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13.1 Clinical Guidelines and Standards

Nurses must be aware of the many organizations and agencies that affect their role in the health-care field. These organizations operate on local, state, and federal levels. It is imperative that nurses know the rules and regulations that govern the care they provide, how to maintain their license, and the consequences for not following the regulations. The scope of nursing practice is outlined by the Nurse Practice Act in each nurse’s state. There are also institutional policies of which nurses must be cognizant in order to demonstrate competence and commit to best practices.

Federal agencies and accrediting agencies also affect nursing practice. Nurses should be familiar with federal insurance providers, like Medicare and Medicaid, safety protocols promulgated by OSHA, and programs like Healthy People 2030 and National Patient Safety Goals to help them focus on national priorities and maintain the safest work and client environments.

13.2 DSM-5 Criteria and Use

The DSM-5-TR provides a widely used diagnostic tool in the field of clinical psychology, PMH nursing, and psychiatry. It provides a standardized framework for the classification and diagnosis of mental disorders. The DSM has been updated many times to adapt to current evidence, research, and the evolving practice of mental health care. Practitioners use it to conceptualize client problems, formulate treatment plans, and bill for services rendered.

13.3 Nursing Assessment and Care Plans

It is important for the PMH RN to utilize the nursing process in helping the mental health client improve and recover. The APNA, in task force with the International Society of Psychiatric-Mental Health Nurses (ISPN), developed the Scope and Standards of Practice, Third Edition (2022) to guide the PMH RN in the nursing process. The nursing process includes assessment to recognize and analyze cues to problems, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

13.4 Promoting Recovery in Psychiatric Nursing

This section has defined the recovery model and orientation in PMH nursing and provided a historical outline of its development. PMH nurses play an essential role in the recovery process through the therapeutic relationship. Nurses support persons toward mental health and addictions recovery through education, advocacy, and promotion of national initiatives like National Recovery Month.

13.5 Special Considerations for PMH Practice

There are a number of challenges and special considerations specific to PMH nursing. First and foremost, nurses must reflect on their own perceptions of, and stigma toward, mental health issues to ensure that they acknowledge the physiological basis of these mental health disorders. These clients cannot just be told to “behave better.” Nurses must also become accustomed to the idea of self as the instrument of intervention, talk therapy, for instance, being the care provided. Other challenges include diagnostic overshadowing, ethical concerns over restrictive treatments like seclusions and restraints, denial of diagnosis by clients, clients’ refusal of medications, and clients’ unpredictable behaviors. Nurses also experience frustration with clients’ aggression and lack of ongoing skills support, and they struggle with stress, incivility in the workplace, and burnout.


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