|

NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment 

ByDaniel Rossi Updated on

NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment – Step-by-Step Guide

The first step before starting to write the NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment 

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment 

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment 

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment 

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment 

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment 

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment 

Week 1: Child and Adolescent Assessment

INTRODUCTION

All diagnoses, from infancy to adulthood, begin with an examination. While an organic basis for most medical disorders can be determined through the use of diagnostic testing, the field of psychiatry is different in that patients cannot be sent to the lab for blood tests to determine the degree of depression. Similarly, patients cannot be sent to the radiology department for a “scan” to determine the severity of their bipolar disorder. Instead, the field of psychiatry must use psychiatric assessments, such as the comprehensive integrated physical exam, diagnostic interviews, and questionnaires to make diagnoses. These tools must be specialized to address the needs of children and adolescents.

Diagnostic assessment of the child and adolescent is a specialized area of expertise. The PMHNP will often see children who have already been seen by a primary care provider. Many PCPs are comfortable handling attention-deficit/hyperactivity disorder (ADHD) and other straightforward childhood disorders. That means that the PMHNP will often treat the more complicated patients. This week, you explore psychiatric assessment techniques and tools for children and adolescents. You also examine the role of the parent/guardian in the assessment process for this patient population.

Week 1 Discussion – Comprehensive Integrated Psychiatric Assessment

Many assessment principles are the same for children and adults; however, unlike with adults/older adults, where consent for participation in the assessment comes from the actual client, with children it is the parents or guardians who must make the decision for treatment. Issues of confidentiality, privacy, and consent must be addressed. When working with children, it is not only important to be able to connect with the pediatric patient, but also to be able to collaborate effectively with the caregivers, other family members, teachers, and school counselors/psychologists, all of whom will be able to provide important context and details to aid in your assessment and treatment plans.

Some children/adolescents may be more difficult to assess than adults, as they can be less psychologically minded. That is, they have less insights into themselves and their motivations than adults (although this is not universally true). The PMHNP must also take into consideration the child’s culture and environmental context. Additionally, with children/adolescents, there are lower rates of neurocognitive disorders superimposed on other clinical conditions, such as depression or anxiety, which create additional diagnostic challenges.

In this Discussion, you review and critique the techniques and methods of a mental health professional as the practitioner completes a comprehensive, integrated psychiatric assessment of an adolescent. You also identify rating scales and treatment options that are specifically appropriate for children/adolescents. Have a look at NRNP 6665 Week 2 Discussion: Ethical and Legal Foundations of PMHNP Care. 

TO PREPARE

  • Review the Learning Resources and consider the insights they provide on comprehensive, integrated psychiatric assessment. Watch the Mental Status Examination B-6 and Simulation Scenario-Adolescent Risk Assessment 
  • Watch the YMH Boston Vignette 5 video and take notes; you will use this video as the basis for your Discussion post.

BY DAY 3 OF WEEK 1

Based on the YMH Boston Vignette 5 video, post answers to the following questions:

  • What did the practitioner do well? In what areas can the practitioner improve?
  • At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
  • What would be your next question, and why?

Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.

  • Explain why a thorough psychiatric assessment of a child/adolescent is important.
  • Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
  • Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
  • Explain the role parents/guardians play in assessment.

Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 1

Respond to at least two of your colleagues on 2 different days by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment Example 1 

Comprehensive Integrated Psychiatric Assessment

In the YMH Boston Vignette 5 video, the practitioner demonstrated effective rapport-building by using a calm tone, maintaining eye contact, and showing genuine concern for the patient’s well-being. They asked open-ended questions to explore the patient’s mood and life experiences, allowing the patient to share more freely. The practitioner also normalized discussions about mental health, reducing stigma and encouraging the patient to engage.

However, the practitioner could improve by further probing when the patient provided vague responses, especially regarding mood and suicidal thoughts. They missed opportunities to explore underlying issues, such as irritability or anger, as potential signs of depression. Additionally, the practitioner could have used more reflective statements to validate the patient’s emotions and ensure they fully understood their perspective (YMH Boston, 2013).

The patient displayed signs of irritability, frustration, and potential emotional withdrawal, which can be indicators of depression in adolescents, particularly in males who may not exhibit traditional symptoms like sadness. There is also a concern about possible risk factors for suicidality, as the practitioner did not fully explore whether the patient has thoughts of self-harm or feelings of hopelessness. Additionally, the patient’s reluctance to elaborate on emotional issues raises concerns about underlying stressors or barriers to communication. Further exploration of family dynamics, social pressures, or academic stress is necessary.

