Annual Conference Saturday Abstracts

4011: Nurses Initiating Change:  Engaging Nurses in Development of Unit Orientation Pathways and Processes at an Inpatient Psychiatric Hospital
Gina Miglore, BSN, RN;  Marissa Boeding, BSN, RN; Jennifer Barut, PhD(c), MSN, RN-BC; Lori Harris, BSN, RN-BC

PURPOSE: A lack of standardized unit orientation, resulting in new hire and preceptor dissatisfaction, was identified through shared governance. Staff surveys highlighted need for unit-specific pathways and education to guide orientation experiences.  Many reported feeling unprepared to operate autonomously due to information overload and a practice of “see one, do one, teach one”. Inconsistent preceptor assignment and expectations resulted in an unreliable and often inadequate onboarding experience. SUMMARY OF EVIDENCE: The nationwide dilemma of nursing shortages necessitate improvement in retention efforts of the psychiatric nursing workforce. Comprehensive orientation pathways improve employee satisfaction, increase morale, and promote staff retention (Cuddy, 2015). Implementing a unit-specific orientation manual provides new employees with confidence needed in a new clinical area. Effective orientation supports destigmization of mental-health nursing, empowers nurses with vital mental health skills, and promotes professional success. DESCRIPTION: An interprofessional shared governance taskforce used facilitative processes and best evidence to develop unit-specific education and pathways guiding the preceptor-orientee partnership. Tools enable closed loop practices involving orientee, preceptor and leadership to validate knowledge acquisition and new hire readiness to function as an autonomous team member. Rollout of the pathway in a phased approach across units allows stepped evaluation of effectiveness. VALIDATION OF EVIDENCE: Leadership ensures best practice orientation occurs through mutual preceptor-orientee partnership. Ninety-day evaluations assess program effectiveness enabling process improvement. RELEVANCE/OUTCOMES: Implementation of structured orientation enhances employees’ confidence in the psychiatric setting by providing resources about protocols, risk assessments and procedures to enhance patient-centered care. IMPLICATIONS: Manual format and ongoing evaluations support continual process-improvement and supplementation of materials using employee feedback.


4012: Preparing Future PMHNPs to care for Child and Adolescent Psychiatric Needs through a Novel Core Competency and Specialized Practice Model
Tina Walde, DNP, PMHNP-BC;  Margaret Scharf, DNP, FNP-BC, PMHNP-BC; Nicole Bennett, MN, PMHNP-BC

PURPOSE: The move to lifespan preparation under the 2008 APRN Consensus Model necessitated creative approaches to provide adequate learning content and clinical placements for advanced practice psychiatric nursing students in the care of children and adolescents. SUMMARY OF EVIDENCE: The need for child and adolescent psychiatry is expected to increase by 100% between 1995 and 2020 (U.S. Bureau of Health Professions, DHHS, 2000). After the retirement of the child and adolescent psychiatric clinical nurse specialist exam in 2014, educational programs had limited guidelines for meeting the unique needs of this vulnerable population. DESCRIPTION: The model implemented at Oregon Health Science University meets generalist educational competencies as well as specialization and sub-specialization at the masters and doctoral levels in child and adolescent psychiatry. A description of child-specific courses in diagnosis and treatment, opportunities for practicum experience beyond minimum expectations, and the development of deeper learning experiences through focused coursework, robust practicum opportunities, and the DNP project will be presented. VALIDATION OF EVIDENCE: A retrospective qualitative review of the impact of this model on graduating student’s practicing with children in the community will take place. RELEVANCE/OUTCOMES: Lifespan trained PMHNPs offer an untapped resource for meeting the tremendous need for child and adolescent psychiatry services, particularly in areas with the most disparity such as rural and impoverished areas. IMPLICATIONS: Rigorous and targeted educational programs that offer robust learning opportunities may attract more students interested in this area, increase their marketability upon graduation, and prepare a cadre of leaders prepared to assume care in a complex health care environment.


