Friday Abstracts: Block One

3011.1: The Aftermath of Workplace Violence:  The Lived Experience Phenomena of Assault Against Nurses
Kathleen Clark, PhD RN PMHCNS-BC

PROBLEM STATEMENT: Nurses, among all healthcare professionals, are assaulted by patients most frequently.  A gap in the research examining immediate post-assault needs for registered nurses exists as little is known regarding what factors support positive psychological outcomes for the nurses who are the victims of a physical attack by a patient. The purpose of this qualitative study was to gather an in-depth understanding of the “lived” experience of registered nurses who returned to high-risk hospital work settings after being assaulted by a patient and provide a voice into the phenomena. THEORETICAL FRAMEWORK: The conceptual framework of resiliency was applied identifying coping mechanisms described by interviewees who demonstrated an ability to positively overcome the psychological impact of being assaulted. METHODS & DESIGN: A phenomenological approach was utilized to provide in-depth insight into the lived experiences of registered nurses. Through 1:1 recorded sessions, nurses who suffered an assault were interviewed using a standard set of open-ended questions with a resiliency focus. RESULTS: Discussion yielded fourteen themes, categorized into three domains: Peer-to-peer culture, awareness an environment IMPLICATIONS FOR PRACTICE: All identified themes highlighted the need for comprehensive measures of support for nurses that experience physical violence from a patient in the workplace. IMPLICATIONS FOR FUTURE RESEARCH: This study provides a foundation for future work examining different modalities of intervention to prevent lasting negative psychological effects post-assault.


3011.2: Preventing Workplace Violence:  Know your Patients and Yourself
Gail Bromley, PhD, RN;  Rose Anne Berila, RN, MSN, CNS

PURPOSE: Early identification and prevention of aggression among patients is a critical issue for nursing staff to promote a safe work environment. A pilot project was implemented involving nurses from two medical surgical units and the emergency department at an academic medical center who collaborated with psychiatric nurses to develop effective clinical interventions when working with patients whose behavioral symptoms posed risks for violence. SUMMARY OF EVIDENCE: Focus groups with the nurses, led by psychiatric nurses, identified the need for education about best practices for clinical interventions and more effective assessment of this patient population. DESCRIPTION: Used successfully with patients on the inpatient psychiatric units, the Broset Violence Checklist (BVC) was identified for use to assist nurses in identifying potentially violent patients. Staff nurses involved in the pilot project participated in educational sessions to practice the use of this tool to identify and discuss how best to preempt violent patient episodes. VALIDATION OF EVIDENCE: BVC data was compiled and analyzed regarding the use of the tool and the incidence of reported/documented violent patient episodes. During the pilot project, there was evidence of a decrease in the incidence of physical aggression. RELEVANCE/OUTCOMES: The pilot project included ongoing discussions with the medical surgical and emergency department nurses regarding their perceptions of the usefulness of this tool. IMPLICATIONS: There was evidence that nurses, once they assessed the patient for being at risk for violence, used the techniques to clinically intervene with these patients and prevent an episode of violence in the emergency department and on the medical surgical units.


3012.1: Suicide Awareness and Prevention for College Students:  Incorporating Campus-Based and Social Media Interventions for a Multidimensional Approach
Jessica Wheeler, MSN, RN, PMHCNS-BC;  Kerstin Gillespie, BSN, RN; Sylvia May, BSN, RN; Molly Glockling, BSN, RN; Anna Kennedy, BSN, RN

PURPOSE: The CDC identifies suicide as a significant public health concern.  It is the second leading cause of death for individuals 17 to 25.  College students have higher risk compared to same age peers due to life changes, increased independence and academic and social pressure.  Campuses normally have help services in place, but they need to be actively sought.   Recommendations for increasing awareness of suicide risk on campuses utilizing awareness campaigns, including social media tools, and student and faculty education will be presented. SUMMARY OF EVIDENCE: Evidence shows access to services, increased awareness, and social support increase help-seeking and reduce suicide and self-harm. Multidimensional awareness and education campaigns that utilize social media and campus outreach programs are well suited for reaching the target population.  Careful development and testing with target audiences ensures campaigns have the desired effect, limiting adverse outcomes. DESCRIPTION: Campuses can develop broad approaches to suicide awareness and prevention by integrating social media and campus-based education and outreach programs. VALIDATION OF EVIDENCE: A sample social media video on suicide awareness will be available to view along with handouts presenting options for student and staff education. RELEVANCE/OUTCOMES: Psychiatric nurses have the expertise to develop and implement awareness campaigns and media tools, provide staff and student education and increase services provided in student health and counseling centers. IMPLICATIONS: The growth of technology and social media can increases awareness and encourage help-seeking behavior.  Wise use of this technology integrated into outreach programs can decrease stigma and increase help-seeking behaviors.


