Chapter 2: Scope and Standards of the
Psychiatric-Mental Health Nurse
Health Insurance Portability and Accountability Act of 1996 (HIPAA) is... - correct
answer-Legislated privacy and security laws to protect personal health identifiers from
disclosure without express consent from the patient or responsible party.
HIPAA guarantees patients four fundamental rights: - correct answer-1- Patients have a right
to be made aware of HIPAA protection of confidentiality.
2- Patients may have access to their medical records.
-The DHHS regards psychotherapy notes as not part of the medical record, and therefore
not subject to patient access.
-Prescription medications, session start and stop times, frequency of treatment, test results,
summaries and prognosis, consultation reports are considered part of the general medical
records.
3- To request an amendment to their record.
4- To require permission for disclosure of personal health information.
Therapeutic alliance is the best predictor of - correct answer-a successful treatment outcome
regardless of the therapeutic technique or psychopharmacological choice
The Nurse Practice Act defines the state's duty to protect the public from unsafe nursing
practice, delineates practice privileges, licensure process, explicit restrictions, and
educational requirements for licensure by defining basic competencies. 5 things covered by
NPA: - correct answer-1- Licensure: A process by which an agency of state government
grants permission to individuals accountable for the practice of a profession. This allows the
professional nurse to practice in the state.
2- Provides title protection (i.e., identifies who may be called a "Professional Registered
Nurse")
3- Grants legal authority and establishes mandates for RN practice
4- Subject to public hearing review before enactment
5- Disciplinary actions
--Practicing without a license or proper collaboration or supervision
--Fraud
--Falsification of records, inaccurate records, incomplete records
--Deviation from standards of care
--Failure to apply nursing judgment
Scope of practice delineates what? - correct answer-who may do what, when, where, how,
and why as governed by the terms of the state's professional license and as described in the
Nurse Practice Act
State exceptions to confidentiality: Usually enacted as a result of case law as decided by the
state judicial system. Examples: - correct answer-- Intent to harm self or others
- Duty to warn potential victims in imminent danger (Tarasoff principle, 1976)
, - Attorney involved in litigation
- Records released to insurance companies
- Answering court orders, subpoenas, or summons
- Mandatory reporting of diseases
- Child or elder abuse
Informed consent: - correct answer-Governed by state laws, a communication process
(respecting the patient's right to autonomy) between patient and provider that clearly
explains risks and benefits of a particular treatment, the condition (diagnosis and prognosis)
being treated, the risks and benefits of refusing the proposed treatment, and alternatives to
the proposed treatment.
Emancipated minors are under the age of 18 and must be married, a parent, or legally
emancipated through court proceedings and/or self-sufficient and living away from the family
home (depending on individual state laws).
Capacity - correct answer-A clinical decision (not a legal designation) based on an
evaluation by a state qualified evaluator (often a mental health professional) to determine the
patient's ability to understand new information, circumstances, and meaningfully interact with
the information and express rational thoughts related to the situation. A capacity
determination can be made by a nonmental healthcare provider directly caring for the
patient. For example, a surgeon planning to operate on a patient can make the
determination as to whether the patient has the capacity to consent to the surgery.
The process of obtaining an informed consent requires that... - correct answer-the clinician
document the explanation provided and that the patient understands the situation and the
risks and benefits of having or not having the procedure. The determination of capacity is a
situational determination (i.e., capacity to consent or assent [allowing for or failing to object]
to treatment for or to accept or refuse treatment).
Competency: A legal designation (not a clinical impression) regarding a person's ability to... -
correct answer-make reasonable decisions regarding their well-being (person or property).
All persons of legal age are presumed competent until a court declares the individual
incompetent. If deemed incompetent, a guardian must be appointed.
Involuntary Commitment Criteria: - correct answer-A process (which differs from state to
state) of forcing an individual to receive a psychiatric evaluation. The patient retains all civil
liberties except the ability to come and go as they please. General criteria include:
- Person must have a diagnosed psychiatric disorder.
- Person poses harm to self or others as a result of the psychiatric disorder.
- Person is unaware or unwilling to accept the nature and severity of the disorder.
- Treatment is likely to improve functioning.
