2014 Pre-Conference Session Abstracts
 

1011:  Cognitive Behavioral Therapy (CBT) Nuts & Bolts for Beginners and Expert Clinicians
Kathleen T. McCoy, DNSc APRN-BC FAANP;  Ruth Milstein, DNP APRN-BC PMHNP LPC;  Pamela Lusk, DNP APRN-BC PMHNP

Abstract
PURPOSE: This Nuts & Bolts Workshop provides both young/experienced PMH-APNs with an introduction/review of CBT and basic skills practice. The intent is to startup willing APNs with CBT basic knowledge/practice skills and review the use of CBT in seasoned APNs. SUMMARY OF EVIDENCE: CBT is widely acknowledged to be the most researched psychotherapy form and is often cited as the most effective form of psychotherapy for a variety of mental health (MH) disorders across the life-span. CBT is highly portable and largely reimbursable. PMH-APNs need to be prepared to provide full scope of MH services, including psychotherapy, where there is a paucity of providers, especially to underserved/under and uninsured in US populations/military services. DESCRIPTION: CBT helps the PMH-APN target problematic thoughts and therapeutically engage patients assisting them to create better thinking patterns more directly, using time and resources efficiently without sacrificing therapeutic use of self. Introduction to Case conceptualization/Cognitive Therapy Rating Scale (CTRS) will be used to frame the applicastion. VALIDATION OF EVIDENCE: The Nuts & Bolts Workshop incorporates: Case Conceptualization & the CTRS. These are integrated to provide feedback. measuring the success of an encounter.  RELEVANCE/OUTCOMES: Populations served by PMH-APNs are likely to benefit from CBT. Challenges exist for the PMH-APN wishing to practice psychotherapy. The Nuts & Bolts Workshop provides opportunities to review, and practice psychotherapy skills used in CBT helping APNs practice more fully. IMPLICATIONS: This Nuts & Bolts Workshop prepares APNs to practice more fully, ultimately benefiting their patient loads across the lifespan and specialty niches.

 


 
 

1012:  Collaborative Primary Care and Behavioral Health Care
Rita M. Haverkamp, MSN, PMHCNS-BC

Abstract
PURPOSE: The purpose of the presentation is to clarify the differences in integrated care models and to show the evidence base for collaborative carel. Participants will learn what tasks need to happen to call a program collaborative care. SUMMARY OF EVIDENCE: The IMPACT research was a randomized controlled trial study using collaborative care principles. The results showed a 50% improvement over care as usual in all 8 sites. Over 40 randomized controlled trial studies of collaborative care show that it is more effective than usual care for treatment of depression in primary care settings. DESCRIPTION: Collaborative care includes a patient centered care team based on Wagner's chronic disease management model, population based care using registries to monitor progress and maintain contact with patients , measurement treat to target using PHQ9 and other tools, evidenced based therapy models and accountable care. VALIDATION OF EVIDENCE: Programs monitor care on a continuous basis and can adjust protocols or help staff improve skills at any time based on this feedback via their registry. Overall the ongoing practice results have show similar improvement rates as the controlled research.  RELEVANCE/OUTCOMES: APRN's are needed in direct treatment roles as well as in consultation roles in these practice models. This would be a new role for psychiatric RN's. IMPLICATIONS: There will be many jobs for APRN's and RN's in collaborative care in the future. Reasons for this are it is more cost effective care, can combine treatment of other medical conditions and depression, and it fits with the medical home model of primary care.

 


 
 

1013:  Integrated Dual Disorders Treatment Mental Health and Substance Abuse
Judith W. Magnon, RN-BC, BS, CAC

Abstract
PURPOSE: To educate psychiatric nurses about the importance of understanding integrated treatment for those who experience mental health and substance abuse disorders in a community based program, which is evidenced based. SUMMARY OF EVIDENCE: Integrated Dual Disorders Treatment is an evidenced based model of care that has been researched by Dr. Robert Drake from Dartmouth College in NH. He started the research in 1980's and has been replicated over 100 times around the world. He and his team have written an IDDT manual and numerous articles in multiple journals. DESCRIPTION: The IDDT model uses a collaborative, multidisciplinary team approach to coordinate every aspect of a client's recovery. IDDT emphases that individuals achieve sobriety, symptom management, and independent living over time. It takes a Stage of Change approach to treatment. IDDT also promotes access to other evidenced based practices, such as psychoeducation, Family Education and Support, supported housing, and supported employment and/or education. VALIDATION OF EVIDENCE: The many years of research has demonstrated this model of care produces positive outcomes.  RELEVANCE/OUTCOMES: PMH nurses bring many skills, including communications skills, to support IDDT. Learning about substance abuse disorders and integrated treatment will enhance their every day skills and increase outcomes for those they serve given the high numbers with co-occurring disorders. IMPLICATIONS: Having PMH nurses who understand IDDT and feel comfortable assessing and treating this population will enhance quality of care in the individual's lives. It will foster the belief that a person with both disorders can recover, if both disorders are treated at the same time by the same team.

