develop a mental representation of themselves and their future behavioral and emotional regulation (Bowlby cited by Bohr et al., 2018). Parents are the first to notice behavior and symptoms that may concern a mental condition; therefore, they have crucial importance to early intervention to benefit their children. Parents provide information about the history of the problem, treatment, and medical condition; they must be seen as partners in the assessment and treatment of the children.

Some specific psychiatric treatment options for children and adolescents are not used when treating adults. For example, play therapy involves the use of toys, blocks, dolls, puppets, drawings, and games to help the child recognize, identify, and verbalize feelings. Another example is that parent-child interaction therapy helps parents and children who struggle with behavior problems or connections through real-time coaching sessions. Parents interact with their children while therapists guide families toward positive interactions.

References

Bohr, Y., Dhayanandhan, B., Kanter, D., Holigrocki, R., Armour, L. & Baumgartner, E. (2018). Mapping the attributions of parents: a client-centered dynamic approach to assessing vulnerable caregivers and their young children. Person-Centered & Experimental Psychotherapies, 17(1), 54-69. Retrieved from https://doi.org/10.1080/14779757.2018.1431562

Boyle, M.H., Duncan, L., Georgiades, K., Bennett, K., Gonzales, A., Lieshout, R.J., Szatmari, P., MacMillan, H.L., Kata, A., Ferro, M.A., Lipman, E.L., & Janus, M. (2017). Classifying children and adolescents psychiatric disorder by problem checklists and standardized interviews. International Journal of Methods in Psychiatric Research. Doi: 10.1002/mpr.1544

Carlat, D.J. (2017). The Psychiatric Interview (4th ed.). Walters Kluer.

Wheeler, K. (2022). Psychotherapy for the Advanced Practice Psychiatric Nurse (3rd ed.). Springer.

CAPS.pdf (73.477 KB)

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Milad Boless

Week 1 Comprehensive Integrated Psychiatric Assessment

WEEK 1 Comprehensive Integrated Psychiatric Assessment

What did the practitioner do well? In what areas can the practitioner improve?

Although the interview between the client and the practitioner did not last more than two and half minutes, the practitioner did great work by asking many open questions and kept her eye contact during her interview, creating trust and building rapport so she could have the opportunity to have a complete and accurate assessment for her client (Dang et al.,2017).

At this point in the clinical interview, do you have any compelling concerns? If so, what are they?

With any group of people referred for evaluation for depression and anxiety, the first thing that comes to mind is the safety of the client. The provider asked the client about suicidal thoughts.

A new client in a clinic to see a new provider puts the client under stress and anxiety because the client does know what he/she is excepting from the visit to a provider. In our vignette 5, the provider did not give enough time to introduce herself to the client and her roles. Besides that, she did not mention the confident rights for the client to build trust.

What would be your next question, and why?

My following questions will be about suicidal thoughts and plan if he has a previous history of suicidal attempts. besides that, I will ask if he has homicidal thoughts and gets details because the safety of the client and others is the main goal for assessing the client during the process of reaching the appropriate diagnosis. (Li et al.,2017).

Explain why a thorough psychiatric assessment of a child/adolescent is important.

It is essential to do a mental assessment for a child/adolescent to determine psychological development and behavior difficulties (Sadock et al.,2015).

Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.

For our vignette #5, As a provider, I am going to use the child behavior checklist (CBCL) and Children's Depression Inventory (CDI). Using the child behavior checklist (CBCL) is helpful in screening behavior of the children aged 6-18; it requires the parents to share in parent-completed measures of emotional, behavioral, and social problems in children (Havdahl et al.,2016). Children's Depression Inventory (CDI) is a good tool for screening depression symptoms in a child/adolescents aged 7-17. According to Stumper et al.,2019 "it assesses five factors (anhedonia, negative mood, negative self-esteem, ineffectiveness, and interpersonal problems."

Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.

Play and Art therapy, According to Woollett et al.,2020 "play therapy is structured that builds on the normal communicative and learning processes of children. On the other hand, Art therapy is helpful to express emotions, decreasing the anxiety, and increase self-esteem".

Explain the role parents/guardians play in assessment.