3012.2: Developing and Implementing a Community Based Child Behavioral Health Collaborative
Genevieve Chandler, PhD, RN;  Maud Low, RNC MSN CLNC

PURPOSE: As nursing students navigate academic and clinical challenges, they report being overwhelmed with expectations and feelings of being different from and having little to offer mental health patients. Using the ABCS of resilience: Active coping, Building strength, Cognitive awareness and Social support, (Chandler, Roberts, & Chido, 2015) students learn self-care skills and share this knowledge with their patients. Positive practices increase self care and diminish perceived differences between caregiver and care receiver. SUMMARY OF EVIDENCE: The brain and body are designed for defending and protecting against stress, making the development of new positive habits challenging.  Supporting students throughout a semester they incorporate positive practices (Hanson, 2011) into their hectic lives and neuropathways are laid for self-care and tools are developed to collaborate with patients. DESCRIPTION: Students integrate one exercise weekly into their daily lives, (Cognitive awareness) and journal about the experience (Active coping, Building strength).  Faculty provide coaching and feedback (Social support) on each submission an student choose to share a journal entry with peers. At mid-semester, students are challenged to use their own positive practice experiences to teach their patients. VALIDATION OF EVIDENCE: Students written reports describe overwhelmingly positive experiences for themselves and their patients citing that their own resilience is further enhanced through the experience of collaborating with patients. RELEVANCE/OUTCOMES: Students are empowered by fostering their own resilience through this mindfulness practice. Patients respond well to student’s ability to share positive practices and sense of shared humanity. IMPLICATIONS: Integration of experiential learning provides a lived experience for nursing students while bridging the gap between patient and nurse.


3013.1: Effectiveness of Resourcefulness Training for Women Dementia Caregivers
Jaclene Zauszniewski, PhD, RN-BC, FAAN; Diana Morris, PhD, RN, FAAN, FGSA; Christopher Burant, PhD, FGSA; Nirmala Lekhak, BSN

PROBLEM STATEMENT: Nearly 10 million women in the U.S. are caregivers for an elder with dementia, which often produces overwhelming stress and adversely affects their health.  Resourcefulness training (RT) may promote the caregiver’s optimal health and continue in their caregiving role. This pilot trial of 138 women dementia caregivers examined the effectiveness of RT on perceived stress, depressive cognitions, and negative emotions over time. THEORETICAL FRAMEWORK: Resourcefulness theory defined the expected outcomes of RT and when their effects would likely occur post-RT. METHODS & DESIGN: Caregivers were first randomized to RT or no-RT; within those groups, they were further randomized to journaling, recording, or a choice between journaling and recording for practicing RT skills, thus creating eight groups. We examined differences on stress, depressive cognitions, and negative emotions between groups: 1) RT versus no-RT, 2) choice versus random condition; and 3) journaling versus recording. RESULTS: Significant time by group interactions were found on stress (F=5.78, p<.05), depressive cognitions (F=13.53, p<.001), and negative emotions (F=27.51, p<.01) in the RT versus no RT group. Average effect sizes on the three outcomes were larger for the choice (D=.66) versus random (D=.48) condition and for journaling (D=.63) versus recording (D=.53) method. IMPLICATIONS FOR PRACTICE: The findings provide evidence for the importance of providing choices to dementia caregivers when implementing interventions in practice. IMPLICATIONS FOR FUTURE RESEARCH: The results provide evidence for the effectiveness of RT for decreasing stress, depressive cognitions, and negative emotions in women dementia caregivers with better effects when they choose a method for practicing the skills and superior effects for journaling over digital voice recording.


3013.2: Effectiveness of a HeartMath® Intervention with Parents or Guardians of Children in Head Start
Beth King, PhD, RN, PMHCNS-BC; Karethy Edwards, DrPH, APRN, FNP-BC

