Population-Focused Nurse Practitioner Competencies

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  • Refer to the “Population-Focused Nurse Practitioner Competencies” in the Learning Resources, and consider the quality measures or indicators advanced practice nurses must possess in your specialty.
  • Refer to your “Clinical Skills Self-Assessment Form” you submitted in Week 1 and consider your strengths and opportunities for improvement.
  • Refer to your Patient Log in Meditrek; consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences.

In 450–500 words, address the following:

Learning From Experiences

  • Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
  • Reflect on the 3 most challenging patients you encountered during the practicum experience. What was most challenging about each?
  • What did you learn from this experience?
  • What resources were available?
  • What evidence-based practice did you use for the patients?
  • What would you do differently?
  • How are you managing patient flow and volume?  How can you apply your growing skillset to be a social change agent within your community?

Communicating and Feedback

  • Reflect on how you might improve your skills and knowledge and how to communicate those efforts to your Preceptor.
  • Answer these questions: How am I doing? What is missing?
  • Reflect on the formal and informal feedback you received from your Preceptor.

This week’s discussion is a two-fold discussion. First, explain the role of the Psychiatric Mental Health Nurse Practitioner as it relates to the scope of psychotherapy. Second, explain how this week’s discussion aligns with the following APNA standard:

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This week’s discussion is a two-fold discussion. First, explain the role of the Psychiatric Mental Health Nurse Practitioner as it relates to the scope of psychotherapy. Second, explain how this week’s discussion aligns with the following APNA standard:

• Standard 5G: Therapeutic Relationship: Psychiatric-mental health registered nurse uses therapeutic relationship as the basis for interactions and the provision of care.

The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/topic(s) posted by the course instructor by Thursday, 11:59 p.m.

Eastern Time. Two scholarly source references are required unless stated otherwise by your professor. The student provides a substantive response to the discussion question or topic on Thursday day and posts at least two additional responses to peers on another day(s). The answers to classmates must be posted by Sunday, 11:59 p.m. Eastern Time. We expect each student to participate in the discussion board respectfully.

Please review the rubric before posting to ensure a maximum of points. Here are the categories of the new discussion rubric:

Initial Post relevance to the topic of discussion, applicability, and insight. (20%)

Quality of Written Communication Appropriateness of audience and word choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)

Inclusion of APNA standards essentials explored in the discussion and the role-specific competencies as applicable. (10%)

Rigor, currency, and relevance of the scholarly references. (Use articles that are below five years old). (20%)

Peer & Professor Responses. The number of responses and quality of response posts.

(20%)

Timeliness of the initial post and the answers to the peers. (10%)

Describe two cognitive techniques and two behavioral techniques. In what types of situations would you choose each? 

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Describe two cognitive techniques and two behavioral techniques. In what types of situations would you choose each?

The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/topic(s) posted by the course instructor by Thursday, 11:59 p.m. Eastern Time. Two scholarly sources references are required unless stated otherwise by your professor.

The student provides a substantive response to the discussion question or topic on Thursday day and posts a minimum of two additional responses to peers on another day(s). The answers to classmates must be posted by Sunday, 11:59 pm Eastern Time. We expect each student to participate in the discussion board in a respectful manner.

Remember that a new discussion rubric was approved by the professors, committee members, and a majority of the students. Please review the rubric before posting to ensure a maximum of points.

Here are the categories of the new discussion rubric:

Initial Post relevance to the topic of discussion, applicability, and insight. (20%)

Quality of Written Communication Appropriateness of audience and words choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)

Inclusion of APNA standards essentials explored in the discussion as well as the role-specific competencies as applicable.(10%)

Rigor, currency,  and relevance of the scholarly references. (Use articles that are below 5 years). (20%)

Peer & Professor Responses. The number of responses, quality of response posts. (20%)

Timeliness of the initial post and the answers to the peers. (10%

Discuss how a comprehensive clinical assessment presents a unique opportunity for intervention in the psychotherapeutic context.

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Discuss how a comprehensive clinical assessment presents a unique opportunity for intervention in the psychotherapeutic context.

The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/topic(s) posted by the course instructor by Thursday, 11:59 p.m. Eastern Time. Two scholarly sources references are required unless stated otherwise by your professor.

The student provides a substantive response to the discussion question or topic on Thursday day and posts a minimum of two additional responses to peers on another day(s). The answers to classmates must be posted by Sunday, 11:59 pm Eastern Time. We expect each student to participate in the discussion board in a respectful manner.

Remember that a new discussion rubric was approved by the professors, committee members, and a majority of the students. Please review the rubric before posting to ensure a maximum of points.

