Occupational health and safety is considered a branch of public health focusing on diseases, health alterations, and injuries within the working population. Occupational health and safety programs implement strategies and regulations that are designed to prevent or reduce the occurrence of occupational disease and injury among the working population. Occupational health exists at the intersection of government regulation, management, and labor relations. Occupational epidemiology is a branch of epidemiology concerned with the determination of the distribution and determinants of health, illness, and risk factors within the occupational environment. It supports healthcare practice in several areas. Occupational health nursing is a specialized area of community and public health nursing practice. Nurses have the knowledge, skills, and ability to integrate nursing knowledge with occupational health knowledge to develop, plan, implement, and evaluate the effectiveness of occupational health programs on employee health outcomes.

Addressing critical health issues requires utilization of tools, such as epidemiology, to assist in determining why people get sick, disabled, or die. Answering why this happens requires one to understand the determinants of health. The World Health Organization identifies the determinants of health as the social and economic environment, the physical environment, and the person’s individual characteristics and behaviors. This chapter describes the determinants of health. It articulates how risk factors affect health and how the social determinants of health affect health inequities. Epidemiology is a discipline that deals with the determinants of health. There is increased realization that focusing on the determinants of health and health disparities is an important aspect of improving the health of populations and improving healthcare outcomes. Inequities in education, housing, job security, and environmental health must be eradicated if health disparities are to be addressed effectively.

Genetic epidemiology is considered a newer branch of epidemiology that focuses on the etiology, distribution, and control of diseases in groups of genetically related individuals and those with inherited genetic diseases. It attempts to understand the manner in which genetic factors interact with the environment in the context of population diseases and health conditions. The content area of genetic epidemiology consists of the etiology of inherited diseases, the distribution of inherited disorders, and methods to prevent or alter the impact of inherited disorders. Simply stated, genetic epidemiology examines the role of inherited factors in disease etiology. This chapter describes genetic and environmental epidemiology and differentiates the types of genetic testing. It helps the reader to identify common air, water, and soil pollutants. The chapter provides the means to conduct a personal environmental assessment of air, water, and soil pollutants and an exposure assessment.

The dissemination of epidemiologic knowledge must be of the utmost ethical manner. Epidemiologists have to promote the development of their scientific reputation to advance their professional careers, but most do this in an ethical manner. Meanwhile the public has the right to know their health risks and expect that epidemiologic research is conducted in a manner of scientific rigor while protecting human subjects. Ethical guidelines and principles guide the ethical practice of epidemiology. This chapter helps the reader to integrate ethical principles into the ethical decision-making process. It demonstrates the utilization of personal and professional core values that influence ethical decision-making.

Nursing as a practice discipline positions nurses to encounter unique events and situations that can serve as the foundation for future research exploration. Case control studies serve as a catalyst to differentiate the occurrence of disease among cases and controls to generate hypotheses. Nurses should remain astute and vigilant for unique situations encountered that could be the tipping point for exploration of unique cases. A case control study design groups the research subjects into cases or controls. This chapter helps the reader calculate an odds ratio from a case control study design, differentiates prospective and retrospective research designs, and describes other research designs such as historical, exploratory, methodological, and correlational. It also differentiates the types of triangulation. Epidemiologic research study appraisal is the systematic evaluation of a research study’s quality based on scientific merit and methodological rigor. The epidemiologic research study appraisal is dependent upon the research study design.

Epidemiologic research studies are conducted to describe the burden of disease in a population, the presence of risk factors, health behaviors, or other characteristics of a population that influence health alterations or disease processes. Epidemiologic studies can determine risk factors associated with disease, causal inferences, and effectiveness of health-related interventions. This chapter differentiates observational research designs and sampling methods and also describes the components of a research proposal, contrasting it with a research report. Epidemiologic research relies on primary and secondary data collection methods: Primary data collection is when the epidemiologist collects the data, such as from medical examinations and direct observations. Secondary data collection is where the data have been collected by others such as medical records, census data, and vital statistics data. Nurse epidemiologists or nurses who engage in epidemiologic research use both primary and secondary data sources to answer the proposed research question.