My next question would be, have you ever had moments when you felt like giving up or thought that life might not be worth living? This question is crucial because it allows for the exploration of suicidal ideation in a non-threatening way. It is phrased to encourage the patient to reflect and respond honestly without feeling judged or overwhelmed. Given the subtle signs of depression and potential emotional distress noted earlier, addressing suicidality is critical to ensure safety and guide further intervention. This question also helps to assess the severity of the patient’s mental health concerns and determine the appropriate level of care or support needed.

Thorough Psychiatric Assessment

A thorough psychiatric assessment of a child or adolescent is essential for identifying mental health issues early, leading to timely intervention and improved outcomes. Mental health challenges during critical developmental stages can disrupt emotional, social, and educational growth. Comprehensive evaluations help make accurate diagnoses, distinguish between similar symptoms, and address co-existing disorders. The process includes understanding the child’s family, school, and social environments, which are vital to effective treatment. Detailed assessments provide insights into the individual’s specific needs, allowing for the creation of personalized treatment plans that support mental health and overall well-being (Walter et al., 2020).

Symptom Rating Scales

Two symptom rating scales appropriate for use during the psychiatric assessment of a child are the pediatric symptom checklist and the strengths and difficulties questionnaire. The pediatric symptom checklist is a caregiver-completed tool that helps identify emotional and behavioral problems in children by assessing areas such as attention, internalizing behaviors, and externalizing behaviors. The Strengths and Difficulties Questionnaire is a brief assessment completed by parents, teachers, or the child and evaluates emotional symptoms, conduct problems, hyperactivity, peer relationship issues, and prosocial behaviors. Both scales provide valuable information to guide diagnosis and treatment planning (Walter et al., 2020).

Psychiatric Treatment Options for Children and Adolescents

School-based interventions are a psychiatric treatment option for children and adolescents that involve collaboration between mental health professionals, educators, and families to provide support in the academic setting. These interventions address issues such as social skills, behavioral challenges, and academic performance, offering therapeutic assistance within the child’s daily environment (Ma et al., 2023).

Another treatment option is play therapy, which uses play as a medium to help children express emotions, process experiences, and address behavioral concerns in a developmentally appropriate way. This approach is particularly effective for younger children who may struggle to verbally articulate their thoughts and feelings (Pine et al., 2024). Both treatments are designed to meet children’s and adolescents’ unique developmental and social needs, making them distinct from adult-focused treatment options that do not incorporate these modalities or rely on these settings.

Role Parents/Guardians

Parents play a pivotal role in the psychiatric assessment of children and adolescents by providing essential context and insights that the child may not be able to articulate. They are often the first to observe changes in behavior, mood, or functioning and can offer a detailed history of the child’s development, medical issues, family dynamics, and stressors (Pine et al., 2024). Their perspective helps clarify patterns and triggers for symptoms, making the assessment more accurate.

Parents also help assess the child’s environment, including school and social relationships, which are critical to understanding the child’s mental health. Their cooperation is vital for completing rating scales and participating in interviews. Beyond providing information, their involvement signals to the child that the process is supportive, fostering trust and engagement, which are crucial to developing an effective treatment plan (Pine et al., 2024).

Reference

Ma, K. K. Y., Anderson, J. K., & Burn, A. M. (2023). School‐based interventions to improve mental health literacy and reduce mental health stigma–a systematic review. Child and Adolescent Mental Health, 28(2), 230–240. https://doi.org/10.1111/camh.12543

Pine, A. E., Baumann, M. G., Modugno, G., & Compas, B. E. (2024). Parental Involvement in Adolescent Psychological Interventions: A Meta-analysis. Clinical Child and Family Psychology Review, 1–20. https://doi.org/10.1007/s10567-024-00481-8

Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107–1124. https://doi.org/10.1016/j.jaac.2020.05.005

YMH Boston. (2013, May 22). Vignette 5 – Assessing depression in a mental health appointment. Video]. YouTube. https://www.youtube.com/watch?v=Gm3FLGxb2ZU

NRNP 6665 Week 1 Discussion: Comprehensive Integrated Psychiatric Assessment Example 2

The practitioner spoke calmly and softly to the patient to create a soothing atmosphere and make the patient comfortable. She had good body language that was open and facing the patient, conveying an interest in his answers. The practitioner did not ask open-ended questions, which could have gotten more information from the patient about what he was feeling. The practitioner did not have the patient expand on his answers to get more information about what bothers him, such as his anger, school problems, and alcohol use.

