Friday, October 24 - APNA 28th Annual Conference Abstracts

3031: Novel Education Strategies in Psychiatric Nursing Education: Video Vignettes
Todd Hastings, MS, RN, PhD(c)

PURPOSE: Conscientious nurse educators strive to engage students with strategies to facilitate learning beyond the typical classroom lecture (Bradshaw & Lowenstein, 2011). Practical innovations support effective teaching practice enhancing student learning (Bradshaw, 2011; Braungart & Braungart, 2008). SUMMARY OF EVIDENCE: Innovative teaching strategies which promote critical thinking include case studies, simulation, role play, and use of media in classroom settings (Bradshaw & Lowenstein, 2011; Fitzgerald, 2008; Rowles & Brigham, 2005). PMH nursing instructors wish to depict psychopathology for guiding student learning (Becker, Rose, Berg, Park, & Shatzer, 2006). DESCRIPTION: Nurse educators teaching PMH nursing assessment and intervention skills may consider video vignettes as way to foster engagement. Students acting as patients with mood disorders were filmed (video) via a smart phone by this nursing instructor. VALIDATION OF EVIDENCE: A synthesis of these options may provide an inexpensive and time effective means to engage students when addressing content relative to mood disorders (Fitzgerald, 2008; Rowles & Brigham, 2005). The video clips were piloted in a PMH nursing course with positive student feedback relative to interest and learning.  RELEVANCE/OUTCOMES: Nursing instructors may use smart technology options such as video capture to effectively depict a range of psychopathologies with minimal time commitment and cost. IMPLICATIONS: Nursing student learning is supported by practical means of engagement to foster a better appreciate for critical case depictions infused during normal class time.



3032: The Impact of Evidence-based Interventions on Patient Depression Outcomes in an Integrated Psycho-Oncology Program
Elizabeth M. Archer-Nanda, DNP, APRN, PMHCNS-BC

PURPOSE: In 2007, the Institute of Medicine released, Cancer Care for the Whole Patient, the report established psychosocial/ mental health assessment as a standard of care for all cancer patients. There is limited information regarding outcome and evlautation metrics after referral to specialized psychiatric services in cancer patient populations. SUMMARY OF EVIDENCE: A well studied- reliable tool for the measurement of depression is the Patient Health Questionnaire 9-item (PHQ-9). Despite availability of screening tools, they are used less than 10% of the time. DESCRIPTION: The purpose of this study was to implement use of the PHQ-9 at each visit for patients seeing a Behavioral Oncology provider in the outpatient setting. Clinical interventions were reviewed. VALIDATION OF EVIDENCE: An IRB approved retrosective chart review was conducted to analyze the impact of evidence-based interventions by Behavioral Oncology Providers on PHQ-9 scores (January 1, 2013- September 30, 2013). Inferential statistics were run with paired-samples t-test analysis to determine changes in PHQ-9 scores.  RELEVANCE/OUTCOMES: The most common psychiatric diagnoses were Unspecified Deperssion (36.5%) and Major Depression (26.8%). All PHQ-9 questions showed a reduction in post-score intervention. Four specific items were statistically significant: Feeling depressed (p = 0.011), sleep problems (p = 0.01), feelings of worthlessness (p = 0.006), difficulty with psychomotor agitation/ retardation (p= 0.05). IMPLICATIONS: Findings from this study suggest that the implementation of quality metrics, sequential assessment with validated tools and the integration of evidence-based treatment guidelines are feasible and translate to improvements in patient outcomes. Psycho-oncology providers need to engage in a process of systematic measurement to better understand patient outcomes.