4013: Report on the National Psychiatric Mental Health Advanced Practice Registered Nurse Survey
Kathleen Delaney, PhD, PMHNP-BC; Barbara Drew, PhD, PMHCNS-BC; Amy Rushton, MSN, PMHCNS-BC

PROBLEM STATEMENT: Psychiatric Mental Health (PMH) Advanced Practice Registered Nurses (ARPNs) provide psychiatric services essential to the mental health of our citizens. Yet scant data exist about the PMH APRN workforce; its size, distribution, types of services they most often provide and methods of psychotherapies used. THEORETICAL FRAMEWORK: A survey was designed in line with the national nursing workforce minimum data set-questions that are considered essential to nursing workforce surveys. Additional questions were added relevant to PMH nursing and psychotherapeutic interventions. METHODS & DESIGN: Method and Design:  The survey was conducted via on-line format during March 2016. A survey link and invitation to participate were sent to a national group of APRNs from a list purchased for the purpose of conducting the survey. RESULTS: Results: This paper will report on the findings of the survey, the PMH APRN workforce size, demographics, educational background, major activities, work place setting and geographic distribution. Additional data will be presented comparing the PMH APRN workforce to other APRN specialties on key elements of practice IMPLICATIONS FOR PRACTICE: Implications for Psychiatric Mental Health Practice: These data have implications for PMH APRN workforce development both in size and educational preparation. The findings will serve as a platform for discussions about the PMH APRN role in new integrated models of service delivery as well as other community based and hospital models. IMPLICATIONS FOR FUTURE RESEARCH: PMH APRN workforce surveys should be conducted on a regular 2 year cycle.


4014: The Explosion of a New Designer Drug - Flakka:  Implications for Practice
Deborah Salani, DNP, PMHNP-BC, ARNP;  Laura Albuja, DNP, FNP-C, MS.Ed

PURPOSE: Healthcare professionals need to be aware of a new synthetic designer drug, Flakka and how to manage the patients after drug ingestion.  A second generation cathinone, Flakka  (x-pyrrolidinopentiophenone, x-PVP) is an extremely potent stimulant.  Often Flakka is mixed with cocaine, heroin, and methamphetamine. The toxic mixture makes the symptoms severe and complicates management of the patient. SUMMARY OF EVIDENCE: Flakka inhibits the reuptake of norepinephrine, serotonin, and dopamine, causing excited delirium where clients display a range of different symptoms including insomnia, anger, anxiety, euphoria, excited delirium, paranoia, hallucinations, psychosis and death.  Hyperthermia may cause clients to remove their clothes and display naked delusional like behavior (Califano, 2015). DESCRIPTION: When clients become extremely agitated, this may lead to “excited delirium syndrome” which constitutes a medical emergency.   Clients may be aggressive while under the influence of Flakka and could be dangerous to themselves and others.  There is no antidote for Flakka, thus care is mostly supportive in nature. VALIDATION OF EVIDENCE: Management must be based on the client symptoms. RELEVANCE/OUTCOMES: Healthcare professionals must ensure the patient is safe and provide supportive care including intravenous fluids, benzodiazepines and aggressive cooling.  Safety is paramount, always be prepared for the unexpected with these clients.  If the client is violent, restraints and involvement of law enforcement may be necessary. IMPLICATIONS: New designer drugs are continuously hitting the market, healthcare professionals must play a key role in prevention, education and detection and removal of these dangerous agents in order to avoid abuse and serious side effects including death.


4015: Responding to the IOM (2015) Report on Psychosocial Interventions:  Application of the Perspectives of Psychiatry
Karan Kverno, PhD, PMHNP-BC, PMHCNS-BC;  Tamar Rodney, MSN, PMHNP-BC

PURPOSE: The purpose of this presentation is to introduce nurses to the Perspectives of Psychiatry (McHugy & Slavney, 1998) and describe how they provide a structure for matching specific psychotherapeutic interventions to the needs of individual patients. SUMMARY OF EVIDENCE: The 2015 IOM report on psychosocial interventions for mental and substance use disorders challenged mental health professionals to examine the "elements" of psychotherapy, that is, the specific strategies or interventions that make up and often cut across psychotherapeutic frameworks.  When psychotherapeutic frameworks are applied broadly to treat disorders (e.g., IPT or CBT for depression), it is often unclear what elements are effecting positive change. DESCRIPTION: By viewing each patient from four different perspectives (disease, dimensional, behavioral and life story), the clinician can better understand the origin of the patient’s problems and develop a comprehensive and personalized formulation and treatment plan.  Treatment goals flow directly from the causes of the problems: disease – medication; dimensional problems – guidance; maladaptive behaviors – interruption; and life story problems – rescripting. VALIDATION OF EVIDENCE: Research evidence supports the use of medications for treating disease-like problems (e.g., schizophrenia, bipolar disorder); consideration of dimensional characteristics (e.g., cognitive capacity, resilience and vulnerability) to provide guidance, behavioral interventions (e.g., ERP; reinforcement) to interrupt maladaptive behaviors; and rescripting/reframing personal narratives based upon stressful life encounters. RELEVANCE/OUTCOMES: Nurses can be leaders in establishing evidence-based standards of practice for person-centered psychotherapeutic interventions. IMPLICATIONS: The Perspectives of Psychiatry are a starting point for systematic reviews and comparison studies that will further identify and validate the elements of psychosocial interventions.


