2016 Annual Conference Pre-Conference Session Abstracts

1011: The Community Resiliency Model (CRM):  Mental Wellness Self-Care
Linda Grabbe, PhD, FNP-C, PMHNP-BC;  Dorothy Jordan, DNP, APRN, PMHNP-BC, PMHCNS-BC

Abstract
PURPOSE: Early trauma experiences may be associated with emotion dysregulation, anxiety, and depression in our patients.  This is a “how to” session on the Community Resiliency Model (CRM). CRM Trainers Grabbe and Jordan will discuss the neuro-physiologic basis for the model and engage learners in practice. SUMMARY OF EVIDENCE: A new direction in mental health care is a “bottom-up” (as opposed to a “top-down” or cognitive) approach, using somatic techniques.  The Community Resiliency Model (CRM) is a research-informed modality that draws on foundational work in the area of somatic experiencing (Miller-Karas, 2015).  This is an innovative, "promising" practice (DOD).  CRM mental wellness skills can be easily taught and applied in a short period of time in diverse settings. DESCRIPTION: A key concept of CRM is the Resilience Zone (RZ), where the nervous system is in balance and we are our “best selves.”  Stress and traumatic events may cause us to leave our RZ and get stuck in a hyper-aroused state (irritable, anxious) or hypo-aroused state (disconnected, depressed).  CRM techniques can widen the RZ or teach individuals how to return to the RZ when “bounced out.” VALIDATION OF EVIDENCE: Research findings thus far will be presented. RELEVANCE/OUTCOMES: Both RNs and APRNs can take leadership opportunities within their organizations to learn more about this cutting-edge approach and will be able to apply basic CRM skills for their own mental well-being.  CRM research protocols will be presented. IMPLICATIONS: This is an innovative approach to mental wellness.  Because of its simplicity, CRM may be highly valuable in diverse settings.

 

1012: Implementation and Evaluation of a Clinical Hybrid Program in a Psychiatric Mental Health Nursing Undergraduate Course
Nancy Bowllan, EdD, CNS, RN

Abstract
PURPOSE: Increasing nursing student enrollments, competition for clinical sites and limited access to qualified clinical instructors became the impetus for creating this innovative mental health clinical hybrid program (MHCHP) in a baccalaureate nursing program. SUMMARY OF EVIDENCE: In a longitudinal study, the National Council of State Boards of Nursing provided substantial evidence that standard clinical competencies and learning outcomes could be maintained with replacing up to 50% of traditional clinical with clinical simulation. Currently, minimal evidence exists regarding the potential impact of mental health simulation on student learning outcomes. DESCRIPTION: With the support of administration, engagement of seasoned clinical instructors and training, a variety of simulation experiences were developed including mock clinical interviews, mental status examination, self-awareness and debriefing processes, suicide interventions, care of actively psychotic patients, drug and alcohol withdrawal, impact of stigma and consumer perspectives, non-violent crisis intervention training and mock psychoeducational groups. VALIDATION OF EVIDENCE: Students who received the MHCHP (three cohorts) are compared to students who received the traditional inpatient clinical experience (three cohorts) on test averages, final grades and ATI test scores Fall, 2013 to Spring, 2016. In addition, narrative feedback is analyzed for experiential themes. RELEVANCE/OUTCOMES: Preliminary findings comparing two cohorts reflected a 23% increase in student achievement of proficiency level 2 or better on ATI exams with positive student feedback. Final data collection to be completed May, 2016. IMPLICATIONS: This innovative MHCHP has the potential to strengthen academic outcomes and enhance clinical competencies to address an array of mental health needs. New psychiatric nurses may also benefit from exposure to these simulation experiences.

 

1013: EMDR Therapy for Pain and Fibromyalgia
Kate Wheeler, Ph.D., PMHNP-BC, APRN, FAAN

Abstract
PURPOSE: This preconference will review and examine the neurophysiology of trauma-related medical illness such as fibromyalgia and chronic pain and the relationship between these disorders and PTSD. The phases and protocol for EMDR therapy for these and other medical disorders will be presented through the use of a video and a case study. SUMMARY OF EVIDENCE: Eye Movement Desensitization & Reprocessing (EMDR) therapy, an innovative and evidence-based treatment for trauma, anxiety and depression, is included in many national and international practice guidelines for the treatment of acute and posttraumatic stress disorder (PTSD).  Research is presented on the use of EMDR therapy for fibromyalgia and pain. DESCRIPTION: The phases and protocol for EMDR therapy for these and other medical disorders will be presented through the use of a video and a case study. VALIDATION OF EVIDENCE: Outcomes were measured through SUD (subjective unit of disturbance) Scale as well as the patient's pre/post images depicting pain. RELEVANCE/OUTCOMES: Significant positive outcomes were obtained after EMDR therapy. IMPLICATIONS: Integrating EMDR therapy into the treatment of pain and fibromyalgia is suggested.

