2015 Annual Conference Pre-Conference Session Abstracts
 

1011: Tricorders to Baymax: Enhancing Patient Care Through Technology
Megan OConnell, PMHCNS-BC

Abstract
PURPOSE: The Patient Protection and Affordable Care Act has lead to increased focus on quality of care with more emphasis on care coordination and patient education and engagement, the aspects of healthcare that are the heart of the nursing role. SUMMARY OF EVIDENCE: The rise of health related technology and social media offers nurses an opportunity to address the growing problem of access to behavioral health services. DESCRIPTION: Focused Acceptance Commitment Therapy (FACT) utilizes action-oriented, values-based behavior strategies drawn from an evidenced based treatment with established efficacy in the treatment of behavioral health disorders, as well as medical issues, such as chronic pain, obesity, diabetes and smoking. Incorporating familiar technology into the patient's FACT treatment plan, such smartphone apps that teach mindfulness with reminders to practice and social networking sites with "offline" options like Living Social and meetup.com with calendar reminders, can improve compliance and self efficacy. Media examples can be used to help provide context for patient education to enhance understanding and increase motivation to change. VALIDATION OF EVIDENCE: Through utilization of health related technology, clinicans can monitor patient compliance, improve communication and enhance problem solving using solution focused methods.  RELEVANCE/OUTCOMES: FACT interventions can be incorporated into all aspects of psychiatric nursing, from medication management appointments and medical consults to mileu activities and psychoeducational groups to enhance patient engagement and autonomy IMPLICATIONS: Options for educating the public and increasing patient engagement through the use of podcasting, digital storytelling and gamificaiton will explored.

 


 
 

1012: Defining and Using Psychiatric Mental Health (PMH) Skills in Undergraduate Nursing Education
David Sharp, RN; PhD;Diane Esposito, PhD, ARNP, PMHCNS-BC

Abstract
PURPOSE: The purpose of this workshop is to familiarize nursing faculty who teach PMH Nursing with the nursing skills that are necessary in undergraduate nursing programs. SUMMARY OF EVIDENCE: The Undergraduate Branch of the APNA Educational Council have conducted a cross walk between the APNA/ANA Scope and Standards of Practice of Psychiatric-Mental Health Nursing and the ISPN/APNA Essentials of Psychiatric Mental Health Nursing in the BSN Curriculum. The result of this exercise is that the 2104 Scope and Standards content has been aligned with the Core Nursing Content for teaching. The thirteen Core Nursing Content areas that require to be taught within the undergraduate curriculum now have been developed in relation to a clinical skills toolkit for teachers DESCRIPTION: The APNA and AACN intend using the skills toolkit for use by educational institutions to assist them in achieving accreditation or re—accreditation for nursing undergraduate programs. VALIDATION OF EVIDENCE: At the conclusion of the workshop a survey as to the perceived effectiveness of the skills toolkit will be given to participants and comments and suggestions for rolling out the toolkit for use nationally via the APNA will be collected.  RELEVANCE/OUTCOMES: This workshop will familiarize nursing faculty with the PMH Nursing skills that should be included in an undergraduate nursing curriculum and provide them with hands on experience in developing, teaching and assessing a range of clinical skills. IMPLICATIONS: It is envisioned that the skills toolkit will be used on a nationwide basis to standardize the PMH Nursing skills taught within nursing curricula and assist with accreditation of future nursing programs.

 


 
 

1013: PART I: COPE A Brief Evidence-Based Cognitive- Behavioral Skills Building Intervention for Children and Adolescents with Anxiety and Depression. Incorporating a CBT based intervention into brief 20-30 minute visits
Bernadette Melnyk, PhD, RN, PMHNP-BC, PNP , CPNP,, FAAN, FAANP;Pamela Lusk, DNP, RN, PMHNP-BC, FAANP

