[Music] Hello there and welcome to our PMHP crash course review by NP exam coach. My name is Dr. Lopez and today we will discover some of the techniques that you can use to increase your chance of success. Well, no matter how much you study, you will encounter situations in which you don't quite know the answer. Well, if you encounter one of those situations, using those strategies that I will show you right now will increase your chance to success. So, let's get right to it. Okay. So in every module that we cover whether it is in the PMHP 30 days walk to success or the PMHP crash course review you will find the road map. The road map will guide you through what's coming up next. Here for this session we'll cover obser uh objective approach to questions answer choice analysis prioritation in clinical judgment emphasis on patient safety the importance of critical thinking will emphasize interpersonal uh interprofessional collaboration and culture consideration in healthcare. there. Okay. So, objective approach to questions. How should you approach every single question? Well, it may seem simple, but you should only focus the information that's provided in the stem of the question. Well, you may think, well, that's too simple. I cannot emphasize that you can only use the information that's provided and you have to keep your role in consideration. What I mean well it's very simple. Some of us are FMPs or have other background. So we cannot use the knowledge as a FMP to answer PMHP question most of the time. So you have to think as a new PMHP. um that's about to be board certified, right? After all, theCC wants to know if you are safe and you have the basic knowledge to start your practice. Avoid making assumption or addressing extra detail not mentioned in a question. What I mean is do not think well this is how I do in my hospital. This is what I have seen. No, think of the book scenario. Everything is perfect and everything you need to know about that question is on the steam of the questions in in the answers provided whether it's A, B, C or D. Ask yourself the core of the question and match it with the correct answer choice. Oftent times if you do not know the answer choice eliminate at least two of the answers on your test you will have a option to strike through or highlight. If you are unsure about the question, a minimum you should highlight this theme of the question and strike through two of the negative answers and then you save the question for later. As you come back towards the end of the exam, you have the option to return to the question. So ask yourself, what is the question asking me? Often times the most important part of the question is at the end of the question. Okay? It may give you a long scenario. So you look at the question, assess it objectively and often times try to answer the question before you see the answers. This might help you a lot. So when you're encountering answer choices, which by the way is all questions, right? So review and narrow down to the two most likely correct answers. As I mentioned, all questions you have to narrow down to two most likely correct answers. I have to warn you that questions will not give you a full DSM5 criteria. What I mean is well let's say you have major depressive disorder for that you need two weeks as a time period and you need five symptoms. The question may give you three symptoms let's say um sadness uh low energy and insomnia for example and ask you which of the following is the most likely diagnosis. So you cannot say for sure this is major depressive disorder but out of the answer choice this may be the most likely diagnosis. Right? So either cases you have to get in a habit of taking two answer choices out after you evaluate options A, B, C, and D. Disregard partially correct answers as they are not the complete solution. What I mean by that, let's give example of the dopamine pathways. Option A may say that uh in the the misolyic pathway dopamine is responsible for the psychotic futures and in the mocortical pathway prolactin is responsible for the negative symptoms. So I give you an answer in which the first part is correct followed by a incorrect rest of the question. So that question is totally eliminated because the sentence in whole is not correct. Okay. So when two answer choices are completely opposite of each other often one is the correct answers. For example, if we say symptoms of um hypothyroidism for example and you may have one answer that's hypothyroidism and the other there are hyperterrorism and then you have option B C or D. So look at those two opposite answers and ask yourself why are they opposite? Most of the time, one of those answers may be the correct answer. Examining the question steam and choose the answer that contains similar words or synonym in the in terms what I mean is if a question is asking for major depressive disorder looking for answer that's sadness or weight gain or excessive eating or insomnia. So it match somehow the symptoms of major depressive disorder in the question to something that's similar or sometimes very close uh sentiment in the steam of the question. Pay attention. Often times you will see that this the steam of the question will match one of the answers. pick the answer that prioritize patient center care. Okay, so this is so important because often times we'll see an answer that is correct but it did not even answer the question. For example, if you pick option B that is a correct answer versus court option A which prioritize the patient that might be the correct answer. Let me give you an example. Let's say that you have a family that's taking care of a patient with autism's disorder. Okay. So let's say the parents one of the choice says hey I you know I just cannot take care of the of my kid because it's giving me too much work and I am super stressed. I don't know what to do and I'm super depressed. Well and option A B might give you um something along the along the lines of prioritizing the patient care through therapy. Okay. So option A it's relevant is a fact that the parents are are having difficulties to take care of the child but option B straight up addresses