 

1014: CBT for Child/Adolescent Inpatient Groups and Brief Outpatient Visits.  An In-depth Training Workshop for Psychiatric RNs & APRNs to implement a Cognitive Behavioral Skills Building Intervention (COPE) with Children and Adolescents in their Treatment Settings
Pamela Lusk, DNP, RN, PMHNP-BC

Abstract
PURPOSE: COPE, a CBT based Intervention -  for children & adolescents has been delivered in  brief  outpatient visits & psychiatric inpatient  groups  with  positive clinical outcomes and patient satisfaction.  With this COPE training workshop,  the psychiatric nurse, as well as the PMHNP will be prepared to provide active, CBT based treatment for children/ adolescents. SUMMARY OF EVIDENCE: Systematic reviews, - support CBT as an effective intervention for children/ adolescents.  COPE - CBT sessions can be delivered in brief individual visits and in groups with good clinical outcomes, reimbursement and patient satisfaction. COPE is a NCI -  RTIP research tested intervention program. DESCRIPTION: COPE  is a CBT based program - in a 7 session Child or Teen manual. Psychiatric nurses as well as PMHNP's can be trained to implement  this active- CBT program in group or individual format in inpatient psychiatric settings and  busy outpatient  practices. VALIDATION OF EVIDENCE: 15 COPE Publications - re: effectiveness of COPE, ( JAPNA, Journal of Pediatric Health Care). RCT with COPE (800 High School students) published AJPM. RELEVANCE/OUTCOMES: In our published studies, with COPE, Children and Adolescents had decreased anxiety and  depression and increased self esteem.  Parents and youth reported the intervention was interesting &  helpful. Psychiatric RN's as well as PMHNP's, can be trained to deliver COPE to their patients. IMPLICATIONS: If  PMH nurses and PMHNP's  implement  COPE into their settings , more children and adolescents will get the active,  evidence-based treatment they need. With COPE, CBT can be delivered by nurses leading groups as well as in individual sessions -  inpatient or outpatient.

 

1015: Pharmacology of Medical Cannabis
Caroline Tassey, MSN PMHNP-BC

Abstract
PURPOSE: Twenty three states and DC  have legalized medical marijuana (cannabis), and a growing number of states are decriminalizing recreational marijuana.  As  a result,  an increasing number of psychiatric patients  are likely to be using marijuana in combination with prescribed psychoactive medications. SUMMARY OF EVIDENCE: Psychiatric providers have had little preparation around the pharmacology of cannabis.  We have generally viewed it only as a substance of abuse and advised our patients to avoid it. Distinguishing myths from realities is difficult when a drug is socially controversial. DESCRIPTION: Clients are already using cannabis for chronic pain, anxiety, sleep and other issues.   Psychiatric NPs are eligible to authorize medical marijuana in states where it is legal. They may be called on by primary care providers  to advise on drug interactions or indications for medical cannabis. VALIDATION OF EVIDENCE: There is a growing body of research focusing on our natural endocannabinoids as well as the physiologic effects of phyto-cannabinoids and their pharmacodynamics and pharmacokinetics.  A number of synthetic cannabinoids are in trials, and  three FDA approved cannabis medications are currently available.by prescription. RELEVANCE/OUTCOMES: Psychiatric nurses need a basic understanding of the pharmacology of cannabis and its potential medical uses.  They need a realistic basis for providing education on healthy practices and risks. IMPLICATIONS: As laws change, psychiatric nurses will encounter more clients using cannabis for medical issues as well as recreationally.  With a sound understanding of the pharmacology of cannabis, they will be best able to advise and assist clients

 

1016: Advanced Practice Psychotherapy:  Next Steps to Develop Intensive Treatment Approaches - Part 1
Kathryn Johnson, PMHNP-BC; PMHCNS-BC;  Sattaria Dilks, DNP

Abstract
PURPOSE: To demonstrate effective use of psychotherapy in various practice settings. SUMMARY OF EVIDENCE: As PMH graduate education has shifted from training clinical nurse specialists to nurse practitioners, there is wide variability in the amount of psychotherapy content offered.  New psychiatric APRNs often find themselves working in agencies that expect them to see high volumes of patients and place emphasis on  diagnostic evaluation and psychopharmacologic interventions, often at the expense of providing psychotherapy. Based on the NONPF PMHNP core competencies, students must meet content specific competencies in psychotherapy theories, including evidence-based psychotherapy modalities. Additionally, students must complete an academic program of study meeting ANA’s Scope and Standards, and ANCC’s PMHNP Certification Eligibility Criteria, which includes clinical training in at least two psychotherapeutic treatment modalities.  Thought leaders in psychiatric mental health nursing have identified a need to train a PMHNP workforce who is prepared to work within the full scope of their practice, and this includes being able to provide psychotherapy  (Delany, K., Hamera, E., & Drew,B.). DESCRIPTION: Novice PMH-APRNs are challenged with developing and staying abreast of psychotherapeutic skills and with how to implement these skills in various practice settings. VALIDATION OF EVIDENCE: Evidence is validated by PMHNP core competencies and by responses from a survey completed by the APRN Steering Committee. RELEVANCE/OUTCOMES: PMH APRNs must be prepared to provide psychotherapy at a novice level upon graduation and must engage in life-long learning which should include content on psychotherapy. IMPLICATIONS: Exposure to several psychotherapeutic approaches will allow participants to determine which therapies best fit their practice settings and patient populations.

 

1021: DBT for Inpatient Psychiatry, a Tool for Recovery Programming
Judy Linn, BS, MSN

This session has been cancelled by the presenter.

