3021: Reducing Avoidable Readmissions Effectively
Chris Walker, MSN, RN, MHA

PURPOSE: Patient readmissions to an inpatient mental health unit can have an effect on patients, staff and your hospital. Learn how to reduce avoidable readmissions effectively. SUMMARY OF EVIDENCE: By focusing on engagning the patient through patient-centered goals, we tested and implemented several process and quality improvement changes for inpatient psychiatric patients, resulting in fewer readmission and improved patient satisfaction. DESCRIPTION: Discussion will include how our hospital set priority focus areas and completed PDSA (Plan, Do, Study, Act) cycles to improve transition care support, comprehensive discharge planning, medication management, transition communication, and patient and family engagement. Learn about patient centered goals, follow up phone calls after discharge, bedside shift report and using a discharge checklist to help improve the transition handoff. VALIDATION OF EVIDENCE: Outcomes measured by patient satisfaction and staff engagement scores.  RELEVANCE/OUTCOMES: Readmissions decreased by over 3 percent. IMPLICATIONS: Learn what practices can be effectively implemented to help reduce your readmissions.



3022: Care Coordination in Integrated Care: Development of a Role for Psychiatric RNs
Joyce Shea, DNSc, APRN, PMHCNS-BC; B. Jamie Stevens, MSN, APRN, PMHNP-BC; Amanda Schuh, MS, RN, PMHNP-BC; Carol Radovich, RN, MSN

PURPOSE: This session will explore the development of integrated care, with a focus on the emerging role of Care Coordinator as it relates to the skill set of a psychiatric RN. Examples of the role in practice at several acute and community-based systems of care will be shared to inform discussion about the responsibilities, competencies, outcomes, and evaluation methods associated with the position. SUMMARY OF EVIDENCE: One in four Americans experience some form of mental illness (MI) in a given year, and the majority receive assistance from providers outside of behavioral health specialties. In addition, those with severe forms of MI face increased risks for serious medical co-morbidities and significantly shorter life spans than the general population. Improvement in the quality of integrated mental health and general health care has been noted to depend upon effective communication, collaboration, and coordination between all providers in all settings. DESCRIPTION: Psychiatric RNs have a unique set of skills which should prepare them well for the role of Care Coordinator in a variety of Integrated Care (IC) settings. However, there has been minimal focus on the development, standardization, or evaluation of IC competencies for RNs. VALIDATION OF EVIDENCE: Presenters will describe the role of Care Coordinator within several IC systems and identify overlapping competencies needed.  RELEVANCE/OUTCOMES: The role of Care Coordinator on an IC team is essential for improving safety and quality of care, decreasing barriers to care, and decreasing overall costs of care. IMPLICATIONS: Psychiatric RNs can take the lead in defining the Care Coordinator role and improving the care of patients.



3023: The Impact of Parent-Directed Education Curriculum on Improved Adolescent Mood Disorder Outcomes
Erica Runkle, MSN, RN

PURPOSE: Parent-directed teaching methods have been developed by the psych mental health nurse working in Mayo Clinic’s Child and Adolescent Integrated Mood Program (CAIMP). These teaching methods can be adapted and utilized by the psych mental health nurse in many ambulatory or outpatient settings. SUMMARY OF EVIDENCE: Parents of adolescents with mood disorders in ambulatory or outpatient settings often receive abbreviated face-to-face mental health education, skills practice, or guidance on supporting their child or teen who is struggling with mood related behaviors and symptoms. This occurs for many reasons, most typically because of lack of provider time, lack of subject matter familiarity/expertise, or lack of resources. DESCRIPTION: In response to parent demand for psychoeducation, and to meet the identified educational needs of the parents, specific psychoeducation content was developed. Topics include: assertiveness, distortions, guilt/grief, parenting styles, conflict styles, neutrality, self-care, processing, and skills training. Implementation barriers for the nurse were identified, such as having limited exposure working with parents, helping parents apply content, and addressing parent learning barriers, such as managing parent resistance. VALIDATION OF EVIDENCE: Implementation of this new education plan created a parent learning experience that was more cohesive with their child's learning experience and enhances both patient and parent outcomes.  RELEVANCE/OUTCOMES: Parenting teens with mood disorders is a challenging endeavor. Parents receiving direct education as a nursing intervention provide enhanced support for their children, resulting in improved safety and patient outcomes. IMPLICATIONS: Psychiatric nurses are able to provide a holistic approach to patient care by addressing parent educational needs.