PROBLEM STATEMENT: On almost every indicator of health, persons with low incomes suffer from the effects of physical and emotional stress. The purpose of this pilot study was to examine the effectiveness of the HeartMath® Self-Regulation Program Intervention (HSPI) with parents or guardians of children in Head Start. The objectives were to increase resiliency, decrease symptoms of anxiety, fatigue, and depressive symptomatology and increase heart rate variability (HRV) and coherence among parents of children enrolled in a Head Start program. THEORETICAL FRAMEWORK: Bandura’s Social Cognitive Theory (1990) focuses on self- monitoring of behavior, effects and response and Grey’s Self-Management Revised Framework (2015) centers on identification of facilitators and barriers to self-management, processes impacting self-management, and outcomes of self-management. METHODS & DESIGN: The study design was a randomized control trial (RCT) pilot study using a between groups pre-test, post-test design to compare the resiliency, anxiety, fatigue and depression scores, and HRV of the HSPI group to the control group. Data analysis consisted of descriptive statistics and repeated measures analysis of variance (ANOVA). RESULTS: The study is ongoing and data analysis will be completed summer, 2016. Measurements include PROMIS anxiety, fatigue and depression, Connor-Davidson resilience scale, and HRV. IMPLICATIONS FOR PRACTICE: HSPI is a low cost approach to self-management of stress, fatigue and depressive symptomatology for persons with low income. IMPLICATIONS FOR FUTURE RESEARCH: The findings from this research will guide the development of further research with various populations and mental health disorders to validate HSPI as an evidence based practice in psychiatric mental health nursing.


3014.1: Addressing Employee Engagement in Health Care:  Strategies to Improve the Experience of Providing Care
Kenneth Longbrake, RN, BSN; Lisa C. Farmer, BSN, RN-BC, LMSW

PURPOSE: Purpose was to improve work engagement, resource availability, and leadership communication in a psychiatric unit by timely implementation of quarterly nurse manager action plans customized from quarterly satisfaction surveys. SUMMARY OF EVIDENCE: Researchers reported unique challenges of psychosocial work environments in inpatient psychiatric units such as workload, under-resourcing, and lack of role clarity.1,2  These challenges lead to nurse burnout, affect work engagement, and impact therapeutic relationships with patients.2,3 DESCRIPTION: Managers developed an employee satisfaction survey specific for a psychiatric unit. Survey included 5 Likert-style items and 4 open-ended questions. Surveys were administered quarterly and managers reviewed results; item-specific action plans were developed. Huddles were instituted to increase communication. Staff-generated supply lists were created. Workgroups were formed to improve shared decision-making. Manager rounding provided encouragement/coaching to staff. VALIDATION OF EVIDENCE: Effectiveness was measured by quarterly percentages of survey completion, attendance at monthly unit meetings, and percentage of “Strongly Agree” or Very Satisfied” responses. RELEVANCE/OUTCOMES: There have been: (1) increased completion on quarterly surveys: from 37% to 57%, (2) increased attendance at staff meetings, (3)  increased staff feedback, (4) improved “Strongly Agree” responses on access to tools/resources—72% to 86%, (5) improved “Very Satisfied” responses to staff involvement—45% to 100%, (6) improved “Very Satisfied” responses for receipt of information—70% to 92%, (7) improved “Strongly Agree” responses to being valued—78% to 100%, and (8) improved “Very Satisfied” responses  on overall job satisfaction—70% to 92%. IMPLICATIONS: Ongoing quarterly staff satisfaction surveys with action plans provided managers with information to ensure issues were addressed timely with improved employee engagement scores.


3014.2: Inspired to Get Certified:  Validation of Expertise for Psychiatric Mental Health Nurses
Kelly Bryant, MS, BSN, RN-BC, NEA-BC, CNE;  Jeanette Rossetti, EdD, MS, RN; Patricia Jones-Bendel, MSN, RN

PURPOSE: Organizations pursuing Magnet designation must establish plans to increase the number of certified nurses as an empirical outcome of structural empowerment .  Embracing certification as a strategic goal to acknowledge specialty expertise in psychiatric nurses is a hallmark of nursing excellence. SUMMARY OF EVIDENCE: Nurses are vital to redesigning health care in the United States. As healthcare complexity increases, higher levels of education and training are required to assure provision of high standards of safe, effective, quality care for patients. DESCRIPTION: A plan was developed to increase the number of specialty certified nurses.  Elements of the plan included removal of barriers preventing nurses from seeking certification.  Onsite certification review courses, cohort study groups, and enrollment in the  ANCC "Success Pays" program were strategies utilized. VALIDATION OF EVIDENCE: Continuous professional development through certification is evidenced in outcomes.  In 2014, 17% of the nurses were certified (26). Following program implementation in 2015, 35% of the nurses were certified (56). To date in 2016, 38% are certified nurses (61) with additional nurses scheduled to test. RELEVANCE/OUTCOMES: Implementing a structured plan to validate specialty expertise through attainment of certification allowed us to more than double our number of certified nurses in 14 months.  Nurse empowerment, role actualization, validation of expertise, enhanced patient safety, and a professional commitment to learning were affirmed through certification attainment. IMPLICATIONS: Transforming psychiatric nursing practice and leading healthcare initiatives in behavioral health care are key imperatives for nurses.   Certification exemplifies a commitment to nursing excellence and better patient outcomes through the attainment of the specialty credentials.