Cohort study designs are a population-based observational epidemiologic study. Cohort studies evolve over time as diagnostic and medical science advances; for example, improved diagnostic screening and testing methods will be integrated into a cohort study design as they are developed or improved. This chapter describes an epidemiologic cohort study design, differentiates a prospective and retrospective cohort study design, and shows how to calculate a risk ratio and rate ratio. Cohort study designs can be developed with an integration of other study designs. A case-control study design can be nested into a cohort study design. In addition, there can be a nested case-control study design within a cohort study design with matching of cases and controls to account for confounding variables. Other study designs can be combined with or integrated into a cohort study design as a strategy to increase internal and external validity of the research study design.

Epidemiologic data can be used as the evidence base to substantiate the development of public health policy. In addition, epidemiologic measures can be used to generate the data necessary to substantiate public health program effectiveness. Essentially, epidemiologic measures serve as evaluative metrics to determine programmatic improvements in population health. Quality improvement metrics can be epidemiologically based for continual quality analysis. Nurses engage in public health policy development, implementation, evaluation, and analysis. Additionally, nurses are involved in policy advocacy for individuals and communities. This chapter defines health policy and differentiates the types of policy. It describes the policy development process and discusses the Centers for Disease Control and Prevention (CDC) policy process model, a nationally accepted policy model that can be applied to population-based community problems. The chapter also distinguishes among efficacy, effectiveness, and efficiency, and presents the PDSA model.

A pandemic impacts the entire health of the community and multiple countries at the same time. During a pandemic, it is imperative to engage the entire community and the healthcare system, and create international exchanges of information and science—a multi-sector approach. To effectively respond to and control a pandemic, it is necessary to have integration of all aspects of the healthcare system inclusive of but not limited to public health, primary care, episodic care, acute care, convalescent or long-term care, and care provided by nontraditional care settings such as community-based or nonprofit organizations. One of the concerns during a pandemic is overstressing the healthcare system to the point of collapse or inability to appropriately and effectively respond to the crisis. In a pandemic situation, clinical disease can range from mild to severe even to the point of causing significant mortality within the population. The chapter also presents brief snapshots of several historical pandemics.

Experimental research designs provide the epidemiologist with the ability to make statements about relationships, associations, and supportive statements regarding causation. Hypotheses generated through observational research study designs can be tested with an experimental research design. Not all epidemiologic areas of inquiry are adaptable to an experimental research study design. Quasi-experimental research study designs provide an alternative research design to experimental research designs when all the essential elements required for a true experimental study cannot be established within the design. This chapter provides an understanding of quasi-experimental research designs and also of the essential elements of an experimental research design. It helps the reader differentiate the phases of a randomized controlled clinical trial. The chapter discusses the design of a vaccine clinical trial. The goal of the Vaccine Adverse Event Reporting System (VAERS) is to detect possible indicators of adverse events associated with the administration of vaccine.

Epidemiologic investigations provide evidence regarding the linkage between an exposure and the occurrence of a disease or health condition. This epidemiologic investigation also provides evidence as to the magnitude of risk associated with the exposure as compared to the extent to which the exposure’s relationship to the disease or health condition occurred by chance alone. Risk can be defined as the probability or likelihood that an adverse health event will occur in an individual or population. This chapter describes the steps of a risk assessment. It helps the reader calculate relative risk, odds ratio, and attributable risk. Nurses, as healthcare providers, educate patients on the risk associated with lifestyle behaviors and exposures to various disease-causing agents. During the nursing assessment, various types of risks can be further investigated and explored to determine an individual level risk profile.

Population health has great potential to mitigate health disparities. It is evident that the need for epidemiology to guide population health continues to grow. It is imperative that epidemiology is utilized to not only identify risk factors but use that knowledge to target the right care to the right individuals at the correct time—now called precision medicine. The population health lens can be used at the individual, practice, institutional, systems, and community levels to drive improvements to health outcomes. The United States’ healthcare system is rapidly evolving and tremendously complex. Most would agree there needs to be a solution to address gaps and fragmented services in healthcare delivery. This chapter articulates the defining characteristics of a population and population health. It describes the determinants of health categories. The chapter differentiates population health strategies and population management strategies and describes the relationship of population health and epidemiology.

Reproductive health includes the ability to regulate and control fertility, safe birthing processes, safe parenting, infant and child health survival, growth and development, and safety from sexually transmitted infections. Reproductive epidemiology includes reproductive health surveillance. Reproductive health surveillance is a component of public health surveillance systems that permit the identification, notification, quantification, and determination of events of reproductive health during a specific period of time in a specific geographical location. Reproductive health surveillance provides the data for reproductive epidemiology, which is the determination of the distribution and determinants of reproductive health. Nurses who specialize in reproductive health are known as reproductive nurses or fertility nurses. Reproductive health nurses provide care to individuals, couples, and families. These reproductive health nurses engage in conducting assessments that may involve genetic testing or fertility testing, fertility counseling, patient education about reproductive health, fertilization and embryonic development, and the course of pregnancy.