 


 
 

1014:  Co-morbidities of Diabetes and Hypertension in Adult Patients with Bipolar Illness and Schizophrenia: Medical Considerations. Using Motivational Interviewing to Help these Patients
Laureen S. Froimson, RN MSN PMHCNS, GNP

Abstract
PURPOSE: REVIEW PATHOPHYSIOLOGY, EPIDEMIOLOGY, DIAGNOSIS, TREATMENTS OF DIABETES AND HYPERTENSION AS THEY RELATE TO PATIENTS WITH BIPOLAR ILLNESS AND SCHIZOPHRENIA. MOTIVATIONAL INTERVIEWING TO HELP PATIENTS Will BE TAUGHT. SUMMARY OF EVIDENCE: Many studies relate to both disorders and standards of care exist. Psychotropic Medications Impact Diabetes and Hypertension especially antipsychotic drugs. These disorders present major health problems for patients that impact their quality of physical and psychological health. DESCRIPTION: Specific Practice Guidelines for Patient Management before starting antipsychotic drugs and while taking these drugs. VALIDATION OF EVIDENCE: Participants will complete pre and post test of their knowledge of this subject. Participants will complete post presentation evaluation of presentation.  RELEVANCE/OUTCOMES: There is limited nursing literature related to topic. The presentor will discuss case studies showing how antipsychotic medications can lead to development of hypotension, hypertension, hypoglycemia and cause patients to develop diabetes who did have the disease prior to starting on these drugs. These health issues of patients impact on skills needed by nurses. Likewise, nurses need to consider carefully the interaction of drugs and impact of diets served to patients and exercise patterns of patients. IMPLICATIONS: Work is needed on helping patients over their life span with these disorders since they impact on their morbidity and mortality. Future research is needed both on prevention and treatment and new nursing measures to help patients.

 


 
 

1015:  Welding Strong Connections Between Research and Practice: PhD and DNP Partnerships to Generate Knowledge and Improve Care
Marianne Smith, PhD, RN;  Andrea Kwasky, DNP, PMHCNS-BC, PMHNP-BC;  M. Jane Suresky, DNP, PMHCNS-BC;  Jaclene Annette Zausaniewski, PhD, RN-BC, FAAN

Abstract
PROBLEM: Close collaborations between psychiatric mental health (PMH) clinical leaders and nurse researchers are critically important to advancing PMH knowledge, and achieving optimal outcomes for patients and families in practice settings.  METHODS: The goal of this workshop is to examine the benefits of, and opportunities for, PMH nurse clinicians and practitioners (e.g., NPs and DNPs) to effectively collaborate with nurse researchers (e.g., PhDs) to develop and implement projects that both generate new knowledge AND assure that knowledge is effectively used in daily practice settings. IMPLICATIONS: This workshop will explore various perspectives on practice and research role preparation, and steps to establish collaborative working relationships among PMH nurses.  FUTURE RESEARCH: The content of the workshop articulates with three additional research-focused preconference intensive programs that were planned by members of the APNA Research Council. The overarching aim of these programs is to generate renewed interest and engagement in PMH nursing research and translation of research to practice.

 


 
 

1016:  Training in the Collaborative Assessment and Management of Suicidality (CAMS)
Janet A. York, PhD, PMHCS, BC, FAAN

Abstract
PURPOSE: The Purpose of this session is to train advanced practice nurse psychotherapists in the Collaborative Assessment and Management of Suicidality (CAMS) (Jobes 2006, 2012). SUMMARY OF EVIDENCE: CAMS is an effective, suicide-specific intervention, recommended in federal reviews of empirically-based best practices. DESCRIPTION: The CAMS Protocol is a structured clinical framework for assessing, monitoring, and intervening with a patient at risk for suicide and includes the use of problem-focused interventions of patient-defined "drivers" of suicide that is guided by a multi-purposed clinical tool, the Suicide Status Form (SSF). VALIDATION OF EVIDENCE: The Evidence base and methodology for CAMS effectiveness includes six correlational studies and one randomized clinical trial (three well-powered trails are in progress). All data to date support the feasibility and effectiveness of CAMS with suicidal outpatients and inpatients in terms of rapid reductions in ideation and overall symptom distress while improving hope and retention.  RELEVANCE/OUTCOMES: The Relevance to PMH nursing is related to patients at high risk for suicide being the most common psychiatric emergencies encountered by APRN’s. The Veterans Health Administration (VHA) is currently developing an SSF template for the computerized record system. IMPLICATIONS: CAMS has not been widely disseminated in PMH nursing but serves as an exemplar for the education of PMH advanced practice nurses in suicide-specific best practices. Training clinicians in assessing suicide is a goal of the 2012 National Strategy for Suicide Prevention. The presenter will discuss her work as an investigator of a multisite RCT of inperson and e-CAMS in the VHA the development of the e-CAMS.