3015.1: Psychiatric Nurses and Sexual Assault Nurse Examiners Partner to Support Victims of Sexual Assault with Mental Illness
Leslie Miles, DNP, APRN- BC;  Linda Mabey, DNP, APRN-BC; Julie Valentine, PhD(c), CNE, SANE-A

PURPOSE: This presentation reports on an inter-professional collaboration between psychiatric mental Health (PMH) nurses and sexual assault nurse examiners (SANEs) in sexual assault cases. It inspires nurses to partner within the profession of nursing and with other community partners to address the needs of sexual assault victims with mental illness (MI). SUMMARY OF EVIDENCE: Recent research indicates that sexual assault is widespread in the MI population and is a risk factor for exacerbation of mental and physical health problems. SANE and PMH have not previously partnered to address sexual assault in those with MI. DESCRIPTION: Meetings between PMH and SANE nurses created common purpose and pressure to instigate reforms in the treatment sexual assault victims with MI. Stakeholders included victims with MI, law enforcement, and mental and physical health providers. Outcomes included statewide educational outreach to SANE’s, mental health providers, and law enforcement. VALIDATION OF EVIDENCE: Law enforcement interviewing practices changed after education on sexual assault’s impact on consciousness and memory. SANE nurses have a better understanding of how to interview a victim with MI. Mental health providers’ feedback indicated improved understanding of evidence based practices for victims of sexual assault with mental illness. RELEVANCE/OUTCOMES: Law enforcement interviewing practices changed after education on sexual assault’s impact on consciousness and memory. SANE nurses have a better understanding of how to interview a victim with MI. Mental health providers’ feedback indicated improved understanding of evidence based practices for victims of sexual assault with mental illness. IMPLICATIONS: PMH nurses should collaborate to improve systems affecting the well-being of those with mental illness.


3015.2: Reducing Pediatric Psychiatric Hospital Re-admissions through the Innovative use of a Nurse Case Manager for Post Discharge Follow-up
Helen Ramsbottom, BSN, RN, LCSW;  Lisa Farmer, BSN, RN-BC, LMSW

PURPOSE: Readmissions are traumatic and costly. Furthermore, with the APR-DRG introduction to pediatric hospitals, additional limitations to reimbursement are anticipated. Therefore, readmission reduction is highly beneficial for multiple reasons. SUMMARY OF EVIDENCE: Our general pediatric hospital’s readmission data indicated that a primary diagnosis of Mood Disorder, NOS was the 3rd most common readmission diagnosis. The Psychiatry RN Case Manager role was created in July, 2014 to identify readmission risk, decrease psychiatric readmissions, and improve patient outcomes. DESCRIPTION: Although discharge planning is common practice during hospitalization, post-discharge case management is an innovative and uncommon intervention in psychiatry.  The post-discharge calls assisted families with their connection to community providers and assured that they are administering medications as prescribed. VALIDATION OF EVIDENCE: After a review of literature regarding contributing factors of pediatric psychiatric readmissions, a Readmit Predictor Tool and Protocol were created for the electronic medical record.  A database was developed to evaluate readmissions prior and subsequent to the implementation of this position. This data allowed the case manager to evaluate common factors of readmission. RELEVANCE/OUTCOMES: Findings have shown a decrease in 30 day readmission rates of 29%. When comparing the cost of the Nurse Case Management program to the potential loss of revenue due to non-reimbursed re-admissions (if federal penalties were applied), our hospital potentially saved $218,470 for the first year. Moreover, staff job satisfaction increased 15% since the addition of this position. IMPLICATIONS: We believe that other hospitals would benefit from the use of a RN Case Manager for post discharge follow-up to improve quality care and financial reimbursement.