Clinical epidemiology is considered a basic science of medical practice that informs diagnostic, prognostic and therapeutic clinical decisions related to individual healthcare. Healthcare epidemiology broadens the scope of clinical epidemiology to include various types of healthcare settings not limited to the acute care setting. It is a more comprehensive term to use to designate epidemiology of clinical care in both acute and primary care settings. This chapter provides an overview of healthcare epidemiology, inclusive of clinical infectious hospital-acquired infections, and the basis of health care epidemiologic data in evidence-based healthcare. Healthcare epidemiologists are expert clinicians who provide information and education in areas such as but not limited to infectious diseases, infection control and prevention principles, antibiotic stewardship, occupational health and safety, and prevention of hospital- or healthcare-acquired infections or health conditions, along with regulatory compliance guidance.

Statistics is all about recognizing and addressing sources of variability, either through study design or statistical analysis. Variability is both essential for understanding associations and a nuisance that encumbers our efforts at measuring them. This chapter provides a description of the properties of variables. Variables are measurable characteristics or traits that vary from object to object. It is useful to classify variables by their scale of measurement. Two goals of research are to characterize attributes or features of a population and assess associations of interest. These activities necessitate the need for observing characteristics of members of a population. Sensitivity can be expressed as the conditional probability that a diagnostic test produces a positive test result given an individual has the disease. Specificity is the conditional probability that a diagnostic test produces a negative test result given an individual is disease free.

Epidemiologic tools consist of counts, rates, ratios, and proportions. The tools of epidemiology present data about health conditions with consideration to person, place, and time. Measures of disease occurrence provide essential data to understand the dynamics of morbidity and mortality in a population in order to develop population-based measures of control and prevention. This chapter helps the reader to calculate morbidity and mortality statistic and describes how to utilize morbidity and mortality data to describe the distribution and determinants of disease within specific populations. The chapter differentiates the population surveillance system methods used to generate epidemiologic data and presents essential elements of a population surveillance system to prevent and control outbreaks, epidemics, and pandemics. The quality of life measures the extent to which a disease or health condition causes alterations in an individual’s daily life and ability to participate in and contribute to society.

Nurses play a key role in the field of epidemiology and in population health. Population-focused nursing demands application of nursing theory and practice while integrating the tenets of public health to contribute to the improvement of community and population health. While advanced practice nurses may not all specialize in public health, it is essential that advanced practice nurses have a foundational knowledge of concepts on the health and illness continuum from a population perspective. This chapter articulates the meaning of advanced practice nursing. It describes the role of the advanced practice nurse in epidemiology and population health. Consistent themes emerge across all functional roles of advanced practice nursing. Advanced assessment and analytic skills to include use of epidemiologic data and concepts to better understand disease occurrence and distribution are crucial to optimal health outcomes.

Field epidemiology is the practical application of epidemiologic knowledge, skills, and methods to resolve population-based public health problems. The core functions of field epidemiology are outbreak investigation, conduct of public health surveillance, collection and analysis of epidemiologic data, engage in epidemiologic judgment, and dissemination and communication of epidemiologic findings. Forensic epidemiology is an area of field epidemiology developing as a specialization. Forensic epidemiology uses epidemiologic field methods to support criminal investigations. Field-based forensic epidemiology is described as the application of public health methods in a field-based setting to investigate health-related criminal events, an integration of public health, epidemiology, and law. Legal epidemiology is an advancing area of epidemiology practice. The legal epidemiology field is an area of scientific study and the deployment of law as a factor in the cause, distribution, determinants, and prevention of health and disease in a population.

A disease has a typical course of progression in a human. This natural course of disease progression that occurs over a period of time provided is known as the natural history of disease. The natural history of disease consists of five stages of disease: susceptibility, incubation, prodromal, acute, and convalescence. This chapter describes an interrelated natural disease history model to include the natural stages of the disease with integrated incubation time periods, subclinical, clinical, prepathogenic, pathogenic, and targeted disease specific interventions. It provides population-based prevention strategies that integrate several types of immunity and prevention levels. The chapter presents prevention strategies to break the chain of infection for specific diseases. Infectious disease incubation periods are dependent upon the rate or organism growth in the host, exposure dosage to the infectious agent, portal of entry, and host immune response.