During mental health assessment, the provider got the information from the child, the parents, and other family members (Sadock et al.,2015). Parents are essential information sources about a chronological picture of a child's growth and development. (Sadock et al.,2015). Very young age, children sometimes cannot express themselves, so the presence of parents will help get a full mental health assessment for the children. Sadock et al.,2015).

References

Li, H., Luo, X., Ke, X., Dai, Q., Zheng, W., Zhang, C., Cassidy, R. M., Soares, J. C., Zhang, X., & Ning, Y. (2017). Major depressive disorder and suicide risk among adult outpatients at several general hospitals in a Chinese Han population. PloS one, 12(10), e0186143. https://doi.org/10.1371/journal.pone.018614

Dang, B. N., Westbrook, R. A., Njue, S. M., & Giordano, T. P. (2017). Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC medical education, 17(1), 32. https://doi.org/10.1186/s12909-017-0868-5

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of psychiatry (11th ed.). Wolters Kluwer.

Woollett, N., Bandeira, M., & Hatcher, A. (2020). Trauma-informed art and play therapy: Pilot study outcomes for children and mothers in domestic violence shelters in the United States and South Africa. Child abuse & neglect, 107, 104564. https://doi.org/10.1016/j.chiabu.2020.104564

Havdahl, K. A., von Tetzchner, S., Huerta, M., Lord, C., & Bishop, S. L. (2016). Utility of the Child Behavior Checklist as a Screener for Autism Spectrum Disorder. Autism research: official journal of the International Society for Autism Research, 9(1), 33–42. https://doi.org/10.1002/aur.1515

Stumper, A., Olino, T. M., Abramson, L. Y., & Alloy, L. B. (2019). A Factor Analysis and Test of Longitudinal Measurement Invariance of the Children's Depression Inventory (CDI) Across Adolescence. Journal of psychopathology and behavioral assessment, 41(4), 692–698. https://doi.org/10.1007/s10862-019-09746-x

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Response to Esther nkwanyuo

Wk 1 Discussion Main

COLLAPSE

Certifying As an Advanced Practice Nurse in the State of Texas

According to the nurse practice act, Senate Bill (SB) 406 ended the mandate of having a physician onsite supervise the Advanced Practice Registered Nurses (APRNs) and raised the number of APRNs a physician can supervise from four to seven. Thus, a physician is needed for collaboration in Texas but does not have to be on site (Texas Board of Nurse,2022). The nurse practitioner must practice within 75 miles of the supervising physician.

Furthermore, physicians can assign power to order Schedule II controlled drugs in hospitals and hospice settings and need periodic face-to-face encounters between APRNs and the assigning physician.

How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in Texas?

· There are two ways to apply for licensure in Texas, with or without prescriptive authority. The Required fee is $100 for APRN licensure only. If you request APRN licensure with prescriptive power, the required price is $150 nonrefundable. The individual must have an RN license with compact privilege must have completed an accredited school for their APRN. The RN must have completed a post-basic advanced educational study suitable for practice in an APRN role and population focus area allowed by the Board. The application can be submitted online or in the paper. Alongside the application will include transcripts, a copy of one's compact license, if RN license is from a different compact state (Jacobs, 2021).

The Application process for Certification in your Texas

The initial process requires the individual to login into the nurse portal from the Texas board of nurses' website. Create an account, manage a profile, apply for licensure through the portal using initial APRN licensure, submit application and registration fee, and check the Texas nurse portal for submission updates. Usually, take 10 to 15 business days, but allow at least 30 days.

State Board of Nursing Website

WWW.bon.texas.gov

How does Texas define the scope of practice of a nurse practitioner?

According to the Texas Board of Nurses, Scope of practice is defined as the venture that an individual health care provider can carry out in the delivery of patient care. Scope of practice shows the types of clients for whom the APRN can care, what course of action the APRN can perform, and influences the ability of the advanced practice registered nurse to seek reimbursement for services provided (Texas Board of Nursing, 2022).

What is included in your state practice agreement?