3033: Expanding Roles: The APRN in the Pediatric Residential Treatment setting
Carla Branson, MSN, APRN, PMHNP-BC; Dawn Marii Glowatz, MSN, APRN, PMHNP-BC

PURPOSE: The purpose of this presentation is to explore the role of the Advanced Practice Nurse as the primary provider in the pediatric residential treatment setting. SUMMARY OF EVIDENCE: According to the most recent report from the CDC, 13-20% of all children and adolescents will experience a mental health condition in any given year. There is a lack of current statistical data regarding the percentage within that group which are considered "seriously mentally Ill" due to ongoing criteria evaluation by SAMSHA and NIMH. DESCRIPTION: Residential treatment is usually reserved for children and adolescents who have required multiple acute admissions, have displayed serious safety related concerns and/or have failed less restrictive forms of care. Patients can have a variety of diagnoses and/or comorbid conditions. In most cases, there are also significant psycho-social contributing and complicating factors. VALIDATION OF EVIDENCE: We will review the liturature on the APRN role in the pediatric residential setting and summarize available research in this area.  RELEVANCE/OUTCOMES: There is an ongoing shortage of Psychiatrists and in particular, Pediatric Psychiatrists across the nation. The Psychiatric Advanced Practice Nurse is, and will continue to be, the key player in solving this ongoing dilemna. As new nurses enter the field, we need to promote and encourage them to consider pursuing advanced education opportunities and practice roles. IMPLICATIONS: The roles and settings of practice for the Psychiatric Advanced Practice Nurse continue to evolve and expand. We play a key role in this process and are responsible for shaping it . There is ongoing need for research and study re best practices.



3034: Spirituality as Coping in Trauma: Mantram Repetition Training for Veterans with Posttraumatic Stress Disorder
Terese M. Schneider, DNPc, MSN, APN, PMHCNS/NP-BC

PROBLEM: Posttraumatic Stress Disorder (PTSD) causes chronic health problems mediated by an overactive stress response. Veterans exposed to combat or sexual assault may experience moral and spiritual injury along with PTSD symptoms. Current evidence-based PTSD psychotherapies leave gaps in treatment and do not address spiritual issues.  FRAMEWORK: Stress reduction may lead to better physical and mental health outcomes. Mantram Repetition Training (MRT) is an evidence-based stress reduction skills training program that integrates spirituality and mindfulness skills.  METHODS: A prospective pre-post test pilot study of MRT, N=20, was conducted at a U.S. Department of Veterans Affairs (VA) outpatient clinic in southeast Pennsylvania in 2013. Training consisted of 6 weekly group sessions; 4 cohorts were scheduled sequentially. Subjects completed the Posttraumatic Stress Disorder Checklist (PCL), Perceived Stress Scale (PSS) and Spiritual Well Being Scale (SWBS) at pre- and post-treatment, and kept a daily log of mantram repetition practice (MRP) frequency. Paired t tests and linear regressions were used for data analysis.  RESULTS: Score changes were significant for all three measures. Mean MRP frequency was significantly related to score changes on the PCL, but not the PSS or SWBS. Mean MRP frequency was positively correlated to post test scores on the SWBS.  IMPLICATIONS: Nurses are front line healthcare workers who interact with military Veterans in a variety of locations and roles. Psychiatric nurses can deliver an effective spiritually-integrated stress reduction program to Veterans with PTSD.  FUTURE RESEARCH: This study supports previous research by Dr. Jill Bormann, PhD, RN. Results need to be replicated to be generalized to the civilian population.



3035: Treatment of Psychiatric Inpatients with Relationship Dysfunction Using a Short Term Cognitive Interpersonal Intervention
Tamra L. Rasberry, PhD, MSN, RN

PROBLEM: Relationship conflict can have significant detrimental effects for the psychiatric patient. Specific interactions can predict the potential for relapse; these have been identified and designated as components of Expressed Emotion (EE).  FRAMEWORK: Cognitive Interpersonal Therapy (CIT) specifically targets relationship dysfunction. There is limited research that utilizes inpatient, short-term, intensive therapy with relationship conflict as its sole focus, targeting known contributors to relapse.  METHODS: This study was a pseudo-experimental, pre-test-post-test, non-blinded pilot trial seeking to provide preliminary evidence for a brief intervention for psychiatric inpatients. Two groups of twenty patients, the ICIT (Intensive Cognitive Interpersonal Therapy) group and the Treatment as Usual (TAU) group, were assessed regarding relationship satisfaction, emotion regulation, and rehospitalization six weeks after discharge. One-way Analysis of Variance (ANOVA) was used for statistical analysis. Eleven patients in the ICIT group and 10 patients in the TAU group completed the follow-up assessments.  RESULTS: Analysis showed no significant statistical differences between these groups on relationship satisfaction, depression or anger scales, although there was a moderate effect size noted for each of these scales. The results indicated a significant difference and large effect size for the anxiety scale. IMPLICATIONS: CIT provides motivated patients with tools to improve relationships. Because the ability to self-regulate negative emotion is essential to a healthy psychological state, the usefulness of ICIT in acute care settings is an important area of study.  FUTURE RESEARCH: Controlled studies using larger, more homogenous groups are recommended.