4016: Integrating Stages of Change into Day to Day Practice
Judith Magnon, BS, RN-BC, CAC

PURPOSE: Stages of change enhances the nurses and clients experience in treatment as understanding what stage the client is in allows the opportunity for the correct and most effective interventions to be used.  It was developed for substance use disorders and works with mental health, medical and other disorders. SUMMARY OF EVIDENCE: This model is based on the book: Changing For Good by J. Prochaska, Ph.D, J. Norcross, Ph.D, C. DiClemente, Ph.D.  They researched how people stopped smoking, leading to the development of Stages of Change.  This model has been used since 1994. DESCRIPTION: Dartmouth Psychiatric Research Center completed the co-occurring disorders research and wrote the manual on Integrated Dual Disorders Treatment, which includes this model of treatment. It is being used in multiple settings, including in ACT (Assertive Community Treatment) teams.  WestBridge uses this model in all of its programs.  SAMSHA has validated use of this model of care. VALIDATION OF EVIDENCE: As noted above the National Institute of Drug Abuse supports use of this model as well as Dartmouth Psychiatric Research Center in NH.  I have provided consultation on this model to multiple providers in the USA, England, Australia, etc.  The book has been in print since 1994 and the authors have provided training all over the world. RELEVANCE/OUTCOMES: This model of care has been used for over 20 years and has been demonstrated to be effective in all areas of practice, in-pt and out-pt practice. It enhances job satisfaction. IMPLICATIONS: As nurses embrace this model, clients will improve and experience a new level of recovery.


4017: Historical Trauma and Mental Health among Native Americans
Nicholas Guenzel, PhD, APRN-NP

PURPOSE: The purpose of this presentation is to detail ways in which nurses must account for historical trauma in the treatment of Native Americans to achieve optimal mental health outcomes. SUMMARY OF EVIDENCE: Historical trauma has been associated with increased depression, anxiety, and drug use among Native Americans. Additional research has implicated historical trauma in elevated rates of poverty, crime, low educational attainment, and child/domestic abuse. DESCRIPTION: Assessment of historical trauma and the engagement of traditional Native American healing practices has been shown to improve mental health outcomes. Two tools assessing historical trauma have been developed. Additional instruments measure ethnic identity, perceived discrimination, and social affiliation which have shown interactions with historical trauma. In addition, specific questions are used to assess an individual’s need for traditional treatments in what has been called “retraditionalization.” VALIDATION OF EVIDENCE: Although no formal studies have been conducted in this area, a published conceptual nursing model including historical trauma among Native Americans will be reviewed. Insights from experienced Native American practitioners will also be shared. RELEVANCE/OUTCOMES: Nurses treating Native Americans must incorporate an understanding of historical trauma into their treatment in order to provide individuals with the highest quality care and facilitate the best patient outcomes. IMPLICATIONS: Nursing techniques for historical trauma should be used with the current generation to help reduce transmission of historical trauma to future generations. In addition, understanding and treating historical trauma among Native Americans can help lay the foundations for expanding treatment to other disadvantaged minorities including African Americans and refugees.


4021: Novelties and Innovations in Assessing Competency in Psychiatric Mental Health Staff Nurses
Nellie Sun, MSN, RN;  Kathleen Zavotsky, PhD, RN, CCRN, CEN, ACNS-BC

PURPOSE: To describe in detail the steps that were taken in the development of a unique process at RWJUH- Somerset to assess competency in the psychiatric mental health staff nurses which include development of a competency based orientation manual specifically for this specialty and a skills fair day. SUMMARY OF EVIDENCE: In 2013 RWJUH acquired an additional Magnet designated campus through a full acquisition merger, RWJUH-Somerset. This merger allowed the Center for Professional Development, Innovation and Research, which consists of 30 Clinical Nurse Specialists (CNS)/ Clinical Nurse Educators (CNE's), that an update to how competency was validated in psychiatric mental health nurses was needed on the newly acquired campus. The CNS/CNE's collaborated with various hospital departments at RWJUH-Somerset and developed an innovative way to validate competency in this very valuable specialty. DESCRIPTION: Why the change? Psychiatric Services offered in the Somerset Campus- Acute Psychiatric Services and Eating Disorder Unit; Care that needed to be based on best practice; standards of care; allocation of resources; competency for the Behavioral Health Staff and ED Staff VALIDATION OF EVIDENCE: This project was lead by the CNS/CNE  group and consisted of case studies, simulation, team games and a fact check station. Each station focused on the psychiatric patient specifically. RELEVANCE/OUTCOMES: Developing competency evaluation methods that are meaningful to staff nurses is crucial; give them new tools to help maintain exemplary practice and positive empirical outcomes. IMPLICATIONS: Nurses must ensure that their practice remains within the limits of their own competence, professional code of ethics, and professional practice standards. (APNA)


