Friday Morning Abstracts


3011.1: Psychiatric Emergency Room/Community Collaboration: Decreasing Unnecessary Hospitalizations
Lorann Murphy, MSN,PMHCNS,BC

PURPOSE: Inpatient psychiatric beds have been in increased demand over the past few years. SUMMARY OF EVIDENCE: Admission of sub acute patients and high utilizers increases the burden on hospitals, emergency rooms and nursing staff. DESCRIPTION: St Vincent Charity Psychiatric Emergency Department (PED) and Frontline Services collaborated to enable patients with psychiatric illness to access services to achieve long-term stabilization and prevent unnecessary hospitalization when presenting to the emergency room. A Crisis Intervention Specialist (CIS) from the Mobile Crisis Team is assigned to the PED, to provide screening, linkage, follow up services and facilitate admissions to the state hospital system. The CIS also works with staff of other agencies and the Board of Mental Health to create coordinated community treatment plans for individuals who have chronic mental illness and are high utilizers. VALIDATION OF EVIDENCE: The use of interdisciplinary assessment, treatment and referral was predicted to decrease the amount of hospital admissions for convenience, social reasons or for crisis stabilization  RELEVANCE/OUTCOMES: In the past year, half of the patients were discharged to follow up at a community mental health agency, 1% were sent to crisis stabilization unit, 24% were given CD referral information and only 25% were admitted to inpatient. The number of Community Care Plans increased eight fold from 2011 to 2015 and have significantly decreased inappropriate admissions and has allowed linkage of these patients to appropriate outpatient services. IMPLICATIONS: PED/Community collaboration with use of community care plans subsequently reduces the number of unnecessary admissions and allows patients to receive appropriate follow up care.



3011.2: Factors Leading to Readmission of Psychiatric Patients
Frankie Wallis, DNP, RN, FNP

PURPOSE: The purpose of the presentation is to provide education related to the common risk factors among psychiatric patients presenting to the hospital emergency department (ED) who are admitted for inpatient psychiatric care and return to the hospital ED for a medical complaint within 72 ho0urs of the psychiatric admission. SUMMARY OF EVIDENCE: The hospital ED has become the gateway for mental health patients to receive necessary medical assistance, because of hospital closures, deinstitutionalization, and the lack of community resources. This vulnerable population has a higher morbidity and mortality rate compared to the general population which requires a systematic, evidence-based medical screening. DESCRIPTION: Patients presenting to the ED should have a targeted history and physical exam (PE) which provides the foundation for the medical screening process. The results of the history and PE should guide subsequent diagnostic testing to establish medical clearance prior to admission to psychiatry. VALIDATION OF EVIDENCE: The overall approach to the care of psychiatric patients in the ED must be the same as that of patients presenting with medical symptoms. 750 psychiatric admissions reviewed. Research concluded that medical admissions within 72 hours of the psychiatric admission were commonly unrecognized in the ED.  RELEVANCE/OUTCOMES: The topic reinforces the significance of an appropriate medical screening to ensure medical clearance of vulnerable populations. Mental health patients often have hidden medical issues that are unrecognized in the ED. IMPLICATIONS: PMH nurses should focus attention on improving mental health, as well as providing interventions for mental health patients presenting to the hospital ED. Mental health are an at-risk population.



3012.1: The Opportunity to Lead and Collaborate: The Consult-Liason Role for PMH-NPs in Primary Care
Jesse Higgins, RN, PMH-NP

PURPOSE: Psychiatric mental health nurse practitioners are an essential component of integrating primary care and behavioral health. In the past, co-located psychiatric providers have maintained specialty mental health care norms; this led to long waiting lists and poor communication between providers. Following a consult/liaison model of integrated psychiatry is evidenced to be a more effective and efficient delivery model. SUMMARY OF EVIDENCE: Over 80 randomized controlled trials that included over 24,000 participants have been carried out over the past 20 years; there is ample evidence that behavioral health integration yields greater effectiveness than segregated care. DESCRIPTION: Adopting a consult/liaison model using evidence-based interventions is far more effective than co-located psychiatric care. We adapt this model to each practice and community include the entire practice team. VALIDATION OF EVIDENCE: Evidence suggests tracking identified patient populations using integrated tracking measures is most effective. We are in the process of developing a registry in which we will be able to track behavioral health quality measures alongside medical quality measures using population health to evaluate interventions and providers.  RELEVANCE/OUTCOMES: PMHNP's are an essential component of this model. Whether via telepsychiatry or in person, this model’s core components can be adapted and tailored to provide integrated psychiatric consultation to very different primary care practices and populations. IMPLICATIONS: As healthcare evolves to embrace an integrated, population-health model of care, PMH-NP's are uniquely poised to contribute expertise as psychiatric providers, educators, collaborators and leaders.