3024: Implementation and Evaluation of Using a Trained Actor to Model Mental Health Nursing Practice
Angela Gerolamo, PhD, APRN, BC

PURPOSE: Although nurse educators have integrated simulation with professional actors into nursing curricula, simulation remains a relatively infrequent pedagogy in mental health nursing. This presentation will describe the implementation and evaluation of simulation using a professional actor to provide students with the opportunity to observe the management of high-risk events (for example, a suicidal patient). SUMMARY OF EVIDENCE: Closures of psychiatric facilities and reduced inpatient hospital capacity create significant challenges for mental health nurse educators. To this end, it is paramount that educators develop innovative teaching strategies to expose students to critical mental health concepts and the management of high-risk clinical events. DESCRIPTION: Faculty developed a simulation that included a role play between a nurse and an actor portraying a depressed patient with psychotic features. Embedded within the role play was a mental status assessment which allowed the students to observe how the nurse puts into practice assessment techniques and therapeutic communication. VALIDATION OF EVIDENCE: The Educational Practices in Simulation Scale-Student Version was administered to baccalaureate nursing students to measure the presence and importance of best educational practices in an instructor-developed simulation.  RELEVANCE/OUTCOMES: Data analysis is underway. However, student feedback was overwhelmingly positive with some students reporting that they enjoyed the experience and benefited by observing the nurse’s use of therapeutic communication. Further, the students believed that the simulation was an actual nurse-patient encounter which is a key goal when designing simulation activities. IMPLICATIONS: Given the national focus on the integration of physical and behavioral health and mental health first aid, this simulation activity has far reaching clinical implications.



3025: Suicide Prevention in Primary Care: How "Zero Suicide" Can Help
Gail Stern, RN, MSN, PMHCNS-BC

PURPOSE: Currently there are a mixture of homegrown suicide screening, assessment and intervention methods in practice. Some are based upon evidence, but often care is based upon past practice and focused on mental illness, not the target problem of Suicidal Ideation and behavior. Evidence based screening, assessment and treatment of the individual with suicidal ideation and behaviors in primary care will be presented. SUMMARY OF EVIDENCE: "Zero Suicide is a commitment to suicide prevention in Health and Behavioral Healthcare systems, and a specific set of tools and strategies. As both a concept and a practice, " Zero Suicide utilizes a healthcare system approach that aims to improve care and outcomes for individuals at risk for suicide. (http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/zero_suicide_final6.pdf) DESCRIPTION: Essential Dimensions of suicide prevention for Health Care sytems include:1. A leadership driven safety oriented culture which includes people with lived experience. 2..Systematically identifying and assessing suicide risk levels 3. Ensuring every person has a path to timely, adequate care. 4. Developing competent and caring workforce. 5. Using evidence based care focused on suicidality. 6. Continued contact and support. 7. Applying data driven quality improvement VALIDATION OF EVIDENCE: Based upon the work of individuals like David Jobes(CUA) and Kelly Posner (Columbia) , organizations such as Henry Ford experienced an 80 % reduction in the suicide rate of their plan members.  RELEVANCE/OUTCOMES: This presentation seeks to identify an important role for psyciatric nursing expertise and practice in healthcare delivery systems. Mental health care needs to be a part of all health care. IMPLICATIONS: Suicide prevention is the responsibility of all health care systems.



3026: The 2015 IOM Report on Psychosocial Interventions for Mental and Substance Use Disorders: Implications for Education, Practice and Research

PURPOSE: This presentation summarizes findings and recommendations of the IOM Report on Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards and provides a forum to discuss implications for education, practice, and research. (Projected Report Publication – Summer 2015) SUMMARY OF EVIDENCE: The 16 member interdisciplinary committee gathered, heard presentations from national and international experts, engaged in lively discussions and iterative reviews within and across the five task groups to reach consensus on definitions, framework, and recommendations over a year long process. DESCRIPTION: The consensus definition of "psychosocial interventions" are "interpersonal or informational activities, techniques or strategies that target biological, behavioral, cognitive, emotional, interpersonal, social or environmental factors in order to improve health, functioning or well-being." This definition includes approaches ranging from various psychotherapies to community-based interventions of Assertive Community Treatment teams, supported employment, and peer assistance. Interventions are comprised of nonspecific elements generic to all effective psychosocial interventions (e.g. therapeutic alliance) and specific elements unique to a particular psychosocial intervention (e.g. cognitive restructuring, family education). VALIDATION OF EVIDENCE: The committee proposes an iterative framework for developing/evaluating psychosocial interventions: 1) identify and standardize elements of interventions, 2) conduct independent systematic reviews to inform clinical guidelines, 3) develop quality measures, 4) implement interventions and improve outcomes, and 5) strengthen evidence base which all evolve around engaging consumers.  RELEVANCE/OUTCOMES: Teaching the elements of therapeutic change rather than a survey course of different psychotherapy approaches offers an innovative approach to developing competency based clinical skills. IMPLICATIONS: An "elements" approach to therapeutic change impacts education, practice and research.



3027: Advancing Clinical Education through an Evidence Based Practicum for Psychiatric Mental Health APNs
Marsha Snyder, PhD, PMHNP-BC

PURPOSE: The purpose of this presentation is to address the development of a student practicum within a nurse managed academic clinic. where graduate students participate in the development of innovative clinical practices in the context of the restructuring mental health service delivery . SUMMARY OF EVIDENCE: PMHNP students are routinely educated within traditional settings that do not embrace an integrated philosophy and continue to promote care that is fragmented and costly to the organization and SMI. Integrated models are evidence based and student participation within these models is critical to development of future practitioners. DESCRIPTION: Students learn first hand that integration of mental health with primary care nursing is the best foundation for tailored evidence based care. VALIDATION OF EVIDENCE: Students who participate in the IHC model work collaboratively with primary care to integrate concepts, approaches, and processes of mental health nursing into the everyday provision of primary care, particularly those related to therapeutic alliance building and cognitive–behavioral change.  RELEVANCE/OUTCOMES: Nurse managed clinics struggle with funding resources and recruitment of qualified practitioners. Students who participate in the practicum return after graduation to work within the IHC setting helping to facilitate both fiscal and philosophical viability of the clinics. IMPLICATIONS: If healthcare for SMI is to move forward in an integrated way, future practitioners will need to be educated in the modality in order for them to provide the required leadership for development and maintenance of integrated systems for care delivery.