Testing consists of screening and diagnostic testing. Both screening and diagnostic testing are secondary prevention measures. The actual test used for screening and diagnostic testing is often the same. However, the differentiation is the context and purpose for which the test is conducted. Screening and diagnostic testing are essential components of surveillance systems. Screening is the presumptive identification of an unrecognized disease or health condition in a population by the application of a test, examination, or other procedure. This chapter differentiates between screening and diagnostic testing. It helps the reader calculate sensitivity and specificity rate. The chapter calculates positive predictive value and negative predictive value measures; and differentiates the types of reliability measures.

Infectious disease epidemiology is a branch of epidemiology that examines the distribution and determinants of diseases of an infectious nature. The essence of infectious disease epidemiology is the focus on the interaction among individuals within a population. An area of prime importance for infectious disease epidemiologists is the interaction between cases and contacts. The fundamentals of infectious disease epidemiology are grounded in the interaction between a causative agent, host, and the environment. Modes of transmission are an integral component to understanding infectious disease epidemiology and are discussed in the chapter. Infectious epidemiology also considers the interaction between individuals within the population group, especially the interaction between infectious cases and potential contacts. Nurses are frequently on the front line of contact with the patient and are essential members of the healthcare team in breaking the chain of infection.

Advances in population health science and population health management are grounded in the utilization of epidemiologic a information. Epidemiologic studies provide another set of tools to assist the epidemiologist to understand the distribution and determinants of health in a population. Thinking epidemiologically integrates scientific method, epidemiologic reasoning, and the epidemiologic triad into a coherent thought pattern. Epidemiologic thinking uses an integrative investigative approach to understanding the distribution of health conditions and determinants of health conditions within a population to develop preventive and therapeutic population-based strategies. This chapter provides an understanding of the definition and scope of epidemiology. It describes a comparison of descriptive and analytic epidemiology and demonstrates an understanding of the epidemiologic process. The chapter compares the similarities and differences in the epidemiologic approach and scientific methods and analyzes a health or disease-related condition using the epidemiologic triad. It describes the differences in the epidemiologic tools.

History is the foundation of the future. If one is not to repeat the errors of the past, one must be knowledgeable about the historical developments that have led to the current modern-day state of affairs. The history of epidemiology has been influenced by many historic leaders from a diverse background of professions and disciplines. These historic leaders shared the purposeful mission to prevent and control health-related events with the desire to promote health among populations. This chapter focuses on historic leaders and events that have shaped modern day epidemiology.

Social epidemiology strives to provide a framework to examine how social factors, such as social relationships, poverty, racial issues, social inequalities, social capital, and work stress impact the health of individuals and populations. Social epidemiologists identify the social characteristics that impact the distribution and pattern of disease occurrence in a population as a means to develop programs that improve the health of individuals, populations, and eventually society as a whole. The nursing assessment is an important element of epidemiologic data collection. During the nursing assessment, nurses collect information on many of the social and lifestyle factors that impact an individual’s health. Additionally, nurses collect data on social networks and family relationships. Nurses must remain aware of the status of the population’s health within a community and ensure that the nurse collects specific social health data as a component of the nursing assessment.

Epidemiologic investigations and research studies attempt to explore the occurrence of a health event or disease within a population. This chapter provides an understanding of the different types of research bias and describes the strategies to impact research bias. It also provides an understanding of confounding and interaction. Bias can be introduced at multiple points in an epidemiologic investigation or research study and can have a direct impact on both the internal and external validity of the epidemiologic findings. The ability to determine the extent of association and causal inference is impacted by research bias, confounding variables, and interaction of variables. Bias reduction or elimination is the responsibility of the nurse researcher, nurse epidemiologist, or public health epidemiologist. Nurses themselves should also explore the extent to which their behavior or method of data collection introduces bias into the epidemiologic research study.