3016.1: Improving Knowledge Through an Educational Program on an Integrated Care Pathway for Self-Injurious Behavior (SIB) and Intellectual and Developmental Disability (IDD)
Regina Green, DNP, PMHCNS-BC

PURPOSE: Addressed how an evidence-based integrated care pathway can increase the level of knowledge for treatment team members in their assessment and treatment of individuals with intellectual and developmental disability (IDD) that engage in frequent self-injurious behavior (SIB). SUMMARY OF EVIDENCE: To date, there is a lack of standardized treatment for individuals with self-injurious behavior (SIB) and intellectual and developmental disability (IDD). DESCRIPTION: Current practices include medication management, utilization of Functional Behavioral Analysis, and behavioral modification. Strategies for implementation include sharing SIB pathway with colleagues, and  SIB Pathway copyright currently in progess;  Stakeholders include individuals with IDD, Psychiatric and IDD nurses, team members, families, and psychiatric and brain injury communities. VALIDATION OF EVIDENCE: After a search was conducted utilizing several databases, a synthesis of the literature was undertaken and yielded that the literature supports the use of an integrated care pathway to manage and standardize care for SIB. Pre / post-test mixed group design, &  Wilcoxon test  and Correlational data analysis were utilized to measure outcomes. RELEVANCE/OUTCOMES: ?Decreased Clinical variation for individuals engaging in SIB, ?Improved clinical outcomes,  ?Standardization of care,  ?Improved patient experience,  ?Foster multi-disciplinary collaboration, and ?Increased evidence-based practices for PMH and DD nurses. Education was effective and an increased level of confidence.  P values were 0.001 indicating findings were highly statistically significant. IMPLICATIONS: Implementing an evidence-based standardized assessment tool will serve to decrease clinical variation, standardize care, and improve outcomes for individuals who engage in frequent SIB.


3016.2: Lethal Pleasures:  Preventing Injury from Autoerotic Asphyxiation and Self-Strangulation Games
Maureen Donohue-Smith, Ph.D., MSN, RN, PMHNP-BC

PURPOSE: Fatalities from the “choking game” and autoerotic asphyxiation may be rare; however, non-suicidal self-strangulation activities result in needless deaths and neurological impairment.  This presentation provides assessment guidelines to facilitate accurate identification and appropriate intervention for self-strangulation behaviors. SUMMARY OF EVIDENCE: Accurate estimates non-suicidal self-strangulation incidents are difficult to obtain. Cases are frequently under-reported and physical indicators are often misinterpreted in primary care settings. The CDC suggests as many as one-third of hanging deaths may actually result from autoerotic asphyxiation or a “get high” game. DESCRIPTION: Psychiatric nurses raise awareness among primary care practitioners of the "red flags" and risks of these activities. The PMHNP differentiates those strangulation activities engaged in to get “high” or to enhance sexual pleasure from suicide attempts, thus assuring the appropriate intervention is recommended. VALIDATION OF EVIDENCE: Research indicates most adolescents know about the “choking game" and 6.6% participate.  Alarmingly, 40% of participants believe it poses no danger.  Even when death is not the outcome, seizures and visual or diffuse neurological deficits may result from repeated episodes of anoxia. RELEVANCE/OUTCOMES: Self-strangulation activities may express a range of emotional distress and are frequently associated with other psychiatric comorbidities. The therapeutic relationship established by the psychiatric nurse provides a climate of psychological safety in which to conduct a thorough assessment, identifying co-existing concerns and recommend or provide appropriate treatment options. IMPLICATIONS: Education of health professionals, mental health providers, primary care providers, educators, parents and the public at large may facilitate accurate estimation of the incidence and prevalence of this activity and prevent unnecessary deaths and disability.


3017.1: Fostering Perinatal Integration Through Educational Collaboration
Kimberly Olson, MSN, RN-BC;  Mary G Mendes de Leon, MA, RN-BC

PURPOSE: Behavioral health nurses must be knowledgeable about perinatal health issues to provide safe and effective care. An interprofessional team developed an educational program to address their learning needs. SUMMARY OF EVIDENCE: Screening of perinatal patients for depression has lead to increased admissions for this patient population. These patients have unique care needs which requires knowledge/skills beyond the typical realm for psychiatric nurses. DESCRIPTION: An inter-professional partnership was created to develop an educational strategy to address this knowledge deficit using subject-matter experts, including clinical educators, staff nurses,  physicians, and a clinical counselor.  Educational sessions were offered on the topics of nursing care, psychopharmacology, and perinatal mood and anxiety disorders. Continuing education credit was offered. VALIDATION OF EVIDENCE: Knowledge validation was evidenced by pre/post-test completion. Program evaluations have indicated high levels of participant engagement and satisfaction. RELEVANCE/OUTCOMES: Clinical staff have obtained requisite knowledge and skill to care for patients across the perinatal continuum. Improved patient outcomes are anticipated for pregnant and postpartum patients. IMPLICATIONS: Psychiatric nurses will continue to be challenged to expand their knowledge base as behavioral health service provision expands.The success of an integrated professional collaboration can be applied with other healthcare services across the continuum of care.