3031: Implementation of a De-escalation Emergency Assistance Team to Improve Patient Outcomes
Jason Drapeau, RN;  Kristen Kichefski, RN-BC

PURPOSE: This presentation describes a clinical practice change involving the creation and implementation of the De-escalation Emergency Assistance Team (DEAT) at Butler Hospital, a psychiatric hospital in Providence, RI. SUMMARY OF EVIDENCE: The concept for the DEAT was developed through the hospital’s Clinical Safety Committee.  Utilizing evidenced based solutions the clinical safety committee, comprised of 80% direct care staff and 20% nursing leadership, strives to close critical gaps in clinical safety at the practice level. DESCRIPTION: The committee assessed a rising number of patient restraints and seclusions as well as an escalation in both patient and staff injuries. In response, they appraised a unique opportunity to create a team with a new set of processes and procedures that would safely de-escalate potentially violent situations through a specially trained volunteer team of staff.  Key stakeholders, including senior staff and members of nursing management, developed the training program for the emergency response team members who focused on SBAR communication, environmental and patient assessment skills, and principles of verbal de-escalation.  Volunteer staff from the evening shift piloted the program and received structured, peer-based educational workshops. VALIDATION OF EVIDENCE: Immediate results reflected a decrease in critical quality measures such as; restraints, seclusions, and patient and staff injuries as compared to the same quarter in prior years.   The same downward trend was noted when the DEAT was expanded to the day and night shifts.  RELEVANCE/OUTCOMES: Systematic decrease in restraint and seclusion through shared governance. IMPLICATIONS: Implications for practice include enhanced safety, staff collaboration, and patient engagement that foster self-mastery and decreases patient distress.


3032: Integrated Physical and Mental Health Care Role for Advanced Practice Psychiatric Nurses: Part of Our Evolving Healthcare System
Diana McIntosh, PhD., PMHCNS-BC

PURPOSE: The 2010 Patient Protection and Affordable Care Act included provisions encouraging increased collaboration of care for individuals with behavioral and physical health service needs in the public sector. Thus, it is imperative that advanced practice psychiatric mental health (APPMH) nurses know challenges and successes in implementing the most effective integrated approach to collaborating and caring for people. SUMMARY OF EVIDENCE: In 2010 the Milbank Memorial Fund commissioned Collins et al to compile a report for policymakers with a primer on integrated care. It included various innovative care delivery models that have led to a continuum of integration and collaboration. Recently the APNA (2014) discussion board put out a call of interest for a position paper on “what would integrated physical and mental health care look like?” This question needs to be taken a step further. What would the role of the integrated care APPMH nurse look like? DESCRIPTION: Examples of APPMH nurses in integrated roles in various practice settings will be compared and contrasted. VALIDATION OF EVIDENCE: Factors contributing to APPMH nurses effectively implementing integrated care models in ‘real-world’ settings will be identified. This will be followed by an analysis of barriers that interfere with successful implementation.  RELEVANCE/OUTCOMES: An emphasis will be placed on the development of integrated care competencies, role expansion for APPMH nurses and the potential of dual certification. IMPLICATIONS: There are implications to consider for the future role of integrated care APPMH nurse; such as, integrated care competencies, role expansion, dual certification, policy development.



3033: Parents’ Self-Help Training for Improved Attention Deficit Hyperactivity Disorders (ADHD) Outcomes
Pierre Ngili, MS, RN, PMHNP-BC; Raul Padilla, MS, CARN-AP, CRNI

PURPOSE: To implement and to evaluate evidence-based interventions that aim at educating parents of children who are diagnosed with attention-deficit hyperactivity disorder (ADHD), fostering healthy parent-child communication, encouraging resource utilization and at empowering the parents in the management of their children’s ADHD symptoms SUMMARY OF EVIDENCE: While a combination of medication and psycho-education has demonstrated superior outcomes over medication or psychotherapy alone in managing ADHD (Fields & Hale, 2011), many parents/guardians cannot engage in standard psycho-educational treatment modalities due to financial limitations, unreliable transportation or conflicting priorities (Daley, O’Brien, 2013). DESCRIPTION: A Six-Step Parenting Program was remotely administered to voluntarily enrolled parents/guardians for their children who are treated for ADHD at Greater Trenton Behavioral Health Care VALIDATION OF EVIDENCE: Eight parents/guardians received instructions and the manual; they read and practiced with their children at home while providers remotely facilitated the training using weekly individual phone calls. Parent/teacher rating scale of ADHD symptoms (SNAP-IV) was administered pre and posttest and scores were analyzed using SPSS  RELEVANCE/OUTCOMES: There was 100% participation and 75 % of parents/guardians reported an overall improvement in the perception of children’ ADHD symptoms. SNAP-IV scores improved by an average of 12.4% (N=8; t8=1.58; P>0.1) with an overall improvement in scores on all 16 of the 18 variables. IMPLICATIONS: A remotely administered six-step parenting program on ADHD offers unmatched alternatives for those having transportation problems, competing priorities or limited financial means for a standard in-person psycho-education or therapy. Implementation at large scale can foster parent participation in psycho-education at affordable or no extra cost.