3012.2: Developing and Implementing a Community Based Child Behavioral Health Collaborative
Eugenia Millender, PhD, RN, PMHNP-BC, CDE

PURPOSE: The purpose of this paper is to explore the utilization of a community based integrated Child Behavioral Health Collaborative (CHBC) team that increases access to mental health services for children and their families. Local government has identified the critical need for communication and coordination within behavioral health systems. Currently, families must navigate through several systems in order to satisfy their child’s mental and substance use needs. SUMMARY OF EVIDENCE: According to the National Institute of Mental Health, less than one in five children receive essential mental health services. DESCRIPTION: Several challenges have hampered efforts in creating a comprehensive system of care including restricted resources and fragmentation of services. In this model partners will regularly engage in team conferences to identify needs, discuss client progress, maintain communication, and reduce barriers between systems. VALIDATION OF EVIDENCE: Clients can access, navigate and monitor needed services from CBHC through a variety of sources including a telephone hotline which provides oriented family-centered solutions and skill-based case management. Effectiveness was measured from the moment of requisition via phone to actual face-to-face appointment.  RELEVANCE/OUTCOMES: Psychiatric and Mental Health nurses provide a comprehensive system of care to meet the behavioral health needs of children, increasing the functionality and stability of families. This enables fluid communication and upholds the continuous necessity of comprehensive mental health services within the community. IMPLICATIONS: Our Child Behavior health collaborative practice encompasses care coordination by implementing both patient outcomes and reduction in cost of care, which are both critical to the improvement of over-utilization of resources by reducing duplication and maximizing collaboration.


3013.1: The Importance of Disclosure and Recovery in Childhood Sexual Abuse: A Nursing Student’s Perspective
Tahanie Omar, SN;Jeanette Rossetti, EdD.MS, RN

PURPOSE: This presentation will share the importance of disclosure and recovery in childhood sexual abuse. A review of the impact of childhood sexual abuse will be shared and the important factors related to the recovery process will be discussed. The student nurse presenter will discuss her own journey of recovery. SUMMARY OF EVIDENCE: The impact of childhood sexual abuse is well documented in the psychiatric nursing literature. Following the tenants of Barker’s Tidal Model it is important for the person in recovery to tell their story. This innovative mode of presentation will highlight the student nurse’s “story” of recovery from childhood sexual abuse. DESCRIPTION: The tragic after-math effects of sexual abuseare well documented/ Those that survive sexual abuse of their childhood go on to a recovery process. This process consists of two major steps: Disclosure and Recovery. VALIDATION OF EVIDENCE: Disclosure and recovery are two major steps in the recovery process of childhood sexual abuse and were integral in the author’s own journey.  RELEVANCE/OUTCOMES: It is important for psychiatric nurses to understand the steps in the recovery process of childhood sexual abuse and how they can assist a patient in their journey of recovery. IMPLICATIONS: It is important for nurses to hear their patients’ stories and assist them along their journey of recovery. This is particularly relevant for those patients who do not have a support system or feel unsafe in disclosing their history of childhood sexual abuse and fear that they would not be believed.


3013.2: Intimate Partner Violence and the Advanced Practice Nurse: Vicarious Trauma, Does it Matter?
Marla McCall, PhD, PMHNP-BC

PROBLEM STATEMENT: One in three to four adults have experienced intimate partner violence (IPV). IPV remains under-diagnosed. Advanced practice nurses (APNs) are increasingly the first diagnosticians patients meet where IPV must be identified. THEORETICAL FRAMEWORK: The job demands resource model proposes that job performance is influenced by job demands and resources.  Due to the high emotional demands of treating IPV victims, APNs treating IPV can be pressed by situations that make them susceptible to vicarious trauma (VT). METHODS AND FRAMEWORK: An electronic quantitative survey of 474 APNs from diverse specialties, geographic areas, and demographics in the U.S. was completed. Standardized questionnaires on personal, professional, and workplace factors were used. Subjects completed questionnaires on general self-efficacy, resilience and VT using validated tools. The subset of APNs who tested positive for VT were analyzed separately to see if they were different from those not meeting the cutoff criteria for moderate VT. Data were analyzed with SPSS. RESULTS: Fifty-five APNs (11%) tested positive for moderate or higher levels of VT. They differed from the overall sample with a higher negative correlation of self-efficacy to treat IPV, and had lower levels of general self-efficacy and resilience. IMPLICATIONS FOR PRACTICE: VT in APNs is correlated with lower self-efficacy to treat IPV. IPV is a prevalent health problem that must be addressed by APNs whose effectiveness may be compromised if they suffer from VT. Health care institutions must address education and supervision to decrease the prevalence and increase APNs' recovery from VT. IMPLICATIONS FOR FUTURE RESEARCH: Further research is needed on how to prevent VT among APNs and promote recovery.