 


 
 

1017:  Collaborative Care: Developing Roles and Organizing Psychiatric Nursing Based Treatment Options and Psychopharmacology in Integrated Mental Health Settings
Sharon R. Katz, FPMH-APRN, CRNP

Abstract
PURPOSE: Psychiatric APRNs understanding of integrated mental health is evolving. Discussing clinical roles, boundary of clinical responsibilities and patient care, management of co-morbid illnesses, and presenting cases with psychopharmacology options is important to validate practice. SUMMARY OF EVIDENCE: Integrated mental health has been studied for over 30 years in public health and medical settings. Recent advances in neuroscience have further validated the mind body connection. Over recent years, clinical psychiatry has encouraged an understanding and clinical application of psychiatry in primary care. Psychiatric nursing has an approach to care that has to be demonstrated with treatment based case presentations. DESCRIPTION: Integrating psychiatric advanced practice nurses into integrated medical settings involve our full scope of practice. Holistic approaches and steps of care need to be introduced to patients, as well as assessment and diagnosis and triage of patients is the backbone to the psychiatric nurse role. Prescribing psychotropic medication in an integrated mental health program has different elements than other clinical settings. VALIDATION OF EVIDENCE: Evidence has been drawn from research, SAMSHA endorsed publications and models, actual measurable outcomes from clinical settings, and publications on the subject.  RELEVANCE/OUTCOMES: We are being call upon to demonstrate this role, and we need to develop a APRN workforce to support and grow the role with a consistent understanding of the boundaries, responsibilities and safe practice considerations. IMPLICATIONS: Integrated mental health is the future of mental health, and supported in health care legislation.

 


 
 

1021:  Mind Your Non-verbals!: An Introduction to Developmental Somatic Psychotherapy
Kirste L. Carlson, DNP, PMHCNS-BC; Deborah J. Schneider-Murphy, LISW

Abstract
PURPOSE: In this experiential workshop the presenters will discuss and demonstrate Developmental Somatic Psychotherapy (DSP), a movement oriented Gestalt psychotherapy, in which they are extensively trained. SUMMARY OF EVIDENCE: DSP is exemplary of the paradigm shift taking place within clinical neuroscientific disciplines to re-unite the body and mind in theory and practice. It is based upon relationally oriented human development theories, regulation theory, modern attachment theory, Gestalt relational theory, and Gestalt body process theory. DESCRIPTION: Phenomenological observation of particular sensorimotor patterns and rhythms associated with habitual postures and gestures, as they occur within the context of the therapeutic relationship, are used to support the client's self-awareness, as well as mutual embodied self-awareness. The specific ways in which such collaborative observation of these experiences can create a novel sense of self and psychotherapeutic change are discussed, VALIDATION OF EVIDENCE: DSP is based upon neurodevelopmental research and has been validated in practice by Dr. Frank and her students since 2000. It was recently published in a full length book: Frank, R., & LaBarre, F. (2011). The first year and the rest of your life: Movement, development, and psychotherapeutic change. New York, NY: Routledge.  RELEVANCE/OUTCOMES: Expansion of the client's movement repertoire, practiced in the therapy dyad, can transform the client’s psychophysiology, permanently change brain structures, and, ultimately, relieve much of the suffering and many of the symptoms associated with mental illnesses that are linked to early non-verbal relational interactions or later trauma. IMPLICATIONS: Psychotherapists can benefit from using this approach within their particular modalities. Further research is needed.

 


 
 

1022:  What’s a Psychiatric Nurse to Do? Exploring Roles and Competencies in Integrated Care
Joyce M. Shea, DNSc, APRN, PMHCNS-BC;  Angelina G. Manchester, MSN, RN;  Lourdes C. Pineda, MSN, RN-BC, CCM;  Amanda L. Schuh, MS, RN, PMHNP-BC

Abstract
PURPOSE: This session will review the development of Integrated Care (IC) and present examples of current IC initiatives and evidence-based resources. Small group discussions will be used to identify IC competencies needed by psychiatric nurses. SUMMARY OF EVIDENCE: Experts have increasingly called for better coordination of mental and physical health care. Primary care providers are expected to deliver behavioral health care, while psychiatric providers struggle to meet their clients’ serious physical health care challenges. Various models of IC have developed, yet little has been done to clarify the roles for psychiatric nurses within IC settings or the competencies they would need to effectively meet the goals of IC. DESCRIPTION: Both generalist and advanced practice psychiatric nurses can be valuable assets to the IC team and their non-psychiatric colleagues. There is currently minimal focus on IC competencies at graduate or undergraduate levels of nursing education, and no formal Continuing Education or Certification programs for nurses on IC were found. VALIDATION OF EVIDENCE: IC can improve patient safety and satisfaction, lower healthcare costs, decrease the barriers to care, and increase the quality of care. The roles played by health providers on IC teams need to be clarified and their competencies evaluated.  RELEVANCE/OUTCOMES: Psychiatric nurses can take the lead in defining their role and identifying needed competencies for quality IC. Based on examples of current IC practice, attendees will be asked to create a list of competencies needed by psychiatric RN’s and APRN’s. IMPLICATIONS: Feedback from attendees will provide the basis for Continuing Education programs, resulting in improved care for patients.