3017.2: Development of the Integrated Care Competency Assessment Tool

PURPOSE: The purpose of the presentation is to review a newly developed Integrated Care Competency Assessment Tool (ICCAT) that will evaluate healthcare clinicians' or healthcare students' skills and competencies in delivering integrated mental health and primary care services. SUMMARY OF EVIDENCE: Approximately one in four adults experience some form of mental illness in a given year, with many receiving assistance from their primary care provider. Experts have called for the development of more efficient and sustainable integrated care models, but no tools exist for measuring clinicians' skills in delivering integrated care. DESCRIPTION: Items for the ICCAT were derived from the current literature on integrated care, and specifically from the nine categories of Core Competencies for Integrated Behavioral Health and Primary Care that were identified by the SAMHSA-HRSA Center for Integrated Health Solutions. A panel of 12 clinical experts in the field of integrated mental health and primary care were asked to rate each item from the ICCAT on its' relevancy and clarity using a 4-point rating scale. VALIDATION OF EVIDENCE: A multi-stage classic Delphi technique was employed in order to reach consensus on each proposed item as well as on new items to be included in the tool or areas to be addressed. Content validity was considered to be reached when 80% (or more) of the expert panel members expressed agreement with the items included on the tool. RELEVANCE/OUTCOMES: The ICCAT is useful in measuring outcomes of efforts to design and implement integrated care models. IMPLICATIONS: Nursing practice and education can be improved through use of the ICCAT.


3021: Mobile Psychiatric Team in an Urban Emergency
Celeste Johnson, DNP, APRN, PMH CNS

PURPOSE Patients with mental illness often present to the emergency department with needs varying from inpatient admission to medication refills. SUMMARY OF EVIDENCE Patients who present to our emergency room for a mental illness complaint, often waited seven hours or more for a psych evaluation. These patients often experienced increased episodes of agitation. Long waits lead to decrease patient satisfaction (Innes et al.,2014). DESCRIPTION We created a multidisciplinary triage team composed of a physician, nurse practitioner, registered nurse and a social worker. Emergency Room Staff “level” patients by classifying them as stat, urgent and routine.The multidisciplinary team will be dispersed based on the patient’s clinical urgency. VALIDATION OF EVIDENCE The goal of the triage team is to decrease the amount of time patients with mental illness wait for their psych needs to be addressed. Goals are: stat < 30min, urgent 1 hour, and routine 4 hours. RELEVANCE/OUTCOMES Researchers have found that ED overcrowding leads to increased morbidity and mortality (Collis, 2010). Studies have proved the presence of multidisciplinary mental health team members in the emergency room, positively impacts patient care (Innes et al., 2014). Emergency department staff identified improved care for patients and staff satisfaction when a multidisciplinary approach was initiated …” (Innes et al., 2014, p.2008). IMPLICATIONS So far we have a decreased in our overall length of stay for patients with mental illness. We will have more specific data to present by October. The new triage process was implemented Jan 25, 2016.


3022: Assessing Metabolic Syndrome in Individuals with Serious Mental Health Disorders as a Student Nurse Service Learning
Suzanne Prestoy, PhD, MSN, RN-BC

PURPOSE: Vulnerable populations experiencing serious mental health disorders need effective evidenced based, cost effective interventions to address their holistic health care needs. Nurses are  front line in health care delivery. Incorporating holistic health practices are essential in the care of individuals with psychiatric disorders. Assessing Metabolic Syndrome in individuals suffering from serious mental health disorders is often an unmet need. SUMMARY OF EVIDENCE: Life style, negative symptoms associated with chronic mental diseases and medications prescribed to treat these disorders can result in this population being particularly hard hit by metabolic disease and reducing life expectancy. DESCRIPTION: Gaining popularity, service learning provides nursing students with hands on learning experience and education about a particular health care need. Addressing population health care concerns in service learning initiatives can have benefits for both the student nurse and the population with serious mental health disorders. VALIDATION OF EVIDENCE: This service was provided during a Mental Health Conference, Harvest Full of Hope, designed for consumers and providers of mental health services, was free of charge, and well received by conference attendees. Students evaluated this as an excellent learning opportunity and increased their understanding of this population’s complex health care needs. RELEVANCE/OUTCOMES: This Service learning was an excellent means of delivering basic, essential screening to individuals who have experienced mental health disorders. IMPLICATIONS: Future research is needed to determine the frequency and effectiveness in which holistic health teaching, including metabolic syndrome screening is provided to clients and how nursing education teaches students to address complex health needs and holistic client education.