3034: Utilizing High Fidelity Simulation of Complex Sedative-Hypnotic and Opiate Withdrawal Scenarios with Senior Nursing Students
Joanne Matthews, DNP, APRN, PMHCNS-BC

PURPOSE: Nurses, regardless of their specialty practice, need to meet the physiological and psychological needs of patients with substance use disorders. SUMMARY OF EVIDENCE: Approximately 25-40% of all hospitalized non-mental health patients have a substance use problem and the number of dual diagnoses patients admitted to psychiatric mental health units is increasing. DESCRIPTION: Currently, care of patients with substance use disorders experiencing withdrawal is inconsistent leading to confrontational nurse-patient interactions and decreased nurse and patient satisfaction. Two high fidelity simulation scenarios for complex opioid and alcohol withdrawal were developed. Standards of Best Practice in Simulation regarding terminology, professional integrity, formulation of objectives, the debriefing process and facilitation were utilized. VALIDATION OF EVIDENCE: Specific simulation guidelines promotes a safe, non-competitive learning environment promoting student judgment and reasoning. Supportive debriefing sessions provided feedback to faculty about student learning and simulation improvement. Debriefing among specialty faculty and the simulation faculty provided additional feedback.  RELEVANCE/OUTCOMES: The PMH nurse has the opportunity to be a leader in helping other non-mental health specialty nurses care for patients with substance use disorders. The outcomes of the simulation, over three semesters with over 240 BSN students, have been overwhelmingly positive; students reported improved learning of the content and teamwork skills. IMPLICATIONS: Utilization of high fidelity simulation by nursing students is highly rated by the students, provides a creative learning environment, and enhances retention of content. The ability of these students to recognize, effectively treat and meet the psychological needs of patients experiencing opioid and alcohol withdrawal, and suicidal thoughts was markedly enhanced.


3035: Implementation of a Screening for Depression and Suicide for Patients Admitted to a Large Medical Center
Linda Parisi, MA, RN-BC; David Karcher, MSN, PMHCNS-BC

PURPOSE: Depression is a chronic, disabling illness associated with increased morbidity and mortality and significant economic implications. Patients with a chronic medical illness are estimated to suffer from comorbid depression in 10-60% of cases depending on the illness. In response to the US Preventive Services Task Force recommendations and Joint Commission requirements, the executive leadership of our hospital gave approval to initiate screening for depression on all inpatients housewide. SUMMARY OF EVIDENCE: After reviewing the literature, the decision was made to utilize th PHQ2 (Patient Health Questionaire) a nationally recognized screening tool for depression and suicide. DESCRIPTION: A multi-disciplinary team including psychiatrists, nurses and social workers collaborated to establish the optimal method to effectively screen all inpatients for depression at Cedars-Sinai Medical Center (CSMC), an 800 bed multi-specialty academic hospital in Los Angeles. VALIDATION OF EVIDENCE: After reviewing the literature, the decision was made to utilize the PHQ Patient Health Questionnaire. If the patient responds positively to either question, a more detailed questionnaire is administered, the PHQ-9. It was determined to be most suitable to have nursing administer the PHQ during the patients’ routine admission intake.  RELEVANCE/OUTCOMES: Routinely screening all patients for depression upon admission, provides thorough mental health treatment and follow-up, with the goal of decreasing overall healthcare costs and minimizing morbidity and mortality of medical and psychiatric illness. This presentation will discuss our process in detail and share preliminary results. IMPLICATIONS: Data will be analyzed regarding the relationship of depression screen scores with length of stay and readmission rates to determine if screening leads to improved care outcomes.



3036: Danger Ahead or Calm Waters? Navigating and Meeting Mandatory Educational Requirements for Psychiatric Mental Health Nursing in the Clinical Setting
Sally Ann Corbo, Ed.S, PMHCNS-BC, NEA-BC

PURPOSE: Nurses responsible for education may not have the knowledge of mandatory training regulations to meet them successfully. This session will review what is required for psychiatric nurses in a variety of settings. SUMMARY OF EVIDENCE: Psychiatric hospitals and facilities who did not meet the required education and were cited by an accrediting organization. New regulations are being added at the state level for workplace violence prevention training, psychotropic medication reduction in long term care and specifications as to who can provide certain types of training. DESCRIPTION: Participants will be able to take the information and apply in in their practice settings or share it with administrators who are responsible for training. VALIDATION OF EVIDENCE: Learners will be asked to complete a self assessment and evaluation.  RELEVANCE/OUTCOMES: Presentation points will focus on specific requirements for training of psychiatric and mental health nurses. Examples of measuring outcomes of training will be presented e.g. reduction of physical containment after changing the training program. IMPLICATIONS: Nurses can be instrumental in achieving organizational success in meeting mandated training standards. Examples can be applied in the practice setting and measured.