 


 
 

1023:  Tobacco Treatment for Persons Living with Mental Illness: Building Connections between Education and Practice
Carol A. Essenmacher, MSN, DNP(c), PMHCNS-BC;  Rhonda G. Schwindt, DNP, RN, PMHCNS-BC

Abstract
PURPOSE: Psychiatric nurses and advanced practice nurses are ideally suited to effectively deliver tobacco cessation interventions to patients. It is important that nurses be presented with current tobacco use information and taught evidence based interventions. SUMMARY OF EVIDENCE: Tobacco and nicotine addiction contributes to approximately 500,000 deaths per ear and adversely affects the quality of lives of countless other patients, especially those living with a mental illness. DESCRIPTION: A presentation overview provides participants with the biological and neurobiological adverse effects of tobacco use, evidence-based intervention strategies (the “5As”), and pharmacological and brief counseling strategies based on the 2008 clinical practice guideline for treating tobacco use and dependence. The protocol includes role plays based on case scenarios, which have been shown as effective in facilitating adult learning. As mentally ill patients suffer disproportionally from tobacco use, intervention strategies will be targeted to this vulnerable population. VALIDATION OF EVIDENCE: Participants will complete pre- and post-test tobacco cessation knowledge and confidence level evaluations. Mid-session evaluations will be used to guide the second half of the presentation. Evaluations of previous studies using similar educational activities will be described.  RELEVANCE/OUTCOMES: The results from similar presentations in education and practice setting will be offered for examination and discussion. IMPLICATIONS: Providing nurses with the opportunity to build competency skills and confidence to deliver tobacco cessation interventions will facilitate nurse-led tobacco treatment interventions being moved from the theoretical realm into the practice domain. Helping patients to stop using tobacco is complex and interactive learning experiences can prepare nurse to be effective tobacco treatment clinicians.

 


 
 

1024:  Therapeutic Neuromodulation: Implications for Psychiatric Mental Health (PMH) Nurses
Donna J. Ecklesdafer, MSN, BSN, RN;  Julie A. Mulder, MS, BA, BSN, RN-BC;  Dawn Miller, RN, BSN;  Mary Rosedale, PhD, PMHNP-BC, NEA-BC

Abstract
PURPOSE: Neuromodulation induces changes in neurons and neuronal circuits to alleviate psychiatric conditions. In this workshop, we will explain how Psychiatric Mental Health (PMH) Nurses can translate neuromodulation research to evidence-based clinical practice. We will explore the mechanisms of action, safety and efficacy of deep brain stimulation (DBS), electroconvulsive therapy (ECT), magnetic seizure therapy (MST), transcranial magnetic stimulation (TMS), deep TMS, vagus nerve stimulation (VNS), and transcranial direct current stimulation (tDCS).This advances PMH nursing specialty and, expands therapeutic options for our patients. SUMMARY OF EVIDENCE: Neuromodulation provides insights into brain function for the treatment of neuropsychiatric disorders. PMH nurses and advanced practice nurses transform findings into clinical practice, participate and conduct interprofessional research. DESCRIPTION: We will identify how psychotherapy, pharmacotherapy and neuromodulation affect the brain and how PMH nurses can evaluate brain stimulation therapies as therapeutic interventions for patients. We will describe the essential role of PMH nurses’ clinical practice, education and research. VALIDATION OF EVIDENCE: We will discuss the use of standardized clinical rating scales to evaluate neuromodulation as well as published qualitative interview data with patients.  RELEVANCE/OUTCOMES: We will provide current outcome data discussing response and remission rates. Neuromodulation combined with antidepressant treatment has been shown to alter neural circuitry to optimize antidepressant response, suggesting the potential for neuromodulation to enhance the potency and durability of standard antidepressant approaches. IMPLICATIONS: Neuromodulation is a rapidly growing field. The implications of these advances will reverberate throughout psychiatric research and clinical practice. PMH nurses are the key to providing exceptional clinical care, education and research in neuromodulation.

 


 
 

1025:  The Making of a Psychiatric Mental Health Nurse Scientist
Linda S. Beeber, PhD, PMHCNS-BC, FAAN;  Bernadette Mazurek, PhD, RN, CPNP/PMHNP, FNAP, FAAN

Abstract
PROBLEM: Psychiatric mental health nursing (PMHN) research defines and guides best practices, yet PMHN research is at a critical tipping point. The future of the specialty depends on a full cadre of psychiatric nurses committed to careers as nurse scientists. In this workshop,  Dr. Bernadette Melnyck, a Rock Star of PMHN research will tell the story of her journey as a nurse scientist and her adventures in discovering practice-changing science. FRAMEWORK: Developmental science.  METHODS: You will have an opportunity to work with other attendees who are at one of four places on the journey: ·         Contemplating a career as a  PMH nurse scientist – you have not yet entered doctoral study but are curious about being a nurse scientist ·Made the leap – you are in doctoral or postdoctoral study ·Venturing forth – you have finished your training and are launching  your independent research career or building your program of research · Seasoned and on the road – you are mid-career and want to chart your next part of the journey You will work with attendees like yourself to formulate a burning question for Dr. Melnyck about your own aspirations and career path. After she completes the story of her journey, your group will have an opportunity to address your question to Dr. Melnyck. RESULTS: Increased interest in PMH nursing research.  IMPLICATIONS: More scientists in the pipeline.  FUTURE RESEARCH: Better care of our clients.