the patient and that's what you need to be concerned with with each and every question addressing the patient care first. I know this is a simple example but but keep the rationale the thought process in mind as you answer each and every questions unless if the questions asking specifically about the family. Okay. So if several answer choices are almost identical they may all be incorrect. So let's give an example. For example, if if the questions is asking about symptoms of ADATD, option A give you a date. Option B give you another stimulant. So option C might give you guenosine or stratera. So option A and B they look similar. So therefore they could not be possible the answers. For example, another one which medications can be used for major depressive disorders. Well, if option A is SSRI and option B is as look at the stem of the questions. There is something that they may be asking that is different. For example, the stimulate the question may say which of the following options does not have serotonin and option C may be well butrin since option A and B there are some similar categories they may be all cross up. I know this is a super simple example I just made this up but be attentive to the details. If two options are very very similar, they both may be the wrong choice. Exercise caution when answers are very obsolute in terms of of only all, always every, never, everything as they are not the correct answer. Most of the time, right? Often times the questions and the answers they should somewhat be in a m range. So they they should not be all because very very few times everything is all and always or never, right? There are very few times. So when you see answer choices that are very obsolute, be at least caution of it. Generally medical evaluation answers is incorrect and a referral to a specialist is needed particularly to OB opeds case. For example, questions that address Reddit uh syndrome. We know what Reddit syndrome is. We cover this during our course. What can we do? Ask yourself, is that something that I can do? If the answer is yes, go ahead and do it. But if the answer is more than collecting labs or anything in advance to that, your choice is to referral. Okay? We are here to take care of patient psychological needs. So if you find yourself with your back against the wall that you cannot do a whole lot, maybe referring is the answer choice here. Especially when it comes to those specialized uh patients with OB beads, look for a collaboration. Collaborations is different, right? So often times we want to collaborate. we may now want to refer only if it's for medical um evaluation specifically. Okay. How to prioritize in clinical judgment? Okay. Questions contain objectives like priority or initial action. you will see so many of them on your task because it's assessing your ability to determine the most critical action to take. For example, if the question says the patient is taking carbomy and the patient is also taking uh well let's say carbomioine and the NC is 700. So what is your priority? Your priority is to stop the medication. What is priority? What is the initial action? It's your assessment. And that goes back to the simple three three frames work that we use here. Well, the first one when ask about priority or initial a action think of it as airway breathing and circulation. Well, if none of those are in your answer choice, you move to the second step. Your second step is your maslo hierarchs of needs. Well, in the bottom you have housing, food, safety, and then goes all the way up to u self actualization for example right that's not as important as having shelter if I don't have shelters how can I be thinking the best professional that I can be correct so if airway be breathing circulation is not a choice if muscle hierarchy need is not a choice Then it comes the nursing process. So the third action on the step of prioritation is the nursing process. Here is a bit different than nursing process. In the past we said that taking virus or doing labs would be an intervention. Now you are the provider and that becomes your assessment. In this case, we do assessment before intervention. So what is an assessment? It's the collection of vitals. You collect information is doing literature uh search that's collecting information. Vital signs is collecting information. Collecting survey is collecting information. That's all part of your assessment. Okay? So don't confuse your role as a RN. in comparison to your new role as a provider. So, and that's about it. If you use this strategy, make sure that you prioritizing airway, breathing, circulation. If none of the choices are available, follow along with the masle hierarchs of need. If none of that is available, then you start your nursing process with assessment as the most likely correct answer. And if all are assessments, then ask yourself which one of the answer choices is actually answering the question. Make sure you are practicing those strategies way before the test date. So emphasis on patient safety. Patient safety must always be the primary concern. Duh. Well, you know, it can be tricky. It cannot often times it will not be simply blunt. So for example here if a patient is taking a mood stabilizer for example let's say uh depical right and um one of your choice is to collect uh to collect a urine analysis to ensure that the patient is not pregnant. Well that is a priority because you want to prevent harm. So that's safety. I did not necessarily say safety on the question, but you as a provider, you are thinking and acting in a safe manner. Okay? For instance, rape cases, right? You must ensure before anything that the patient is safe. For example, if you have a rape case and someone comes to you, the first thing you want to ensure for the patient is the patient is safe. The immediate and appropriate action is the patient safe. That overcomes even doing a collection of evidence, right? I know you need both, but your priority is, hey, are you safe? Do you have a place to stay tonight? Right? Because you're addressing safety. Even if the question did not ask you about safety, your answer choice is before the patient