This agreement includes state practices and licensure laws, carrier supervision, and agreement. The various classes of drugs and devices the APRN may order and/or prescribe or the types or categories of drugs and devices the APRN may not order or prescribe; Signatures by all parties to the agreement with the date the physician or APRN signed the PAA.

How do you get a DEA license?

The APRN must have a prescriptive authority number that the Texas Board of Nursing has issued before submitting the controlled substance registration form. DEA applications may be obtained via the DEA's website or by calling the local DEA office telephone number (Texas Board of Nursing, 2022).

Does Texas have a prescription monitoring program (PMP)?

Yes, Texas does have a PMP. The PMP is engaged in monitoring and gathering prescription data II, III, and V Controlled Substance (CS) The role of an APRN includes: Before prescribing any controlled substance for patients being treated for pain, APRNs s access and review PMP authorized by Chapter 481, Health and Safety Code, (2) APRNs must access and check the PMP before ordering opioids, benzodiazepines, barbiturates, or carisoprodol. Except the client has a diagnosis of cancer or is under hospice care. AS APPLICABLE, the APRN notes on the prescription or in the electronic prescription record that the patient was diagnosed with cancer or is receiving hospice care.

How does your state describe a nurse practitioner's controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

Yes. APRNs must maintain a prescriptive authority agreement or protocol with a physician. The APRN must file a separate application with the state Department of Public Safety for controlled substances registration to order controlled substances. (Board website (http://www.bne.state.tx.us). Most APRNs ordering a 90-day supply of CSS in Schedules 3 -5, to person’s age two years and older (Coalition for Nurses in Advanced practice, 2018).

Individual states regulate NP practice. Currently, 22 states and the District of Columbia, or 44%, have adopted full practice authority licensure and practice laws for NPs. Full practice authority is defined by the American Association of Nurse Practitioners (AANP) as follows: "State practice and licensure law provides for all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing." The remaining states are categorized as either "reduced practice" (17 states, or 34%) or "restricted practice" (12 states, or 24%). The AANP further defines these categories as follows:

Reduced Practice: The NP can participate in at least one part of the NP practice and is regulated through a joint pact with an outside health discipline to provide patient care.

Restricted Practice: The NP can participate in at least one part of NP practice and involves supervision, delegation, or team management by an outside health discipline to provide patient care. Texas is a restrictive state; this obstacle can be self-limiting and detrimental to the patients, particularly those situated in rural areas. Several research has shown that the medical Board's claim citing safety as a concern has not been founded to be true. The same study found that many safety concerns were more significant with physicians than with APRNs (Peterson, 2017).

Several guidelines act as obstacles, and they impact the roles of APRNs in Texas; these obstacles include federal guidelines, state laws, old-fashioned insurance institutional practice, and reimbursement models (National Academics of Sciences, Engineering, and Medicine, 2016). That was most surprising the number of barriers APRNs face.

References

Coalition for Nurses in Advanced Practice. (2018). Prescribing Controlled Substances in Texas. https://cnaptexas.com/aprn-practice/controlled-substances-prescribing/#:~:text=Most%20APRNs%20are%20limited%20to,TSBP%20through%20the%20AWARxE%20clearinghouse.

Jacobs, A. (2021, December 15). How to become a nurse practitioner in Texas – TX: APRN Certification and jobs. GraduateNursingEDU.org. Retrieved February 28, 2022, from https://www.graduatenursingedu.org/texas

National Academies of Sciences, Engineering, and Medicine. (2016). Assessing progress on the Institute of Medicine report The Future of Nursing. National Academies Press.

Peterson, M. (2017). Barriers to practice and the impact on Health Care: A nurse practitioner focus. Journal of the advanced practitioner in oncology. Retrieved February 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/

Texas Board of Nursing (2021). Obtaining DEA number. https://www.bon.texas.gov/applications_obtaining_dea_number.asp

Texas Board of Nursing (2021). Scope of Practice of A Nurse Practitioner https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp

Texas Board of Nursing. (2019). Controlled-substance Prescriptive Authority. https://www.bon.texas.gov/rr_current/222-5.asp

Texas Board of Nursing. https://www.bon.texas.gov/practice_nursing_practice_aprninfo.asp

Texas Prescription Monitoring Program. Texas Prescription Monitoring Program (PMP). (n.d.). Retrieved February 28, 2022, from https://www.pharmacy.texas.gov/PMP/

——————————————————————————————————————————————-Response to Jenrry Medinilla

Week 1: Discussion. Main Post

COLLAPSE

Hello professor Benjamin, and classmates:

Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.