 


 
 
1027: Conquering Clinical Conundrums: Psychopharmacology in the 21st Century
Laura G. Leahy, DrNPc, APN, PMH-CNS/FNP

Abstract
This session will provide the PMH APRN with real life prescriptive challenges and offer new and innovative ways to address them. Utilizing psychopharmacogenetics, laboratory studies, review of systems, symptom evaluation and observation as clinical tools, this presentation will guide PMH APRNs in how to personalize psychopharmacological treatments for their patients. 

 

 
 

1031:  The Making of a Therapist: How Are We teaching Psychotherapy in Graduate Psychiatric Nursing Curriculums? from the APNA Education Council, Graduate Branch
Pamela Lusk, DNP, PMHNP-BC;  Candice Knight, PhD, EdD, APN, PMHNP-BC, PMHNP-BC;  Richard Pessagno, DNP, PMHNP-BC;  Mary D. 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 using the state hospital 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 such as 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: 1.) Create a forum where individual, group and family psychotherapy PMHNP learning opportunities can be shared.

 


 
 

1032:  The Transition to Behavioral Health Consultant: Successes and Missteps
Joseph Wolf Schatz, MSN, CRNP, PMHNP-BC

Abstract
PURPOSE: The specialty area of Primary Care Mental Health continues to grow and PMH-APRNs are under represented in the role of Behavioral Health Consultant. PMH-APRNs are uniquely prepared to function in this specialized role. SUMMARY OF EVIDENCE: The Behavioral Health Consultant model of Physical Health/Behavioral Health integration involves imbedding a behavioral health clinician within the primary care team. This clinician functions as a behavioral health generalist and has a population-focus. DESCRIPTION: Working as a Behavioral Health Consultant requires the PMH-APRN to re-conceptualize assessment and intervention techniques in a manner congruent with the culture of primary care. This practical presentation discusses a PMH-APRN's transition into the BHC role and addresses lessons learned both in the exam room and at the systems-level. VALIDATION OF EVIDENCE: This presentation will discuss both the successes and missteps encountered during the pilot phase of imbedding a Behavioral Health Consultant/PMH-APRN within the a Federally Qualified Health Center.  RELEVANCE/OUTCOMES: As funding structures change, the value of the Behavioral Health Consultant model is increasing. IMPLICATIONS: Participants will leave prepared to continue a thoughtful conversation regarding Primary Care Mental Health.

 


 
 

1033:  Risk Management Considerations When Treating Suicidal and Violent Patients
Moira K. Wertheimer, BSN, JD

Abstract
PURPOSE: Recent violent incidents have thrust the issues of mental health and violence to the forefront of a national debate. A central theme in this debate involves the role of mental health providers in the prevention of suicide and violence. This program will explore the unique liability exposures that may occur when working with a potentially violent (suicidal or homicidal) patient, and risk management strategies designed to reduce those liability exposures. SUMMARY OF EVIDENCE: Medical malpractice claims involving suicidal/violent patients can be common claims made against mental health providers. PMH nurse practitioners continue to be vulnerable to professional liability claims. DESCRIPTION: Participants will have concrete risk managment recommendations when treating potentially suicidal/violent patients, including documentation principles, duty warn/protect laws as well as timely updates to state and national gun control laws. VALIDATION OF EVIDENCE: This program will explore liability risks through lecture, case examples and Q & A.  RELEVANCE/OUTCOMES: Awareness of the recurring issues arising in treating suicidal/violent patients, and the employment of appropriate risk management processes, can reduce the likelihood of being sued and can increase the chances of successfully defending actions that may be filed. IMPLICATIONS: New federal/state laws regarding this subject continue to be proposed and implemented. Many, may result in changes in the management/ treatment suicidal/violent patients.

 


 
 

1034:  Creating an Inpatient Treatment Program to Instill Hope and Provide a Continuing Path to Recovery
Judy S. Linn, BSEd, MSN