Abstract
PURPOSE: Limited inpatient stays require efficient, yet powerful tools to assist patients in their recovery.  DBT skills training empowers patients to leave the hospital with immediate tools to facilitate their recovery. SUMMARY OF EVIDENCE: DBT has proven to improve inpatient outcomes and satisfaction. DESCRIPTION: Mindfulness and Distress Tolerance Skills Groups can be learned by inpatient psychiatric nurses with minimal in-service time to improve patient outcomes for depression, links to wellness and recovery plans, and patient satisfaction. Most diagnostic groups of inpatients have reported benefit from select DBT priniciples and skills groups. VALIDATION OF EVIDENCE: In an unpublished study at University of Colorado Inpatient Unit 80% of patients reported an improvement in depression using the PHQ9.  Patients also maintained over a 90% patient satisfaction with programing and nursing on the Press Ganey Patient Satisfaction  Questionnaire for more than 12 months. RELEVANCE/OUTCOMES: PMH nurses seek to partner with patients to instill hope for recovery.  By introducing skills for distress tolerance at the time of crisis the PMH nurse provides the patient skills to moderate their illness and its symptoms. IMPLICATIONS: DBT skills groups offer PMH nurses tools to assist patients with transition to outpatient treatment and hope for recovery.

 

1022: Brain Stimulation – Best Clinical Practices, Research and Integration into a PMHNP Program
Mary Rosedale, PhD, PMHNP-BC;  Donna Ecklesdafer, MSN, RN; Paula Bolton, MSm ANP-BC; Nicole Cerussi, BS, RN; Florence Leighton, BS, RN; Anthony DeDonatis, BS, RN; Janet Standard, DNP, PMHNP-BC; Danielle Conklin, MSN, PMHNP-BC; Candice Knight, PhD, EdD, PMHNP-BC

Abstract
PURPOSE: The purpose of our workshop is to provide a state of the science overview of brain stimulation modalities highlighting PMH nursing clinical and research advances. Principles of electricity and physics common to all methods are rarely taught in programs of nursing; we explore the experiences of students and faculty about the integration of brain stimulation content and "hands on learning" in a PMHNP program. SUMMARY OF EVIDENCE: We provide evidence regard the safety and efficacy of brain stimulation approaches and the qualitative experience of students and faculty regarding integration of brain stimulation content and practice in a graduate program. We critically and efficiently review the evidence for each method, examine nursing research and practice and investigate educational practices for educating graduate students about brain stimulation. VALIDATION OF EVIDENCE: We validate the evidence regarding brain stimulation methods and nursing research by reviewing meta-anlayses, systematic reviews and clinical trials. We validate the experience of students and faculty regarding teaching/learning about brain stimulation through analysis of qualitative data and student capstone projects. RELEVANCE/OUTCOMES: Brain stimulation is a rapidly expanding field in PMH Nursing. This topic is critically important to PMH nurse clinicians, researchers and educators. Highlighted capstone projects concerning advocacy, treatment protocols and position papers underscore the need for practice change.IMPLICATIONS: PMH Nurses play a central role providing outstanding patient care, education, and research but the amount of information in the burgeoning field of brain stimulation can be overwhelming. We provide an overview of brain stimulation and a model for integrating brain stimulation into a PMHNP program.

 

1023: Psychotherapeutic Modalities for the Psychiatric Nurse:  Application of Motivational Interviewing and Behavioral Activation
Dawn Vanderhoef, PhD, DNP, PMHNP/CS-BC;  Rita Haverkamp, PMHCNS-BC; Barbara Warren, PhD, RN, PMHCNS-BC, FNAP, FAAN

Abstract
PURPOSE: Understanding how to effectively communicate with patients to make health related, and lifestyle changes is necessary for successful treatment outcomes. Psychiatric nurses are poised to effectively use motivational interviewing (MI) techniques to improve outcomes. SUMMARY OF EVIDENCE: MI is an EB treatment that uses techniques to inspire patients to change lifestyle problems and manage diseases. The techniques used in MI have been successful in working with diverse patient populations. DESCRIPTION: Access to MI training sessions varies. Providing psychiatric nurses with information about MI will increase the knowledge, skills and attitudes about this effective, EB strategy to be used in every day practice. VALIDATION OF EVIDENCE: There is a body of literature that demonstrates MI decreases substance use (Stauder, 2012), medication adherence (McKenzie & Chang, 2013), smoking cessation (Lindson-Hawley, Thompson & Begh, 2015), and lifestyle and disease management strategies (Jansink, Braspenning, van der Weijden, Niessen, Elwyn & Grol, 2009). RELEVANCE/OUTCOMES: Psychiatric nurses use themselves as a therapeutic instrument on a daily basis. In addition to self as a therapeutic intervention, it is imperative that psychiatric nurses are taught evidence based therapeutic techniques to increase available interventions when working with diverse patients. IMPLICATIONS: Psychiatric nurses are at the forefront of assessing patient needs, developing plans of care, and providing direct care. Educating nurses about evidence based practices will provide the knowledge, and improve skills, abilities and has the ability to increase patient outcomes and improve the overall health and mental health of patients across the country.