4022:  Enhancing Child and Adolescent Content & Clinical Training in Advanced Practice Psychiatric Nursing Programs:  A Joint Workshop from the APNA Child & Adolescent Council and the APNA Education Council, Graduate Branch
Pamela Lusk, DNP, RN, PMHNP-BC;  Jason Earle, PhD, PMHNP-BC; Erin Ellington, DNP, RN, PMHNP-BC

PURPOSE: Board Certification for PMHNP’s is now “across the lifespan”. Graduate programs for advanced practice psychiatric nurses must include child/ adolescent content to meet the ANCC requirements/ NONPF competencies. This workshop will feature a panel of graduate faculty in PMHNP programs from different geographical areas of the country, using different educational delivery formats (online, hybrid, on campus) and with varying clinical resources –discussing how they incorporate child/ adolescent content and arrange for clinical experiences with these age groups for all of their students. SUMMARY OF EVIDENCE: Evidence will be presented  that supports methods of teaching and providing clinical training for graduate nursing students. DESCRIPTION: Panelists will share how they have creatively leveraged the community psychiatric resources to provide quality clinical experiences for their graduate psychiatric nursing students.  Examples include: providing didactic/ experiential  training in CBT for children, (Online, and brick and mortar presentation), an 8 week clinical training. VALIDATION OF EVIDENCE: Graduate Student outcomes and feedback will be shared.  The panelists have been collecting outcome data, and student evaluations re: effectiveness of the specific educational approaches they are using in their graduate programs. RELEVANCE/OUTCOMES: PMHNP programs are incorporating didactic and clinical experiences with children and adolescents to educate the students to care for patients across the lifespan. This specialty area is new for many graduate programs. This workshop will include time for questions, discussion, sharing of teaching resources and active interaction with workshop participants. IMPLICATIONS: Create an ongoing  forum where child/ adolescent age related PMHNP learning/ teaching exemplars can be shared.


4023: Florence Nightingale Meets the New Generation of Evidenced-Based Practice:  A Tale of Collaborative Inquiry
Diane Hurd, BSN, RN-BC; Keri Cross, BSN, RN-BC; Heather Landon, BSN

PROBLEM STATEMENT: Suicide is the 2nd leading cause of death among adolescents in the United States.  The need for rapid treatment of depression and suicidality in the adolescent population has prompted this team to implement an evidence-based protocol known as triple chronotherapy on an inpatient psychiatric youth treatment unit. THEORETICAL FRAMEWORK: The theoretical framework which best captures the work of this team is Nightingale’s Environmental Theory (Nightingale, 1869). The triple chronotherapy procedure is a nurse-driven, environmental manipulation of sleep cycles and exposure to bright light to promote rapid recovery from acute depression and suicidality. METHODS & DESIGN: The triple chronotherapy protocol used with adults by Sahlem, et al (2014) will be used by this team to treat adolescents.  IRB approval has been obtained for an open label pilot study using the same protocol with measurements more specific to the adolescent population. RESULTS: The literature indicates that adjunct triple chronotherapy has been established as evidence-based practice in the treatment of depression in the adult population.  Trials with adolescents on an inpatient psychiatric unit indicate that similar results can be achieved with adolescents. IMPLICATIONS FOR PRACTICE: Acute depression and suicidality call for emergent treatment.  Currently, antidepressant treatment may take between 6 - 8 weeks to achieve even partial remission.  Triple chronotherapy offers rapid treatment, often achieving complete remission of symptoms within the first few days of treatment. IMPLICATIONS FOR FUTURE RESEARCH: Research on triple chronotherapy in the adolescent population is nonexistent.  This team aims to establish the feasibility of triple chronotherapy as an adjunct treatment for acute suicidality and depression in the adolescent population.