3036: Staying Safe: Reducing Assaults and Staff Injuries
Diane E. Allen, MN, RN, PMH-BC, NEA-BC; Kathleen Cummings, BSN, RN-BC

PURPOSE: Describe a staff training program that has helped to reduce assaults by patients, staff injuries and lost time from work in an acute inpatient psychiatric hospital. SUMMARY OF EVIDENCE: While exploring staff perceptions about assaults, hospital leaders found that many workers held firmly to what the APNA's Position Paper on Workplace Violence (2008) called "the belief that violence is part of the work." DESCRIPTION: A key element of the Staying Safe program is the message that getting hurt is not an expected part of the job. Staff is discouraged from intervening physically alone and proactive approaches are taught - get help and have a plan. Other proactive planning and communication approaches are encouraged. VALIDATION OF EVIDENCE: Over the past five years, outcomes data were collected and evaluated.  RELEVANCE/OUTCOMES: Assaults to staff, staff injuries and lost time from work due to injuries have decreased dramatically, while calls for help have increased. Over the past five years, Staying Safe discussion forums were regularly repeated at the request of clinical staff. Staff have been encouraged to openly debate the concepts taught, including the idea that getting help is not the same as "doing nothing." IMPLICATIONS: Staying Safe concepts have been incorporated into new employee orientation as well as required crisis management refreshers.Open and respectful discussions continue about an issue that is central to psychiatric care - balancing the duty to protect patient rights and keep patients from harm with the duty to provide a safe environment for staff and others.



3037: Developing & Evaluating a New Role in Medical/Surgical Inpatient Units: Geriatric-Psychiatric Safety Specialist (GPS)
Carole Farley-Toombs, MS, RN, NEA, BC; Mary G. Carey, PhD, RN, CNS, FAHA

PURPOSE: Medical/surgical patients with co-morbid psychiatric or substance abuse disorders, dementia, delirium or admitted after a suicide attempt pose unique safety issues in acute non-psychiatric settings, including risk of self-harm, falls or aggression. Agency 1:1 sitters are often used but have a very limited role. We have developed a new role, the Geriatric-Psychiatric Safety Specialist (GPS), to provide therapeutic interventions to maintain safety, improve patient’s ability to cope, improve staff satisfaction and reduce agency costs. SUMMARY OF EVIDENCE: Inpatient suicide is a top sentinel event and disruptive behaviors related to co-morbid conditions contribute to falls, increased use of restraints and psychotropic medications and nursing staff distress; and the stigma associated with psychiatric disorders has a negative impact on the therapeutic process. DESCRIPTION: The Adult Medical Surgical and Psychiatric Nursing services developed the GPS position based on the senior psychiatric technician position. Qualifications included Bachelor’s Degree as well as experience with human services. Psychiatric Nursing and NICHE (Nurses Improving Care for Healthsystem Elders) educators conducted the training. The 16 fulltime GPSs were deployed from an automated 24/7 system. VALIDATION OF EVIDENCE: This pilot demonstrated financial savings, reduction in restraints, falls with injury and high nursing staff satisfaction. Additional GPS FTEs were approved and the Emergency Department was added as a service site.  RELEVANCE/OUTCOMES: The GPS role provides a therapeutic benefit for any patient suffering from disruptive behaviors. IMPLICATIONS: Adding a therapeutic component to the 1:1 role on med/surg units is cost-effective and patient centered response to safety issues among hospitalized patients.