It is estimated that over 50% of people with mental health disorders and serious mental illness (SMI) also have a co-occurring substance use disorder (SUD). With concerning numbers of co-occurring psychiatric and substance use disorders (CODs), exacerbated by repercussions of the global COVID-19 pandemic, it is imperative that mental health clinicians are aware of an intensifying dual diagnosis epidemic. Knowledge of treatment, barriers, and referral options, integrating facets of mental and medical healthcare with substance abuse recovery, is critical for achieving sustainable results with this client population. Twenty percent of individuals with a severe mental illness will develop a SUD during their lifetime. Estimates are that only 7.4% of these individuals receive treatment for both disorders, and 55% receive no treatment at all. This chapter discusses factors in the development of SUDs and CODs, epidemiology, theory of addiction, diagnosis, levels of care, clinical manifestations, and diagnostic criteria.

Integrative treatment is a prospective, relationship-based, client-centered, holistic approach that focuses on clients’ priorities for well-being, as well as preventing, managing, and rehabilitating diseases. This chapter provides definitions and a basic understanding of the synergy of integrated treatment as it is delivered by psychiatric-mental health advanced practice registered nurses (PMH-APRNs). It addresses the rationale and importance of an integrated approach. Furthermore, the chapter presents the importance of the clinician recognizing their own theory base and ways of thinking that may or may not facilitate the ability to provide integrated treatment. Although the Diagnostic and Statistical Manual of Mental Disorders is referred to throughout, the actual focus of treatment is transdiagnostic syndromes presented by each client. The chapter explores this concept in depth, and emphasizes the nonlinear thinking and recognition of a continuum of interventions.

This chapter focuses on both attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). ADHD and ASD are chronic neurocognitive disorders originating in childhood. The etiology of ADHD involves complex interactions of neuroanatomical and neurochemical systems based on twin and adoption family genetic studies, dopamine (DA) transport gene studies, neuroimaging studies, and neurotransmitter data. According to Weber and Newmark, the treatments for ADHD include nutritional interventions, biofeedback, herbal and natural products, vitamins and minerals, homeopathy, massage and yoga, and the beneficial impact of playing in green spaces. A small meta-analysis reviewed three studies regarding acupuncture for the treatment of ADHD. Electroencephalographic (EEG) biofeedback is a growing area of research for ADHD and is based on the finding that children who have ADHD demonstrate increased theta activity and decreased beta activity on EEG.

This chapter focuses on psychosis that is associated with severe mental illness recognized within the schizophrenia spectrum, such as schizophrenia, delusional disorder, schizophreniform disorder, and schizoaffective disorder. Caring for individuals with psychosis can be a challenging yet rewarding aspect of nursing practice. Interviewing and communication have always been primary nursing skills, but these skills are the core of the assessment and care of the client with mental health concerns. In brief psychotic disorder, the psychotic symptoms are sudden and last for at least a day or more, but do not persist beyond a month. Psychotic illness continues to have many misconceptions and myths surrounding it. There remains much fear, stigma, and stereotyping about the concept of psychosis; this is not only perpetuated in the media, but at times even with other health professionals. Nurses are in an excellent position to help educate individuals about these disorders and to help destigmatize these ideas.

The purpose of this chapter is to discuss various psychiatric disorders including anxiety, obsessive-compulsive disorder, depression, bipolar illness, schizophrenia, and substance abuse in the context of pregnancy. Risk factors, assessment and screening strategies, and treatment options within each diagnostic category are reviewed. Content includes relevant research and is consistent with the most recent Diagnostic and Statistical Manual of Mental Disorders (5th ed.) changes. General principles of fetal development and prescribing guidelines are included, along with information on standard, adjunctive, and complementary forms of treatment. Paternal perinatal mood disorders, intimate partner violence, and perinatal loss are also addressed.

Anxiety is a sense of distress in response to a perceived threat, either to one’s physical safety or emotional well-being. Anxiety-related conditions include separation anxiety, social anxiety (social phobia), specific phobia, agoraphobia, panic, and generalized anxiety. Obsessive-compulsive disorder, hoarding, trauma-related conditions, and trichotillomania also include prominent symptoms of anxiety. This chapter broadly examines anxiety-related conditions with a focus on key symptom profiles. Mood and substance abuse disorders are the most common comorbid disorders with generalized anxiety, and the presence of alcohol dependence is particularly high in persons with social anxiety. Benzodiazepines, while controversial, remain an important component of a large medication arsenal available in the treatment of anxiety disorders. All benzodiazepines are effective in treating acute and chronic anxiety; however, the most robust support for their use appears to be in treating generalized anxiety disorder, social anxiety disorder, and panic disorder.