4024: Electronic Nicotine Delivery Systems (ENDS):  Information and Discussion on Electronic Cigarettes and “Vape Pens”
Carol Essenmacher, PMHCNS-BC, DNP, CTTS;  Carolyn Baird, DNP, MBA, RN-BC, CARN-AP, CCDPD, FIAAN

PURPOSE: Current evidence shows mental health (MH) nurses are often not knowledgeable or comfortable providing nicotine dependency treatment. This presentation provides a learning forum for nurses to gain practical knowledge about ENDS. SUMMARY OF EVIDENCE: Duffy et al (2012) and Rice & Stead (2004) show that nurses have historically been reluctant to provide interventions for nicotine dependent patients. Trained and educated nurses do provide effective interventions. New devices such as ENDS can obfuscate pharmacological recommendations, so nurses need updated information. DESCRIPTION: Current evidence shows psychiatric mental health patients do want to quit tobacco use, yet are not consistently offered effective treatment (Duffy et al., 2012). ENDS are heavily marketed to appeal to people as a means of quitting tobacco use, but new evidence shows dual tobacco and ENDS use is the  norm. VALIDATION OF EVIDENCE: Dual ENDS and tobacco use places persons MH patients at high risk for harm. Nurses must be informed about ENDS in order to deliver appropriate interventions. Evidence is scant that specific nursing education and training about ENDS occurs. This presentation seeks to begin to correct that deficiency. RELEVANCE/OUTCOMES: Nurses are the largest category of health care clinicians, seeing patients in a variety of settings. MH nurses who feel competently trained can clarify information about ENDS, opens opportunities to help patients quit. IMPLICATIONS: This presentation will improve nursing understanding about treatment implications of current literature about ENDS.  Nurses are the largest category of clinicians and have a responsibility to acquire and translate new information into practice.


4025: Ending the Identity Crisis:  The Resurrection of Psychotherapy in Contemporary PMH-APRN Practice
Donna Rolin, PhD, APRN, PMHCNS-BC;  David R. Goen, MSN, PMHNP-BC; Sherrie Margiotta, MSN, PMHNP-BC; Angela Retano, RN, PMHNP-BC

PURPOSE: The Psychiatric Mental Health-Clinical Nurse Specialist (PMH-CNS) was the first Advanced Practice Registered Nurse (APRN) role developed by Hildegard Peplau in 1955, and psychotherapy was the central focus of mental health service. The evolution of the role of the Psychiatric Mental Health-Nurse Practitioner (PMH-NP) as the contemporary PMH-APRN de-emphasized psychotherapy. SUMMARY OF EVIDENCE: During the 1960s and 1970s, the PMH-CNS graduate curricula included content on psychotherapy and the therapeutic use one’s self. The evolution of the PMH-NP graduate curricula in the 1990s shifted its emphasis to a primary care model of assessment, which moved the PMH-APRN role away from a traditional therapy model to one of psychoeducation, brief therapy, and interventions focusing on diagnosis and pharmacotherapy. DESCRIPTION: Now is the time to re-integrate psychotherapy into the standard of practice for the PMH-APRN graduate level curriculum and into clincal practice. VALIDATION OF EVIDENCE: The psychotherapy modalities of psychodynamic psychotherapy, cognitive behavioral therapy, and interpersonal therapy have shown high efficacy in research trials for the treatment of psychiatric disorders. In fact, these modalities have been shown to be as effective as antidepressant medications. RELEVANCE/OUTCOMES: Yet, there continues to be a steady decline in teaching psychotherapy in advanced education and its use by the PMH-APRN in practice. Peplau’s vital emphasis on the nurse-patient relationship has yet to be fully implemented. IMPLICATIONS: Current barriers seem to include an emphasis on cost containment, preventative health care and medication management for potentially faster symptom relief. However, proper emphasis on psychotherapy is essential for best practice in psychiatric care.


4026: The Importance of Patient Engagement to Achieving Recovery
Edward Herzog, MSN, APRN-CNS

PURPOSE: True therapeutic engagement is central to patient recovery yet seems to be too often neglected in clinical practice. This presentation will discuss engagement (or the lack thereof), factors that limit or promote it, and solutions for improving it. SUMMARY OF EVIDENCE: Observations of clinical practice have suggested that true therapeutic engagement is not occurring on a consistent basis. Some speculate that the emphasis on the biological basis of illness has led to a de-emphasis of the interpersonal aspects of care. Patients too often see staff as providing medication and responding to crises, but not as caring professionals truly invested in their recovery. DESCRIPTION: Nurses learn nursing roles while in nursing school, and subsequently via actual practice. If their educational and clinical role models do not themselves value and demonstrate patient engagement, students in turn will practice similarly, to the patients' and their own detriment. VALIDATION OF EVIDENCE: Too often psychiatric nursing is taught by faculty who are not themselves psychiatric nurses, or who have not themselves come to understand engagement or appreciate its importance to recovery. Funding cutbacks, staff stress and burnout, and a dearth of positive role models all contribute to reduced engagement, which in turn leads to negative outcomes such as treatment non-adherence. RELEVANCE/OUTCOMES: Trusting therapeutic relationships are essential to recovery yet not consistently practiced by many nurses. IMPLICATIONS: Clinicians' understanding and appreciation of engagement, currently on the wane, can be enhanced and increased. Doing so will enhance patient recovery and improve their prognosis, in turn reducing societal and healthcare costs and increasing job satisfaction for staff.


