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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.

 

  • Select one of the following ethical/legal topics:
  • 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.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

Read a selection of your colleagues’ responses.

 

 

Some sources:

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Respond to peer

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.

 

 

 

 

The practitioner in the video created a calm and comfortable environment for the patient, maintained eye contact, used open-ended questions, and actively listened to the patient’s responses. The practitioner demonstrated empathy and professionalism by summarizing the client’s narratives, which comforted the client and allowed him to share the main source of his anger and depression. Older children and adolescents may not want to be consulted about their behavior, especially if it is disruptive or if they are embarrassed to have their parents discuss their behavior with others (Srinath et al., 2019). She asked appropriate questions to identify the source of his feelings and spoke calmly, using familiar vocabulary. At this point in the interview the practitioner should ask more specific and targeted questions to gather additional information about the patient’s symptoms and provide more education on depression. Open-ended questions would allow for greater interaction between the client and provider. The biggest concern I have is treating the patient’s anger and depression early before it progresses. The next question should be focused on gathering more information about the patient’s suicidal thoughts and ideation (YMH Boston, 2019). This could include asking about the frequency and intensity of these thoughts, any previous attempts or plans for suicide, and any current support systems or coping strategies in place. These questions can help assess the severity of the patient’s depression and determine the level of intervention needed.

Adolescence is a critical period for the onset of mood disorders, and depression in adolescence is associated with relapse later in life, social and educational impairment, and physical health difficulties, and represents a significant risk factor for suicide (Orchard et al., 2019). A thorough psychiatric assessment of a child or adolescent is important for many reasons. First, it allows for the identification and diagnosis of any mental health disorders that may be impacting the child’s functioning and overall well-being. This is crucial as early detection and intervention can lead to better outcomes and prevent the development of more severe symptoms in the future. Additionally, a thorough psychiatric assessment considers all aspects of a child’s life, including their family dynamics, school environment, and social relationships. It can help identify any underlying factors or stressors that may be contributing to the child’s mental health concerns.

Two different symptom rating scales that would be appropriate to use during a psychiatric assessment of a child or adolescent are the Children’s Depression Inventory (CDI) and the Child Behavior Checklist (CBCL). The CDI is a self-report questionnaire used to assess depressive symptoms in children and adolescents, while the CBCL is a comprehensive checklist that evaluates a wide range of emotional and behavioral problems in children. Two psychiatric treatment options for children and adolescents that may not be used when treating adults are play therapy and family therapy. Play therapy involves using toys, games, and other activities to help children express their thoughts and emotions. It can be an effective way to engage younger children who may struggle with verbal communication. Family therapy involves working with the child’s family to improve communication, resolve conflicts, and address any issues that may be contributing to the child’s symptoms.

Adolescents need support and protection due to their physical, psychological and social vulnerabilities, and excessive adverse exposure can have destructive effects on adolescents’ lives and health (Rahmani et al., 2022). Although social support could play a pivotal role in helping adolescents transition to a new role as a caregiver, adolescents often perceive themselves as supportless and neglected. Parents and guardians play a crucial role in the assessment process. They can provide valuable information about the child’s behavior, symptoms, and family history, aiding the diagnostic process. They can also provide insight into the child’s daily functioning and help monitor any changes in symptoms or behaviors. In some cases, parents may also participate in therapy sessions with their child, making them an essential part of the treatment process.

 

References

Orchard, F., Pass, L., Cocks, L., Chessell, C., & Reynolds, S. (2019). Examining parent and child agreement in the diagnosis of adolescent depression. Child and Adolescent Mental Health, 24(4), 338–344. https://doi.org/10.1111/CAMH.12348

Rahmani, F., Roshanghar, F., Gholizadeh, L., & Dickens, G. L. (2022). Caregiver or care receiver: Adolescents’ experience of caregiving to a parent with severe mental illness: A qualitative study. Child and Family Social Work, 27(4), 795–804. https://doi.org/10.1111/CFS.12926

Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescentsLinks to an external site.Links to an external site..Indian Journal of Psychiatry, 61(2), 158–175. http://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18

YMH Boston. (2013, May 22). Vignette 5 – Assessing for depression in a mental health appointmentLinks to an external site.

