"Advanced Practice Psychiatric Nursing" (2nd Edition) by Kathleen Tusaie provides a comprehensive and detailed guide for psychiatric mental health nurse practitioners (PMHNPs) and other advanced practice nurses in psychiatric care. This textbook addresses the full scope of advanced practice roles, including diagnostic evaluation, psychotherapy, and psychopharmacologic management. With in-depth discussions of psychiatric conditions, treatment strategies, and specific patient populations, this edition reflects current best practices and evidencebased approaches for effective psychiatric care.
1. Role and Scope of Advanced Practice Psychiatric Nursing
The book opens with an examination of the professional role of PMHNPs:
• Evolution of the PMHNP Role: Tusaie provides a historical overview of the PMHNP role, emphasizing the gradual expansion of scope and responsibility in psychiatric settings.
• Scope of Practice: The book outlines the responsibilities of advanced practice psychiatric nurses, which includes performing psychiatric evaluations, formulating diagnoses, and managing patient treatment plans through therapy and medication.
• Legal and Ethical Considerations: Tusaie emphasizes the ethical principles central to psychiatric nursing practice, including confidentiality, informed consent, and respecting patient autonomy. This section highlights state and federal regulations governing psychiatric care, ensuring practitioners understand the legal boundaries and responsibilities of their practice.
2. Psychiatric Assessment and Diagnosis
The textbook provides a step-by-step approach to psychiatric assessment and the diagnostic process:
• Comprehensive Psychiatric Assessments: Detailed guidance is given on conducting psychiatric evaluations, from taking medical and
psychiatric histories to assessing the mental status of patients.
• Diagnostic Tools: The DSM-5 is discussed extensively as a primary diagnostic tool, along with scales and questionnaires used for specific psychiatric conditions (e.g., PHQ-9 for depression).
• Cultural and Developmental Considerations: Tusaie highlights the importance of cultural competence in psychiatric assessment, acknowledging how cultural background, socioeconomic factors, and developmental stage influence symptoms and diagnosis.
3. Psychopharmacology and Medication Management
An essential aspect of PMHNP practice, psychopharmacology is covered thoroughly to equip nurses with necessary medication management skills:
• Foundations of Psychopharmacology: Tusaie reviews the neurobiological underpinnings of psychiatric disorders, helping practitioners
understand the mechanisms of action for psychiatric medications.
• Medication Classes: Each major class of psychiatric medication—antidepressants, antipsychotics, anxiolytics, and mood stabilizers—is discussed in depth. Information on indications, side effects, dosage guidelines, and specific considerations for different populations is included.
• Medication Monitoring and Side Effects: The book emphasizes the importance of monitoring for adverse effects and managing side effects, providing strategies for dealing with challenges such as drug interactions and patient adherence to medication regimens.
4. Therapeutic Modalities for Advanced Practice
In addition to medication, PMHNPs provide a variety of therapeutic interventions. Tusaie covers multiple approaches in detail:
• Cognitive Behavioral Therapy (CBT): This section explores the foundations of CBT, a widely-used
approach for treating depression, anxiety, and other mental health issues. Key CBT techniques, including cognitive restructuring and behavioral activation, are described.
• Dialectical Behavior Therapy (DBT): Originally developed for borderline personality disorder, DBT techniques such as mindfulness, emotional regulation, and interpersonal effectiveness are explained. Tusaie provides practical strategies for applying DBT in various clinical contexts.
• Other Therapeutic Approaches: The book includes discussions on other therapies like psychodynamic therapy, interpersonal therapy, and family therapy, giving PMHNPs a broad toolkit for treating complex cases. The integration of multiple approaches to customize care for individual patients is emphasized.
5. Specific Psychiatric Disorders and Treatment Strategies
Tusaie provides a detailed breakdown of various psychiatric disorders, focusing on evidence-based diagnosis and treatment:
• Mood Disorders: The text includes in-depth discussions on major depressive disorder, bipolar disorder, and dysthymia. Each condition’s symptomatology, risk factors, and treatment options are explored, with a focus on pharmacotherapy and psychotherapy.
• Anxiety Disorders: Generalized anxiety disorder, panic disorder, social anxiety disorder, and obsessive-compulsive disorder are covered, with a comprehensive look at both psychopharmacologic and therapeutic options. The book discusses the effectiveness of CBT and exposure therapy for anxiety disorders.
• Psychotic Disorders: Schizophrenia and other psychotic disorders are discussed, with an emphasis on the challenges of managing symptoms such as hallucinations and delusions. Tusaie highlights the importance of early intervention and continuous monitoring to improve patient outcomes.
• Substance Use Disorders: This section emphasizes the integration of mental health and
addiction treatment. Tusaie provides information on medication-assisted treatment (MAT) for substance use disorders and strategies for relapse prevention and harm reduction.
6. Psychiatric Nursing for Special Populations
Tusaie dedicates chapters to the unique needs of various patient populations, acknowledging that psychiatric care must be tailored to individual characteristics:
• Child and Adolescent Mental Health: Developmental considerations, family dynamics, and common disorders such as ADHD and autism spectrum disorder are discussed. Tusaie provides strategies for engaging young patients and their families in treatment.
• Geriatric Psychiatry: The mental health needs of older adults, including depression, dementia, and anxiety, are explored. Tusaie highlights the pharmacologic considerations specific to older adults, such as polypharmacy risks and slower metabolism.
• Cultural Sensitivity and Competence: Tusaie emphasizes the importance of cultural competence, discussing ways to respect and adapt to cultural differences. This includes addressing language barriers and understanding cultural views on mental health and treatment.
7. Health Promotion, Prevention, and Education
Preventative care and health promotion are central to reducing mental health challenges in communities:
• Preventive Mental Health Care: Tusaie discusses primary, secondary, and tertiary prevention in mental health care. The focus is on early detection, lifestyle factors, and reducing the impact of mental illness through ongoing support and education.
• Patient and Family Education: Education is emphasized as a key strategy to empower patients and families. The book includes strategies for explaining diagnoses, medications, and coping strategies, helping patients to better understand and manage their conditions.
8. Interprofessional Collaboration and Integrated Care
Recognizing that mental health care often requires a collaborative approach, the book emphasizes the importance of teamwork in psychiatric nursing:
• Interprofessional Collaboration: Tusaie highlights the PMHNP’s role within a larger healthcare team, working alongside social workers, psychologists, primary care providers, and others to deliver holistic care.
• Integrated Care Models: This section describes integrated care settings where mental health care is provided within primary care. The text discusses the benefits of this approach, particularly for patients with co-occurring medical and psychiatric conditions.
• Care Coordination: Tusaie emphasizes the importance of continuity of care, particularly during transitions from inpatient to outpatient settings. Effective care coordination improves patient adherence and long-term outcomes.