Mood disorders are a unique and broad diagnostic category used by traditional as well as current diagnostic classifications. This chapter discusses the disorders of mood ranging from sadness (subclinical depression) to mania which cross over several Diagnostic and Statistical Manual of Mental Disorders diagnostic categories. It presents the theories explaining etiology of disordered moods, assessment, and treatment strategies across the life span. A persistent depressed mood is problematic and can occur at any age from a wide range of causes. The importance of early identification of mood disorders versus normal mood fluctuations is crucial for the appropriate interventions to be initiated. There is a large buffet of possible interventions available for treatment of mood disorders. The possible treatment modalities include self-help, guided selfhelp, psychotherapy, pharmacotherapy, alternative or complementary approaches, bright light therapy, electroconvulsive therapy, transcranial magnetic stimulation, and vagal nerve stimulation. These interventions may be used individually or in various combinations.

Psychiatric-mental health advanced practice registered nurses (PMH-APRNs) are frequently called upon to manage the care of clients with presenting complaints of sleep disturbance or of clients with other mental health issues such as comorbid sleep disturbance. This chapter describes sleep disorders based on the International Classification of Diseases (ICSD-3) classification system. The management of sleep disturbance requires basic knowledge of normal sleep, age-related changes in sleep, interrelationships of sleep with common psychiatric disorders, sleep assessment methods and findings, and recommended treatment modalities. For example, insomnia and obstructive sleep apnea (OSA) increase the risk of hypertension, which has major implications for cardiac health. From a developmental perspective, sleep may be divided into age groups from infancy to older adulthood. Management of behavioral insomnia of childhood is primarily focused on parenting skills, but may include pharmacological therapy.

Complementary approaches to treatment are considered nonconventional (in a specific culture) and used together to complement conventional, “Western” treatments. Alternative approaches are nonconventional, nonallopathic interventions used in place of conventional treatment approaches. These approaches form the basis of the thriving treatment category known as complementary and alternative medicine (CAM). Naturopathic, or “Eastern medicine,” are terms used to describe these more “natural” CAM approaches which have evolved, mostly from Asia, over thousands of years. Integrative approaches seek to treat the whole person, not just their illness or disease, and are often referred to as a “holistic,” mind, body, and spiritual care approach. Integrative approaches to treatment combine conventional and nonconventional practices, holistically addressing all aspects of a person’s well-being. Lack of understanding of the background and philosophies underlying a complementary, alternative, or integrative technique may be a missed opportunity to treat a client holistically and offer additional therapeutic benefits and modalities.

This chapter provides a comprehensive foundation to issues of disordered eating. It covers the eight feeding and eating disorders, as well as obesity. The chapter provides a brief overview of disordered eating, highlighting the issues of normative discontent. Pica, rumination disorder, avoidant restrictive food intake disorder, anorexia nervosa, bulimia nervosa, binge eating disorder, and describes other specified and unspecified eating disorders through their differing clinical presentations. It explains about guidance on assessment, including outcome measures and expected treatment outcomes. The chapter provides an in-depth synopsis of evidence-based treatments for the disorders. Highlights include diaphragmatic breathing; cognitive behavioral therapy for avoidant/restrictive food intake disorder; enhanced cognitive behavioral therapy for eating disorders; family based therapy; and psychopharmacological treatments. The chapter presents the treatment of an individual with an eating disorder and reviews the issues of obesity and related treatment options. The chapter finishes with recommendations for further reading and training.

Working with clients is dynamic and challenging. Although there are many variations of psychiatric-mental health problems, there are specific core issues to be considered for all clients. These include the overall purpose of treatment, theory base and resources, client’s perspective and resources, and stages of treatment. This chapter discusses the concepts to be considered for all clients and all types of psychiatric-mental health treatment. The foundation is the development of a therapeutic relationship. The resources of the advanced practice registered nurse as well as the client are identified as necessary to bring about change including increased self-awareness, broader perspective, increased functioning, and neurobiological shifts during psychotherapy. The stages of treatment across the process of therapy are based upon Peplau’s Interpersonal Therapy and the sections of each individual session are also presented. The chapter provides the groundwork for the chapters focusing upon treatment of specific symptom clusters later in the book.