Abstract
PURPOSE: Children and Adolescents aren't receiving the evidence-based mental health intervention they need for anxiety and depression. COPE,a CBT based Intervention - for children & adolescents used in brief 30 minute visits resulted in positive clinical outcomes, reimbursement, and patient satisfaction. COPE allows the PMHNP to practice within their full scope of practice - providing psychotherapy as well as medication management in 30 min visits. SUMMARY OF EVIDENCE: Systematic reviews, meta analysis, RCTs - the highest level of evidence, support CBT as the most effective intervention for children and adolescents with anxiety / depression. It is feasible to provide the COPE sessions in brief visits with good clinical outcomes, 100% reimbursement and patient satisfaction. DESCRIPTION: COPE program is CBT - as adapted for youth, in a manual for 7 brief visits. Our work demonstrates that the APRN can provide this active- psychotherapy along with medication management in busy practices. VALIDATION OF EVIDENCE: Publications - effectiveness of COPE, ( JAPNA, Journal of Pediatric Health Care). RCT with COPE (800 High School students) published American Journal of Preventive Medicine.  RELEVANCE/OUTCOMES: With COPE, Children and Adolescents had decreased anxiety and depression and increased self esteem. COPE sessions were reimbursed. Parents and young people reported the intervention was helpful and they are using the skills they learned. Advanced practice nurses could practice in their full practice scope. IMPLICATIONS: If APRN's have COPE for their practice, more children and adolescents will get the evidence-based treatment they need, and the APRN can practice in his/ her full scope of psychiatric nursing practice. Cost effective.

 


 
 

1014: Sex, Gambling and the Internet: Drawing the Line Between Normal and Addictive Behaviors
Diane Wieland, PhD, MSN, PMHCNS-BC, PMHNP-BC, CNE;Cindy Kerber, PhD, APRN

Abstract
PURPOSE: The purpose of this presentation is to provide a comprehensive overview of behavioral addictions, diagnosis, and treatment. Clients with sex addiction led to one author's practice change. SUMMARY OF EVIDENCE: The DSM 5 notes Gambling Disorder and Internet Gaming Disorder. Addiction is more than physiological dependence. Behavioral addictions (process addictions), are a result of repetitive activity which is impulsive and compulsive. Sex, gambling, excessive use of the Internet, video-gaming, food, exercise, and shopping are types of behavioral addictions. These addictions stimulate the nucleus accumbens and the VTA in the pleasure reward circuits in the brain. Acting-out behaviors result from emotional dysregulation. DESCRIPTION: Specialized education and training exists for sex addiction through IITAP. Research is supported by Patrick Carnes and others for sex addiction. Specialized treatment exists for Gambling Disorder. Psychotherapy, groups, and 12 Step Fellowships are treatment modalities for clients with behavioral addictions. VALIDATION OF EVIDENCE: Literature on sex addiction and Gambling Disorder are extensive. Sobriety is an outcome. Individuals with behavioral addictions must identify their bottom line behaviors.  RELEVANCE/OUTCOMES: Behavioral addictions are considered "new" because only two of the disorders have been published in the DSM-5; however, future editions will explore the need to include others as evidence is available. As a vital workforce in mental health, nurses cannot let other disciplines take over the field of behavioral addictions. An outcome would be more nurses certified as CSATs. IMPLICATIONS: Behavioral addictions are cutting edge conditions receiving recognition. Nurses need to be in the forefront in addressing research, publications, and practice related to these developing mental health issues.

 


 
 

1015: Evidence-Based Prescribing Practices for Treating PTSD in Military Combat Veterans
Jess Calohan, DNP, MN, PMHNP-BC

Abstract
PURPOSE: To identify evidence-based pharmacological interventions for treatment of PTSD. SUMMARY OF EVIDENCE: Multiple medications are available to treat PTSD symptoms, however there is limited evidence to support the efficacy of the broad-range of medications currently used in clinical practice. DESCRIPTION: Despite the availability of Clinical Practice Guidelines to guide PTSD treatment, clinicians continue medications from multiple drug classes to manage and treat the symptoms of PTSD, some of which may cause harm to patients. VALIDATION OF EVIDENCE: A review and appraisal of the evidence for psychopharmacological interventions along with current Clinical Practice Guidelines will be presented.  RELEVANCE/OUTCOMES: As military veterans' with PTSD continue to transition from the military and into civilian health systems, it is important for clinicians to have familiarity with evidence-based psychopharmacological interventions used in the treatment of this population. IMPLICATIONS: Identifying current treatment practices can further validate and/or lead to revision of current Clinical Practice Guidelines (CPG’s) for treating PTSD.

