Psychiatric Diagnosis and Management: Adults
Mental illnesses are among the leading causes of compromised quality of life, disability, and deaths emanating from suicidality and self-harm. Besides these effects, mental disorders increase the demand for quality and timely care by impairing patients’ cognition and affecting their ability to complete activities for daily living.
Amidst the intricacies, demands, and complexities associated with delivering care to patients with mental conditions, psychiatric health nurse practitioners (PMHNPs) have the ethical and professional obligation of creating conducive clinical environments for patients and ensure the safety of various nursing practice processes, including psychiatric diagnosis, case management, medication prescribing, administration, and follow-up.
As a result, this paper aims to reflect on my practice as a psychiatric mental health nurse practitioner (PMHNP), describe my experiences with prescribing during clinical, identify strengths and weaknesses during prescribing, and elaborate on the personal plan for addressing prescribing weaknesses. Also, it discusses the kind of experiences expected for this and the next semester regarding prescribing.
Reflection of My Practice as a Psychiatric Mental Health Nurse Professional (PMHNP)
My practice as a psychiatric mental health nurse practitioner has been challenging, insightful, and overly satisfactory. The challenging part of my practice as a PMHNP emanates from the overarching need to translate theoretical knowledge into clinical practice. For instance, my profession requires me to incorporate various mental health assessment tools and scales to examine patients’ behaviors, moods, cognition, judgment, and insights.
After assessing these aspects and indicators of mental health, I have an ethical and professional obligation to identify the underlying mental health, create a collaborative care plan to improve the patient’s health and well-being and prevent further complications associated with the identified mental health condition (s).
My ability to conduct mental status exams represents a professional strength that enables me to develop comprehensive and collaborative care plans for my client. Voss & Das (2021) perceive mental status examinations as the psychiatric versions of physical examinations that allow healthcare professionals to identify underlying conditions.
In this sense, mental status examinations enable psychiatric mental health nurse practitioners to recognize disruptions in patients’ behaviors, cognitive performance, mood, and functionality (Bharuchi & Rasheed, 2021). An effective mental status examination is a prerequisite for evidence-based medication prescription, administration, and other interventions for improving patients’ health and wellness.
As a mental health nurse practitioner, I have had opportunities for providing care consistent with findings from mental status examinations. For instance, I have familiarized myself with clinical guidelines for providing individualized care to people with various mental health issues, including schizophrenia, post-traumatic stress disorder (PTSD), and bipolar disorder.
Further, I have gained insights and knowledge on various therapies for improving the health and well-being of people with mental health issues. Examples of these therapies include cognitive behavioral therapy (CBT), psychodynamic, psychoanalysis, exposure, and eye movement desensitization and reprocessing (EMDR). The knowledge and awareness of these therapeutic approaches have enabled me to understand the intricacies and demands of the psychiatric care setting.
Another essential aspect of my experience as a mental health nurse practitioner is the subsequent knowledge of medication management processes, including prescription, administration, and reconciliation. According to Khawagi et al. (2019), healthcare professionals in psychiatric care settings use medications as the most profound type of treatment for mental disorders.
However, they endure a high propensity to risks associated with handling, prescribing, and administering medications for mental disorders. For instance, high doses, combination antipsychotic prescribing, polypharmacy, and the use of different high-risk drugs like clozapine and lithium pose multiple problems to healthcare professionals, including the overarching need to adhere to mental health laws, co-existing substance abuse, medication errors, and the subsequent consequences.
In my clinical experience, I have encountered scenarios of near misses and incidences of medication errors that resulted in life-threatening conditions and a series of legal implications for healthcare professionals. As a result, I perceive medication management processes like reconciliation, labeling, storage, verification, prescribing, and administration as vital aspects in the psychiatric care setting because they determine the levels of patients’ safety.
Further, I have learned that forming an interprofessional team consisting of physicians, advanced practice registered nurses, nurses, nurse assistants, and patients can promote medication management safety and reduce the prevalence of medication mistakes. Equally, I have realized that professional behaviors like double-checking medications, proper storage of high-risk medications, and taking adequate time to review physicians’ prescription notes can prevent errors and improve medication safety.
My Experiences with Prescribing During Clinicals
As a mental health nurse practitioner, I have participated in individual and interprofessional team efforts for assessing patients’ mental status, developing care plans, implementing pharmacologic and non-pharmacologic interventions for improving health and well-being, and monitoring progress. Besides these essential roles, I have had opportunities to familiarize myself with medication prescribing and the current guidelines for administering pharmacotherapies to patients with various mental disorders.