3038: The Truth about Electroconvulsive Therapy (ECT)
Donna J. Ecklesdafer, MSN, BSN, RN; Dawn Miller, RN, BSN

PURPOSE: In this workshop, we will look at the truth about ECT – exploring the safety, efficacy and mechanisms of action. We will focus on real patient outcomes looking at response and remission rates. We will look at the critical roles the PMH nurses and advanced practice nurses have in providing clinical care, education and research in ECT advancing the nursing specialty. SUMMARY OF EVIDENCE: Through research, brain stimulation procedures such as ECT are shown to be alternative treatment options for many patients. ECT has been successfully utilized in treatment resistant depression among other psychiatric disorders. Clinical practice, caring for patients pre-, intra-, and post-ECT, and patient education are key areas that PMH nurses provide. Research in ECT is a growing field for the PMH nurse which can impact how care is given, improving patient outcomes. DESCRIPTION: We will identify the crucial role of the PMH nurse in providing education and clinical care of the ECT patient. Also how the PMH nurse can improve patient care and outcomes based on participating in ECT research. VALIDATION OF EVIDENCE: Trained PMH nurses utilized a number of rating scales in determining patient response to ECT. Focus on patient outcomes, responses and remission rates will be discussed.  RELEVANCE/OUTCOMES: We will present data on patient outcomes based on response and remission rates. Patients treated with ECT continue to show significant improvement. IMPLICATIONS: Nurses play a crucial role in ECT including education, providing care, and conducting research. PMH nurses have the opportunities to improve best practices with the work they do in ECT.



3041: Can Undergraduate Psychiatric Nursing Students Benefit from Learning and Implementing Group Therapy?
Debra Kloesz, MS, RN, CNE-BC; Grace Katherine Wlasowicz, RN, PhD, PMHNP-BC

PURPOSE: Nursing Students are challenged by many aspects of their psychiatric clinical rotation. The focus of inpatient treatment is melieu and group interventions. Most students have little experience in these specialized modalities. The purpose of this project was to increase the knowledge and skill of students in group therapy during their clinical rotation. SUMMARY OF EVIDENCE: A literature search revealed a poverty of literature on educating undergraduate nursing students in group therapy skills. Whereas staff nurses are frequently required to lead groups, undergraduate education provides little practice with this skill. Many nurses perceive leading groups as a challenging part of their role due to lack of knowledge and skill. DESCRIPTION: The University of Rochester School of Nursing is piloting a competency program for students to co-lead educational groups on inpatient units. Requirements include readings, group observations, written assignments, and co-leading a health group. The patients will benefit from having health education. Students will gain knowledge and skill about leading groups. Development of a more positive attitude toward mental health nursing is a possible outcome. This coincides with the knowledge, skill, and attitude development consistent with the goals of the Quality and Safety Education for Nurses. VALIDATION OF EVIDENCE: Students will be asked to evaluate their perceived value related to learning about and co-leading groups during their clinical.  RELEVANCE/OUTCOMES: Descriptive data will be reported based on two student cohorts. Outcomes will measure perception of knowledge, skill and attitude. IMPLICATIONS: Students may have a more positive attitude toward their psychiatric education and view psychiatric nursing more favorably as a career.



3042: The Chronic Care Model and Persons with Severe Mental Illness: An Integrated Approach to Care
Melinda McCusker, PMHNP; Dawn M. Vanderhoef, PhD, DNP, PMHNP/CNS-BC

PURPOSE: The purpose is to discuss the use of the Chronic Care Model (CCM) as an integrated care approach to the care of persons with a severe mental illness. SUMMARY OF EVIDENCE: Persons with severe mental illness (SMI) prematurely lose up to 25 – 30 year of life compared to the general population. Data have highlighted that persons with a SMI have higher morbidity and mortality rates due to cardiometabolic illnesses. Atypical antipsychotic (AA) medications used to treat SMI has been identified as further increasing the risk of mortality. Several integrated care models have been studied to provide a framework to treat both the physical and mental health conditions. The CCM is an integrated care model that can successfully be applied to persons with a SMI to target decreasing the morbidity and mortality of this population. DESCRIPTION: Current practices recognize the comorbidity between mental and physical health as proportional to the severity of disability. Unfortunately, less than 15 percent of individuals with chronic psychiatric disorders receive evidence based care. Studies have identified that health care systems are the main barrier to quality management of chronic conditions. VALIDATION OF EVIDENCE: The CCM has been well studied to improve outcomes for persons with other chronic health conditions, such as diabetes mellitus and asthma.  RELEVANCE/OUTCOMES: The CCM has utility in guiding evidence based care for persons with a SMI, which invokes participation at all levels of care and psychiatric nursing, along with other health care disciplines. IMPLICATIONS: The implications include providing theoretical based care for persons with multimorbid physical and mental health conditions.