Here are the categories of the new discussion rubric:

Initial Post relevance to the topic of discussion, applicability, and insight. (20%)

Quality of Written Communication Appropriateness of audience and words choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)

Inclusion of APNA standards essentials explored in the discussion as well as the role-specific competencies as applicable.(10%)

Rigor, currency,  and relevance of the scholarly references. (Use articles that are below 5 years). (20%)

Peer & Professor Responses. The number of responses, quality of response posts. (20%)

Timeliness of the initial post and the answers to the peers. (10%

Search forumsSearch forumsAdd discussion topic

How are men portrayed in movies and tv shows? 

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How are men portrayed in movies and tv shows?

How does this portrayal have an impact on how men see themselves?

This is a blog post and should be about 550 words plus references.

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:

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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 symptomology 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 priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
  • Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

BY DAY 7 OF WEEK 3

Revise your study plan summarizing your current strengths and opportunities for improvement.

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  • Revise your study plan summarizing your current strengths and opportunities for improvement.
  • Develop 3–4 new SMART goals for this quarter 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.

Who are the useful informants for a doctor diagnosing a child who may have ADHD and why?

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Week 2 discussion 1 page

1. Who are the useful informants for a doctor diagnosing a child who may have ADHD and why?

2. What non-pharmacological treatment has been useful in treating children with ADHD?

Assignment please see direction

 

You are working in a community health center as a NP. Although you see children for mental health, you will also see children for some basic “bridge” care until primary care providers have openings. If the medical issue is complex then the clinic coordinator will escalate the referral for quicker appointment scheduling.

Presentation Ellie, who is 6-years old, has come to the clinic with a suspected ear infection and as referral for her daughter’s behaviors. Ellie’s mother says that her daughter has been rocking rhythmically and clutching her ear at the same time. There has been some moisture on her pillow in the morning and Ellie is reluctant to let her mother investigate what is wrong.

Ellie is attempting to rock while she is seated on her mother’s knee and uses the same repetitive vocalization, “Don’t wanna go to the shops” over and over again.

She has a history of speech delay but can now complete many full sentences. She has also had some behavior and attention issues in school. She disrupts the teacher often and then gets up from her seat during focus time to go to play centers. She is not easily redirected and becomes argumentative.

She feels hot to touch and will not let healthcare practitioners approach her with any equipment. Her vocalization becomes louder and more insistent when you attempt examination.

Recognizing possible autism as well as some ADHD diagnosis criteria discuss next steps in the answers to the questions.

Wri te a 2-3 page paper answering the following questions. Be sure to include a minimum of two scholarly articles to support your discussion.

1. Discuss autism and ADHD diagnostic criteria.

2. How should you approach examining Ellie as a child, and strive to gain her trust?

3. You suspect that autism may be a possibility. What should you do to ensure that your suspicions are correct and how should you go about referring Ellie to the local autism team?

4. Ellie is showing signs and symptoms that may overlap between autism and ADHD. How do you differentiate autism from ADHD based on diagnostic criteria?

Discussion

 

Nurse Practice Act 1 page

Review the American Association for Nurse Practitioners State Practice Environment Map (AANP) and determine your state’s color — green, yellow, or red. Then review the Nurse Practice Act and Advanced Practice Act in your state to assist you in answering the questions listed below:

Determine your state’s practice environment color — green, yellow, or red.

Discuss how your state is an independent practice or practice restricted state.

Describe the prescriptive authority for your state.

1. (For California students) Review the CA standardized procedures requirement of NPs and discuss the meaning of standardized procedures (California BRN — Standardized Procedures Guideline).

Assignment unit 2

 

Discuss the role differences between an RN and APRN-NP, focusing on the psych NP role as much as possible. What is the PMHNP role in health policy and public awareness of psychiatric mental health trends and issues? How do your PMHNP program and the ANCC PMHNP board certification ensure you are prepared to practice professionally as a PMHNP?

· Title page (APA format)

· Introduction to RN to APRN-NP role transition

· Discuss the differences in nursing roles of RN and APRN-NP.

· Discuss potential differences/challenges regarding ethical issues.

· Discuss role of PMHNP in health policy and public awareness of psychiatric mental health trends and issues.

· Preparation as a PMHNP through education and certification

· Conclusion

You will submit a brief, 3- to 5-page paper discussing the role differences between an RN and APRN-NP.

Your assignment should:

· follow the conventions of Standard English (correct grammar, punctuation, etc.);

· be well ordered, logical, and unified, as well as original and insightful;

· display superior content, organization, style, and mechanics; and

· use APA formatting and citation style.