Abstract
PURPOSE: Create inpatient programs that move from a medical model to a program that instills hope by embracing recovery principles. . SUMMARY OF EVIDENCE: A national agenda has been established for mental health systems to move to a recovery model of care. Recovery principles are integral to psychiatric/mental health nursing yet inpatient treatment is still rooted in the medical model. Nurses are charged with patient safety and maintaining control of the unit rather than embracing recovery principles. DESCRIPTION: 1. Solution-Focused, Person Centered Thought, and Goal Setting 2. Program Core Groups- "Why Now?" (What was the precipitating event to hospitalization?) "What Works?" (What are the pt's skills and coping mechanisms that have worked? "What's Next?" ( What are the first small steps to recovery?) 3. Program Tools: Creating the Recovery Action Plan; Individual Interview, Unit Guidelines vs Rules 4. Integration with the community resources 5. Stakeholders- Patient Treatment Team - Facility VALIDATION OF EVIDENCE: This program reached 100% patient satisfaction on the national Press-Ganey patient survey. Staff engagement scores as measured by Press-Ganey were the highest in the University system.  RELEVANCE/OUTCOMES: This program facilitates implementation of recovery principles; instills hope; and assists patients to heal. PHN nursing continues to evolve through embracing our core principles and finding professional satisfaction as we listen to patient stories. IMPLICATIONS: The future is waiting for inpatient PMH nurses to claim their potential to instill hope for the future and provide patient centered care. This treatment program is a foundation to continue honing the tools for patient recovery.

 


 
 

1035:  Understanding the Funding Landscape
Debra J. Barksdale, PhD, FNP-BC, ANP-BC, FAANP, FAAN;  Tonna Thomas, MS;  Valerie Maholmes, PhD, CPS

Abstract
PROBLEM: Psychiatric mental health nursing faces a challenging funding landscape. Federal options have been downsized and non-governmental sources of funding may be difficult to identify. The future of Psychiatric-Mental Health Nursing is dependent on the research that provides scientific evidence for PMH practice, benefits clients with efficacious interventions, and reduces community costs for public assistance. During this session, we will identify funding options and assist attendees to match the mission and priorities of funding institutes and foundations. IMPLICATIONS: Research funding permits innovative discovery and applications to practice.  FUTURE RESEARCH: Research funding permits study results that enhance current practice and measure effectiveness of interventions with improved outcomes for consumers and families/partners

 


 
 

1037:  Nuts and Bolts of Board Leadership: Get Ready to Nominate Yourself
Diane M. Wieland, PhD, RN, PMHCNS-BC, CNE;  Leslie Oleck, MSN, RN, PMHCNS-BC, LMFT

Abstract
PURPOSE: To provide information for APNA members and conference attendees on board leadership SUMMARY OF EVIDENCE: Nurses may be hesitant to step forward for a role on a local, state, or national board due to lack of knowledge. APNA is a member driven organization. Members should feel comfortable to nominate themselves for leadership positions DESCRIPTION: In this presentation, the "nuts and bolts" of board leadership will be summarized through use of Board Source materials, the review of the literature on board leadership, and interactive dialogue with speakers who have served on the APNA Board of Directors. Exemplars of nurse leaders on national boards and opportunities through APNA for board leadership will be discussed. This presentation will assist participants to identify and appreciate their strengths and empower them to consider a role in governance through board leadership in APNA. VALIDATION OF EVIDENCE: Participants will be asked questions during the session to evaluate their strengths and readiness to nominate themselves for board leadership positions.  RELEVANCE/OUTCOMES: Nurses are needed on national boards so to influence health care and to be at the table when decisions are made. This session will provide information on board leadership and encouragement of members to consider such roles in the future. IMPLICATIONS: All APNA members should feel comfortable in running for positions on boards in their local communities, at the state, and at the national levels. New leadership invigorates an organization. New leaders need to be educated so that they can plan ahead and become board members.

 


 
 

1041:  Transforming Culture: Building Appreciative Connections
Rebecca B. Harmon, PhD, RN;  Anita Thompson-Heisterman, MSN, PMH CNS-BC, PMHNP-BC

Abstract
PURPOSE: To educate educators to educate students about the power of language; To build connections among School of Nursing stakeholders (administrators, educators, practitioners, and researchers) to achieve an inclusive and respectful work environment; To integrate recent research findings into daily practice; To set expectations and role model respectful communication among all School of Nursing (SON) constituents. SUMMARY OF EVIDENCE: Incivility is not always obvious. Sometimes subtle words and deeds promote negative emotions and create a hostile environment that interferes with achieving desired personal and workplace goals. Recent research indicates that individuals observe and emulate communication and behaviors, positive or negative. New findings in the fields of positive psychology and appreciative practice demonstrate that more proactive skills can be learned. DESCRIPTION: All SON stakeholders (administrators, educators, practitioners, preceptors, and researchers) attended an initial retreat and follow-up workshops to identify and practice more inclusive, nonjudgmental communication strategies. VALIDATION OF EVIDENCE: Evaluation is ongoing; all stakeholders signed a document agreeing to the “desired behaviors” for a healthy work environment (HWE).  RELEVANCE/OUTCOMES: Annual self-evaluations now require a statement of personal contributions to the HWE, in addition to teaching, scholarship, and service. IMPLICATIONS: PMH nurses know the power of communication. Now, others are using communication to transform culture and to build a healthy workplace. Research indicates that a happy workforce has less staff turnover, is more productive, and makes fewer mistakes. By educating ourselves and our students to engage in and expect respectful behavior, we are improving the future of nursing (IOM, 2010).