 

1024: Childhood Trauma:  Advances in Neuroscience and Innovative Therapeutic Interventions
Joy Lauerer, DNP PMHCNS BC;  Kathleen Gaffney, MSN, PMHCNS, CPNP, PMHS-BC; Linda Grabbe, PhD, FNP-C, PMHNP-BC

Abstract
PURPOSE: To increase understanding of the neurobiology of trauma and its effect on both the mind and body. To help APRN's understand how to implement evidence based strategies that more effectively help traumatized children regulate emotions and their body. SUMMARY OF EVIDENCE: Children are increasingly presenting to behavioral health due to dysregulated behaviors. These behaviors are interfering with the child's emotional and educational development. Many of these children a have a history of trauma ( ACEs) which directly effects their neurobiology and thus their ability to appropriately handle triggers and stressors .We are proposing to expand the knowledge base regarding the neurobiology of trauma and to offer evidence based / standard of care interventions based on a deeper understanding of how not only the brain but the body can be affected by trauma DESCRIPTION: Current practice for treating dysregulated children is often the use of anti- psychotics ( off label ) or talk therapy. Proposing non-pharmacological interventions based on neuroscience. VALIDATION OF EVIDENCE: Current literature supports neurobiological changes in children who experience trauma. Interventions must address these changes so children can more effectively regulate emotions and their bodies. RELEVANCE/OUTCOMES: Present new knowledge and evidence based interventions regarding childhood trauma. IMPLICATIONS: The use of non-pharmacological interventions (alone or in conjunction with Pharmacology )  would prevent / limit  physiological side effects, promote optimal development of the child as well as increase resilience.

 

1025: Risk Management Considerations When Prescribing Controlled Substances
Moira Wertheimer, Esq., RN, CPHRM

Abstract
PURPOSE: Death rates from drug overdoses now represent the number one cause of death in the United States, surpassing motor vehicle accidents.  As a result, there is a national public health initiative to take efforts to curtail drug deaths and prevent drug diversion, through the use of tougher laws and penalties for improper prescribing practices and the implementation of prescription drug monitoring programs in virtually every state.  These initiatives designed to safeguard the public health and safety while supporting the legitimate use of controlled substances often results in prescribers interacting more frequently with pharmacies, law enforcement and regulatory agencies. This presentation will help identify the legal and regulatory obligations faced by those prescribing controlled substances. SUMMARY OF EVIDENCE: New and developing federal/state prescribing regulations coupled with the increased number of states permitting autonomous practice has resulted in an increased liability exposure for advance practice nurses who work in a prescribing role. DESCRIPTION: Prescriber obligations pursuant to increased regulatory oversight, including the enactment of state prescription drug monitoring programs will be identified along with information regarding e-prescribing and general prescribing best practices overall. VALIDATION OF EVIDENCE: Increased autonomous practice may create additional liability exposures, particularly when prescribing for patients. RELEVANCE/OUTCOMES: For PMH nurses engaged in/considering prescribing roles, it is important to recognize potential malpractice liability considerations when prescribing controlled substances. IMPLICATIONS: Novel liability exposures are emerging as more states move toward permitting autonomous practice, and as regulations regarding prescribing controlled substances increase.

 

1026: Advanced Practice Psychotherapy:  Next Steps to Develop Intensive Treatment Approaches - Part 2
Kathryn Johnson, PMHNP-BC; PMHCNS-BC;  Sattaria Dilks, DNP

Abstract
PURPOSE: To demonstrate effective use of psychotherapy in various practice settings. SUMMARY OF EVIDENCE: As PMH graduate education has shifted from training clinical nurse specialists to nurse practitioners, there is wide variability in the amount of psychotherapy content offered.  New psychiatric APRNs often find themselves working in agencies that expect them to see high volumes of patients and place emphasis on  diagnostic evaluation and psychopharmacologic interventions, often at the expense of providing psychotherapy. Based on the NONPF PMHNP core competencies, students must meet content specific competencies in psychotherapy theories, including evidence-based psychotherapy modalities. Additionally, students must complete an academic program of study meeting ANA’s Scope and Standards, and ANCC’s PMHNP Certification Eligibility Criteria, which includes clinical training in at least two psychotherapeutic treatment modalities.  Thought leaders in psychiatric mental health nursing have identified a need to train a PMHNP workforce who is prepared to work within the full scope of their practice, and this includes being able to provide psychotherapy  (Delany, K., Hamera, E., & Drew,B.). DESCRIPTION: Novice PMH-APRNs are challenged with developing and staying abreast of psychotherapeutic skills and with how to implement these skills in various practice settings. VALIDATION OF EVIDENCE: Evidence is validated by PMHNP core competencies and by responses from a survey completed by the APRN Steering Committee. RELEVANCE/OUTCOMES: PMH APRNs must be prepared to provide psychotherapy at a novice level upon graduation and must engage in life-long learning which should include content on psychotherapy. IMPLICATIONS: Exposure to several psychotherapeutic approaches will allow participants to determine which therapies best fit their practice settings and patient populations.