4027: The Assessment and Management of Impulsive and Compulsive Phenotypes of Severe Trauma-related Disorders
Aaron Miller, MS, RN, PMHNP-BC;  Rosalind De Lisser, MS, RN, PMHNP-BC, FNP-BC

PURPOSE: To recognize the symptoms and understand the management of the impulsive/compulsive symptom cluster of severe trauma-related disorders. SUMMARY OF EVIDENCE: 70% of individuals in the US have experienced some type of traumatic event in their lifetime.  It is now well-known that the majority of individuals that report exposure to trauma have suffered multiple and/or prolonged, traumatic experiences rather than a single event. This can lead to a spectrum of severe trauma-related disorders. This includes Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, Posttraumatic Stress Disorder and potentially the development of co-morbid Personality Disorders. Often seen with these diagnoses is a presenting symptom cluster of impulsive and compulsive behaviors.  This phenotypic symptom cluster may include substance abuse, antisocial behaviors, interpersonal instability and violence, binge-eating and purging, deliberate self-harm, and risky sexual behavior. This impulsive/compulsive cluster can be particularly challenging for clinicians to assess and treat, and present a risk for psychiatric co-morbidity and deterioration. DESCRIPTION: This presentation will examine the impact across the lifespan of impulsive/compulsive symptomatology related to severe trauma related disorders. Three case studies will be presented to illustrate the neurobiological underpinnings and longitudinal course of this impulsive/compulsive symptom cluster. VALIDATION OF EVIDENCE: Current evidence and consensus-based treatment modalities for effective assessment and management of these symptom clusters will be discussed. RELEVANCE/OUTCOMES: Psychiatric nurses are often the first responders to assess and treat individuals affected by prolonged trauma and thus require unique skills with which to engage and provide care. IMPLICATIONS: Trauma-related disorders may be conceptualized as a spectrum disorder, with distinct clusters of symptoms, including the impulsive/compulsive subtype.


4031: "Leading Through the Night"  How an Inpatient Psychiatric Hospital Successfully Engaged and Empowered their Night Shift Staff
Joyce Streeter, BSN, RN-BC;  Nancy Moore, MSN-BC

PURPOSE: Engagement of night shift staff in non-mandatory activities has been and continues to be difficult.  Due to work conflicting sleep/wake patterns often the night shift staff are isolated from the important activities and opportunities that are offered to the other shifts.  This is not limited to our inpatient psychiatric hospital. SUMMARY OF EVIDENCE: Night shift staff had a lack of engagement and sense of belonging in relationship to the other shifts. DESCRIPTION: Our transformational leadership, especially our CNO, provided amazing support and resources needed and made himself available during the night shift hours. A night shift committee was developed and nurtured. Inservices and meetings were offered at times convenient for night shift staff. VALIDATION OF EVIDENCE: Outcomes were measured by increased attendance and participation in committees and projects and professional advancement.  Increased feelings of belonging and value voiced by night shift staff. RELEVANCE/OUTCOMES: Board certification increased from none to six.  Committee attendance has doubled.and is finally lead by night shift staff. IMPLICATIONS: Implementing the changes described in our presentation have shown to be beneficial to our inpatient hospital and will help other hospitals engage and empower their own night shift staff.