Impulsive or disruptive disorders take an enormous toll on clients, their families, and the community. Understanding etiologic pathways through their complex interlinked perspectives can help us find more effective upstream solutions. The epidemiological scope of impulsive/disruptive disorders is over 3% in children, yet these are the number one reason for the earliest mental health referrals. Ironically, it is the least studied or understood of early-onset disorders, which may improve or worsen with maturity, yet in adulthood it is virtually ignored. Nonetheless, there is intense interest in adult forensic psychiatry among concerned justice officials and the public at large. This chapter briefly surveys the multiple contributing factors systematically: maternal medical factors; parental substance abuse; environmental toxins; birth complications; mother–infant attachment and synchrony; genomic/epigenetic factors; brain structural development; neuro-immuno-endocrinological development; multi-omics of early development; family environment and dynamics; social environments, educational milieu; community and ethnocultural variables for children; the intense peer bonding as youth and while expanding to adult responsibilities; and client’s own direct interactions within specific socioeconomic, sociocultural, and sociopolitical domains.

A developmental multiscale integrated systems approach to understanding the dimensional spectrums of this disorder, will update the usual automatic assignment into Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categories. A step-by-step assessment approach and tools are presented. The evidence-based and the most highly recommended early preventive interventions and treatments are then briefly outlined, with selected psychopharmacological agents and precautions. Through an upstream preventive, thoughtful, and empathic approach, those suffering from these disorders may be able to improve their responses, roles, lives, and community contributions.

Working with clients is dynamic and challenging. Although there are many variations of psychiatric-mental health problems, there are specific core issues to be considered for all clients. These include the overall purpose of treatment, theory base and resources, client’s perspective and resources, and stages of treatment. This chapter discusses the concepts to be considered for all clients and all types of psychiatric-mental health treatment. The foundation is the development of a therapeutic relationship. The resources of the advanced practice registered nurse as well as the client are identified as necessary to bring about change including increased self-awareness, broader perspective, increased functioning, and neurobiological shifts during psychotherapy. The stages of treatment across the process of therapy are based upon Peplau’s Interpersonal Therapy and the sections of each individual session are also presented. The chapter provides the groundwork for the chapters focusing upon treatment of specific symptom clusters later in the book.

The relationship between the psychiatric-mental health advanced practice registered nurse (PMH-APRN) and the client is the foundation for any assessment or intervention. This chapter describes the ethical principles underpinning psychiatric-mental health nursing, and shows that any intervention can be described by pointing out the various tensions inherent within these principles. The components of building a therapeutic relationship have been described by several nurse authors, beginning with Peplau. However, recent studies have moved on to explore the process of decision-making within that therapeutic relationship. In an ideal world, everyone would be in possession of all necessary evidence to support any decision they were making. The chapter shows that concordance should be viewed as the ethical goal of partnership, and that partnership can be broken down into achievable goals. It considers the place of knowledge, health beliefs, and collaboration as aspects of successful practice.

Nurses have the unique task of caring for both the perpetrators of other-directed violence as well as their victims, while also finding themselves at an increased risk of experiencing work-related violence. The American Nurses Association website states that one in four nurses have been assaulted at work, and their likelihood to be exposed to violence at work is higher than that of prison guards or police officers. The World Health Organization proclaims violence to be the leading worldwide health problem and is the fourth-leading cause of death worldwide. This chapter focuses upon the other-directed violence that psychiatric-mental health advanced practice registered nurses are likely to encounter in the workplace and suggests how to identify and treat both the victim and the perpetrators of violence, while staying safe.

Cognition is observed clinically as cognitive status, or cognitive function, and is understood to be a concern across several populations and clinical disorders. Detection of cognitive impairments, particularly in older adults, can be a challenge for the most skilled clinicians. This chapter addresses disorders of cognition in adult populations. Neurocognitive disorders have—as the basis of inclusion in a diagnostic category—deviations in cognitive function. Typically, the underlying biology can be inferred from the observed behavior. Thus, integrative management of neurocognitive disorders requires a working knowledge of physiological findings; a skillful mental status examination; in-depth assessment of cognition, using reliable and valid cognitive screening instruments; and awareness of the pharmacological and nonpharmacological approaches to managing the psychiatric and behavioral symptoms in dementia, one of the prototype neurocognitive disorders.

Working with individuals who are self-injuring or contemplating suicide is complicated and difficult. This chapter provides information to assist with methodical and sound clinical approaches in the assessment and treatment of individuals who are considering self-harm or engaging in self-injuring. Caring for an individual who is self-injuring is a reality for most psychiatric-mental health advanced practice registered nurses and is a rising occurrence for nurses (e.g., family nurse practitioners, school health nurses, and others) caring for individuals in the general population. Fortunately, the literature providing evidence-based approaches to self-injury prevention and treatment is increasing.