3037: The Clinician Educator: A New Model of Academic-Practice Partnership for Training Psychiatric Mental Health NPs
Bethany Phoenix, PhD, RN, FAAN; Rosalind De Lisser, RN, MS, PMHNP-BC, FNP-BC; Aaron Miller, RN, MS, PMHNP-BC

PURPOSE: Shortages of clinical faculty and high-quality clinical placements are significant factors constraining growth in Psychiatric-Mental Health NP programs. This presentation will describe an innovative model of academic-clinical partnership to expand the clinical preceptor role, provide clinical training for PMHNP students and develop a pool of potential applicants for clinical faculty positions. SUMMARY OF EVIDENCE: To address mental health workforce shortages, PMHNP educational programs will have to expand their capacity. This necessitates recruiting and retaining clinical faculty and increasing clinical sites that provide high-quality clinical training and role preparation. High turnover of NP faculty is largely due to markedly lower academic salaries (AACN, 2014). Factors affecting clinical placement opportunities for PMHNP students include shortages of qualified preceptors, productivity pressures, and competition with students from other mental health professions. DESCRIPTION: Through a state-funded project to expand educational capacity of PMHNP programs, two clinician educator positions have been created. These experienced clinicians are employees of public mental health agencies with volunteer clinical faculty appointments. Part of their salaries are underwritten in exchange for assuming selected faculty responsibilities such as conducting clinical seminars and grading assignments associated with the placement. Clinician educators have a faculty mentor who helps them to develop clinical teaching skills. VALIDATION OF EVIDENCE: Clinician educator positions combine teaching responsibilities with clinical practice, similar to faculty practice models that are well-established in nursing.  RELEVANCE/OUTCOMES: Outcomes will include increase in student enrollment, expansion of placement sites, student satisfaction, and employment sites of PMHNP graduates. IMPLICATIONS: If successful, this model could be replicated by other PMHNP programs.



3041: Reducing Patient Violence to Self and Others: A Quality Improvement Project
Shelley Geil, DNP, PMHNP-BC;David Kester, BA, ADN, RN-BC

PURPOSE: Patient-related workplace violence negatively impacts patient care and patient/caregiver safety in every hospital service. Violence assessment can be conducted in any hospital setting and allows for early assessment and interventions. SUMMARY OF EVIDENCE: Assessing patients for risk of violence and implementing precautions can significantly reduce violence by patients to themselves or others. An inter-specialty nursing team developed a screening, assessment and interventions program which was implemented hospital-wide, significantly impacted safety throughout the hospital, and appears to have made a significant decrease in patient self-injury and violent events overall. DESCRIPTION: During the standard nursing admission process a brief safety screening was performed on all inpatients within 24 hours of admission. If this screening indicated a potential for violence towards self or others, a Risk of Violence Assessment was performed and a Safety Precaution Plan of Care was implemented, based on the result of the assessment. VALIDATION OF EVIDENCE: Our presentation will detail the method for evaluating the effectiveness of the Risk of Violence Assessment Tool and Safety Precaution Plan of Care.  RELEVANCE/OUTCOMES: PMH nurses have the ability and responsibility to impact medical patient care and patient/caregiver safety, through the promotion and training in risk of violence assessment and appropriate nursing safety interventions. IMPLICATIONS: Patient violence occurs on any hospital unit; any violent episode significantly affects patient care, patient and staff safety, and staff satisfaction. Implementing a risk of violence assessment and safety precaution plan of care can occur in any hospital setting and is one effective component of a multifaceted approach to the reduction of patient violence.


3042: The Role of the Psychiatric-Mental Health Advanced Practice Nurse in the Behavioral Intervention Team (BIT) Model of Care
Jasper Tolarba, DNP, MSN, RN, NEA-BC;Joanne Iennaco, ; , ; , ; ,

PURPOSE: This new role of APNs in BIT Model of Care helped reduce the length of stay (LOS) of medicine patient with psychiatric comorbidity admitted in the general inpatient medical floor by 1 day. It helped improve nursing staff competence in caring for psychiatyric patients admitted in the general medicine floor. Improve collaboration among multidisciplines in caring for psychiatric patients with medical issues admitted to the inpatient hospital. SUMMARY OF EVIDENCE: This new BIT program was launched at Yale New Haven Hospital after a pilot study in 2010. Currently, the BIT program at YNHH covers the entire medicine service line and showed increased hospital revenue, decreased the number of denied days, and increased nursing staff satisfaction. DESCRIPTION: Development and implementation of a new program called Behavioral Intervention Team (BIT) with PMH Advanced Practice Nurses as the key discipline that provides psychiatric care. Stakeholders include advanced practice nurses (NPs and CNSs), hospital adminisrators, nurses, physicians, patients and families, etc. VALIDATION OF EVIDENCE: patients' length of stay involving more than 5,000 cases in the study; denied days from payors; nursing staff satisfaction  RELEVANCE/OUTCOMES: Demonstrates the value of Advanced Practice Nurses in terms of bringing in revenue for the hospital Highlights how the PMH Advanced Practice Nurses improve patient care outcome Promotes the role of the PMH Advanced Practice Nurses as very valuable member of a multidisciplinary team IMPLICATIONS: Prevent premature readmission of psychiatric patients Decrease incidents of staff injuries Decrease utilization of patient sitters