 

1027: Learning the Nuts and Bolts of Reviewing Scholarly Journal Submissions
Geraldine Pearson, PHD, PMH-CNS, FAAN

Abstract
PURPOSE: Nurses are often reluctant to write for publication.  The premise of this workshop is that writing begins with learning how to review manuscripts.  The goal of this workshop is to have participants feel more comfortable becoming reviewers for a professional nursing journal.  The workshop is not aimed at only advanced practice nurses and assumes that all professional nurses can effectively and competently review manuscripts, regardless of practice level. SUMMARY OF EVIDENCE: The best way for psychiatric nurses to disseminate their practice is to write about it.  If they feel comfortable with reviewing manuscripts they will be exposed to scholarly writing and may be encouraged to plan and submit their own paper for publication. DESCRIPTION: There is little formal education given to nurses on the process of reviewing manuscripts, particularly in undergraduate nursing programs.  Many doctoral programs address critical thinking with regards to the literature.  This workshop will make this a practical, useful process for all nurses. VALIDATION OF EVIDENCE: Peer reviewed nursing journals depend on the competence of their manuscript reviewers.  Increasing the numbers of nurses willing to effectively review papers can only improved the quality of the journal.  Practice change will be measured in increase of individuals willing to review for JAPNA RELEVANCE/OUTCOMES: PMH nurses have a wealth of information to share about their practices and activities.  This workshop will encourage them to review manuscripts at the least and the most, to submit their own work for publication in a peer reviewed publication. IMPLICATIONS: This workshop is aimed at strengthening the visibility and quality of JAPNA.

 

1031: Technology Dependence and Its Impact on Anxiety and Depression, Violence and Predatory Behavior
John Kriger, MSM, LCADC, CPS

Abstract
PURPOSE: This session provides the most current research on the decline in social skills, social isolation, violence in the school and workplace, and the use of technology by predators, traffickers, and radical groups. SUMMARY OF EVIDENCE: Currently two Asian countries have declared technology dependence their number one national health problem, while here in the US the problem continues to be discussed but is largely unaddressed. DESCRIPTION: Few individuals in medical and therapeutic settings have training on technology dependence, psychiatric facilities are becoming increasingly populated with individuals with social anxiety and depression issues. Violence in schools, the home and workplace appears to be more prevalent so that those systems responding need background information to deal with it. VALIDATION OF EVIDENCE: The current edition of the DSM 5 eludes to tech overuse as a disorder, while our work with social workers, therapists, and psychiatric facilities we are seeing increasing numbers of individuals confronted with problematic issues surrounding tech usage. RELEVANCE/OUTCOMES: From a leadership perspective, technology dependence often creates a distorted communications, misunderstandings and the potential for Interaction avoidance while for others it is eroding their ability to read social and interpersonal communication cues, creating challenges for managers and leaders working with those individuals. IMPLICATIONS: 1. Decreased frustration tolerance and elevated reactive responses 2. Organizational discord and communication breakdowns 3. Increased social avoidance, anxiety and depression 4. Increased sophistication of predators and recruiters of various fringe groups in Internet grooming and recruitment

 

1032: Teaching Psychotherapy in Graduate PMHNP Programs: Part I   An In-Depth  Workshop for Faculty   (The 5 W's of the 4th P: Who, What, When, Where, Why of Teaching Psychotherapy in Graduate Schools)
Pamela Lusk, DNP, RN, PMHNP-BC, FAANP;  Kathleen Wheeler, Ph.D., PMHNP-BC, APRN, FAAN; Candice Knight, PhD, EdD, APN, PMHNP-BC, PMHNP-BC; Mary Moller, DNP, APRN, PMHCNS-BC,CPRP, FAAN

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

 

1033: Neuroscience & Psychotherapy:  Implications for Practice
Kathrene Brendell, DNP, APRN, PMHNP-BC

Abstract
Psychotherapy is an integral component of the advanced psychiatric nurse’ therapeutic regimen. Healthcare is a consumers market. Patients want the latest, most effect treatment available. Clinicians need complete understanding regarding why a particular psychotherapy is the preferred treatment in order to provide patients a rationale for the proposed treatment plan.SUMMARY OF EVIDENCE: Historically the evidence for the efficacy of psychotherapy has been observational in nature. New brain imaging technologies provide for measuring structural and functional change in the brain during activities providing avenues of studying the impact of psychotherapy on the brain. Advances in neuroscience coupled with those in genetics and epigenetics provide explanatory hypotheses that illuminate understanding of how lived experience shapes the brain. DESCRIPTION: Currently students are taught about different types of psychotherapy including historical development, methods of application and use. Some programs are now incorporating neuroscience into their curriculum. However, most current practicing clinicians were not taught neuroscience. VALIDATION OF EVIDENCE: Neuroscience is in its infancy. Yet, new technologies have already resulted in research that provides a neuroscientific understanding of the efficacy of psychotherapy. Other neuroscientific research has provided evidence to differentiate application of therapeutic techniques to mental health conditions. RELEVANCE/OUTCOMES: Advanced practice nurses who learn to apply the principles of neuroscience to their current clinical practice will be best positioned to incorporate new developments as they unfold.IMPLICATIONS: Understanding the interconnectedness of an individual’s lived experience with their genetic/epigenetic self has the potential to provide the clinician insight into the patient’s present condition along with presenting a clearer path to treatment and recovery.