4032: Integrating Mental Health Topics into a Family Practice Primary Care Curriculum
Shonda Phelon, DNP, APMHNP-BC, FNP-BC, GNP-BC;  Sueanne Davidson, DNP, FNP-BC

PURPOSE: The purpose of this presentation is to examine how mental health topics were integrated into a successful Master's Family Nurse Practitioner Program through the collaboration of Psychiatric Nurse Practitioners and  Family Nurse Practitioners. SUMMARY OF EVIDENCE: Nearly 50% of all primary care office visits involve a mental health complaint. In many areas family nurse practitioner's are the primary care providers for most patients, including those with mental illness. There is a shortage of mental health providers and often family nurse practitioners fill this void.It is imperative that family nurse practitioners be educated on what illnesses they can treat and when to collaborate or refer. DESCRIPTION: In a family nurse practitioner curriculum there is a strong focus on diagnosing and treating mental health conditions. This education prepares the NP to treat many common illnesses in  areas where there is a shortage of psychiatric nurse practitioners. Students are taught basic diagnosis and treatment as well as collaboration and referral with psychiatric nurse practitioners. VALIDATION OF EVIDENCE: Basic mental health issues including depression, anxiety, insomnia, and adhd are a part of family nurse practitioner education and practice. Integrating robust teaching of psychiatric content throughout the family nurse practitioner curriculum collaborating with and utilizing psychiatric nurse experts provides the best instruction and foundation for care. RELEVANCE/OUTCOMES: Psychiatric Nurse Practitioners are experts on mental health issues and are vital for collaboration with as well as educating other primary care providers. IMPLICATIONS: The current model exemplifies how important Psychiatric Mental Health Nurse Practitioners are to the education of Family Nurse Practitioners.


4033: Assessing the Mental Health Needs of First Responders:  A Systematic Review
Sara Jones, PhD, APRN, PMHNP-BC

PROBLEM STATEMENT: The frequency, nature, and intensity of duty-related traumatic exposures put firefighters, paramedics, and emergency medical technicians at high risk for developing mental and substance use disorders. However, the stigma attached to mental illness and culture of self-reliance among first responders deter many from reporting symptoms and help-seeking. This limits our abilities to provide evidence-based mental health services to this population. THEORETICAL FRAMEWORK: The Institute of Medicine proposes a framework for establishing evidence-based psychosocial interventions. It aims to use consumers’ experiences to inform the overall processes of development and implementation of these interventions. METHODS & DESIGN: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify the prevalence of mental disorders among first responders. Research articles published in English (2000-2015) were included. Studies aimed at interventions, physical health, law enforcement, and specific critical incidents were excluded. RESULTS: Twenty-eight articles met inclusion criteria, of which, 18 focused on post-traumatic stress disorder (PTSD). First responders met criteria for PTSD at a rate of 18-37%, and had a suicide risk 25 times that of general populations. Studies estimated rates of depression at 7-22%; anxiety at 4-22%; binge drinking at 34-56%; and, sleep problems at 58-70%. IMPLICATIONS FOR PRACTICE: While it is important to routinely assess for trauma, this practice has traditionally been done with veterans and abuse victims. This review emphasizes the importance of assessing for trauma among first responders. IMPLICATIONS FOR FUTURE RESEARCH: This review will guide future research to explore the mental health needs of first responders and inform the development of tailored mental health interventions.


4034: Practice and Dissemination of EBP:  Behavioral Couples Therapy for Alcohol/Drug Dependence in the Veterans Administration
Steve Gentz, MSN, PMHCNS, NP

PURPOSE: Describing an evidenced based practice in use by and discriminated to nurses treating veterans with SUDs. SUMMARY OF EVIDENCE: Multiple research studies in veteran and non-veteran populations primary by O'Farrell. DESCRIPTION: 12 week couples therapy. VALIDATION OF EVIDENCE: Outcomes measured by couples assessment tools. RELEVANCE/OUTCOMES: Successful dissemination of this practice to APN's and other therapists treating  veterans. IMPLICATIONS: Increased need in the veteran population and the general population.  Victims of the current opiate epidemic is a potential target of this intervention. The VA roll out process might be used within our profession.


4035: Self-reflective Practice:  A Critical-reflection Workshop for Building Reflective Skill in Clinical Practice and Training
Rosalind DeLisser, MS, FNP, PMHNP;  Aaron Miller, MS, PMHNP