gets discharged, ensuring the patient's safety. That goes for someone that's impatient. Your priority is to ensure that the patient gets discharged safely. Here is the impatient setting. Ensure the patient is secured before discharge without relying solely on safety contract. Why did I mention safety contract? Safety contract is the old way of doing things. We no longer do safety contract. Anytime you see safety contract, your action is actually to cross that option. We don't do safety contract. On the other hand, we do safety planning. Safety planning is a sixstepwide progressive list of things that patients can do to prevent suicidal uh ideation and harmful um ways to hurt themselves. Right? So safety planning is okay. Never never never never we do a safety contract for example telling the patient that the patient tells you that he signed a safe contract and he is good to go well that's not a good option okay so that's a old way of thinking we should stay away from that is not endorsed by NCC because it's not evidencebased uh conduct interview in same private setting to prioritize safety above privacy. Well, let me give you another example here. Let's say you have a patient that is aggressive. You want to ensure the patient privacy but never never over your own safety. So, how to do that then? Right. Do you want to be in a patient room with a closed door? No. No. No. No. Because that's not safety to you. Do you want to have a meeting in front of everybody else? No. No. No. No. Because that doesn't give the patient the privacy. Okay. So what you want to do is perhaps have a semiopen room in which you can walk away safely and also ensuring the patient privacy. So it's a midterm right. So always consider your safety and the patient safety first no matter what situation is involved. Okay? So please make sure you're writing down those examples because you may see them again in one shape or another. Okay? So as you are walking through those strategies, you have to have something to anchor your thoughts so that way you remember about those scenarios. In case of a suspect child abuse, interview the child separately and reports to CPS if necessary. So here is the thing. If you know that the child is actually abused, you conducted some assessment first. Then your next action is to make a phone call to CPS and allow them to collect the evidence. But first, make sure you have some evidence in place, right? So, if the child reports abuse and you don't know who abused the child, make sure you actually conduct the interview separately from the parents. Now, if you know that the child's been abused by someone else, then it's okay for the parents to be in the room with the patient. Okay? So, most of the times you want to do a child uh abuse interview alone if you don't know who it who is the uh who is the the person being accused of of the child abuse. If you know the parents are the one so you want to ensure the patient is safe and do the interview alone. Now if you know that the parents were not involved then perhaps having the child and the parents in the same uh room would be beneficial. Often times I see this scenario as a child playing sexually with a dog, right? Your action is to collect more information. You want to collect more information and then report to CPS. You shouldn't just pick up the phone and say, "Hey, this child is playing sexually with a doll." You want to have a time and assess if there's an option for assess and then report. That usually is a better option than straight up reporting. When dealing with teenagers, establish trust. When dealing with teenagers, you must establish rapport to ensure that you are getting the information that you need. So how do you do that is by ensuring the patient the confidentiality. Okay. So unless obviously if their safety is at risk, they have the right to confidentiality. They do not have the right to privacy. Okay? So let's give you an example here. Let's say you are dealing with a teenager female of 14 years old and the child tells you or the teenager tells you, "Well, I have sexual feelings for my classmates of the same age and the same sex." So, your job is not to report to the parents. Your job is to ensure the patient can disclose her feelings to you. So that way you can collaborate with the patients and improve her mental health. So your job is not to tell the parents. Your job is to ensure the confidentiality of the patient. Well, as you may guess, this will create a dilemma, right? a ethical dilemma because you want to attend to the parents as well and the patient. Well, that creates a problem. But above all, they have the right to confidentiality, not the right of privacy per se. If you can provide confidentiality and privacy, then it's okay to do so. Okay. So we interview teenagers privately to maintain confidentiality assess when they desires unless they desire otherwise. If they say hey I would like my parents to be in the meeting then then it's totally okay. This action will create a ethical dilemma as I mentioned regarding their confidentiality and the parents need to know of the information. For example, if she or he is arriving is having sexual attraction to someone else, as I mentioned, they are dating someone at the same age. So, here is when the things can be a little tricky. If there if the child is dating someone that's older than you know, not child, teenagers, dating someone that's of a older age, they are not in the same age. then it becomes a matter of reporting. Okay, let's say the the teenager is a 14 years old dating a 25 years old. So that it's reporting to CPS. Okay. Now, if you're dating someone of the same age and whether same sex or not, then it's a matter of confidentiality. You keeping the confidentiality piece. Okay. And I mentioned they have the right to confidentiality but not the right to privacy. Okay. The importance of critical thinking understanding the reasoning behind the clinical decisions particularly for diagnostic test. Right? So when collecting a diagnostic test or ordering one, you must ensure that there is a reason for that. Not just because you want to collect a CBC, C, CMP, vitamin D because of a habit. There