3023: Assessing Clinical Outcomes in a Community Based Outpatient Child and Adolescent Mental Health Services (CAMHS)
Geraldine Pearson, PHD, PMH-CNS, FAAN

PURPOSE: To describe developing a database, assessing treatment progress, using data to inform clinic care. SUMMARY OF EVIDENCE: 1)  To determine if it is feasible to develop a systematic measurement-based and client specific outcomes monitoring methodology under resource-limited treatment as usual clinic conditions.  2)  To assess outcomes from a psychotherapeutically sensitive, evidence-based, and measurement-based clinical disease management standard of care DESCRIPTION: In effective care parents and children stay with the treatment interventions.  This research looked specifically at responder status versus non-responder status. Responder status was associated with the number of appointments in the clinic.  Responding to treatment was greater for every subsequent appointment.  The practice changes  involve increased training around engagement strategies, improving clarity of realistic treatment expectations. VALIDATION OF EVIDENCE: The longer individuals remain in treatment and successfully complete it, the better the clinical outcome.  There is very little literature measuring symptom improvement and severity IN EVERY SESSION held with the child or adolescent.  This data, derived from the CGI (Clinical Global Impressions), CGS (Clinical Global Severity), and CGAS (clinician rated in first and last session), comprised the dataset from which this study is drawn. RELEVANCE/OUTCOMES: Advanced Practice Nurses evaluate and treat patients in this interdisciplinary clinic.  Outcomes include more identification of patient populations at risk for prematurely ending treatment, more attention to engagement strategies from first phone call to intake and beyond, and improvement in symptom severity. IMPLICATIONS: Implications include: Emphasizing continuous quality improvement Viewing care as beginning with the first phone call Aiming all clinical activities at client engagement 5) Educating trainees about measuring progress in treatment


3024: Understanding the Legal and Regulatory Ramifications related to Psychiatric Nursing Scope of Practice
Gina Reiners, PhD, APRN, PMHNP, PMHCNS

PURPOSE: To educate Psychiatric nurses about the role of the Board of Nurse Examiners and malpractice related to their practice. SUMMARY OF EVIDENCE: There is evidence that nurses are not cognizant of legal and regulatory implications of their practice. DESCRIPTION: Nurses practicing in psychiatry should know their Nurse Practice Acts and guidelines of psychiatric nursing. Based on this presenter's membership on a Board of Nursing and connection with the National Council of State  Boards of Nursing, including legal consultation through expert testimony at two trial legal firms in the State of CT, it is critical that nurses are educated about the ramifications of their practice. VALIDATION OF EVIDENCE: The evidence of not implementing adopted practice guidelines is validated  through the National Council of State Boards of Nursing. RELEVANCE/OUTCOMES: PMHNPs and PMHCNSs ( APNs) and RNs are treating complicated high risk patients. It is critical they are cognizant of their scopes of practice and adopted treatment guidelines. Violations  may include discipline including revocation. This provider has in concert with the other Board members disciplined RNs and APNs , who have not executed treatment guidelines that ensure safety for their patients. This provider has testified in depositions and in court rooms related to the lack of or implementation of customary psychiatric clinical guidelines espoused by regulatory agencies. IMPLICATIONS: As more nurses enter  psychiatric nursing and decide to become PMHNPs and PMHCNSs (APNs), either practicing in collaboration or independently , it is imperative that they are educated about the role of the Board related to discipline and potential legal implications related to malpractice.


3025: The Unique Needs Initiative:  A Collaborative Approach to Meeting the Needs of Individuals with Developmental Disability, Non-suicidal Self Injury, and Impulsive Violence in an Unionized Psychiatric Hospital
Richard Johnson, MHA RN;  Kevin Ritchie, BSN RN; Bethany Williamson, BA RN; Jason Drapeau, BS RN; Hannah Roosa, BS RN

PURPOSE: The Unique Needs Initiative was developed to address the inpatient psychiatric needs individuals with developmental disability (IDD), NSSI, and aggression. SUMMARY OF EVIDENCE: An increase in admissions of individuals with developmental disabilities, NSSI and impulsive violence resulted in increasing seclusion/restraint, injuries, and lengths of stay.  In response, staff and leadership identified the need for a change in practice.  Evidence has shown multilevel and targeted interventions to address staff’s ability to manage aggression reduces aggressive behavior overall in patients (Hensel, Lunsky, & Dewa , 2013). DESCRIPTION: Implementation occurred with a re-education of nurses and mental health workers and a three-month trial period of new multi-tract programming. Education focused on clinical diagnoses, milieu management, therapeutic relationships, communication, documentation and group skills. The multi-tract programming allowed staff to use the education to provide de-escalation focused activities. A questionnaire developed for community caregivers that ensured critical information regarding routines and triggers were obtained upon admission. VALIDATION OF EVIDENCE: Outcomes were measured by evaluating changes in patient satisfaction survey scores, staff satisfaction surveys, and rates of seclusion, restraint and staff injury.  Effectiveness was determined by comparing the three-month trial period to both the prior three-months and the period one-year prior. RELEVANCE/OUTCOMES: Decreases in staff injuries and seclusion/restraint rates were realized during the trial.   Patient satisfaction increased, particular in the areas of nursing care, program activities and likelihood to recommend.  Staff satisfaction scores increased with the indication staff felt interactions with patients were more therapeutic. IMPLICATIONS: The Unique Needs initiative provides a model for education, milieu management and individualized patient care that can be replicated.