The state of Florida defines an Advanced Registered Nurse Practitioner (ARNP) as any person certified in the state to practice professional nursing and who is a licensed nurse practitioner, including a Mental Health and Psychiatry Nurse Practitioner (MHPNP). According to the Florida Board of Nursing, a signed protocol must illustrate the reciprocal contract between physician and ARNP. In addition, this protocol must contain general data like the signatures of professionals involved in the agreement in which the physician is the supervising part, as well as the name, address, certificate and DEA numbers of all the professionals. Other equally fundamental details are the location where the practice will take place and the duties and responsibilities of the stakeholders.

However, after meeting certain requirements, ARNP can register for self-directed practice. These requirements include holding an operational Florida APRN license. In addition, the concerned party, besides having no disciplinary actions, must meet at least 3000 CE hours under a physician's oversight within the past 5 years, three graduate-level semester hours in differential diagnosis and pharmacology achieved within the last five years.

How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?

The process to get certified in Florida as an MHPNP is the same for all APRNs. As per the Florida Board of Nursing, the applicant must have a valid Registered Nurse (RN) license from any U.S. state, has met all the requirements from an approved MSN or post MSN program, shows evidence of a national advanced practice diploma from an authorized nursing specialty board, as well as verification of malpractice insurance or exemption.

What is your state's board of nursing website?

The website is https://floridasnursing.gov

How does your state define the scope of practice of a nurse practitioner?

An ARNP is allowed to practice in practically every health care setting, and this practice comprises assessment, prescribing, performing duties, managing, and analyzing diagnostic and laboratory studies. Also, making diagnosing diseases; starting and overseeing therapy, including "prescribing medication and non-pharmacologic treatments; coordinating care; counselling; and educating patients and their families and communities." (AANP, 2015)

How do you get a DEA license?

In order to prescribe any regulated substance, the ARNP must register with the federal Drug Enforcement Administration (DEA). The American Association of Nurse Practitioners (AANP) recommends either applying online at the U.S. Department of Justice website, which is only available for new applicants or getting in contact via phone with the DEA Headquarters Registration Unit to request a hard copy of the official form, which is usually mailed within 10 working days. Once in possession of the document, the applicant must fill out and submit the form with all requested information (DEA Form 222a) to DEA's Registration Unit's P.O. Box in Washington D.C.

How does your state describe a nurse practitioner's controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

According to the Florida Board of Nursing, the bill HB 423, which became law on 4/14/2016, enables an ARNP to prescribe regulated substances detailed in Schedule II, Schedule III or Schedule IV as illustrated in s. 893.03 Florida Statutes, starting January 1, 2017. (Florida Board of Nursing, 2017). Florida senate website mentions that ARNP's prescribing rights for controlled substances documented in Schedule II are restricted to a seven-day supply and does not authorize ordering psychotropic drugs for children under 18 years of age unless prescribed by an MHPNP. In addition, an MHPNP may prescribe certain controlled substances under HB 977. Finally, this bill authorizes a psychiatric nurse operating within the framework of an established collaboration protocol with a psychiatrist to prescribe psychotropic regulated medications to treat psychiatric conditions.

Does your state have a prescription monitoring program (PMP)?

The Florida Prescription Drug Monitoring Program is known as E-FORCSE®, which stands for Electronic-Florida Online Reporting of Controlled Substance Evaluation Program. According to floridahealth.gov, it was created in 2009 to promote securer prescribing of controlled substances to decrease drug misuse and diversion in Florida. Since ARNP's may prescribe controlled substances, an E-FORCSE account is required. Therefore, applicants must provide general personal information and prescriber's DEA, NPI, and professional license numbers. Likewise, the applicant must provide the email address of his supervisor(s). (floridahealth.gov)

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