 


 
 

1021: Solution Focused Therapy, a Unifying Framework for Recovery Oriented Inpatient Practice
Judy Linn, BSEd, BSN, MSN, RN

Abstract
PURPOSE: Solution Focused Brief Therapy facilitates the nurse and the clinical team to provide patient focused, goal oriented treatment. Its principles are simple and easily implemented and result in hope for the future. SUMMARY OF EVIDENCE: SFBT is a subset of Cognitive Behavioral Therapy that focuses on the client identifying and using past successes to build behavior changes. Three SFT inpatient programs resulted in 99% patient satisfaction, top-tier employee engagement and significant symptom reduction. . DESCRIPTION: The stake holders include the clinical team, the patient/family and the outpatient team who receives the patient with a clearly identified patient owned goal for treatment.The group structure is built on identification and practice of the patients' strengths. The result is a patient with hope for the future and a written "mini-recovery action plan." Implementation requires a 2 hour education for all staff and a program revision. VALIDATION OF EVIDENCE: The use of SFT has resulted in 3 different inpatient hospitals going from a bottom quartile patient satisfaction score to 99% patient satisfaction. One unpublished study demonstrated a 60-90% reduction is symptoms on the PHQ9 adapted for inpatient use. Re-admission decreased in all hospitals.  RELEVANCE/OUTCOMES: SFT gives nurses a tool to engage patients strengths, reinvigorate hope and move from simply monitoring medication and safety to providing meaningful nursing care as part of the clinical team. IMPLICATIONS: * Patients satisfied with their care engage in treatment. * Patients with hope for their future continue with care. * Nurses using SFT are more engaged in their practice.

 


 
 

1022: Creating Standardized Patient Simulations for Interprofessional Psychiatric/Mental Health Nursing, Pharm.D, and OT Education and Collaborative Team-Based Care
Merrie Kaas, Ph.D, RN, PMHCNS-BC, FAAN; Barbara Peterson, Ph.D, RN, PMHCNS-BC; Jane Miller, Ph.D

Abstract
PURPOSE: The purpose of this workshop is to demonstrate the “how tos” of developing, implementing, and evaluating simulations using standardized patients to teach and assess interprofessional (PMH NP, Pharm.D, OT) clinical interviewing skills and team-based care for patients experiencing psychiatric conditions. SUMMARY OF EVIDENCE: Increasingly complex needs of mental health clients require more interprofessional, team-based care, yet health professional students continue to be educated in uni-professional models, isolated from other health care professionals until graduation when mental health care services demand collaborative practice. Using standardized patients for teaching PMH NP students clinical interviewing and diagnostic skills has been shown to be an important teaching methodology that improves clinical competence and decision-making. DESCRIPTION: Through presentation, examples, and discussion, workshop participants will learn to develop interprofessional, team-based case simulations for standardized patients demonstrating psychiatric disorders, discuss best practices for working with standardized mental health patients, and describe evaluation/assessment methods for determining student learning about clinical interviewing and interprofessional team-work for mental health care. Examples come from PMH NP curriculum enhancements developed as a result of a HRSA ANE funded grant. VALIDATION OF EVIDENCE: Workshop participants will be able to describe best practices for interprofessional clinical learning using standardized patient simulations and evaluation.  RELEVANCE/OUTCOMES: With more emphasis placed on interprofessional student learning, standardized patient simulations can provide PMH NP students authentic learning experiences to prepare them to participate in interprofessional clinical interviewing and team- based mental health care. IMPLICATIONS: PMH NP, PharmD, and OT students can enhance both uni-professional and interprofessional clinical competence and team-based care through effective standardized patient simulations and assessments.