Standards of practice: - correct answer-An official reference explicitly stating the rights and
privileges regarding the type of practice. It further defines the PMHN roles and actions,
identifies competencies assumed among members of the profession, guides the manner in
which professional practice is judged, reflects expectations of care, can be used to legally
Psychiatric-Mental Health Nurse
Health Insurance Portability and Accountability Act of 1996 (HIPAA) is... - correct
answer-Legislated privacy and security laws to protect personal health identifiers from
disclosure without express consent from the patient or responsible party.
HIPAA guarantees patients four fundamental rights: - correct answer-1- Patients have a right
to be made aware of HIPAA protection of confidentiality.
2- Patients may have access to their medical records.
-The DHHS regards psychotherapy notes as not part of the medical record, and therefore
not subject to patient access.
-Prescription medications, session start and stop times, frequency of treatment, test results,
summaries and prognosis, consultation reports are considered part of the general medical
records.
3- To request an amendment to their record.
4- To require permission for disclosure of personal health information.
Therapeutic alliance is the best predictor of - correct answer-a successful treatment outcome
regardless of the therapeutic technique or psychopharmacological choice
The Nurse Practice Act defines the state's duty to protect the public from unsafe nursing
practice, delineates practice privileges, licensure process, explicit restrictions, and
educational requirements for licensure by defining basic competencies. 5 things covered by
NPA: - correct answer-1- Licensure: A process by which an agency of state government
grants permission to individuals accountable for the practice of a profession. This allows the
professional nurse to practice in the state.
2- Provides title protection (i.e., identifies who may be called a "Professional Registered
Nurse")
3- Grants legal authority and establishes mandates for RN practice
4- Subject to public hearing review before enactment
5- Disciplinary actions
--Practicing without a license or proper collaboration or supervision
--Fraud
--Falsification of records, inaccurate records, incomplete records
--Deviation from standards of care
--Failure to apply nursing judgment
Scope of practice delineates what? - correct answer-who may do what, when, where, how,
and why as governed by the terms of the state's professional license and as described in the
Nurse Practice Act
State exceptions to confidentiality: Usually enacted as a result of case law as decided by the
state judicial system. Examples: - correct answer-- Intent to harm self or others
- Duty to warn potential victims in imminent danger (Tarasoff principle, 1976)
, - Attorney involved in litigation
- Records released to insurance companies
- Answering court orders, subpoenas, or summons
- Mandatory reporting of diseases
- Child or elder abuse
Informed consent: - correct answer-Governed by state laws, a communication process
(respecting the patient's right to autonomy) between patient and provider that clearly
explains risks and benefits of a particular treatment, the condition (diagnosis and prognosis)
being treated, the risks and benefits of refusing the proposed treatment, and alternatives to
the proposed treatment.
Emancipated minors are under the age of 18 and must be married, a parent, or legally
emancipated through court proceedings and/or self-sufficient and living away from the family
home (depending on individual state laws).
Capacity - correct answer-A clinical decision (not a legal designation) based on an
evaluation by a state qualified evaluator (often a mental health professional) to determine the
patient's ability to understand new information, circumstances, and meaningfully interact with
the information and express rational thoughts related to the situation. A capacity
determination can be made by a nonmental healthcare provider directly caring for the
patient. For example, a surgeon planning to operate on a patient can make the
determination as to whether the patient has the capacity to consent to the surgery.
The process of obtaining an informed consent requires that... - correct answer-the clinician
document the explanation provided and that the patient understands the situation and the
risks and benefits of having or not having the procedure. The determination of capacity is a
situational determination (i.e., capacity to consent or assent [allowing for or failing to object]
to treatment for or to accept or refuse treatment).
Competency: A legal designation (not a clinical impression) regarding a person's ability to... -
correct answer-make reasonable decisions regarding their well-being (person or property).
All persons of legal age are presumed competent until a court declares the individual
incompetent. If deemed incompetent, a guardian must be appointed.
Involuntary Commitment Criteria: - correct answer-A process (which differs from state to
state) of forcing an individual to receive a psychiatric evaluation. The patient retains all civil
liberties except the ability to come and go as they please. General criteria include:
- Person must have a diagnosed psychiatric disorder.
- Person poses harm to self or others as a result of the psychiatric disorder.
- Person is unaware or unwilling to accept the nature and severity of the disorder.
- Treatment is likely to improve functioning.
Standards of practice: - correct answer-An official reference explicitly stating the rights and
privileges regarding the type of practice. It further defines the PMHN roles and actions,
identifies competencies assumed among members of the profession, guides the manner in
which professional practice is judged, reflects expectations of care, can be used to legally