 


 
 

1042:  Integrating Psychiatric & Mental Health Nursing and Palliative Care Nursing: Building Bridges to Improve Outcomes
John D. Chovan, PhD, DNP, CNP, CNS, PMHNP-BC, PMHCNS-BC, ACHPN, AHN-BC

Abstract
PURPOSE: To refine a framework integrating PMH nursing and palliative care (PC) to improve patient outcomes, save costs, and serve a high-risk community of persons living with severe and persistent mental illness (SPMI) in light of quality and financial pressures on healthcare systems and growing need; and discuss expanding opportunities for PMH nurses. SUMMARY OF EVIDENCE: PC saves costs and reduces readmissions. PC guidelines promote interdisciplinary team approaches that include multiple domains. Scope and practice guidelines are evidence that PMH nursing skills mesh with work done by PC teams and that PMH nurses uniquely understand the needs of the SPMI population. DESCRIPTION: Teams comprise multiple disciplines. Nurses apply the nursing process, with or without CE and certification in PC, interact with patients and families during times of stress, evaluate coping, and intervene to alleviate pain and the fallout from dysfunctional family relationships. VALIDATION OF EVIDENCE: PC practice guidelines promote an interdisciplinary approach. Nursing tasks span multiple domains, consistent with scope and practice guidelines for nurses in PMH settings. PMH nurses are the only nursing specialty prepared to work with the SPMI population.  RELEVANCE/OUTCOMES: Expands the role of PMH nurses; both disciplines will provide better, more cost effective services to the patients already using PC as well as expanding PC to the SPMI population. IMPLICATIONS: While enhancing cost savings, improving service quality, and expanding, we create new opportunities for PMH nurses. CE and co-certification will emerge for this blended discipline as we rethink and reimagine the essential sets of skills and abilities of the modern psychiatric & palliative care-certified nurse.

 


 
 

1043:  The Missing Vital Sign: Adverse Childhood Experiences (ACEs) Impact on the Epigenome, Behavioral Health and the Critical Need for Nurses to Practice Trauma Informed Care
Joy A. Lauerer, DNP PMHCNS BC;  Colleen C. Williams, DNP, PMHNP-BC;  Kathleen C. Gaffney, APN, PMHCNS, CPNP, PMHS-BC

Abstract
PURPOSE: Expand nursing knowledge of the connection between adverse childhood experiences (ACE), effects on brain development, behavior and health throughout the lifespan. Empower nurses to provide care with a trauma-informed approach based on emerging research from the fields of genetics, epigenetics, and the promise of neuroplasticity. SUMMARY OF EVIDENCE: The physiological activity created by ACEs is powerful in shaping brain architecture and actually changes the chemistry that encodes the genes in brain cells. Positive experiences such as exposure to rich learning opportunities and negative influences, such as trauma or environmental toxins, leave a chemical “signature” on the genes, which can be temporary or permanent. DESCRIPTION: Use ACE and Resilience Questionnaires, a thorough psychosocial history that includes prenatal exposure to alcohol, drugs and environmental stressors. Using a trauma informed approach, develop a collaborative plan of care that empowers the patient to change behaviors and improve quality of life. VALIDATION OF EVIDENCE: A critical review of the literature and synthesis of findings were conducted on the impact of ACEs, epigenetics, neuroplasticity, fetal alcohol exposure and trauma informed care.  RELEVANCE/OUTCOMES: Mental health interventions must be evidence-based but fluid enough to accommodate both the needs of the client and incorporation of new research findings. Epigenetic regulation likely plays a role as the mediator of fetal programming of adult health with these effects being transmitted through both maternal and paternal lines affecting future generations. If we don't ask, they won't. IMPLICATIONS: With this new knowledge, nurses can and must assess for trauma and intervene using Evidence Based Practice to promote resilience and improve health outcomes.

 


 
 

1044:  Caring for the Hallucinating Patient: Non-Pharmacological Interventions
Edward A. Herzog, MSN, APRN-CNS

Abstract
PURPOSE: Hallucinations can significantly affect functioning, quality of life, and safety. They are often challenging to understand and manage, both for staff and for significant others. This presentation will improve the care of persons experiencing hallucinations by focusing on practical, non-pharmacological interventions for improving reality testing, reducing risk, enhancing coping, and reducing hallucinatory experiences. SUMMARY OF EVIDENCE: The cause of hallucinations is not well understood; research suggests causes ranging from neurotransmitter dysfunction to temporal processing errors resulting in misidentification of self-generated verbal stimuli. While medications can dampen and sometimes eliminate hallucinations, they require extended periods of time to work and are not always fully effective. Recent developments such as cognitive-behavioral interventions have not been fully implemented, and nurses may over-rely on pharmaceutical interventions while neglecting non-pharmacological approaches that could also assist consumers experiencing hallucinations. DESCRIPTION: Interventions and strategies include trust-based incremental reality orientation, active engagement in concrete/reality-based activities, psychoeducation, guided reality testing, cognitive interventions, competing aural stimuli, isolation reduction, stimulation management, peer support, stress/anxiety reduction, and trigger reduction. VALIDATION OF EVIDENCE: Validation is based on qualitative research and consumer feedback, and is limited; areas for future research will be discussed.  RELEVANCE/OUTCOMES: Hallucinations are common (70% of those with schizophrenia, 20% in mania, 10% in depression) and can cause significant distress and risk to self and others. Therefore it is essential for nurses to be able to recognize, assess, understand, and intervene in hallucinations. IMPLICATIONS: Improvement in care for hallucinations can improve comfort and function, reduce consumer and staff distress, and increase the safety of all.