3043: Evaluating the Effectiveness of Multiple Family Group Therapy in Reducing Stress among Families Coping with Autism
Claudia Mitzeliotis, DNP PMHNP-BC, PMHCNS-BC; , ; , ; , ; ,

PURPOSE: The purpose of this translational research study was to explore the effectiveness of Multiple Family Group Therapy (MFGT) on reducing stress in parents coping with Autism Spectrum Disorder (ASD). There have been limited studies and interventions focused on helping parents cope raising a child with ASD. SUMMARY OF EVIDENCE: Illness in one family member impacts on all family members. Numerous studies have been conducted measuring the impact of autism spectrum disorder (ASD) on families. Limited studies explored interventions to reduce stress in families who have a child with ASD. Multiple Family Group Therapy (MFGT) has been effective in helping parents coping with schizophrenia and other disorders. The application of MFGT with parents coping with ASD was explored. DESCRIPTION: The literature search demonstrate a deficit in the area of interventions for parents coping with ASD. VALIDATION OF EVIDENCE: The intervention was evaluated using the Parental Stress Index Short Form (PSI-SF). The PSI-SF was administered at pre-group intervention and at the end of the last group session. The parents also completed a written evaluation at the end of each session.  RELEVANCE/OUTCOMES: The group evaluations validated the need and benefit the parents experienced while participating in the groups. The project was conducted with a small sample size which is applicable in intervention studies. IMPLICATIONS: The effectiveness of MFGT in helping parents cope with the stress they encounter while raising a child with ASD has been supported by the group evaluations. The challenge is encouraging parents especially the fathers to participate.



3044: Integrated Clinical Approaches in a Concept-Based Undergraduate Nursing Curriculum
Lindsay Anderson, MSN, PMHCNS-BC;Bethany Tollefson, MSN, RN; , ; , ; ,

PURPOSE: This presentation exhibits the positive effects of an innovative clinical model that reinforces the need for psychiatric/mental health (PMH) nursing concepts to be integrated across clinical settings. SUMMARY OF EVIDENCE: Emerging evidence on concept-based curriculum lacks guidelines for effective clinical models to integrate biophysical and psychosocial nursing concepts. Lack of integration of PMH nursing concepts within the curriculum places students at risk for being ill-prepared to manage the holistic health needs of patients across clinical areas. Stakeholder feedback regarding poor collaboration and increased inappropriate use of psychiatric consultations supported the need for integrating PMH nursing concepts throughout the curriculum. DESCRIPTION: Lack of guidelines on integrated clinical models resulted in faculty developing innovative clinical experiences. Intentional integration of PMH nursing concepts and competencies into all clinical experiences across the lifespan were developed to foster holistic nursing practice in students. To facilitate effective integration, there are PMH nursing faculty in all clinical courses. VALIDATION OF EVIDENCE: Student surveys and clinical evaluation suggests improved ability to provide holistic care. Students have demonstrated improved prioritization and synthesis of patient-centered care. Staff nurses and unit educator feedback suggests a positive change in staff perception, behavior and provision of care.  RELEVANCE/OUTCOMES: Emerging healthcare trends suggest the need for integrated care models. Clinical models developed and discussed reinforce integration of psychiatric nursing concepts across setting and reinforce application of holistic care. IMPLICATIONS: The future of nursing depends on improved collaboration and respect between psychiatric and non-psychiatric nurses. The clinical model presented increases student competencies in holistic, person-centered nursing care that may contribute to improved patie



3045: Implementation of a Health and Hospital System Nurse-Driven Suicide Screening Protocol
Celeste Johnson, DNP, APRN, PMH CNS;Kimberly Roaten, PhD; Russell Genzel, BSN, RN; , ; ,

PURPOSE: To exceed best practice for suicide risk identification, the decision was made to implement a suicide screening procedure in the hospital system emergency departments, inpatient services, and outpatient clinics. SUMMARY OF EVIDENCE: Self-inflicted violence caused >41,000 fatalities and >494,000 non-fatal injuries in the United States in 2013. The Joint Commission NPSG state that patients being treated for behavioral health issues must be assessed for suicide risk. However, emerging data suggests that a portion of patients presenting with non-behavioral health issues also acknowledge risk factors such as suicidal ideation DESCRIPTION: Psychiatry leadership chose the Columbia-Suicide Severity Rating Scale (Screen version - Recent) as the instrument to implement in the hospital system. The education and implementation process proceeded in a phased rollout over six months. The project involved collaboration with key stakeholders including medical staff leadership, nursing leadership, psychiatry, education, and information technology. VALIDATION OF EVIDENCE: Outcomes include: number of patients identified as moderate or high risk for suicide; number of patients who would not have been identified prior to the protocol; impact on emergency detentions and 1:1 sitter use with the new protocol.  RELEVANCE/OUTCOMES: The screening tool is administered by non PMH RNs. Patients who would previously not have been identified at risk for suicide were referred to psychiatry for assessment, safety planning, and referrals. IMPLICATIONS: A nurse-driven suicide screening protocol was succesffuly implemented in a large, urban hospital with more than 240,000 total emergency room visits and over one million outpatient encounters per year. This initiative can be easily replicated in other hea