3014.1: Use of Standardized Patient Simulations to Teach Essential Psychiatric Nursing Skills
Laura Rodgers, PhD, PMHNP-BC;Barbara Limandri, PhD, PMHNP, BC

PURPOSE: This presentation will demonstrate how one psychiatric nursing faculty used standardized professional actors to enact three scenarios for students to experience and practice essential nursing interactive skills. SUMMARY OF EVIDENCE: All nurses regardless of their practice venue will face patients who are suicidal, hallucinating, and manic. With our reduced psychiatric nursing clinical time and placement opportunities in nursing education, it is not always possible for students to face these situations to learn how to effectively respond. DESCRIPTION: One faculty member designed three scenarios according to NLN Simulation Innovation Resource Center standardized for the hallucinating, the highly suicidal, and the manic patient. The other faculty member critiqued and revised the scripts, which were then given to the standardized patient actors along with sample videos of patients demonstrating the behaviors we were seeking. Students had 10 or 15 minutes to meet, assess, and intervene with the client. After a group of 8 students completed the scenarios, one faculty member met with the whole group to view the videos and provide constructive feedback for each other’s work. VALIDATION OF EVIDENCE: Both the students and the actors completed evaluations of the experience and the scenarios in relation to the stated expected outcomes.  RELEVANCE/OUTCOMES: This practice assures the all students have the same learning experience for crucial patient situations and provides at least beginning safety for patients and nurses in these situations. IMPLICATIONS: This clinical practice will strengthen nursing student skills in a uniform manner.



3014.2: Inter-collaborative Coaching between Third and Fourth Semester Nursing Students to Foster Mental Health Nursing Competencies
Karen Pugsley, MN, RN

PURPOSE: Undergraduate nursing students enrolled in a mental health course repeatedly expressed anxiety about caring for patients with mental illnesses. During focus groups conducted at the end of each semester, students recommended having fourth semester students who completed the course provide support and coaching to third semester students currently enrolled in the course. Therefore, a teaching strategy was designed to provide inter-collaborative coaching. SUMMARY OF EVIDENCE: The literature indicates one benefit of a coaching relationship is building self-confidence in new environments, provided both positive and constructive feedback is included. DESCRIPTION: The teaching strategy consisted of fourth semester students coaching third semester students during three different patient simulations over a 15 week semester. For each simulation, the fourth semester student coached and evaluated the third semester student and provided one-on-one feedback on the use of therapeutic communication and the application of the nursing process. VALIDATION OF EVIDENCE: To evaluate the teaching strategy, students completed two reflection journals, participated in one focus group, and completed one or two Blackboard surveys.  RELEVANCE/OUTCOMES: Third semester student responses indicated a reduction of anxiety in providing care to patients with mental health illnesses. Fourth semester students reported feeling more comfortable providing feedback to colleagues and improved confidence in the use of therapeutic communication and caring for patients with mental illness. IMPLICATIONS: Implications from this research suggest that providing inter-collaborative coaching is an effective and feasible teaching strategy for improving self-confidence in undergraduate nursing students.



3015.1: Vagus Nerve Stimulation: Potential Role in PTSD and Implications for Advanced Psychiatric Nurses
William Nicholson, MSN, PMHNP-BC

PURPOSE: Post-traumatic stress disorder (PTSD) is a chronic and debilitating mental disorder which affects approximately 8% of the general population. The lifetime effects to the individual (increases in unemployment, substance abuse, etc.) and economic cost of PTSD exceed that of any other anxiety disorder. SUMMARY OF EVIDENCE: Despite gross psychosocial and economic burdens, effective treatment interventions are lacking in this population which can help restore healthy brain functionality, hold symptomology in remission, and sustain improvements in quality of life. DESCRIPTION: Currently, cognitive-behavioral therapy and pharmacotherapy are first-line treatment for PTSD. Despite their empirical support, lifetime efficacies of these treatments are debatable. VALIDATION OF EVIDENCE: The dearth of effective and accessible treatment options for this population has increased the need to identify pathogenic mediators of PTSD symptomology. Recent research has implicated the vagus nerve as a potential mediator due to its parasympathetic involvement in anxiety, depression, fragmented sleep patterns, impulsivity and arousal, endocrine and inflammatory responses, cardiometabolic dysfunctions, and neurocognitive disorders. Furthermore, vagus nerve stimulation (VNS) provides a safe and effective treatment option which targets the vagus nerve.  RELEVANCE/OUTCOMES: Historically, vagus nerve stimulation provided access to the vagus nerve via surgical implant; however, new technology called transcutaneous vagus nerve stimulation (tVNS) exists which can access the vagus nerve non-surgically, is more cost-effective with higher potential for psychiatric outpatient availability, and has comparable results to traditional VNS. IMPLICATIONS: Although experimental research with vagus nerve and PTSD is lacking (excepting mice models) and remains largely theoretical, advanced psychiatric nurses should anticipate a larger clinical role for tVNS for future treatment of PTSD.