3026: Inter-professional Collaboration to Promote LGBTQ Mental Health Care to Reduce Healthcare Disparities:  Are Nursing Students Educated to Provide Sensitive Quality Care to Improve Health Care Outcomes of LGBTQ Individuals?
Tatayana Maltseva, MSN, ARNP, PMHNP-BC;  Deborah Salani, DNP, PMHNP-BC, ARNP, BC-NE

PURPOSE: The purpose is to incorporate Lesbian, Gay, Bisexual, and Transgender (LGBT) health content into the undergraduate and graduate nursing curricula to better prepare students to provide sensitive quality care and to improve health care outcomes. SUMMARY OF EVIDENCE: LGBT individuals experience poorer health outcomes (Global and serious mental health disparities and treatment inequities (Bidell, 2013). There is a lack of educational opportunities in nursing Baccalaureate and Master's program; limited knowledge about community resources with regards to LGBT sensitive mental health services. DESCRIPTION: Currently in two different universities in South Florida the LGBT mental health care concerns are not adequately addressed in curricular. Few nursing education program address cultural care of LGBT population. This collaborative partnership developed and integrated sexual minority healthcare issues including mental health to improve clinical skills, cultural competency in working with LGBT clients.  Many LGBT individuals do not trust health care professionals; therefore, they may not seek help when necessary. This population often suffers from psychiatric disorders including substance abuse, self-harm, and suicidal ideations ( Wight, Leblanc, Vries, & Detels, 2012). VALIDATION OF EVIDENCE: Few opportunities exist for nursing students and nurses to obtain education and gain comfort, expertise in providing medical and psychiatric care to LGBT individuals. RELEVANCE/OUTCOMES: Incorporation of LGBT psychiatric health content into the nursing curricula in two universities may contribute to a reduction of healthcare disparities to LGBT population. IMPLICATIONS: Nurses play a pivotal role in reducing health care disparities and unequal treatment to LGBT individuals. Educating nurses about LGBT mental health issues may improve access and health care outcomes.


3027: A User's Guide to Integrating Mindfulness in Undergraduate Nursing Education
Bethany Tollefson, MSN, RN;  Lindsay Anderson, MS, PMHCNS-BC

PURPOSE: This presentation demonstrates how engaging nursing students in self-care practices, including mindfulness, impacted their perceived stress.  The audience will receive strategies for integrating mindfulness into undergraduate nursing curriculum. SUMMARY OF EVIDENCE: Mental health concerns are increasing among college students.  Nursing students, who report higher levels of perceived stress compared to their peers, are at greater risk of psychological distress.  Self-care, including mindfulness, has been shown to reduce stress, burnout, and emotional fatigue.   Integrating mindfulness among nursing students may decrease their risk of mental health concerns while improving academic performance, role satisfaction, and self-regulation skills. DESCRIPTION: Self-care, including mindfulness, was intentionally integrated into learning objectives for an initial clinical course.  Course orientation included a description of self-care and mindfulness.  Students participated in six, 15-minute classroom-based mindfulness activities that included yoga, walking meditation, body scan, and sitting meditation during the semester.  Additionally, students completed a series of journal entries that reflected on self-directed mindfulness activities. VALIDATION OF EVIDENCE: Quantitative and qualitative data were assessed to evaluate the effects of the implementation of mindfulness into nursing education.  Data sources included: journals, a course exit survey, and the Perceived Stress Scale 10. RELEVANCE/OUTCOMES: Nursing is a high stress profession with student nurses feeling higher levels of perceived stress than their peers.  Improved self-care is related to decreased stress, improved role satisfaction, less burnout, thus, may positively impact nurse retention. IMPLICATIONS: Ongoing curricular revision to increase integration of mindfulness into nursing education.   Plan for more sophisticated evaluation of effect of mindfulness on nursing student learning outcomes, NCLEX pass rates, role satisfaction, and perceived stress.


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