 

1034: Psychiatric Nurses: Empowered to Treat Opioid Use Disorder in the Current Epidemic. Part 1: Epidemiology & Assessment
Matthew Tierney, MS, ANP-BC, PMHNP-BC;  Laura Leahy, DrNP, APRN, PMH-CNS/FNP, BC; Mary Kastner, PMHNP-BC; Carolyn Baird, DNP, MBA, RN-BC, CARN-AP, CCDPD, FIAAN; Susan Caverly, PhD, ARNP, BC, PLLC

Abstract
PURPOSE: Purpose: to educate nurses on epidemiology and treatment approaches for opioid use disorder. SUMMARY OF EVIDENCE: There is a US opioid epidemic.  By 2014, rapidly escalating opioid use over many years resulted in 10,574 heroin-related overdose deaths and 18,893 prescription pain reliever deaths.  That same year, 1.9 million users of prescription opioids and 585,000 users of heroin met criteria for opioid use disorders; yet, only a fraction of those received treatment. DESCRIPTION: Stigma and health policy contribute to lack of treatment. Of the 2.3 million Americans with opioid use disorder in 2012, only 311,718 received care at licensed methadone clinics.  The same year, physicians treated 709,000 patients with buprenorphine despite their capacity to treat over 1 million.  Currently nurses, even APRNs with the ability to prescribe controlled substances, are prohibited by law from prescribing buprenorphine. VALIDATION OF EVIDENCE: Epidemiological evidence of opioid use disorders from trusted sources is presented.  Best practice treatment approaches are also presented to motivate attendees to promote and provide treatment where currently treatment is grossly underprovided. RELEVANCE/OUTCOMES: Psychiatric nurses can provide leadership and help stop this epidemic by working with their full scope of practice. Patients and communities must be educated by nurses on this topic to clearly define and address the problem. IMPLICATIONS: Psychiatric nurses must provide leadership to address opioid use and help reverse escalating morbidity and mortality.


1035: T-3 + T-4: Do You Know Your Patient's Score? The Importance of Thyroid Function in the Management of Mood Disorders
Mary Moller, DNP, ARNP, APRN, PMHCNS-BC, CPRP, FAAN

Abstract to come.

 

1036: Advanced Practice Psychotherapy:  Next Steps to Develop Intensive Treatment Approaches - Part 3
Kathryn Johnson, PMHNP-BC; PMHCNS-BC;  Sattaria Dilks, DNP

Abstract
PURPOSE: To demonstrate effective use of psychotherapy in various practice settings. SUMMARY OF EVIDENCE: As PMH graduate education has shifted from training clinical nurse specialists to nurse practitioners, there is wide variability in the amount of psychotherapy content offered.  New psychiatric APRNs often find themselves working in agencies that expect them to see high volumes of patients and place emphasis on  diagnostic evaluation and psychopharmacologic interventions, often at the expense of providing psychotherapy. Based on the NONPF PMHNP core competencies, students must meet content specific competencies in psychotherapy theories, including evidence-based psychotherapy modalities. Additionally, students must complete an academic program of study meeting ANA’s Scope and Standards, and ANCC’s PMHNP Certification Eligibility Criteria, which includes clinical training in at least two psychotherapeutic treatment modalities.  Thought leaders in psychiatric mental health nursing have identified a need to train a PMHNP workforce who is prepared to work within the full scope of their practice, and this includes being able to provide psychotherapy  (Delany, K., Hamera, E., & Drew,B.). DESCRIPTION: Novice PMH-APRNs are challenged with developing and staying abreast of psychotherapeutic skills and with how to implement these skills in various practice settings. VALIDATION OF EVIDENCE: Evidence is validated by PMHNP core competencies and by responses from a survey completed by the APRN Steering Committee. RELEVANCE/OUTCOMES: PMH APRNs must be prepared to provide psychotherapy at a novice level upon graduation and must engage in life-long learning which should include content on psychotherapy. IMPLICATIONS: Exposure to several psychotherapeutic approaches will allow participants to determine which therapies best fit their practice settings and patient populations.

 

1037: Writing for Publication:  Getting Your Abstract Ready for Developing of a Manuscript
Geraldine Pearson, PHD, PMH-CNS, FAAN

Abstract
PURPOSE: Nurses need encouragement and support to write and submit manuscripts for publication.  Using their peers to review and critique their ideas can be a fundamental way to encourage writing.  This workshop will focus on that. SUMMARY OF EVIDENCE: Writing for publication is one aspect of professional practice and can change the work done by nurses. DESCRIPTION: Many nurses believe that they need special skills or ideas to write for publication.  Granted there is a high value on research and theory development manuscripts. There are also other types of writing that can be described and encouraged. VALIDATION OF EVIDENCE: A pre and post test will be done during the workshop to assess attitudinal changes around writing.  The only way nurses will begin to write is if they do it regularly and develop confidence and skill in the process.  This workshop aims to further this. RELEVANCE/OUTCOMES: PMH nurses are practicing, teaching, and researching in creative ways. The only way that knowledge and practice will be widely disseminated is through presentation and publication. IMPLICATIONS: This workshop is one step of many aimed at strengthening JAPNA and making the readers part of the process of its publication.