3015.2: Introducing Light Therapy for Treatment of Depressive Symptoms in the In-Patient Setting at the VA Pittsburgh Hospital System
Robert Kendall, RN, MSN;Patricia Fedorka, PhD, RNC-OB, C-EFM, CNE

PURPOSE: Depressive symptoms are prevalent among the inpatient psychiatric population. Great opportunities exist for improving patient outcomes through treatment modalities that exhibit comparative effectiveness to pharmacological treatment without costs and side effects which negatively impact compliance. SUMMARY OF EVIDENCE: Research shows that light therapy is a safe, effective, noninvasive, non-pharmaceutical treatment option for patients suffering depressive symptoms, providing comparable improvement to pharmaceutical treatment while decreasing costs and side effects, increasing compliance, and improving patient outcomes. DESCRIPTION: Stakeholders include the PMH nurse, psychiatrist, psychologist, the Department of Veterans' Affairs, patient, and family. Implementation strategies include education of all stakeholders on light therapy, communication between mental health professionals and the organization, and between professionals and patient and family, and data collection and analysis to monitor effectiveness. VALIDATION OF EVIDENCE: Severity of depressive symptoms will be measured prior to and during light therapy tratment by the PMH-administered Hamilton Depression Rating Scale and the PHQ9 self report. These are established tools for measuring depression, and using multiple tools will allow for correlation of self-report and professionally-administered results.  RELEVANCE/OUTCOMES: Project is ongoing; updates will be presented at the Conference. IMPLICATIONS: Light therapy has shown comparable effectiveness to pharmacological treatment of depressive symptoms in the outpatient setting, as well as decreased costs and side effects and increased patient compliance. Expanding the use of light therapy in inpatient settings can enable the PMH nurse to meet the physical and mental needs of the population across the lifespan and improve the population’s mental health by increasing inter- and intra-professional stakeholder, especially patient, collaboration in treatment.


3016.1: Improving a Fall Risk Assessment Policy in an Inpatient Psychiatric Hospital: Successes and Areas for Improvement
Amy LaValla, BSN, RN, PHN

PURPOSE: Hospitals need comprehensive fall risk assessment policies to support patient safety. Administration at one inpatient psychiatric hospital identified that their policy did not meet standards set forth by the Joint Commission and other safety-focused agencies. Lack of a comprehensive fall policy left individuals at risk for injury, increased costs, and greater disability. SUMMARY OF EVIDENCE: Guidelines and literature recommend using fall risk assessment tools that are specific to age, the environment, and that individuals at risk for falls are visually identifiable. DESCRIPTION: Literature was searched for fall risk assessment tools which were appropriate for use in the hospital, and a new policy was written that included the assessment tools, specific reassessment parameters, and the use of visual identification. Lippitt's change theory was used to support implementation of the change. Stakeholders were: the Director of Nursing, the nurse educator, a nurse leader, the project designer, nursing staff, and patients. VALIDATION OF EVIDENCE: Chart audits and unit inspections were conducted before implementation and three months after to determine rates of change. Examination of charts included if patients were assessed with the correct tool, if they were reassessed according to the updated policy, and if patients were visually identifiable if at increased risk for falling.  RELEVANCE/OUTCOMES: Results showed adherence to policy with the use of specific assessment tools and improvement in rates of assessments and reassessments. However, areas were also identified where additional steps may be taken to further enhance improvements and policy adherence. IMPLICATIONS: Future policy changes can utilize lessons learned with this project to improve systems and guide changes.