 The most significant concern is for the patient’s safety. He has expressed that he has thought of suicide and is not coping well. He also stated that he has been having anger issues which can lead to impulsive actions that could lead to further thoughts of suicide or self-harm. The next question that should be asked would be if the patient has any plan or intent or has thought of how he would hurt himself or others. This questioning would open up the conversation about what safety steps need to be addressed with the patient.

A thorough psychiatric assessment is vital with children and conducted with patience and time for them to answer the questions. The comprehensive evaluation will allow the practitioner to know all the problems the patient faces and determine the priorities that need to be a priority in a treatment plan. A comprehensive assessment will evaluate all aspects of the child or adolescent life, including possible family issues, trauma, abuse, bullying, or conflicts at school. The reason that an assessment is so critical is that pediatricians complete the majority of assessments in their yearly exams.

It is a quick assessment that may not identify actual problems the patient is having. Many children and adolescents get referred for further treatment, precipitating the comprehensive assessment. More than fifty percent of all mental health disorders emerge by the time a patient is fifteen years old (McGorry et al., 2022). Failing to identify mental health needs in childhood and adolescence can affect the further development of the person’s future social, educational, and economic opportunities (McGorry et al., 2022).

Two assessment tools that could be utilized when assessing a child or adolescent are the Adverse Childhood Experiences (ACEs) scale and the NICHQ Vanderbilt Assessment Scale. The ACEs screening identifies adverse childhood experiences that can precipitate or be a component of mental health issues for children (Watson, 2019). The ACEs can help identify exposure to abuse, neglect, family trauma, and other events that can affect a child’s mental health (Centers for Disease Control and Prevention, 2021). The NICHQ can help identify ADHD, Oppositional Defiant Disorder, anxiety, and depression (Kemper et al., 2018). The parent, teacher, and patient can complete the questionnaire, which gives a view from all parties on the symptomology the patient is experiencing.

Two treatments unique to children and adolescents are play therapy and occupational therapy. Play therapy is utilized in individual, group, and educational settings (Zhang et al., 2019). Play therapy gives children/adolescents a comfortable, safe place to play and addresses their issues. Play therapy utilizes games to identify problems, determine strengths, and allow the child to create a therapeutic relationship with the therapist.

Game therapy can assist with behavioral, mental health, social interaction, and cognition problems (Zhang et al., 2019). If used in a group setting, it can help build relationships between children and help them learn coping skills, improve concentration, address social anxiety fears, and teach appropriate social skills. Participating in group play can also help alleviate the fear of new situations, new environments, and new interactions with others (Zhang et al., 2019).

Occupational therapy is a treatment that can be utilized to treat many physical and mental health issues. Occupational therapy helps with autistic, ADHD, developmentally delayed, behaviorally challenged, and children with comorbid problems related to other diagnoses. Occupational therapy can address sensory and physical limitations, executive functioning, neuro-developmental issues, and many more challenges (Novak & Honan, 2019).

Occupational therapy helps the child acquire skills to become more independent and includes a great deal of parental education to utilize at home. The therapy consists of carrying over the skill implementation at home, school, and other settings where the child would spend much time. The activities that the child and parents are educated on are specific to the child’s needs to help the child adapt and change to become more independent.

The inclusion of the parent or caregiver of a child or adolescent in the assessment is essential because they will provide information that the child may not be able to express or that they see from a different perspective. Including the parent in the assessment allows the parent to give their perspective on what is happening and what they see.

Without their view, the practitioner may not get the full story or may get a version of the situation that is inaccurate. Sometimes parents or caregivers may see that a child behaves in a way the child cannot identify. Without that input, the practitioner could not evaluate the whole situation. Having the caregiver or parent involved also creates a connection for the patient that they are invested in helping the child address and treat the issues (Waid & Kelly, 2020).

The sources of reference utilized for this paper are either peer-reviewed journal articles written for the mental health profession or journals prepared for the professionals working in mental health. They include specific language for the profession, are educational, and include further references to support their information.

References

Centers for Disease Control and Prevention. (2021). Adverse childhood experiences prevention strategy [PDF]. cdc.gov. https://www.cdc.gov/injury/pdfs/priority/ACEs-Strategic-Plan_Final_508.pdf.