This chapter focuses on comorbidity as the combination of a psychiatric syndrome and one or more medical illnesses in the same client. It presents common comorbid conditions in individuals with psychiatric syndromes. The management of clients with psychiatric syndromes and medical comorbidity is complex and requires significant coordination of care. A “collaborative care” approach that uses a multidisciplinary team to provide care for both medical and mental conditions is paramount. Medications can play an important role in the management of comorbidities and can also be a cause of comorbidities. Given the advances in biological psychiatry, treatments of mental health, and medical disorders, a holistic approach that includes a biopsychosocial perspective should be an intricate component of treatment. The management of children with comorbid medical and psychiatric disorders should be treated from the perspective of lifelong impact of disease management.

This chapter focuses on the principles that support the fundamental models of psychotherapy. It describes the principles of therapy models, focusing on how the techniques of the therapy are purported to relieve the patient’s distress. Within each model, the chapter explores the implicit or explicit assumptions around the cause of a client’s distress, the rationale for why a method should relieve it, and the techniques used to put the intervention in motion. Psychodynamic therapies cover a range of approaches from the traditional psychoanalytic models to supportive psychotherapy. Recent meta-analysis of manual driven psychodynamic therapies demonstrated equivalence in efficacy of dynamic therapy to established therapies. In contrast to the interpretive psychoanalytic approaches, cognitive interventions seem accessible to even the beginning therapist. The client–therapist relationship is a critical component of cognitive therapy and intentionally structured to build a sense of teamwork.

This chapter includes an overview of the science, including the theory and research dimensions that form the basis of psychiatric-mental health nursing, that is particularly relevant to the advanced practice nurse. It also includes educational and credentialing requirements for psychiatric-mental health advanced practice registered nurses (PMH-APRNs) along with attention to the graduate level competencies for PMH-APRNs. While there are a number of theoretical perspectives that have influenced the development of psychiatric-mental health nursing, the emphasis on nursing science, including theory development and research, holds the most promise for the further development of PMH-APRNs' practice. The integration of a range of therapeutic interventions is particularly relevant to the holistic perspective of nursing science. Advanced education and credentialing position PMH-APRNs for a wide range of roles in mental health prevention and treatment. PMH-APRNs play a pivotal role in expanding mental healthcare services, including services to those throughout the United States.

There are many opportunities for global connections based on one’s area of expertise and the model for partnership development that is desired. Professional organizations in nursing rely on the volunteers at both the elected and appointed levels to make certain that the organizational goals and activities are successfully accomplished. Nurse leaders in all specialties are masters at “paying forward”, investing in future generations of nurses through mentoring and coaching formally and informally. One of the most important responsibilities that advanced practice nurses share is that of improving future generations of clinicians through education and dissemination of scholarship. In addition to the disciplinary partnerships within nursing, there are multiple opportunities for interdisciplinary partnerships. Advanced practice psychiatric-mental health nurses have a responsibility to participate in the development and dissemination of scholarship through their professional work.

This chapter discusses the mental health needs of sexual and gender minority (SGM) people. An historical and cultural context as well as the Minority Stress Model provide a framework for understanding the challenges and health disparities SGM people face. Learners are urged to view this content through a lens of strengths and resilience, observing how the SGM community itself has led the changes that have resulted in reductions in stress and mental health sequelae. The chapter reviews the issues and challenges for SGM people across the life span, and presents considerations for the diagnosis and management of mental health disorders including trauma-informed care. It provides a framework in which to understand mental health conditions for SGM people and considerations for the psychiatric-mental health advanced practice registered nurse when providing affirming care and working against stigma and discrimination.

Over the past decade, the role of the psychiatric-mental health advanced practice registered nurse (PMH-APRN) has become a more visible presence in the specialty of forensics, which is the application of science to legal questions. This chapter provides an in-depth look at the role of the PMH-APRN in the forensic settings. The largest area of practice opportunities is in corrections. The chapter explores at length the personal and professional rewards of providing service to the truly severely mentally ill, as well as the challenges of doing so in a correctional setting. It introduces specific skill sets and tools, such as a Forensic APRN Practice Conceptual Model-Decision Tree, for successful navigation of the many challenges. Selfcare strategies, active clinical supervision, and management of healthy boundaries are stressed as essential professional traits for this work environment.