For example, I have acquired knowledge of essential medicines for mental health disorders, including chlorpromazine, fluphenazine, and haloperidol for psychotic disorders, amitriptyline, and fluoxetine for depressive disorders, and carbamazepine, lithium carbonate, and valproic acid for bipolar disorder. Administering these medicines requires healthcare professionals to adhere to the “rights” of medication administration, including correct dosage, timing, route, patient, and documentation.
Although I participated in medication management processes like verification and administration, the institutional policy required nurses to operate under physicians’ supervision when prescribing medications for treating mental disorders. Equally, we were supposed to form long-term interpersonal teams with physicians and advanced practice registered nurses (APRNs) to execute our roles as medication prescribers.
Regardless of regulatory limitations, I acquired knowledge of the organizational guidelines for prescribing medications, including the World Health Organization’s six-step framework for medication prescription. According to Rongen et al. (2021), the World Health Organization’s guidelines for medication prescription include defining the patient’s problem, establishing the aim or objective of the pharmacotherapy, verifying the suitability of P-drugs, writing a prescription, giving instructions, information, and warnings, and monitoring the treatment’s efficiency. Notably, the WHO-enforced six-step method enables healthcare professionals to systematically select the best pharmacotherapy and the most effective dose for patients.
During my clinical practice, I participated in non-medical prescription, a role that enabled me to take on greater responsibility for managing patient care and enhancing my professional knowledge and prescribing competency. Graham-Clarke et al. (2022) contend that non-medical prescribing originated in the United Kingdom (UK) as a profound strategy for improving access to medicines, enhancing patient care, matching increased patient demands, and addressing workforce shortages, pressures, and funding shortfalls.
As a non-medical prescriber, I overly relied upon the World Health Organization’s six-step method of medication prescription. By using this model, I acquired knowledge of effective strategies for assessing and identifying patients’ needs, establishing objectives and aims of pharmacotherapies, determining the efficacy and safety of therapeutic options, identifying patients’ characteristics that influence therapeutic options, writing prescriptions, giving instructions and information to patients, and monitoring the treatment’s efficacy and safety. Going forward, I will apply this knowledge and competency to ensure safer medication prescription and administration.
My Prescribing Strengths
Consistent with the six steps of the World Health Organization’s medication prescription framework, my experience in the psychiatric clinical setting improved my prescribing competency. Prescribing competency entails the ability to assess the patient, consider medication options, make informed decisions depending on the patient’s health needs and priorities, write prescriptions, provide information, instructions, and warnings to patients, and monitor and review medication safety and efficiency (Hall & Picton, 2020).
Further, prescribing competency involves the skill of safer and professional prescription and the ability to prescribe as a team. It is essential to note that safer and professional prescribing practices are essential in preventing and reducing the prevalence of medication errors as well as adverse consequences associated with medication mistakes.
During my clinical practice, I conducted a personal assessment of prescribing competency to identify strengths, weaknesses, and areas of improvement regarding team-based medical and non-medical prescriptions. After conducting a competency evaluation, I realized that my prescribing strengths include the ability to examine patients’ mental health needs effectively, individual awareness of medication options, verify the suitability of P-drugs, write prescriptions, and monitor treatment efficacy and safety. These strengths align with the World Health Organization’s six-step method and are vital in promoting medication safety and patients’ well-being.
My Prescribing Weaknesses
Besides these strengths, I noticed some areas of improvement and weaknesses when prescribing medications. These weaknesses include the inability to effectively prescribe medications amidst time pressure, increased workloads, and nursing staff shortages, ineffective communication with patients when providing instructions, information, and warnings regarding pharmacotherapies, and challenges during dose calculations.
Also, I realized that I fear committing medication mistakes and encountering constraints when using advanced technologies to enhance faster and more secure medication prescriptions. Examples of these technologies are e-prescribing systems, computerized physician order entry (CPOE), and clinical decision support systems (CDSSs). A contingency plan comprising interventions for ongoing learning can improve my prescribing competency and address these weaknesses.
A Plan for Addressing Prescribing Weaknesses
I plan to address my prescribing weaknesses by attentively and keenly observing physicians’ prescription practices, participating in training and education activities, and conducting research to obtain insights into the scholarly recommendations for safer medication prescription and administration.
According to Omer et al. (2020), medication prescription is a complex endeavor that requires healthcare professionals to consolidate and amalgamate knowledge of medicines, diagnostic, and communication skills, a comprehensive understanding of principles that underpin clinical pharmacology, and an appreciation of uncertainties and risks.