3046: PMH Nurses and the Evolving Behavioral Health Care Workforce: The Road to Directing our Future
Kathleen Delaney, PhD, PMHNP-BC; , ; , ; , ; ,

PURPOSE: Mental health service delivery is changing at a dizzying pace; careening us towards a system where a team of providers in a largely capitated system will partner with clients as they select (perhaps electronically) methods to best manage their mental health issues. Accelerating this transformation is integrated behavioral health care; workforce shortages that favor team-based care, expansion of Accountable Care Entities and state initiatives moving individuals with Medicaid into managed care insurance plans SUMMARY OF EVIDENCE: To assure that individuals have access to effective patient-centered, recovery oriented services will require PMH RNs and Advanced Practice Nurses (APNs) practice at the top of their scope of practice. Current data on PMH (RN and APN) practice and outcomes is spare and thus does not support expanded role. DESCRIPTION: Accomplishing this will require educators, practitioners and researchers coordinate efforts to clearly articulate the skill set of PMH nurses, to join the conversations on workforce via the use of data on PMH practice, and to strategically collect outcomes of PMH patient-centered practice. VALIDATION OF EVIDENCE: This presentation will review data on our current workforce numbers, both RN and APN, the major trends pushing change as well as the current PMH nursing response.  RELEVANCE/OUTCOMES: Necessary innovations in education and research will be presented; ones in line with the current goals of the national Graduate Nursing Education demonstration project and the demand for PMH nurses in evolving practice models. IMPLICATIONS: Such strategies will move PMH nursing toward a leadership role in the evolving behavioral health care field.



3047: The Making of a Therapist: How Are We teaching Psychotherapy in Graduate Psychiatric Nursing Curriculums?
Pamela Lusk, DNP, RN, PMHNP-BC, FAANP;Candice Knight, PhD, EdD, APN, PMHNP-BC, PMHNP-BC; Mary Moller, DNP, APRN, PMHCNS-BC,CPRP, FAAN; Rick Pessagno, DNP, PMHNP-BC; ,

PURPOSE: Psychotherapy is a foundation of advanced practice psychiatric nursing and referred to as ‘our fourth P’. Currently, the ANCC requires that PMHNP graduates have “clinical training in at least two psychotherapeutic treatment modalities” in order to meet eligibility requirements for certification as a PMHNP. This workshop will feature a panel of graduate faculty in PMHNP programs from different geographical areas of the country and with varying clinical resources discussing how they incorporate psychotherapy content and arrange for psychotherapy clinical experiences in their programs. SUMMARY OF EVIDENCE: Evidence will be reviewed that supports methods of teaching and providing clinical training. DESCRIPTION: Panelists will share how they have creatively leveraged the community psychiatric resources to provide quality clinical experiences for their graduate psychiatric nursing students. Examples include using the state hospital for individual and group psychotherapy experiences, utilizing psychotherapy training institutes for clinical hours, promoting students to choose their personal theoretical orientations of therapy that resonate with them, role play and patient simulation experiences, student psychotherapy presentations to classmates, preceptorships combining prescribing and psychotherapy experiences together in settings such as primary care settings, and utilizing a trauma focused model for psychotherapy with outpatient clients. VALIDATION OF EVIDENCE: Graduate Student outcomes and feedback will be shared.  RELEVANCE/OUTCOMES: This workshop will include time for questions, discussion and active interaction with workshop participants. IMPLICATIONS: Create a forum where individual, group and family psychotherapy PMHNP learning opportunities can be shared.



3051: APRN Council Interactive Session
Kathryn Johnson, PMHNP-BC; PMHCNS-BC;Sattaria Dilks, DNP; , ; , ; ,

PURPOSE: The purpose of this interactive panel discussion is to share the results of the APRN Steering Committee's efforts of the past year and to engage APNA's APRN community in a dialogue about issues of concern to their practice. SUMMARY OF EVIDENCE: N/A DESCRIPTION: N/A VALIDATION OF EVIDENCE: N/A  RELEVANCE/OUTCOMES: PMH APRNs are faced with many barriers to practice. Many APRNs live and work in restricted practice states that necessitate collaborative agreements with physicians in order to practice. There is a shortage of psychiatrists, and an even greater shortage of psychiatrists who are willing to act as APRN collaborators. Many APRNs may work in relative isolation from their colleagues. Insurance constraints often necessitate seeing clients for short time intervals. IMPLICATIONS: Information shared at the open discussion will serve to guide next steps for APRNs working toward barrier free, full practice that includes psychiatric evaluation, prescription of medications and psychotherapy.