3043: 1300 to 3: Lessons Learned on a Journey out of Seclusion, Restraint and Coercion on a Child and Adolescent Inpatient Unit
Theresa R. Searls, APRN

PURPOSE: The pupose of this presentation is to share lessons learned from the adoption of Collaborative Problem Solving on an inpatient child and adolescent unit, in language and processes that are accessible to bedside nursing staff. SUMMARY OF EVIDENCE: In 2003, this 30 bed unit averaged 1300 seclusions and restraints each year with patient and staff injuries costing over $500,000 annually. Nursing leadership used the lessons learned from an iintial failure in the adoption of the Collaborative Problem Solving Model, to develop necessary concepts and practices that could be adopted by bedside nursing staff. From this foundation, adoption of the model became a reality. DESCRIPTION: There are 5 foundational elements of understanding and practice that have been identifed as necessary for successful understanding and adoption of Collaborative Problem Solving. The elements can be understood and adopted independent of the model as part of an initiative to improve the quality of inpatient care. VALIDATION OF EVIDENCE: Identified nursing quality indicators showed significant improvement in both child and adolescent populations and have remained constant for 7 years.  RELEVANCE/OUTCOMES: Many nurse leaders in child mental health have attempted to adopt Collaborative Problem Solving. The model has powerful implications for the role of nursing in inpatient settings but needs clear, simple, foundational concepts and steps described, that can be understood and accepted by bedside nursing staff, including non-licensed staff. IMPLICATIONS: The presentation is part of the author's work to support individuals and institutions to move foward in their journey to quality care and improved outcomes.



3044: Prazosin for the Treatment of Combat-Related Nightmares in Military Veterans with Post-Traumatic Stress Disorder.
Jess A. Calohan, DNP, MN, PMHNP-BC

PURPOSE: Post-Traumatic Stress Disorder has been identified as a "signature injury" from the Global War on Terrorism (GWOT). Sleep disturbance caused by combat-related nightmares can significantly impair level of functioning and limit the effectiveness of treatment interventions. Safe and effective treatments for military veterans with combat-related nightmares are limited. SUMMARY OF EVIDENCE: Multiple studies have repeatedly demonstrated the effectiveness of Prazosin for the treatment of combat-related nightmares in military veterans. However, Prazosin continues to be under-utilized by prescribing providers treating PTSD patients. DESCRIPTION: A standardized protocol for prescribing Prazosin has been developed and serves a guide for clinicians that treat patients experiencing combat-related nightmares. VALIDATION OF EVIDENCE: Standardized measures using the Clinician Administered PTSD scale's (CAPS) nightmare and sleep items demonstrate independent content validity, along with the statistically validated Clinical Global Impression of Change (CGIC) scale can be used to measure the effectiveness of the intervention.  RELEVANCE/OUTCOMES: Prazosin is effective for combat-related nightmares by improving sleep quality, global function, and CAPS score. Prazosin is well tolerated and there were no significant changes in blood pressure between treatment and placebo groups. IMPLICATIONS: The psychological impacts of the Global War on Terrorism will persist for generations. Clinicians need effective tools in the clinician toolkit for treating Post-Traumatic Stress Disorder. Treating sleep disturbances improves quality of life and can facilitate additional treatment interventions that can assist our veterans in overcoming PTSD symptoms.



3045: Impact of Therapeutic Milieu and Unit Aggression on Progression to Discharge: Correlation of Emergency Events with Outcomes for Psychiatric Peers
Alexander Johnston, MS, MTCM, PMHNP-BC; Brenda Hamel-Bissell, EdD, MS; Jean Coffey, PhD, CPNP; Peter Callas, PhD