Direct observation and collaborating with physicians are vital approaches for improving my prescribing competency. In this sense, physicians will provide expertise, guidance, and technical/psychological support necessary for eliminating the fear of committing mistakes and addressing constraints that compromise interventions for safer medication prescription.
Equally, enrolling in education and training sessions and self-directed and online learning can improve my prescribing competency. Firstly, participating in training and education programs will enhance my knowledge and skills to effectively take patients’ drug histories, prescribe medications for acute medical emergencies, discharge prescriptions, and drug monitoring (Omer et al., 2021).
Finally, self-directed and online learning provides opportunities for utilizing the best available external evidence to improve prescribing competency. Self-directed and online learning modalities will allow me to access online simulations, obtain findings from scientific studies, and utilize scholarly findings and suggestions to improve my prescribing competency.
Anticipated Experiences for this and Next Semester Regarding Prescribing
This and next semester, I look forward to improving and developing my prescribing competency by participating in interprofessional teamwork and conducting non-medical prescriptions. I anticipate that this semester’s experiences will emphasize more on clinical practice to provide opportunities for translating theoretical knowledge into real-life practices.
Finally, I perceive that next semester’s experiences will enhance my knowledge and awareness of safer medication management practices by focusing on contextual risk factors for medication errors and emphasizing personal and professional development through ongoing learning and collaborating with physicians and senior nurses in the psychiatric care setting.
My experience as a mental health nurse practitioner (MHNP) has been insightful and satisfactory despite various challenges encountered when translating theoretical knowledge to practice. In my clinical experience, I have gained knowledge and awareness of safer medication prescribing, including effective assessment of patients’ mental health needs, considering medication options, making shared decisions, writing prescriptions, and monitoring treatments’ efficacy through follow-ups.
However, enhancing prescribing competency is a continuous process that entails updating knowledge of medications, understanding the functionality of advanced technologies, and adhering to clinical guidelines. As a result, I endeavor to consistently improve my prescribing competency by observing physicians’ prescription practices, enrolling in education and training programs, conducting research, and engaging in self-driven learning.
Bharuchi, V., & Rasheed, M. A. (2022). Development and feasibility testing of the mental status examination scale to assess the functional status of young, hospitalized children in Pakistan. SSM – Mental Health, 100126. https://doi.org/10.1016/j.ssmmh.2022.100126
Graham-Clarke, E., Rushton, A., & Marriott, J. (2022). Exploring the barriers and facilitators to non-medical prescribing experienced by pharmacists and physiotherapists, using focus groups. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-07559-5
Hall, K., & Picton, C. (2020). Analyzing the competency framework for all prescribers. Journal of Prescribing Practice, 2(3), 122–128. https://doi.org/10.12968/jprp.2020.2.3.122
Khawagi, W. Y., Steinke, D. T., Nguyen, J., & Keers, R. N. (2019). Identifying potential prescribing safety indicators related to mental health disorders and medications: A systematic review. PLOS ONE, 14(5), e0217406. https://doi.org/10.1371/journal.pone.0217406
Omer, U., Danopoulos, E., Veysey, M., Crampton, P., & Finn, G. (2020). A rapid review of prescribing education interventions. Medical Science Educator, 31(1), 273–289. https://doi.org/10.1007/s40670-020-01131-8
Rongen, G. A., Marquet, P., van Gerven, J. M. A., & EACPT research working group. (2021). The scientific basis of rational prescribing. A guide to precision clinical pharmacology based on the WHO 6-step method. European Journal of Clinical Pharmacology, 77(5), 677–683. https://doi.org/10.1007/s00228-020-03044-2
Voss, R. M., & Das, J. M. (2021, September 16). Mental status examination. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546682/
Psychiatric diagnosis and management: Adults
Appendix A. Reflective Video Journal. #1, #2, #3, #4 each worth 25 points = 100 points
To complete this assignment:
A Reflect on your practice as a Psychiatric mental health nurse practitioner-PMHNP
B: Describe your experiences with prescribing during clinicals.
C: What are your strengths with Prescribing?
- What are your weaknesses with prescribing?
E: What are your plans for addressing your weak areas with prescribing.
F: What kinds of experiences will you be looking for this and next semester regarding prescribing?
Each of these assignments will be evaluated according to the following rubric:
|Follows the prompt||5 points|
|Is within time limits for the prompt||5 points|
|Thoughtfully addresses the prompt||15 points|