Kemper, A. R., Maslow, G. R., & Hill, S., et al. (2018). Attention Deficit Hyperactivity Disorder: diagnosis and treatment in children and adolescents [Internet] (Comparative Effectiveness Reviews, No. 203 ed.). Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK487766/table/results.t2/.

McGorry, P. D., Mei, C., Chanen, A., Hodges, C., Alvarez‐Jimenez, M., & Killackey, E. (2022). Designing and scaling up integrated youth mental health care. World Psychiatry, 21(1), 61–76. https://doi.org/10.1002/wps.20938.

Novak, I., & Honan, I. (2019). Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian Occupational Therapy Journal, 66(3), 258–273. https://doi.org/10.1111/1440-1630.12573.

Waid, J., & Kelly, M. (2020). Supporting family engagement with child and adolescent mental health services: A scoping review. Health & Social Care in the Community, 28(5), 1333–1342. https://doi.org/10.1111/hsc.12947.

Watson, P. (2019). How to screen for aces in an efficient, sensitive, and effective manner. Paediatrics & Child Health, 24(1), 37–38. https://doi.org/10.1093/pch/pxy146.

Zhang, A., Jia, Y., & Wang, J. (2019). Applying play therapy in mental health services at primary school. SHS Web of Conferences, 60, 01008. https://doi.org/10.1051/shsconf/20196001008.

NRNP 6665 Week 2 Discussion – Ethical and Legal Foundations of PMHNP Care

Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.

For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.

TO PREPARE

  • Select one of the following ethical/legal topics:
    • Autonomy
    • Beneficence
    • Justice
    • Fidelity
    • Veracity
    • Involuntary hospitalization and due process of civil commitment
    • Informed assent/consent and capacity
    • Duty to warn
    • Restraints
    • HIPPA
    • Child and elder abuse reporting
    • Tort law
    • Negligence/malpractice
  • In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.

BY DAY 3 OF WEEK 2

Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic as they concern psychiatric-mental health practice for children/adolescents and for adults. Explain how this information could apply to your clinical practice, including specific implications for practice within your state. Attach the PDFs of your articles.

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 2

Respond to at least two of your colleagues on 2 different days by sharing cultural considerations that may impact the legal or ethical issues present in their articles.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

NRNP 6665 Week 2 Discussion Example

Ethical and Legal Foundations of PMHNP Care – Autonomy

Autonomy in medical practice is the right of competent adults to make decisions on their own healthcare based on information from medical professionals. The principle of autonomy requires healthcare professionals to acquire consent from the patient before engaging in any investigations or treatments. Typically, a decision is considered autonomous when two conditions are met; the individual must have all relevant mental capacity to make rational decisions and must be unaffected by external constraints (Chapman, Toretsky, & Phoenix, 2019). In the healthcare field, a decision is viewed as autonomous when the patient has sufficient information, the capacity to make a decision and arrives at a decision voluntarily.

According to Chapman, Toretsky and Phoenix (2019), medical practitioners are expected to respect the principle of autonomy by disclosing medical information including the available treatment options to allow patients to make their own decisions. The principle of autonomy is not applicable to people who do not have the capacity or competence to make autonomous decisions such as infants and young children and patients who lack competence due to mental, developmental, or physical disorders (Chapman, Toretsky, & Phoenix, 2019). To make informed consent, there are several requirements; the patient must have the capacity to understand and decide based on the information provided to them, understand the disclosure, and acts voluntarily to give consent.

According to the article by Gómez-Vírseda, De Maeseneer and Gastmans (2020), patients have the legal right to make decisions as long as they are in their right mental status. Patients can decide whether or not to get treatment even if their decisions do not align with the physicians’ recommendations. Legal precedents have advanced the necessary requirements for patient autonomy such that patient autonomy is now the dominant principle instead of the physician’s beneficence.

McGee, Dingle, & Edelsohn, (2016), note that the welfare and health of children are maintained by their guardians. However, children and adolescents should also be involved in the decision-making process on the types of treatment they receive. Medical professionals should explain the medical issues and possible treatment options in a way that both the children/ adolescent patient and the guardian can understand.

The child/adolescent should then be allowed to participate in decisions about the care they will receive to the best of their abilities to act rationally and comprehend their options. Children or adolescents have the right to agree or disagree with the treatment options presented to them. The guardians of the children or adolescents have the right of proxy consent where they can make decisions for the minors under their care. In some jurisdictions, the consent of adolescents of a certain age is required.