 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.

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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.

 

  • 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.
  • 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.

CLINICAL PRACTICE

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1 CLINICAL PRACTICE

GUIDELINEPTSD www.apa.org/ptsd-guideline

CASE EXAMPLE

Jill, a 32-year-old Afghanistan War Veteran This case example explains how Jill’s therapist used a cognitive worksheet as a starting point for engaging in Socratic dialogue.

This is a case example for the treatment of PTSD using Cognitive Behavioral Therapy. Cognitive Behavioral Therapy is strongly recommended by the APA Clinical Practice Guideline for the Treatment of PTSD.

Jill, a 32-year-old Afghanistan war veteran, had been experiencing PTSD symptoms for over 5 years. She consistently avoided thoughts and images related to witnessing her fellow service members being hit by an improvised explosive device (IED) while driving a combat supply truck. Over the years, Jill became increasingly depressed and began using alcohol on a daily basis to help assuage her PTSD symptoms. She had difficulties in her employment, missing many days of work, and she reported feeling disconnected and numb around her husband and children. In addition to a range of other PTSD symptoms, Jill had a recurring nightmare of the event in which she was the leader of a convoy and her lead truck broke down. She waved the second truck forward, the truck that hit the IED, while she and her fellow service members on the first truck worked feverishly to repair it. Consistent with the traumatic event, her nightmare included images of her and the service members on the first truck smiling and waving at those on the second truck, and the service members on the second truck making fun of the broken truck and their efforts to fix it — “Look at that piece of junk truck — good luck getting that clunker fixed.”

After a thorough assessment of her PTSD and comorbid symptoms, psychoeducation about PTSD symptoms, and a rationale for using trauma focused cognitive interventions, Jill received 10 sessions of cognitive therapy for PTSD. She was first assigned cognitive worksheets to begin self-monitoring events, her thoughts about these events, and consequent feelings. These worksheets were used to sensitize Jill to the types of cognitions that she was having about current day events and to appraisals that she had about the explosion. For example, one of the thoughts she recorded related to the explosion was, “I should have had them wait and not had them go on.” She recorded her related feeling to be guilt. Jill’s therapist used this worksheet as a starting point for engaging in Socratic dialogue, as shown in the following example:

Therapist: Jill, do you mind if I ask you a few questions about this thought that you noticed, “I should have had them wait and not had them go on?”

Client: Sure.

Therapist: Can you tell me what the protocol tells you to do in a situation in which a truck breaks down during a convoy?

Client: You want to get the truck repaired as soon as possible, because the point of a convoy is to keep the trucks moving so that you aren’t sitting ducks.

Therapist: The truck that broke down was the lead truck that you were on. What is the protocol in that case?

 

 

2 CLINICAL PRACTICE

GUIDELINEPTSD www.apa.org/ptsd-guideline

Client: The protocol says to wave the other trucks through and keep them moving so that you don’t have multiple trucks just sitting there together more vulnerable.

Therapist: Okay. That’s helpful for me to understand. In light of the protocol you just described and the reasons for it, why do you think you should have had the second truck wait and not had them go on?

Client: If I hadn’t have waved them through and told them to carry on, this wouldn’t have happened. It is my fault that they died. (Begins to cry)

Therapist: (Pause) It is certainly sad that they died. (Pause) However, I want us to think through the idea that you should have had them wait and not had them go on, and consequently that it was your fault. (Pause) If you think back about what you knew at the time — not what you know now 5 years after the outcome — did you see anything that looked like a possible explosive device when you were scanning the road as the original lead truck?

Client: No. Prior to the truck breaking down, there was nothing that we noticed. It was an area of Iraq that could be dangerous, but there hadn’t been much insurgent activity in the days and weeks prior to it happening.

Therapist: Okay. So, prior to the explosion, you hadn’t seen anything suspicious.

Client: No.

Therapist: When the second truck took over as the lead truck, what was their responsibility and what was your responsibility at that point?

Client: The next truck that Mike and my other friends were on essentially became the lead truck, and I was responsible for trying to get my truck moving again so that we weren’t in danger.

Therapist: Okay. In that scenario then, would it be Mike and the others’ jobs to be scanning the environment ahead for potential dangers?

Client: Yes, but I should have been able to see and warn them.

Therapist: Before we determine that, how far ahead of you were Mike and the others when the explosion occurred?

Client: Oh (pause), probably 200 yards?

Therapist: 200 yards—that’s two football fields’ worth of distance, right?

Client: Right.

Therapist: You’ll have to educate me. Are there explosive devices that you wouldn’t be able to detect 200 yards ahead?

