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 Module 1. Discussion: The PMHNP as a Psychotherapist

 

Jessica Hernandez

St. Thomas University

NUR 640: Psychiatric Management III

Dr. Edna PetitHomme

Aug 24, 2023

 

Module 1. Discussion: The PMHNP as a Psychotherapist

The PMHNP as a Psychotherapist

Psychiatric Mental Health Nurse Practitioners (PMHNP) are advanced practice nurses with a wide range of skills and abilities. In addition, they can assess patients, administer treatment, and formulate treatment plans. They also diagnose patients with mental health problems, provide psychotherapy, and prescribe medication. PMHNPs educate patients, families, and the community about mental health disorders and remove the stigma of treatment. Some PMHNPs specialize in certain types of patients, such as children, adolescents, families, or people with substance abuse problems.

There is significant overlap between the role of the psychiatrist and PMHNP. Both can treat the same types of mental health conditions and prescribe medications. However, psychiatrists must obtain a medical degree, which takes more time than obtaining an MSN. Psychiatrists also earn a higher salary on average. PMHNP typically work in collaborative teams, while psychiatrists are more likely to have private practices. PMHNP can act as a primary mental health care provider and perform many, but not all, of the functions of a physician. These nurses have strong medical backgrounds and experience in psychiatric settings. PMHNPs practice in a variety of settings, but are most commonly found in hospitals, nursing homes, and public health departments. They have significantly greater decision-making autonomy than registered nurses or licensed practical nurses and can dispense medication to psychiatric patients. Some work in nurse practitioner offices or fill in for psychiatrists. Psychiatric nurses can and do provide psychotherapy, in addition to managing the medical aspect of psychiatric illnesses (Wesemann, 2019). They can also offer advice and support to individuals and their families just as a psychiatrist or other doctor would.

Given the high prevalence of mental health disorders, the significant impact, and unmet treatment needs, PMHNPs have an opportunity, as well as an ethical and professional obligation, to play a leadership role in improving the mental health of the patients. PMHNP must align with patient needs to design future systems and position ourselves as providers of a distinct domain of mental health care, delivering what can be considered “primary mental health care”; that is, care based on the general mental health needs of the population (Kumar et al., 2020).

The American Psychiatric Nurses Association (APNA) takes the policy position that psychiatric nurses should be considered members of the primary care workforce; this is in contrast to the traditional medical model, which positions mental health care as a specialized discipline. The responsibilities of the PMHNP role are grounded in the nursing process and therapeutic relationship and include: educating patients and families; diagnose, treat and control acute diseases; provide psychotherapy; prescription of drugs for acute and chronic diseases; diagnose, treat and control acute diseases; provide coordination of care; make referrals; order, perform and interpret laboratory tests, diagnostic studies; and provide preventive care, including screening (American Psychiatric Nurses Association (APNA), 2019). In the current delivery system, PMHNPs provide psychiatric consultation services in primary care settings. However, in both the general preventive and consultative roles of the PMHNP, there is potential to expand beyond these services to include basic interventions such as sleep hygiene, healthy nutrition, parental support, increased quality of parent-child interaction and relaxation. and coping strategies. Simple and brief intervention, as well as Cognitive Behavioral Therapy (CBT) strategies, can also be integrated into the role. Such competencies should be more explicitly defined as part of the PMHNP role.

Discuss whether it is feasible to provide psychotherapy at each patient encounter

Psychotherapy is the foundation of psychiatric care. The provision of psychotherapy is an essential component of psychiatric nursing and is a standard of practice in psychiatric and mental health nursing (Scarvaglieri, 2020). From early roles in the 1960s to now, PMH nurses have consistently delivered a variety of psychotherapies to treat mental health and psychiatric conditions to a variety of specific audiences (individuals, groups, couples, families) and settings (p eg, in-patient and outpatient). These psychotherapies include humanistic, psychodynamic, cognitive-behavioral, and interpersonal approaches that have been incorporated into PMHNP practice. Selection of psychotherapeutic approach is based on the needs of the care recipient, as well as the PMHNP’s knowledge of evidence-based research and relevant biological, psychological, and developmental theories.

About 75 percent of people who enter psychotherapy show some benefit. Psychotherapy has been shown to improve emotional and psychological well-being and is linked to positive changes in the brain and body. All forms of psychotherapy have one thing in common: they involve communication between the patient and the therapist to treat mental disorders and other problems. In general, there are two main factors that determine the effectiveness of psychotherapy: the will of the patient and the quality of the therapist. Ideally each patient should receive therapy in each section, but each patient has specific characteristics that make this operation in practice different. A weekly session is a great place to start the start of therapy. In general, most patients will start at this rate and then increase or decrease as needed. A weekly session is ideal for people who want to develop skills related to things like mindfulness, coping, and communication (Scarvaglieri, 2020). Other authors point out that, in many cases, the more therapy sessions a person attends, the less likely they are to be effective as some patients actually suffer from too much therapy.

References

American Psychiatric Nurses Association (APNA). (2019, Sep 26). 
An informational report prepared by the American Psychiatric Nurses Association . Retrieved from Expanding mental health care services in America: The pivotol role of psychiatric-mental health nurses: https://www.apna.org/files/public/Resources/Workforce_Development_Report_Final_Draft_6_25.pdf

Kumar, A., Kearney, A., Hoskins, K., & Iyengar, A. (2020). The role of psychiatric mental health nurse practitioners in improving mental and behavioral health care delivery for children and adolescents in multiple settings. 
Archives of Psychiatric Nursing, 34 (5), 275-280. doi:10.1016/j.apnu.2020.07.022

Scarvaglieri, C. (2020). First encounters in psychotherapy: Relationship building and the pursuit of institutional goals. 
Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.585038

Wesemann, D. (2019). Maximizing the use of psychotherapy with PMHNP: A call to action for nurse leaders. 
Nurse Leader, 17 (6), 537-541. https://doi.org/10.1016/j.mnl.2019.09.013

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