The psychiatrist of the child/ adolescent is required to obtain the minor’s assent whenever it is reasonable as well as the legal guardian’s consent before any medical actions take place. However, as noted by McGee, Dingle and Edelsohn (2018). There are some provisions for emergencies and in the case of emancipated minors.

During emergency medical care, medical professionals are allowed to consider assent and consent as secondary considerations in order to provide urgent medical care to the minor patient. Emancipated minors are legally responsible for their own care and their consent must be obtained before any actions take place. In some jurisdictions, minors involved with sexually-related situations, minors are allowed to make autonomous decisions regarding their care.

Song et al. (2020) argue that there are cases when the decisions of the child or adolescent and the guardians are in conflict. In situations where the guardian consents to treatment while the minor dissents, medical practitioners may opt to treat the minor patient in spite of their dissent. It is up to the minor patient’s psychiatrist to determine the consequences of treating the patient without their consent and encourage the minor and guardians to collaborate to enhance the health of the minor.

Psychiatrists and all medical professionals have the ethical responsibility to maintain their patient’s autonomy through providing the all necessary information and allowing them to make their own decision. In my practice, I will strive to maintain my patient’s autonomy and in cases where my ethical responsibilities conflict with the law or other governing legal authority, I will take the necessary steps to resolve the conflicts using the Ethical Standards of Ethics Code and General Principles. I will also ensure that I never use any conflicts or standards to violate my patients’ right to autonomy.

References

Chapman, S. A., Toretsky, C., & Phoenix, B. J. (2019). Enhancing psychiatric mental health nurse practitioner practice: impact of state scope of practice regulations. Journal of Nursing Regulation, 10(1), 35-43. https://doi.org/10.1016/S2155-8256(19)30081-X.

Gómez-Vírseda, C., De Maeseneer, Y., & Gastmans, C. (2020). Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities. BMC Medical Ethics, 21, 1-14. 

McGee, M. E., Dingle, A. D., & Edelsohn, G. A. (2018). Review of the revised 2014 American  Academy of Child and Adolescent Psychiatry code of ethics. Journal of the American   Academy of Child and Adolescent Psychiatry, 55(4), 257-261.

Song, S. Y., Wang, C., Espelage, D. L., Fenning, P., & Jimerson, S. R. (2020). COVID-19 and school psychology: Adaptations and new directions for the field. School Psychology Review, 49(4), 431-437.

NRNP 6665 Week 3 Assignment 1: Prescribing for Children and Adolescents

Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.

—Agency for Healthcare Research and Quality

Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients.

Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?

For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.

Reference:

Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html.

TO PREPARE

  • Your Instructor will assign a specific disorder for you to research for this Assignment.
  • Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.

THE ASSIGNMENT (1–2 PAGES)

  • Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
  • Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
  • Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
  • Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.

BY DAY 7 OF WEEK 3

Submit your Assignment.

NRNP 6665 Week 3 Assignment 2: Study Plan

Based on your practice exam question results from Week 2, identify strengths and areas of opportunity and create a tailored study plan to use throughout this course to help you prepare for the national certification exam. This will serve as an action plan to help you track your goals, tasks, and progress. You will revisit and update your study plan in NRNP 6675, and you may continue to refine and use it until you take the exam.

TO PREPARE

  • Reflect on your practice exam question results from Week 2. Identify content-area strengths and opportunities for improvement.
  • Also reflect on your overall test taking. Was the length of time allotted comfortable, or did you run out of time? Did a particular question format prove difficult?

THE ASSIGNMENT

  • Based on your practice test question results, and considering the national certification exam, summarize your strengths and opportunities for improvement. Note: Your grade for this Assignment will not be derived from your test results but from your self-reflection and study plan.
  • Create a study plan for this quarter to prepare for the certification exam, including three or four SMART goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress.
  • Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study.

BY DAY 7 OF WEEK 3

Submit your study plan.

NRNP 6665 Week 4 Assignment – Assessing, Diagnosing, and Treating Adults with Mood Disorders

It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.

In this Assignment you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder.

TO PREPARE

  • Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders.
  • Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
  • Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Consider patient diagnostics missing from the video:

Provider Review outside of interview:

Temp 98.2  Pulse  90 Respiration 18  B/P  138/88

Laboratory Data Available: Urine drug and alcohol screen negative.  CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)

THE ASSIGNMENT

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomatology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
  • Objective: What observations did you make during the psychiatric assessment?
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
  • Reflection notes: Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

BY DAY 7 OF WEEK 4

Submit your Focused SOAP Note.