PURPOSE: Self-reflective practice is linked to increased empathy, engagement, improved awareness of biases, and better communication.These skills are necessary to promote clinician empowerment and prevent burnout. SUMMARY OF EVIDENCE: Critical-reflection is a technique used to build self-reflective practice and is well documented in the literature. Active critical-reflection has shown to improve clinical decision making, patient outcomes, improve clinician work place satisfaction, and decrease burn out. Critical-reflection is defined as the process of analyzing, questioning, and re-framing a personal experience to enhance learning and inform future behavior. DESCRIPTION: In this workshop we will present two experiential exercises for engaging in critical reflection: a verbal and written critical-reflection. Exercise 1: Participants will be given a scenario and will respond in a “think-pair-share.” In this verbal exercise we will identify common themes and model the use of this technique for use as an individual and for use on teams wishing to improve reflective capacity. Exercise 2: Participants will listen to an audio clip and will engage using the written critical-reflection.Participants will share their reflections and a guide for enhancing reflective writing will be presented. VALIDATION OF EVIDENCE: Active critical-reflection engages the learner through 1) content reflection—describing the problem or situation; 2) process reflection—finding strategies to solve the problem; and 3) premise reflection—questioning assumptions, values, or beliefs that underlie the situation. RELEVANCE/OUTCOMES: Self-reflective exercises such as this are often found in academic settings, however, can be used by professionals in the workplace environment to enhance professional development and lifelong learning. IMPLICATIONS: Self-reflective practice enhances psychiatric nursing empowerment and prevents burnout.


4036: From Command and Control to Celebrating the "WE" in Wellness and Recovery:  Inspired Culture Change in Acute Mental Health
Mary Laufer, DNP, RN, NE-BC;  Amy Monger, RN-BC; Ramona De La Cruz, RN

PURPOSE: Have we disenfranchised our patients by discounting their self-determination and feedback based on mental illness? When and why did we become “the boss of them?” Triggered by restraint statistics, patient satisfaction and employee engagement surveys, nursing leaders challenged staff of a 48-bed acute mental health hospital to examine illness-centered unit customs and folklore influencing daily practice. SUMMARY OF EVIDENCE: Evidence supporting cultural transformation includes recovery-oriented principles outlined in the American Psychiatric Nurses Association (APNA) Recovery to Practice (RTP) curriculum. Additionally, Ragins’s (2011) emphasizes hope, shifting the practice paradigm from treating deficits to building on strengths of persons with mental illnesses. DESCRIPTION: Culture change strategies include staff RTP education, 3-day immersion training through Mental Health America, as well as peer guests (former patients) and table topics at monthly staff meetings. Wellness and recovery stakeholders include patients, mental health nurses at all levels, psychiatry residents, and the interdisciplinary team. Sustained practice change requires new language to communicate person-centered focus. Treatment goals truly reflect the patient’s voice: “To me, recovery means I will be able to….” Newly developed recovery-oriented programming includes weekly groups presented by representatives of clergy, food and nutrition, and pharmacy. VALIDATION OF EVIDENCE: Evaluation methods of culture change are restraint use, patient satisfaction and employee engagement surveys. RELEVANCE/OUTCOMES: Exciting results in 2015 include 31% restraint episode reduction, 11% improvement in patient hopefulness, and the highest staff engagement results since 2009! IMPLICATIONS: Future plans involve partnering with former patients to revise milieu treatment and create peer mentor program, training psychiatry residents in RTP, and sharing unique treatment plans through APNA.


4037: Young Urban Female Survivors of Commercial Sexual Exploitation and Trafficking: Complex Trauma and An Integrated Model of the Path to Recovery
Joan Kearney, PhD PMHCNS APRN; Mary Byrne, PhD, PNP; Jessica Trudeau, MPH; Jasmine Johnson, MSW; Mary Lauren Magargee, BS, RN; Patricia Semeraro, PhD, CNM

PROBLEM STATEMENT: There is no commonly accepted understanding of trauma recovery in young female survivors of commercial sexual exploitation and domestic trafficking. To address this gap, this study examined complex trauma and the nature of  recovery in a group of young urban female survivors receiving services through a model program in NYC. THEORETICAL FRAMEWORK: Harvey's ecological theory of trauma recovery was used as a theoretical frame of reference as well as Herman's, Courtois' and others' work on the construct of complex trauma METHODS & DESIGN: Qualitative descriptive design was employed using individual and focus group interviews. Thirty one young women using GEMS services, 7 staff members, 4 persons in GEMS leadership roles and 2 from another leading agency were interviewed. A semi-structured interview guide examined the nature of trauma recovery in this context. Data was analyzed using emergent content analysis. RESULTS: Findings suggest a multifaceted model of trauma recovery specific to this group encompassing relational, psychological, behavioral, and social processes. Extension is made to specific characteristics, processes, and issues in these young women as they reflect a complex trauma trajectory. IMPLICATIONS FOR PRACTICE: This seminal study informs current thinking and practice on intervention course and outcome in this high risk group of young women. Clinical implications indicate the need for trauma- informed approaches which consider the uniquely dynamic, complex and long term nature of recovery in this population. IMPLICATIONS FOR FUTURE RESEARCH: Future research must incorporate an ecological , trauma-informed approach which considers all aspects of recovery in this population


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