PROBLEM: Inpatient psychiatric length-of-stay has decreased in the past 40 years, with the therapeutic milieu de-emphasized during this period.  Studies associate perception of milieu impacting treatment outcome, but literature is scant on the specific impact of milieu on treatment outcome.  FRAMEWORK: Stress and coping models explain outcome variance associated with milieu variables.  METHODS: This retrospective study investigated exposure to aggression, control and disorder on a psychiatric milieu as independent variables predicting psychiatric peer outcomes.  The region experienced a statewide reduction in inpatient beds, resulting in increased unit emergency events. Data analysis was of two cohorts on the same unit, pre-and-post  this change in population.   Descriptive and inferential statistical analysis provided data for discussion.  RESULTS: After exclusion criteria were applied, 610 visits were analyzed.  Statistical analysis identified significant differences between groups.  Mean number of emergency events experienced by patients in the post change group increased 619%.  Male patients with psychosis had a 39% increase in length-of-stay. Regression analysis identified exposure to emergency events as a predictor of the observed variance in length-of-stay for male patients with psychosis.  IMPLICATIONS: Therapeutic milieu variables predict length-of-stay (LOS) for male patients with psychosis, confirming relevance of the therapeutic milieu. These findings impact policy associated with duration of untreated psychosis on the milieu, education about the differing responses to stress by diagnosis, and milieu stress and coping practices.  FUTURE RESEARCH: Further research should be conducted with diverse inpatient settings to improve generalizability, to increase statistical power in subgroup analysis, and to validate tools that assess coping with milieu variables.


3046: Using Simulation to Connect Meaning to Inpatient Mental Health Safety
Candice L. Walsh, BS, RN-BC; Krista Kipper, BSN, RN, CHSE

PURPOSE: Mental Health staff find it difficult to maintain skills required for safe management of infrequent, high risk incidents such a patient suicide attempts, cardiac arrests, seclusion and restraints. SUMMARY OF EVIDENCE: Joint Commission National Safety Goal to Identify patients that are a safety risk. The Centers for Medicaid & Medicare Services requires that staff demonstrate competency in the application of restraints and uses least restrictive interventions. Our organization's goal is zero seclusion/restraint. With this, we need to ensure our staff maintain a high level of competency in evidence-based practices in mental health. DESCRIPTION: Staff attend a four hour mandatory safety course annually. We have incorporated simulation-based methodology to provide an immersive engaging learning experience which is followed by meaningful debriefing sessions. The debriefings are focused discussions related to individual and environmental risk factors for unsafe behaviors, patient safety needs and evidence-based practices. VALIDATION OF EVIDENCE: Current literature supports the benefits of continuing education and simulation methodology as essential for staff to maintain competency and seek professional growth.  RELEVANCE/OUTCOMES: Literature supports simulation-based learning as an effective strategy for nursing students and professionals in mental health. In our organization, simulation debriefing discussions related to best practice have proven to be valuable and have led to increased implementation rates. IMPLICATIONS: The incorporation of simulation in education for nursing students and professionals will be a necessity to keep staff competent in the complex skills needed to provide quality care. This is especially true with the growing diversity of new staff with limited clinical experiences.



3047: Implementing a Behavioral Emergency Response Team (BERT): A Performance Improvement Strategy to Address Workplace Violence
Constance Noll, MA, BSN, RN-BC; Karen Doyle, MBA, MS, RN, NEA-BC

PURPOSE: Our urban, academic medical center addressed promoting positive communication in an environment conducive to patient, family, and staff satisfaction. Originating from staff participation in a patient/public conflict task force, a Behavioral Emergency Response Team (BERT) was created for bedside support in situational conflict. SUMMARY OF EVIDENCE: Nationally, violence in acute health care settings is increasingly prevalent and concerning in terms of injuries, decreased morale, and increased staff turnover. DESCRIPTION: BERT is an innovative strategy comprised of core members of psychiatric emergency nurses and pastoral and security staff; available to front-line clinical staff for de-escalating potentially volatile events in real time, 24/7. Core member staff have adjusted roles without requesting additional resources. After identification of behavioral triggers and development of an algorithm for BERT activation, core members were trained. Collaborative educational sessions with key nursing and medical stakeholders in the medical ICU and an acute care trauma unit was completed and a 90-day pilot was launched. VALIDATION OF EVIDENCE: Pilot results revealed success in deescalating hostile situations involving patients and family, and frustrated staff. Trends indicate educational needs for recovery oriented, de-escalation techniques; capacity for medical decisions and refusal of treatment; and improved multidisciplinary communications. No change occurred in the number of calls for security assistance pre & post BERT implementation.  RELEVANCE/OUTCOMES: Long term plans will focus on the integration of patient and staff satisfaction, lost staff work days and number of staff injuries. IMPLICATIONS: Subsequently, BERT was expanded to five additional medical units with plans to implement the strategy throughout the organization. Expansion results are pending.