must be a reason behind it. Interprofessional is important. Earlier I mentioned about um refer. We prefer almost never to refer unless they're a specialized case, unless if they are medical evaluation cases, but we should at all possibilities endorse interprofessional collaboration. So we aim to actively informed be involved in the patient care decision rather than delegating those tasks. Right? For example, let's say that you that the patient requested that you release a medical information to another hospitals for example. So your action here is to confidentially well you need the first informed consent to do so. Once you got the informed consent you can fax the information you can electronically send the information to the hospital rather than giving to the patient directly to handwalk this information. Right? So in this way you maintaining confidentiality and privacy and also delivering the product directly to the institution that will make the best use of it. Okay. You prefer not to delegate the patient to carry the medical records unless if the absolutely patient choice. Okay. If you have a choice send it in a secured way. So um for example in answer choice that I work collaboratively with the nurse manage dietician uh supervisors is essential. If they say delegate to them that's a no no you want to collaborate but not delegate. Okay, collaboration is the key here. In cases where a postpartum suicide risks without an assessment, collaborations with the OB department is necessary before the patient's discharge. So for example in postpartum patients you want to collaborate with the OB department so they can have a measurement of depression before they get discharged so that an appointment can be made for a followup rather than not having anything to do with the OB. You want to collaborate with the OB department to ensure they have a way to track those patients for postpartum depression. Ensure the informed consent is obtained when transferring patients information or making referrals. Okay, we mentioned this. The patient request to transfer their health records. uh the appropriate choices to fax the patient's medical health to the receiving facility rather than delegating to the patient or other uh ways of uh delegating anything. In fact, two forms of consent are required for patients with psychiatric condition and such. I'll repeat two forms of consent. They need two forms of consent if the patient has a psychiatric condition and a si disorder. Right? Consider what can be done for the patient before making a referral. I mentioned this early. Is there anything that you can do before you request the referral? If the answer is yes, collect in lab if it's one of your answer choice, would that help the patient? Yes. So that might be your answer choice. If the answer is no, then perhaps referring is the option. But always or most of the time referring is not the correct answer unless if it's a specialized case of pedes, OB or medical evaluation. Okay. Now here I have a very specific uh scenario here. Let's say consider that you what can be done for the patient before making a referral such as requesting a urine drug screen if a teenager has ingested a substance for example acetone to rule out other substance use disorders. Well, before you refer this patient to a specialized location, ask yourself, can I at least get a labs? If the answer is yes, go ahead and collect those labs and allow the patient to have some information and allow the care to take upon the referral. The receiving providers will not have to wait for the labs. Everything has been clear. So that's most likely your answer choice. Please annotate that examples because it help you memorize and understand the concept. Next cultural consideration is huge for the PMHP board certification. You want to always choose the answer that reflect cultural sensitivity if they different from the usual practice. Even if they different from the usual practice. Well, let's give you an example here. Let's say you have someone that uh robs green leaves to their skin, right? And the skin is now inflamed. So your action is not to say you need to be admitted. Your action is to say tell me tell me more about it. How is does it how is it part of your culture? Help me understand. Okay. So it's a culturally sensitive answer rather than say well what I learned in school is that your skin is inflamed and you need the antibiotic or whatever is the case. Right? It's not what we see or how we see the world. is how the patient see the world. Again, patient focused answers, right? Do not equate culturally influenced response to mental health. Well, again, if in my culture it's normal for me to wake up at middle of the night and go for a run, okay, that does not equate to insomnia, okay, or does not equate to uh anxiety disorder. That basically that's what I do in my culture. So ask, tell me how does it work in your culture? Tell me a little bit more. Help me understand or help the patient. Can you explain what does it what this condition is for you? Okay. Rather than saying, well, it's insomnia. Okay. So clarifying the meaning of the illness or predictment to seek to understand the culture context of the patient illness and challenges. You want to uh contextualize the situation in their own world, right? How they see the situation. And you want to empower the patient by understanding the prospective and validating their symptoms within their cultural uh framework. For example, somatic complaint. That's huge. That's huge. Somatic complaints without a medical diagnosis. Your job is to validate the patient by asking more questions and acknowledging the patient pain. For example, if someone says mao, which is Hispanic uh uh cultural significant uh syndrome for uh evil eyes, you don't want to say, well, I don't believe in it. You know, it must be something else. You want to understand what it is like in their culture and validate their symptoms rather than saying, "No, this is not happen. This is not possible. Okay. And that is about it for your strategy. Strategies are good. Knowledge is better. So let's go now to the meat and potato of the PMHP crash course review.