Medication Review

Depression   Premenstrual dysphoric disorder Seasonal affective disorder (MDD with Seasonal Variation)
agomelatine
amitriptyline
amoxapine
aripiprazole
(adjunct)
brexpiprazole (adjunct)bupropion
citalopram
clomipramine
cyamemazine
desipramine
desvenlafaxine
dothiepindoxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
iloperidone
imipramine
isocarboxazid
ketamine
lithium (adjunct)
l-methylfolate (adjunct)		 lofepramine
maprotiline
mianserin
milnacipran
mirtazapine
moclobemide
nefazodone
nortriptyline
paroxetine
phenelzine
protriptyline quetiapine (adjunct)
reboxetine
selegiline
sertindole
sertraline
sulpiride
tianeptine
tranylcypromine
trazodone
trimipramine
venlafaxine
vilazodone
vortioxetine		 citalopram
desvenlafaxine
duloxetin
eescitalopram
fluoxetin
eparoxetine
pepexev
sarafe,
sertraline
venlafaxine		 Bupropion HCL extended-release
Bipolar depression Bipolar disorder (mixed Mania/Depression Bipolar maintenance Mania
lithium (used with lurasidone)
lurasidone
olanzapine-fluoxetine combination (symbyax)
quetiapine
valproate (divalproex) (used with lurasidone)		 aripiprazole
asenapine
carbamazepine		 olanzapine
ziprasidone		 aripiprazole

lamotrigine
lithium
olanzapine

 aripiprazole
asenapine
carbamazepine
lithium
olanzapine
quetiapine
risperidone

valproate (divalproex)
ziprasidone
         

NRBP 6665 Week 5: Mood and Anxiety Disorders in Children and Adolescents

INTRODUCTION

School and going out with my friends used to be fun, but not anymore. Mom keeps telling me just to go out and have fun, but I don’t see the point of trying. All my friends are better than I am. I keep having these headaches and just feel worthless. I used to get As and Bs in school, but not anymore. I can’t concentrate at school. I would rather be at home sleeping.

—Madison, age 16

Mood and anxiety disorders can be particularly challenging to address in childhood and adolescence for many reasons. Children may not be able to fully express or understand their feelings and behaviors. Parents may misattribute or not recognize signs and symptoms. The symptoms of disorders also vary when present in children as opposed to adults. The PMHNP needs to know how to diagnose these conditions and must understand the importance of integrating medication management strategies with both individual and family therapy to optimize treatment outcomes.

Medication  Review

Review the FDA-approved use of the following medicines related to treating mood and anxiety disorders in children and adolescents.

Bipolar depression Bipolar disorder
lurasidone (age 10–17)
olanzapine-fluoxetine combination (age 10–17)		 aripiprazole (age 10–17)
asenapine  (for mania or mixed episodes, age 10–17)
lithium (for mania, age 12–17)

olanzapine (age 13–17)
quetiapine (age 10–17)
risperidone (age 10–17)
Generalized anxiety disorder Depression
duloxetine (age 7–17) escitalopram (age 12–17)
fluoxetine (age 8–17)
Obsessive-compulsive disorder
clomipramine (age 10–17)
fluoxetine (age 7–17)
fluvoxamine (age 8–17)
sertraline (age 6–17)

NRNP 6665 Week 5 Assignment – Patient Education for Children and Adolescents

Patient education is an effective tool in supporting compliance and treatment for a diagnosis. It is important to consider effective ways to educate patients and their families about a diagnosis—such as coaching, brochures, or videos—and to recognize that the efficacy of any materials may differ based on the needs and learning preferences of a particular patient. Because patients or their families may be overwhelmed with a new diagnosis, it is important that materials provided by the practitioner clearly outline the information that patients need to know.

For this Assignment, you will pretend that you are a contributing writer to a health blog. You are tasked with explaining important information about an assigned mental health disorder in language appropriate for child/adolescent patients and/or their caregivers.

THE ASSIGNMENT

In a 300- to 500-word blog post written for a patient and/or caregiver audience, explain signs and symptoms for your diagnosis, pharmacological treatments, nonpharmacological treatments, and appropriate community resources and referrals.
Although you are not required to respond to colleagues, collegial discussion is welcome.

BY DAY 7 OF WEEK 5

Submit your Assignment.

NRNP 6665 Week 6: Eating, Sleeping, and Elimination Disorders; Midterm Exam

INTRODUCTION

Eating, sleeping, and elimination disorders may come to the attention of providers in a variety of settings. These disorders can be profoundly disturbing to patients’ lives and may have significant comorbidities with other disorders. Eating disorders, such as anorexia and bulimia, are widely known. But it is important to understand and be able to recognize less common disorders, such as pica and rumination disorder.