3016.2: Improving Patient Flow and Nurse Satisfaction by Implementing an Admission Discharge Nurse on an Inpatient Behavioral Health Unit
Amy Roark, RN, MSN;Apryl Cutler, RN; Virtud Oloan, Ed.D, RN-BC

PURPOSE: An Admission/Discharge RN pilot position was proposed by a nursing leadership student to improve patient throughput and nursing satisfaction on the Scripps Mercy Behavioral Health Inpatient Unit. SUMMARY OF EVIDENCE: Throughput of patients is a complex problem. Delays in admitting and discharging patients causes emergency room backup with psychiatric patients waiting an average of 14 hours for an inpatient psychiatric bed. DESCRIPTION: The patient Care Manager gained approval for a 3 month pilot position of the ADRN. The position was scheduled on Mondays and Fridays, 0800-1630. This was identified as a high volume time for admissions and discharges based on previous calculations.The primary stakeholders involved include: staff RNs, MDs, and patients on the Inpatient Behavioral Health Unit. VALIDATION OF EVIDENCE: Discharge time of patients were measured before and after the implementation of the ADRN. Number of admissions on the day shift (0700-1530) were measured before and after the implementation of the ADRN. Average discharge time of the patient was measured both before and after the implementation of the ADRN. Nursing satisfaction was measured by administration of a written questionnaire to nursing staff.  RELEVANCE/OUTCOMES: This ADRN position had a significant impact on the unit. Discharge time improved, the average discharge time before ADRN position was 1300, after ADRN, time improved to 1045. The average admissions accepted on day shift was 1.5, after implementation of ADRN was 3. Nurses were polled and have reported increased levels of satisfaction. IMPLICATIONS: The pilot position is pending approval for a part time regular position due to increased patient throughput and improved nursing satisfaction.



3017.1: Enhancing a Culture of Safety in a Behavioral Health Organization By Using a Comprehensive Approach Incorporating Crisis Aversion Strategies and Integrated Educational Programming
Kelly Bryant, MS, BSN, RN, CNE;Kathleen Wright, RN; Kristina Koeppl, BSN, RN-C; Fran Zucco, BSN, RN

PURPOSE: Ensuring a culture of safety through the use of crisis prevention strategies and ongoing staff education has been demonstrated to reduce use of restraints and seclusion episode and patient/staff injuries. SUMMARY OF EVIDENCE: Staff who have received training in crisis aversion strategies better mitigate crisis episodes at various levels (anxiety, defensive, and acting out). Ongoing education and hands-on training are key to fostering a team approach focusing on de-escalation and less " hands-on" intervention. DESCRIPTION: All staff attend CPI training as a required organizational competency. The establishment of an "in-house" interdisciplinary team of certified instructors provides initial and refresher training to their colleagues. Team teaching strategies are utilized with integration of hospital specific training on restraint application and gurney use during behavioral health emergencies. VALIDATION OF EVIDENCE: An integrated approach during a "Code Yellow" - our behavioral health emergency incorporates CPI techniques and debriefing strategies using the six-step CPI coping model. Data is trended to evaluate outcomes and impact on utilization of restraints/seclusion and injury rates.  RELEVANCE/OUTCOMES: Safety in the work setting through the use of crisis aversion strategies is a strategy key to supporting a culture of safety. Outcome measures have shown a reduction in all parameters monitored and the opportunity for ongoing learning through reflective debriefing. IMPLICATIONS: Ongoing expansion of the current CPI program will incorporate annual refreshers, simulation, and inclusion of new courses focusing on trauma informed and applied physical techniques. Additionally, research using predictive measures of violence will be explored as a future strategy.


3017.2: Sensory Rooms: Decreasing Stressors and Symptoms by Stimulating Senses
Jessica Walker, BSN, RN-BC;Johnny Woodard, BSN, RN-BC

PURPOSE: A registered nurse working on an adult thought disorders unit conducted an evidence based practice project in an inpatient psychiatric hospital looking for a de-escalation tool to improve patient care and decrease violence. SUMMARY OF EVIDENCE: After searching the literature, the evidence of best practice showed that sensory rooms have contributed to a reduction in seclusion and restraint, a reduction in patients' stress and agitation, and an increase in patients' relaxation and cooperativeness. DESCRIPTION: A task force was formed to develop a sensory room and identify patient criteria for use, how to measure results, the construction, layout, and supplies, rules for usage, and how to train staff. The project was approved and funded by the stakeholders, the CEO, CMO, CNO, and nurse manager, who are executive leadership at the hospital. VALIDATION OF EVIDENCE: The measurable outcomes were the number of seclusions and restraints on the unit along with PRN medication usage for agitation both before and after the room's implementation and also scores of patient symptoms before and after a visit in the room.  RELEVANCE/OUTCOMES: There was a statistically significant reduction in number of patient symptoms recorded from before to after use of the room. There were no statistically significant differences in restraint use pre to post room implementation. The mean number of PRN medications administered did not differ from pre to post room implementation. IMPLICATIONS: Sensory rooms are feasible to implement and can be used for patient de-escalation and to improve patient care.




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