 


 
 

1045:  Depression Recognition, Assessment and Intervention: Emerging Psychiatric Mental Health Nursing Research
Linda S. Beeber, PhD, PMHCNS-BC, FAAN;  Carla J. Groh, PhD;  Jaclene A. Zauszniewski, RN-BC, PhD, FAAN

Abstract
PROBLEM: Depression and the spectrum of depressive symptoms affect more than 15 million American adults and constitute the leading cause of disability for adults aged 15-44 years of age. Women are 70% more likely to suffer from depression. The very young and the elderly are also at risk – very young children as a result of maternal depression and elders in the context of changes in health and mobility. FRAMEWORK: Interpersonal Theory of Nursing (Beeber); Theory of Resourcefulness (Zauszniewski); Biopsychosocial (Groh).  METHODS: This session will feature three psychiatric mental health nurse researchers who will present new research findings and provide insights and guidance for clinicians caring for individuals and families along the lifespan.  RESULTS: Strategic decisions to partner with trusted community agencies to embed depression treatment made a major impact on mothers who had previously avoided or been barred from treatment which has potential impact for both mothers and children (Beeber). Resourcefulness has shown the potential to buffer life changes and negative events in the development of depression (Zauszniewski). Positive integration of depression into primary care settings can be achieved by nurses (Groh).  IMPLICATIONS: Psychiatric mental health nurses are in key positions to identify, assess and intervene with depressed individuals and their families at all points along the lifespan. With its many faces and presentations, expanding the capacity of nurses to intervene in depression can have a major impact on the mental health of populations. FUTURE RESEARCH: More research, especially randomized clinical trials of nursing intervention approaches tailored for distinct populations are needed.

 


 
 

1046:  The Phenomenon of Suicide: Competency Number One for the Psychiatric Mental Health Nurse Generalist
Pamela E. Marcus, RN APRN/PMH-BC;  Amanda L. Schuh, PhDc, RN, PMHNP-BC; Eric C. Arauz, MA, MLER

Abstract
PURPOSE: Inpatient PMH nurses provide care to patients who are suicidal based on the current practices at the facility where they practice. This care may not meet the specific standards of care. One critical area of care relates to current practices of contracting for safety vs developing safety plans. This presentation will clarify evidence-based criteria for safety plans as opposed to previous practice of no harm contracts. An example of how to facilitate a safety plan and the effect this intervention has on the patient will be presented. SUMMARY OF EVIDENCE: In 2008 Stanley and Brown published a Safety Plan for the VA system in order to provide a structured method to assist individuals to prevent suicide. The VA system implemented this safety plan with a significant reduction of suicide attempts. The APA Clinical Practice Guidelines has expressed a concern about using a no harm contract due to not enough research to determine the efficacy of it's use. (APA 2010). DESCRIPTION: Participants will be taught the 6 steps Safety Plan to use for patients who are admitted to an inpatient unit with suicidal thoughts. VALIDATION OF EVIDENCE: The No Harm Contract for care of a patient who is exhibiting a risk for suicide will be compared to the Safety Plan.  RELEVANCE/OUTCOMES: Inpatient PMH nurses will learn an evidence-based intervention that is within the scope of practice and provides a structured plan to use to reduce the risk for a suicide attempt. IMPLICATIONS: The presentation will assist the PMH nurse to use an evidenced based intervention to decrease suicide risk.

 


 
 

1047:  Compassion Without Fatigue
Michael E. Holtby, LCSW, BCD

Abstract
PURPOSE: To increase awareness of the risks and signs of vicarious trauma, burnout and compassion fatigue; and provide strategies for self-care and greater professional and personal resilience. SUMMARY OF EVIDENCE: Based upon the presenter's four decades of clinical experience, specifically within the AIDS crisis; supplemented with additional reading. Saakvitne & Pearlman, Transforming the Pain: a Workbook on Vicarious Traumatization (1996) DESCRIPTION: In private practice in Denver for thirty-seven years as a clinical social worker. Worked within the AIDS epidemic since the beginning. VALIDATION OF EVIDENCE: This is not a research endeavor. Feedback forms on the workshop itself have averaged 9.4 out of a possible 10.  RELEVANCE/OUTCOMES: Psychiatric nurses will readily identify with the risks of regularly dealing "in the trenches" with the pain and trauma of their patients. We absorb it, and must have coping skills to be able to throw it off. IMPLICATIONS: The more we can address compassion fatigue the longer we can work in this field, and reduce turnover in our agencies and hospitals.