Sleep is essential for a healthy mind and body, and lack of quality sleep can cause distress during the daytime. Sleep disorders can involve difficulties with quality, timing, and amount of sleep, and they frequently accompany other disorders, especially depression, anxiety, and PTSD. The elimination disorders of enuresis and encopresis are troubling to children and parents and cause significant difficulty in daily functioning.

Obtaining a thorough history is essential to diagnosing eating, sleeping, and elimination disorders; formulating a treatment plan; and monitoring the plan’s effectiveness. This week, you will explore these categories of disorders and complete your midterm exam.

Attempt History

  Attempt Time Score
LATEST Attempt 1 100 minutes 89.75 out of 100

Quiz results are protected for this quiz and are not visible to students.

Correct answers are hidden.

Score for this quiz: 89.75 out of 100

Medication Review

Review the FDA-approved use of the following medicines related to treating eating, sleeping, and elimination disorders.

Bulimia nervosa/binge eating Enuresis
Fluoxetine – bulimia
Lisdexamfetamine – binge eating		 Desmopressin
Tofranil
Excessive sleepiness in narcolepsy, obstructive sleep apnea/hypopnea
syndrome, shift work sleep disorder		 Insomnia Restless leg syndrome
armodafinil
modafinil
pitolisant
sodium oxybate
Solriamfetol		 Doxepin
Eszopiclone
Estazolam
Flurazepam
Lemborexant
Quazepam
Ramelteon
Suvorexant
Temazepam
Triazolam
Zaleplon
Zolpidem		 Ropinirole
Pramipexole
Rotigotine patch
Gabapentin enacarbil

NRNP 6665 Module 3: Assessing, Diagnosing, and Treating Neurocognitive, Neurodevelopmental, Dissociative, Somatic Symptom-Related, Disruptive, Impulse-Control, and Conduct Disorders

Medication Review

Review the FDA-approved use of the following medicines related to treating neurocognitive disorders.

Alzheimer’s disease Delirium Parkinson’s disease dementia/psychosis
caprylidene
donepezil
galantamine
memantine
rivastigmine		 There are no FDA-approved medications for the treatment of delirium. nuplazid
rivastigmine
pimavanserin

Week 7: Assignment

  • Due No Due Date
  • Points None

Diagnosing and Treating Patients with Neurocognitive Disorders

Neurocognitive disorders (NCDs) such as delirium, dementia, and amnestic disorders are more prevalent in older adults. As the population ages and as life expectancy in the United States continues to increase, the incidence of these disorders will continue to increase. Cognitive functioning in such areas as memory, language, orientation, judgment, and problem solving are affected in clients with NCDs. Caring for someone with a neurocognitive disorder is not only challenging for the clinician; it is stressful for the family as well. The PMHNP needs to consider not only the patient but also the “family as patient.” Collaboration with primary care providers and specialty providers is essential. Anticipatory guidance also becomes extremely important.

NRNP 6665 Week 8: Neurodevelopmental Disorders

INTRODUCTION

I can’t believe I am sitting here talking to this lady. Mom thinks I am nuts just because I will not do what she asks. She doesn’t care about me. She only cares about my little brother and that man that keeps coming around. I don’t care about her. That is why I throw things and won’t do what she asks. I don’t care about anyone. Those kids at school who used to be my friends don’t know anything. I am so much smarter than they are.

—Jacob, age 11

There are many mental disorders that occur early in the life course. The DSM-5-TR described neurodevelopmental disorders such as intellectual disability and delay, autism spectrum disorder, language, speech and communication disorders, ADHD, motor disorders, developmental coordination disorder, stereotypic movement disorder, tic disorder, and specific learning disorders (e.g., dyslexia, difficulty mastering mathematical reasoning).

Diagnosis of these various conditions can rarely be made in a single office visit and often requires a comprehensive approach involving multiple stakeholders, including the child, his or her parents, teachers, other significant figures in the child’s life, and medical and mental health professionals, such as psychologists who can conduct comprehensive neuropsychological testing.

The PMHNP must coordinate and integrate several sources of information to arrive at an accurate diagnosis of these disorders. Early and accurate diagnosis is essential to developing an effective treatment plan, which will have the potential to minimize the impact of these disorders on the child’s developmental trajectory. When one considers appropriate diagnosis from this perspective, the importance of diagnostic accuracy becomes quite apparent.