Respond to peer

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.

 

 

 

 

 

Introduction

            When assessing the mental health of children and adolescents, a healthcare professional must engage the young patient and collaborate successfully with other significant figures in the child’s life, including caregivers. This is a delicate and complex process. Thus, during the mental evaluation of a young patient in the video YMH Boston Vignette 5, the practitioner displayed several strengths and shortcomings.

Practitioner’s Strengths and Areas for Improvement

            The practitioner showed in the video a commendable ability to try and establish rapport with the adolescent patient, which is the essential feature of the psychiatric assessment of a young and reluctant patient who feels uncomfortable describing feelings. The calm manner of the practitioner and the open-ended questions helped create a safe space for the patient. However, there are areas where this practitioner could improve well. For instance, while asking the patient about symptoms of depression, an opportunity was missed to get further into the patient’s environmental and social context, as with questions concerning peer relationships or family dynamics. Therefore, a deeper look at these variables might provide further insight into the patient’s mind.

Compelling Concerns and Next Steps

            In this phase of the clinical interview, the most critical concern, one that has not been fully taken up in the video-relates to the risk that the patient presents for self-harm or suicidal ideation. Although some depression among adolescents may demonstrate an association with such risks, it is significant to address the issue directly. I would then ask, “Have you thought of hurting yourself or feeling that life is not worth living? This is an essential question in determining the extent of the patient’s depression and the immediate risks to safety.

Importance of a Thorough Psychiatric Assessment

            A comprehensive psychiatric assessment among children and adolescents is crucial for several reasons; for instance, it helps to conceptualize the full scope of the child’s symptomatic presentation in light of their stage of development, the environmental context in which they live, and their family background (U.S. Department of Education, 2021). Therefore, a comprehensive assessment is essential because children and adolescents are generally less articulate about their internal experiences, information which might otherwise not be elicited. Such an assessment also serves to formulate a diagnostic impression and a consequent treatment plan for a younger patient.

Symptom Rating Scales

            The Pediatric Symptom Checklist and the Children’s Depression Inventory are two potential symptom-rating measures that may be utilized while doing a psychiatric assessment on a child or adolescent. According to Jessica K. Jeffrey et al. (2021), the CDI is a self-report rating scale designed to verify whether depressive symptoms exist and how severe they are in children between the ages of 7 and 17. The PSC is a psychosocial screening instrument that aids in identifying issues with behavior, emotions, and cognition in kids and teens; as such, it typically offers a more thorough picture of a child’s mental health.

Psychiatric Treatment Options for Children and Adolescents

            Two psychiatric treatments that are specific to children and adolescents and likely used less often with adults are play therapy and family therapy. Play therapy allows children to express feelings and experiences through play, which may be most helpful for younger preschool children who have not yet developed the linguistic ability to describe emotions (American Academy of Child and Adolescent Psychiatry, 2019). Family therapy operates on all levels of the family system to explore issues that may be contributing to the child’s mental health difficulties, emphasizing the improvement of communication, conflict resolution, and the establishment of a caring home environment.

Role of Parents/Guardians in Assessment

            Parents and guardians play a significant role in psychiatric assessment, as they provide essential background information on developmental history, behavior at home, and interaction with others (Sharma et al., 2019). Therefore, treatment consent involves the parents/guardians, who play a critical role in home implementation and treatment reinforcement. Their involvement in ensuring that the child gets comprehensive care is paramount.

Conclusion

            In conclusion, the psychiatric evaluation of children and adolescents must be tailored in a manner that considers explicitly developmental, environmental, and familial factors unique to the younger population. Utilizing appropriate symptom rating scales and treatment options, including parents/guardians, can allow practitioners to meet the population’s needs better.