3052: Integrating the Lived Experience of Recovery into Psychiatric Mental Health Nursing Graduate and Undergraduate Curriculum through Collaborative Partnerships and Reflective Learning
Kristen Lambert, PhD, RN;Susan Brammer, PhD, RN; Jennifer Barut, MSN, RN-BC; Genevieve Chandler, PhD, RN; ,

PURPOSE: To share best practices in nursing education utilizing lived experience scenarios and reflective practice to more fully integrate recovery principles into undergraduate and graduate education in preparation for entering practice. SUMMARY OF EVIDENCE: Preparing the nursing workforce to utilize and integrate the principles of recovery into care delivery models is a national mandate. This change in focus, attitude and care delivery must start at the undergraduate level through opportunities to interact and work with individuals with lived experience of recovery. DESCRIPTION: Recovery is a key aspect of mental health reform. PMH nursing education is also facing challenges in terms of faculty preparation and availability, curriculum selection and clinical opportunities. The Recovery Council has developed work groups to look at the needs of the nursing workforce with specific attention to current best practices utilizing recovery oriented, trauma informed care in nursing undergraduate and graduate education. VALIDATION OF EVIDENCE: Currently, the work groups are continuing to develop resources for PMH nurses and nurse educators to promote recovery oriented practices that are introduced at the undergraduate level, sustained in the practice arena and expanded at the graduate level.  RELEVANCE/OUTCOMES: The Recovery Council endeavors to provide resources to help the PMH nurse and nurse education promote a meaningful life for the person experiencing mental illness through educational practices that promote the collaboration of the experience of individuals living with mental illness. IMPLICATIONS: Recovery resources for educators will help to enhance practice, support research, and promote education of mental health professionals in support of persons with mental illnesses.



3053: Child and Adolescent Council Interactive Panel
Julie Carbray, PhD,FPMHNP, PMHCNS, APN-BC;Diane Wieland, PhD, CNE; , ; , ; ,

PURPOSE: Provide a forum to distribute information about council activities over the past year and to promote discussion of members. SUMMARY OF EVIDENCE: Council minutes and notes of meetings over the past year will be used to update members on council activities. Evidence based information on social media and technology and child and adolescent mental health nursing practice will also be presented to provoke discussion about how members manage/incorporate social media into their nursing practice. DESCRIPTION: n/a VALIDATION OF EVIDENCE: n/a  RELEVANCE/OUTCOMES: Members will understand the council activities and engage in workgroups to best collaborate with peers in changing and influencing practice, education, research in child and adolescent mentall health nursing. IMPLICATIONS: Plans for continued work of the council will also be solicited.



3054: Education Council Interactive Panel
Barbara Jones Warren, PhD, RN, CNS-BC, PMH, FAAN;Donna Rolin, PhD, APRN, PMHCNS-BC; , ; , ; ,

PURPOSE: The purpose of this session is to provide updated information regarding the role and context of work of the APNA Education Council for the 2015 year. In addition, Council members not only discuss the 2015 work but also develop future goals and objectives for the Graduate, Undergraduate and Continuing Education Council committees. SUMMARY OF EVIDENCE: The sharing of past APNA Education Council work has provided an opportunity for additional growth within the Council committees. Information is also shared between other APNA Councils and Institutes, as well as with APNA membership. DESCRIPTION: Updates will be provided on Education Council progress and projects, and interactive workgroups will establish ongoing priorities. VALIDATION OF EVIDENCE: See above.  RELEVANCE/OUTCOMES: The Education Council serves to enhance APNA's mission through a series of focused endeavors aimed at promoting educational initiatives within APNA. Graduate, Undergraduate, and Continuing Education levels of PMH Nursing Education are targeted. IMPLICATIONS: The Education Council promotes collaboration between other APNA Councils and Institutes and fosters educational initiatives for APNA members.



3055: Addictions and Tobacco Dependence Council Interactive Panel: Addressing Stigma & Treatment
Matthew Tierney, APRN;Carol Essenmacher, DNP, C-TTS; , ; , ; ,

PURPOSE: Addictive disorders are mental health disorders, and substance use can lead to mental health problems and addictive behaviors. The Addictions Council is APNA's expert resource in advancing excellence in the prevention and treatment of substance use and addictive disorders. This Interactive Panel will address issues of concern to the APNA membership that relate to substance use and addictive disorders. SUMMARY OF EVIDENCE: Nurses can and do make a positive impact on the treatment of substance use and addictive disorders, but the profession still has much to accomplish. Areas of concern to the APNA membership have been identified, and include: the experience of stigma in addressing addictive disorders; inability to exercise full nursing scopes of practice in addressing addictive disorders; underutilization of medication-assisted treatments for substance use, including tobacco, opioids, alcohol and others. DESCRIPTION: The shared expertise of APNA members, including APNA's Addicitons Council steering committee, can identify key issues and begin to implement improvements in addressing substance use and addictive disorders. VALIDATION OF EVIDENCE: Effective treatments are evidenced by patient, family and community wellness.  RELEVANCE/OUTCOMES: Psychiatric nurses are in a unique and favorable position to improve understanding of and effective treatment for substance use and addictive disorders. IMPLICATIONS: With the appropriate engagement of psychiatric nurses and key stakeholders, it is possible to envision a future where substance use and addictive disorders are understood as medical and psychiatric illnesses,and where where providers, patients and communi




The American Psychiatric Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.