This week, you begin exploring disorders that occur early in the life course and use this knowledge to create a study guide for a neurodevelopmental disorder.

Medication Review

Irritability in autism Attention-deficit/hyperactivity disorder
aripiprazole
risperidone		 amphetamine IR, XR, and ER
dextroamphetamine
atomoxetine

clonidine hydrocholoride ER
Dexmethylphenidate IR and XR
guanfacine hydrocholride ER
lisdexamfetamine
methylphenidate
methylphenidate hydrocholoride IR and ER, transdermal

NRNP 6665 Week 8: Assignment – Study Guide Forum

Abnormal brain development or damage at an early age can lead to neurodevelopmental disorders. Within this group of disorders, some are resolvable with appropriate and timely interventions, either pharmacological or nonpharmacological, while other disorders are chronic and need to be managed throughout the lifespan.

For this Assignment, you will develop a study guide for an assigned disorder and share it with your colleagues. In sum, these study guides will be a powerful tool in preparing for your certification exam.

TO PREPARE

  • Your Instructor will assign you to a specific neurodevelopmental disorder from the DSM-5-TR.
  • Research your assigned disorder using the Walden Library. Then, develop an organizational scheme for the important information about the disorder.

THE ASSIGNMENT

Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5-TR but also supported by at least three other scholarly resources.

Areas of importance you should address, but are not limited to, are:

  • Signs and symptoms according to the DSM-5-TR
  • Differential diagnoses
  • Incidence
  • Development and course
  • Prognosis
  • Considerations related to culture, gender, age
  • Pharmacological treatments, including any side effects
  • Nonpharmacological treatments
  • Diagnostics and labs
  • Comorbidities
  • Legal and ethical considerations
  • Pertinent patient education considerations

BY DAY 7 OF WEEK 8

You will need to submit your Assignment to two places: the Week 8 Study Guide discussion forum as an attachment and the Week 8 Assignment submission link. Although no responses are required in the discussion forum, collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned neurodevelopmental disorders for study.

Access the Study Guide Forum (or click the Next button).

NRNP 6665 Week 9: Dissociative Disorders

INTRODUCTION

Have you ever been driving and realized you don’t remember the last few minutes of driving? Or have you gotten so wrapped up in a book or movie that you lose some awareness of your surroundings? These are examples of common and very mild dissociation, or a disconnect or lack of continuity between thoughts, feelings, actions, and sense of self.

There are three major dissociative disorders defined in the DSM-5-TR: dissociative identity disorder, dissociative amnesia, and depersonalization-derealization disorder. Dissociative disorders may be associated with traumatic events in order to help manage difficult memories or experiences. Patients with these types of disorders are likely to also exhibit symptoms of a variety of other dysfunctions, such as depression, alcoholism, or self-harm and may also be more susceptible to personality, sleeping, and eating disorders.

This week, you will analyze issues related to the diagnosis and treatment of dissociative disorders as well as associated legal and ethical considerations.

NRNP 6665 Week 9: Assignment – Controversy Associated with Dissociative Disorders

The DSM-5-TR is a diagnostic tool. It has evolved over the decades, as have the classifications and criteria within its pages. It is used not just for diagnosis, however, but also for billing, access to services, and legal cases. Not all practitioners are in agreement with the content and structure of the DSM-5-TR, and dissociative disorders are one such area. These disorders can be difficult to distinguish and diagnose. There is also controversy in the field over the legitimacy of certain dissociative disorders, such as dissociative identity disorder, which was formerly called multiple personality disorder.

In this Assignment, you will examine the controversy surrounding dissociative disorders. You will also explore clinical, ethical, and legal considerations pertinent to working with patients with these disorders.

TO PREPARE

  • Review this week’s Learning Resources on dissociative disorders.
  • Use the Walden Library to investigate the controversy regarding dissociative disorders. Locate at least three scholarly articles that you can use to support your Assignment.

THE ASSIGNMENT (2–3 PAGES)

  • Explain the controversy that surrounds dissociative disorders.
  • Explain your professional beliefs about dissociative disorders, supporting your rationale with at least three scholarly references from the literature.
  • Explain strategies for maintaining the therapeutic relationship with a client that may present with a dissociative disorder.
  • Finally, explain ethical and legal considerations related to dissociative disorders that you need to bring to your practice and why they are important.

BY DAY 7 OF WEEK 9

Submit your Assignment