3048: Recommendations for prescribing exercise, the impact of exercise on the brain and a program to enhance motivation, support patient participation and promote adherence to exercise.
Kirk Bergmark, APN, PMHCNS-BC

PURPOSE: The positive impact of exercise on the brain and mood are scientifically clear. This presentation will address how exercise can be successfully integrated into the treatment plans of patients with depression using evidence based recommendations and connections with health and fitness facilities. SUMMARY OF EVIDENCE: Exercise is included in the most recent American Psychiatric Association Practice Guidelines for Major Depression. A recent literature review provides guidelines for exercise recommendations as a treatment for major depressive disorders. DESCRIPTION: Patients treated for depression receive a prescription for exercise based on evidence based recommendations. These recommendations have been incorporated into a template used by mental health practitioners in an outpatient office setting and printed out with other patient instructions. Through collaboration with a fitness center, a program designed to meet the needs of patients transitioning to the facility from physical/medical issues has been expanded and tailored to met the needs of patients with depression based on evidence based recommendations. VALIDATION OF EVIDENCE: Case examples and the challenges of implementing exercise as a treatment for major depression will be discussed.  RELEVANCE/OUTCOMES: Offering exercise as an option in addition to medications or psychotherapy is scientifically sound and consistent with a recovery based approach to treatment. Exercise is an adoption that is fully under the control of the patient and supports an increase in self-efficacy. IMPLICATIONS: Evidence is emerging on the positive impact that exercise has on the brain. The dosage and recommendations for exercise will be developed for a variety of mental health issues such as anxiety, ADHD and addiction.



3051: Education Council Interactive Panel (RN, APRN)
Barbara Jones Warren, PhD, RN, CNS-BC, PMH, FAAN

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 2014 year. In addition, this Interactive APNA Education Council session provides an opportunity for Council members to not only discuss the 2014 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 as well as share information between other APNA Councils and APNA members. DESCRIPTION: See above. VALIDATION OF EVIDENCE: See above.  RELEVANCE/OUTCOMES: The Education Council was organized to enhance APNA's mission through a series of focused endeavors aimed at promoting educational initiatives within APNA. IMPLICATIONS: The Education Council promotes collaboration between other APNA Councils and foster educational initiatives for APNA members.



3052: Institute for Safe Envrionments Interactive Panel Session
Diane E. Allen, MN, RN, PMH-BC, NEA-BC

PURPOSE: Provide a forum for ISE leaders to engage members while discussing issues, sharing concerns and describing innovations that are related to safe practice for psychiatric nurses. SUMMARY OF EVIDENCE: Institute for Safe Environments has strived to identify relevant and timely safety-related topics. DESCRIPTION: Members of the Institute for Safe Environments Steering Committee and Advisory Panel have endeavored to seek out and explore scientific evidence that supports safe best practices in psychiatric nursing care. VALIDATION OF EVIDENCE: Workgroups have been established to explore issues related to emergencies and engagement.  RELEVANCE/OUTCOMES: Results of the workgroups will be shared with attendees. IMPLICATIONS: Members of the ISE hope to be able to recommend practices that are both safe and therapeutic.



3053: Administrative Council Interactive Panel Presentation - Staffing Discusion and Updates
Avni Cirpili, RN, DNP, NEA-BC