Client: Absolutely.

Therapist: How about explosive devices that you might not see 10 yards ahead?

Client: Sure. If they are really good, you wouldn’t see them at all.

 

 

3 CLINICAL PRACTICE

GUIDELINEPTSD www.apa.org/ptsd-guideline

Therapist: So, in light of the facts that you didn’t see anything at the time when you waved them through at 200 yards behind and that they obviously didn’t see anything 10 yards ahead before they hit the explosion, and that protocol would call for you preventing another danger of being sitting ducks, help me understand why you wouldn’t have waved them through at that time? Again, based on what you knew at the time?

Client: (Quietly) I hadn’t thought about the fact that Mike and the others obviously didn’t see the device at 10 yards, as you say, or they would have probably done something else. (Pause) Also, when you say that we were trying to prevent another danger at the time of being “sitting ducks,” it makes me feel better about waving them through.

Therapist: Can you describe the type of emotion you have when you say, “It makes me feel better?”

Client: I guess I feel less guilty.

Therapist: That makes sense to me. As we go back and more accurately see the reality of what was really going on at the time of this explosion, it is important to notice that it makes you feel better emotionally. (Pause) In fact, I was wondering if you had ever considered that, in this situation, you actually did exactly what you were supposed to do and that something worse could have happened had you chosen to make them wait?

Client: No. I haven’t thought about that.

Therapist: Obviously this was an area that insurgents were active in if they were planting explosives. Is it possible that it could have gone down worse had you chosen not to follow protocol and send them through?

Client: Hmmm. I hadn’t thought about that either.

Therapist: That’s okay. Many people don’t think through what could have happened if they had chosen an alternative course of action at the time or they assume that there would have only been positive outcomes if they had done something different. I call it “happily ever after” thinking — assuming that a different action would have resulted in a positive outcome. (Pause) When you think, “I did a good job following protocol in a stressful situation that may have prevented more harm from happening,” how does that make you feel?

Client: It definitely makes me feel less guilty.

Therapist: I’m wondering if there is any pride that you might feel?

Client: Hmmm…I don’t know if I can go that far.

Therapist: What do you mean?

Client: It seems wrong to feel pride when my friends died.

Therapist: Is it possible to feel both pride and sadness in this situation? (Pause) Do you think Mike would hold it against you for feeling pride, as well as sadness for his and others’ losses?

Client: Mike wouldn’t hold it against me. In fact, he’d probably reassure me that I did a good job.

Therapist: (Pause) That seems really important for you to remember. It may be helpful to remind yourself of what you have discovered today, because you have some habits in thinking about this event in a particular way. We are also going to be doing some practice assignments [Challenging Questions Worksheets] that will help to walk you through your thoughts about what happened during this event, help you to remember what you knew at the time, and remind you how different thoughts can result in different feelings about what happened.

 

 

4 CLINICAL PRACTICE

GUIDELINEPTSD www.apa.org/ptsd-guideline

Client: I actually feel a bit better after this conversation.

Another thought that Jill described in relation to the traumatic event was, “I should have seen the explosion was going to happen to prevent my friends from dying.” Her related feelings were guilt and self-directed anger. The therapist used this thought to introduce the cognitive intervention of “challenging thoughts” and provided a worksheet for practice. The therapist first provided education about the different types of thinking errors, including habitual thinking, all-or-none thinking, taking things out of context, overestimating probabilities, and emotional reasoning, as well as discussing other important factors, such as gathering evidence for and against the thought, evaluating the source of the information, and focusing on irrelevant factors.

More specifically, Jill noted that she experienced 100 percent intensity of guilt and 75 percent intensity of anger at herself in relation to the thought “I should have seen the explosive device to prevent my friends from dying.” She posed several challenging questions, including the notion that improvised explosive devices are meant to be concealed, that she is the source of the information (because others don’t blame her), and that her feelings are not based on facts (i.e., she feels guilt and therefore must be guilty). She came up with the alternative thought, “The best explosive devices aren’t seen and Mike (driver of the second truck) was a good soldier. If he saw something he would stopped or tried to evade it,” which she rated as 90 percent confidence in believing. She consequently believed her original thought 10 percent, and re-rated her emotions as only 10 percent guilt and 5 percent anger at self.

REPRINTED WITH PERMISSION

Treating PTSD with cognitive-behavioral therapies: Interventions that work This case example is reprinted with permission from: Monson, C. M. & Shnaider, P. (2014). Treating PTSD with cognitive- behavioral therapies: Interventions that work. Washington, DC: American Psychological Association