 

1041: What We Don't Know Can Hurt Us:  A Comprehensive Model for Managing Violence & Aggression on Psychiatric Inpatient Units
Diane Allen, MN,RN-BC, NEA-BC;  Lisa Mistler, MD, MS; Alexander deNesnera, MD; Frank Harris, Lt

Abstract
PURPOSE: Violence and aggression on inpatient psychiatric units are critical issues, resulting in injuries, trauma and demoralization for staff and patients. A comprehensive model has helped to manage and decrease violence and aggression in an acute psychiatric inpatient setting. SUMMARY OF EVIDENCE: Little is understood about actual prevalence and underlying reasons, and there is no common language used to define, describe and measure violence and aggression. However, we know that  violence and aggression negatively impact treatment and retention of staff. Research and quality improvement programs have demonstrated that innovative, collaborative strategies can reduce aggression that leads to staff injuries. DESCRIPTION: Cultural norms were challenged and novel solutions were explored. Mobile technology is being studied to identify emergent violent ideation. Staff have been trained how to safely respond to aggression. Clear policies guide staff when violence is unmanageable or weapons are present. Administrative reviews assure that policies are followed, and clinical staff collaborate with law enforcement personnel when necessary. VALIDATION OF EVIDENCE: Psychiatric emergencies, assaults and injuries to staff and patients were measured. Data was collected from handheld electronic devices and aggression assessments. RELEVANCE/OUTCOMES: Data supports the effectiveness of the comprehensive model to manage violence and aggression. More calls for help, significant decreases in assaults and injuries to staff resulted. Mobile technology applications continue to be explored. IMPLICATIONS: Effective management of aggression and violence in acute inpatient settings is critical. The comprehensive model described includes emerging research, administrative support, staff training, interdisciplinary collaboration and alliances with law enforcement as key elements.

 

1042: Teaching Psychotherapy in Graduate PMHNP Programs: Part II   An In-Depth Workshop for Faculty   (The 5 W's of the 4th P: Who, What, When, Where, Why of Teaching Psychotherapy in Graduate Schools)
Pamela Lusk, DNP, RN, PMHNP-BC, FAANP;  Kathleen Wheeler, Ph.D., PMHNP-BC, APRN, FAAN; Candice Knight, PhD, EdD, APN, PMHNP-BC, PMHNP-BC; Mary Moller, DNP, APRN, PMHCNS-BC,CPRP, FAAN

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

 

1043: The Elephant in the Therapy Session:  Treating Abortion-Related Trauma and Grief
Diane Sellers, MA, PMHRN-BC, LMFT

Abstract
PURPOSE: To normalize and illustrate post-abortion syndrome as a form of PTSD/grief, inspiring nurses to apply their therapeutic skills fostering healing in this neglected population. SUMMARY OF EVIDENCE: Just as psychiatry took over 50 years to validate PTSD, so it is slow to validate abortion-related trauma. Approximately 1 in 4 women and men are post-abortive. 65% report being coerced. Suicide rate is 6x the general population; risk of clinical depression is 65% higher. 65% report symptoms of PTSD. DESCRIPTION: Most professional clinicians with skills in treating PTSD and complicated grief do not apply them to those with abortion-related trauma/grief. Most after-abortion recovery is through volunteer, lay counseling. VALIDATION OF EVIDENCE: Abortion-related trauma/grief is well-documented by Vincent Rue, PhD; David Reardon, PhD; Catherine Coyle, RN, MSN, PhD; and others. In practice, patients generally do not offer information about abortion, tell themselves it is a political issue and are unaware their depression, anxiety and/or addiction may be connected to abortion. Clinicians who ask their patients about abortion are "surprised at how high the numbers are." RELEVANCE/OUTCOMES: As economist and statesman Manual Ayau stated, “When the cause of the disease is not identified, the remedies will be of no avail.” IMPLICATIONS: It is past time for abortion-related trauma and grief to be transferred from the political arena to the clinical setting. When PMH nurses sensitively ask about abortion, they will provide a safe place to have this overlooked grief and trauma validated, apply the correct remedy, and bring real hope, healing, forgiveness and freedom to live again to this population.

 

1044: Psychiatric Nurses: Empowered to Treat Opioid Use Disorder in the Current Epidemic. Part 2: Treatment
Matthew Tierney, MS, ANP-BC, PMHNP-BC;  Laura Leahy, DrNP, APRN, PMH-CNS/FNP, BC; Mary Kastner, PMHNP-BC; Carolyn Baird, DNP, MBA, RN-BC, CARN-AP, CCDPD, FIAAN; Susan Caverly, PhD, ARNP, BC, PLLC

Abstract
PURPOSE: The purpose of this presentation is to educate nurses on evidence-based practices that treat opioid use disorders. SUMMARY OF EVIDENCE: There is a US opioid epidemic.  By 2014, rapidly escalating opioid use over many years resulted in 10,574 heroin-related overdose deaths and 18,893 prescription pain reliever deaths.  That same year, 1.9 million users of prescription opioids and 585,000 users of heroin met criteria for opioid use disorders; yet, only a fraction of those received treatment. DESCRIPTION: Stigma and health policy contribute to lack of treatment. Of the 2.3 million Americans with opioid use disorder in 2012, only 311,718 received care at licensed methadone clinics.  The same year, physicians treated 709,000 patients with buprenorphine despite their capacity to treat over 1 million.  Currently nurses, even APRNs with the ability to prescribe controlled substances, are prohibited by law from prescribing buprenorphine. VALIDATION OF EVIDENCE: Research-based evidence will be presented on treatments for opioid use disorders.  A motivational message of empowerment will be delivered to attendees, encouraging participation in the provision of treatment where currently treatment is grossly underprovided. RELEVANCE/OUTCOMES: Psychiatric nurses can provide leadership and help stop this epidemic by working with their full scope of practice.  They can deliver evidence-based psychotherapies and assist with medication treatments for opioid use disorders. IMPLICATIONS: Psychiatric nurses can provide leadership by delivering effective therapies to treat opioid use.  With a workforce of over 3 million, reverse escalating morbidity and mortality by getting involved to increase access to care for opioid use disorders.