PURPOSE: January 2012 the APNA position statement on "Staffing Inpatient Psychiatric Units" was published. The position statement made 10 recommendations related to nurse staffing. This presentation will obtain feedback from APNA members about the position statement and hear from members any concerns about inpatient staffing. The feedback and discussion will be examined by the Administrative Council to review the existing position statement and make any recommendations to APNA leaders about future actions plans as it relates to inpatient staffing. SUMMARY OF EVIDENCE: Multiple factors influence safe staffing levels and must be considered when a comprehensive staffing plan is developed. The panel discussion will review the evidence related to factors that infleunce staffing decisions: i.e. throughput, multimorbidity, financial, technology, staff engagement. DESCRIPTION: The Administrative Council is providing psychiatric nurse leaders with the information to examine their own staffing practices. The interactive panel discussion will also allow participants to hear from other staff and leaders on how they make staffing decisions and the concerns that have arisen. This sharing of knowledge will allow for the opportunity to problem solve actions around inpatient staffing plan development. VALIDATION OF EVIDENCE: A literature review will be presented to participants about inpatient psychiatric staffing.  RELEVANCE/OUTCOMES: Staffing is a topic that has significant relevance to PMH direct care staff and leaders of inpatient programs. It has been the topic of many member bridge discussion threads. IMPLICATIONS: Feedback from the interactive panel discussion will enable the Administrative Council Steering committee to evaluate the current staffing position paper to provide APNA leadership with recommendations related to inpatient staffing.



3054: Interactive Panel: Addiction Council
Matthew Tierney, APRN

PURPOSE: This Interactive Panel will present and openly discuss issues of substance use disorders and addiction relevant to psychiatric nursing. SUMMARY OF EVIDENCE: Substance Use and Addiction Disorders are mental health disorders that affect brain function. Manifestations of these disorders are seen in many areas including: behavioral abnormalities, loss of functional abilities, damage to numerous organ systems, risk for victimization, harm to families and communities, and increased mortality. Like other mental health problems, addiction and substance use disorders are present throughout the lifespan, from inherited genetic vulnerabilities, to the vulnerable developing brains of youth and adolescents, to adult and geriatric populations. DESCRIPTION: .. VALIDATION OF EVIDENCE: ..  RELEVANCE/OUTCOMES: Psychiatric nurses recognize that wherever patients and families are on the disease spectrum, addiction treatment and recovery is always possible: patients, families and communities can and do get better. In cases where full recovery is not possible, psychiatric nurses promote healing and always work to alleviate suffering. With appropriate health care maintenance plans and education, addiction and substance use disorders can in many cases be prevented. IMPLICATIONS: Research clearly points to the numerous benefits of integrated care for co-occurring substance use and mental health disorders; yet, too many systems of care and providers remain unable to deliver integrated care despite the potential for improved outcomes, including cost savings, and reduced morbidity and mortality . APNA’s Addiction Council is a national leader role and a professional resource for the identification and treatment of addictions and substance use disorders as they relate to psychiatric nursing.



3055: Trauma and Healing: Findings and Insights from Three Nurse Scientists
Danny G. Willis, DNS, RN, PMHCNS-BC;  Claire B. Draucker, PhD, RN, APRN, FAAN;  Ursula A. Kelly, PhD, ANP-BC, PMHNP-BC

PROBLEM: Interpersonal violence and abuse including sexual assault, rape, and child maltreatment have been associated with myriad negative health consequences for which psychiatric mental health nurses can intervene based on the science of healing.  FRAMEWORK: Stress reduction may lead to better physical and mental health outcomes. Mantram Repetition Training (MRT) is an evidence-based stress reduction skills training program that integrates spirituality and mindfulness skills.  METHODS: The nurse scientists presenting this interactive panel have used qualitative and quantitative research design and methods including hermeneutic phenomenology, grounded theory, and qualitative and quantitative description in developing the empirical and theoretical foundations for a nursing perspective on trauma, healing, and intervention.  RESULTS: SResults including a grounded theory of the key processes associated with women and men's experiences of healing from sexual violence as well as a situation-specific theory of adult male survivors' experiences of healing from child maltreatment will be presented. Risk and resilience factors that influence health seeking treatment for female Veterans who experienced military sexual trauma will be presented.  IMPLICATIONS: Psychiatric nurse scientists provide the evidence, knowledge, and the theoretical bases from a nursing perspective to help psychiatric nurses better understand human experiences of trauma and healing. Basic research in psychiatric mental health nursing provides the basis for the development and testing of innovative healing interventions for trauma. FUTURE RESEARCH: Building on the knowledge and theories developed by nurse scientists studying trauma and healing, future research should focus on nursing interventions to facilitate healing in the aftermath of trauma, violence, and abuse for both men and women.