Diagnosing and Treating Conditions

Although the terms may not be familiar to you, it’s likely that you’re already diagnosing and treating conditions in your practice. When you plan for and provide psychiatric nursing care, you’re making clinical judgments about your client’s status and carrying out appropriate psychiatric nursing treatment.

For example, based on your assessment:

  • You diagnose acute confusion in your client, and decide to withhold antipsychotic medication, check vital signs, perform a glucometer to assess blood sugar level, and perform a mini-mental status examination.
  • You diagnose hypoglycemia in your client with diabetes, and treat it, following your organization’s hypoglycemic decision support tool (DST).
  • You assess abdominal pain and distention in your elderly client with a known urinary tract infection, and apply ultrasound using a bladder scanner to diagnose urinary retention
  • You diagnose an immediate risk for physical violence from a client who is no longer responding to other de-escalation interventions and determine a reduced stimulation secure room is required following your organization`s policy/protocol

Diagnosing

In B.C., diagnosing (a disease, disorder or condition) is a restricted activity granted to some regulated health professionals. For instance, physicians and nurse practitioners are authorized to diagnose diseases, disorders and conditions. Registered Psychiatric Nurses (RPNs) have the authority to diagnose conditions only.

Conditions

Conditions usually have associated signs and symptoms such as abnormal temperature, pulse or pain. However, in mental health there may be exceptions when the signs and symptoms may not be as readily observable, for example, internal suicidal ideation, thoughts of paranoia, or anxiety. A condition may also be the result or be related to a known disease, disorder or its treatment. For example, an RPN may diagnose a disturbed thought process in a person who has schizophrenia, chronic confusion in a person who has been diagnosed with Parkinson`s disease, hypoglycemia in a client with diabetes, or angina in a client with a history of coronary artery disease. Other conditions, such as hypoxia, or pain may result from a medical problem such as an undiagnosed disease or disorder. In these situations, an RPN may diagnose and stabilize the condition until another authorized health practitioner diagnoses the underlying disease or disorder.

Controls on RPN practice – what should I consider?

There are four levels of control on RPN’s practice:

  1. The Health Professions Act and the Nurses (Registered Psychiatric) Regulation which sets out the broad scope of practice (this applies to all RPNs)
  2. CRPNBC standards, limits and conditions, which complement and further define and limit the scope of practice set out in the Regulation (this applies to all RPNs)
  3. Employer/Organization policies¹, which may further restrict what activities an RPN may do in the workplace (this applies only to RPNs at that workplace)
  4. Individual RPN competence to carry out a particular activity, which reflects an RPN’s level of education, knowledge, skills, experience and currency (this applies to an individual RPN)

¹ RPNs in independent practice assume the responsibilities of employers.

Communication, documentation and collaboration

RPNs clarify their roles and responsibilities in their organization when acting within autonomous scope of practice. See scope of practice standard Acting within Autonomous Scope of Practice for more details.

RPNs work with other members of the health care team to provide clients with safe and effective care. Consider how you communicate and consult with others on the team. You may seek advice from colleagues or consult with listed or non-listed healthcare professionals before arriving at a nursing diagnosis, finalizing a plan of care, or determining the most appropriate treatment for a client.

Ask yourself:

  • How do I communicate my diagnosis, plan, treatment and client outcomes to other team members?
  • How does my documentation reflect this process?

Things to remember when diagnosing and treating

  • Diagnosing involves critical thinking and judgment.
  • Conditions have associated signs and symptoms.
  • Diagnosing a condition involves determining the cause of your client’s signs and symptoms.
  • You diagnose the condition to determine whether you can improve or resolve it with psychiatric nursing treatment.
  • Diagnosing a condition is linked to the standard Acting within Autonomous Scope of Practice. You determine the plan for treating a condition; your plan is based on what you’ve decided the likely cause is.
  • Your assessment might identify a medical problem and lead to a request for assistance/client-specific orders.
  • You do not treat if you cannot manage the intended and unintended outcomes.
  • Evaluating treatment can help rule out, refine or validate your diagnosis.

Think about the clients in your clinical practice, and consider the conditions you may diagnose and treat.

Ask yourself:

  • What is the clinical decision-making process I use when I plan for and provide care?
  • How does diagnosing conditions fit into my practice?
  • What knowledge, skill and judgment may be required?

 

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