1045: Pharmacogenomics Nursing:  Personalized Health Care
Julie Follett, MSN, PMHCNS-BC

Abstract
PURPOSE: To share current knowledge of pharmacogenomics. Nurses are required to achieve competence in pharmacogenomics. SUMMARY OF EVIDENCE: The trend in health care is moving towards personalized medicine utilizing individual's genotype to determine most appropriate drugs. The sequencing of genome, government initiatives to fund research on genetics and drug response have yielded useable information. The American Nurses Association endorses core competences in pharmacogenomics nursing. DESCRIPTION: Pharmacogenomics is not yet a standardized approach. It is not fully integrated in nursing education programs. Pharmacogenomic nursing should be included in education, forums where nursing information is presented. Opportunities during clinical internships need to be created. Stakeholders include patients, and nurses at the forefront of establishing pharmacogenomics as standard practice. VALIDATION OF EVIDENCE: A good example of evidence validated by literature describing CYP2D6 allelic variations and drug responses. The shift in analyzing drug response is from lack of adherence by patient to altered gene function. I have measured outcomes by patients' reports of increased drug efficacy, decreased side effects, partial or complete remission. RELEVANCE/OUTCOMES: PMH nursing often involves the need for medication prescription, education of patient. Genotype information increases the safety and efficacy of medication trials. Patients may be more willing to try medications if educated. I utilize genotyping for all patients who request test. I explain the benefit of genotyping and offer to all my patients. There are patients who elect to defer because they are currently satisfied with drug treatment and would not want a change. IMPLICATIONS: Pharmacogenomics will be a standard of nursing care.

1046: Advanced Practice Psychotherapy:  Next Steps to Develop Intensive Treatment Approaches - Part 4
Kathryn Johnson, PMHNP-BC; PMHCNS-BC;  Sattaria Dilks, DNP

Abstract
PURPOSE:To demonstrate effective use of psychotherapy in various practice settings. SUMMARY OF EVIDENCE: As PMH graduate education has shifted from training clinical nurse specialists to nurse practitioners, there is wide variability in the amount of psychotherapy content offered.  New psychiatric APRNs often find themselves working in agencies that expect them to see high volumes of patients and place emphasis on  diagnostic evaluation and psychopharmacologic interventions, often at the expense of providing psychotherapy. Based on the NONPF PMHNP core competencies, students must meet content specific competencies in psychotherapy theories, including evidence-based psychotherapy modalities. Additionally, students must complete an academic program of study meeting ANA’s Scope and Standards, and ANCC’s PMHNP Certification Eligibility Criteria, which includes clinical training in at least two psychotherapeutic treatment modalities.  Thought leaders in psychiatric mental health nursing have identified a need to train a PMHNP workforce who is prepared to work within the full scope of their practice, and this includes being able to provide psychotherapy  (Delany, K., Hamera, E., & Drew,B.). DESCRIPTION: Novice PMH-APRNs are challenged with developing and staying abreast of psychotherapeutic skills and with how to implement these skills in various practice settings. VALIDATION OF EVIDENCE: Evidence is validated by PMHNP core competencies and by responses from a survey completed by the APRN Steering Committee. RELEVANCE/OUTCOMES: PMH APRNs must be prepared to provide psychotherapy at a novice level upon graduation and must engage in life-long learning which should include content on psychotherapy. IMPLICATIONS: Exposure to several psychotherapeutic approaches will allow participants to determine which therapies best fit their practice settings and patient populations.

 

1047: Toolkit for New Leaders in Psychiatric/Mental Health Nursing
Avni Cirpili, RN, DNP, NEA-BC;  Kathy Lee, MS, PMHCNS-BC, APN

Abstract
PURPOSE: This presentation is designed to provide new and emerging leaders with a set of competencies that will allow them to effectively transition into their leadership role.  It is being presented by 2 leaders with over 50 years experience in a variety of leadership roles and healthcare settings. SUMMARY OF EVIDENCE: Research has demonstrated that new leaders have a limited understanding of their roles and responsibilities.  Research also demonstrates that when leadership skills are taught to emerging leaders this results has a positive impact an individual leadership practices.  Providing emerging leaders with the tools to effectively perform their role will increase their self-confidence and performance. DESCRIPTION: The development of new nurse leaders is now recognized as an essential responsibility of organizations.  Through didactic discussion participants will understand the basics of finance, employee engagement, customer service, quality and patient safety, and conflict management.  Participants will explore their leadership potential and begin to build their own leadership toolbox. VALIDATION OF EVIDENCE: Literature demonstrates that the skills which will be presented when performed effectively increase staff engagement and improve patient outcomes. RELEVANCE/OUTCOMES: The information provided is extremely helpful to any individual who is entering into a new leadership position.  Literature demonstrates that without the proper training and support many new leaders do not succeed or become dissatisfied with the role and withdraw from leadership. IMPLICATIONS: The future of nursing leadership within psychiatric mental health nursing is dependent on these emerging leaders.


 

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