 


 
 

1023: PART II: COPE A Brief Evidence-Based Cognitive- Behavioral Skills Building Intervention for Children and Adolescents with Anxiety and Depression. Incorporating a CBT based intervention into brief 20-30 minute visits.
Bernadette Melnyk, PhD, RN, PMHNP-BC, PNP, CPNP, FAAN, FAANP; Pamela Lusk, DNP, RN, PMHNP-BC, FAANP

Abstract
PURPOSE: Children and Adolescents aren't receiving the evidence-based mental health intervention they need for anxiety and depression. COPE,a CBT based Intervention - for youth, used in brief 30 minute visits resulted in positive clinical outcomes, reimbursement, and patient satisfaction. COPE allows the PMHNP to practice within their full scope of practice - providing psychotherapy as well as medication management in 30 min visits. SUMMARY OF EVIDENCE: Systematic reviews, meta analysis, RCTs - the highest level of evidence, support CBT as the most effective intervention for children and adolescents with anxiety / depression. It is feasible to provide the COPE sessions in brief visits with good clinical outcomes, 100% reimbursement and patient satisfaction DESCRIPTION: COPE program is CBT - as adapted for youth, in a manual for 7 brief visits. Our work demonstrates that the APRN can provide this active- psychotherapy along with medication management in busy practices. VALIDATION OF EVIDENCE: Publications - JAPNA, Journal of Pediatric Health Care). RCT with COPE (800 High School students) published American Journal of Preventive Medicine.  RELEVANCE/OUTCOMES: Relevance to PMH Nursing / Results* With COPE, Children and Adolescents had decreased anxiety and depression and increased self esteem. COPE sessions were reimbursed. Parents and young people reported the intervention was helpful and they are using the skills they learned. Advanced practice nurses could practice in their full practice scope. IMPLICATIONS: If APRN's have COPE for their practice, more children and adolescents will get the evidence-based treatment they need, and the APRN can practice in his/ her full scope of psychiatric nursing practice.

 


 
 

1024: Integrating Dialectical Behavior Therapy with the Twelve Steps: A Non-Pharmacologic Approach to Managing Emotion Dysregulation in Early Recovery
Bari Platter, MS, RN, PMHCNS-BC

Abstract
PURPOSE: In early recovery, clients commonly experience emotion dysregulation that prevents them from successfully participating in therapeutic programming. Nurses are charged with the responsibility of supporting clients who experience emotion dysregulation. Non-pharmacologic approaches can be as effective and provide clients with tools to successfully manage emotion dysregulation in the future. SUMMARY OF EVIDENCE: DBT was initially developed for chronically mentally ill clients. There has been extensive research reagrding the use of DBT with a variety of populations, including those with substance use disorders. Numerous research articles describe the effectiveness of utilizing DBT in addiction treatment. Many addiction treatment centers have included DBT programming into their treatment models. Addiction literature also clearly demonstrates the utility of Twelve Step programming in supporting recovery and this approach is also commonly integrated into addiction treatment programs. DESCRIPTION: DBT and Twelve Step philosophy have many conceptual similarities. Both are evidence-based treatment approaches. Because they both work well together, the authors developed a treatment model that integrates the two to provide a curriculum that directly addresses emotion dysregulation commonly experienced in early recovery from addiction. VALIDATION OF EVIDENCE: The authors are currently working on an outcomes study to measure the effectivness of the model.  RELEVANCE/OUTCOMES: The curriculum is designed to assist nurses in structuring individual coaching sessions and psycho-educational groups in both inpatient and outpatient addiction treatment settings. IMPLICATIONS: The nurses' role in early recovery includes both pharmacologic and non-pharmacologic interventions. By strengthening the nurses' role in providing non-pharmacologic strategies to manage emotion dysregulation, clients can develop skills that can be accessed during and after treatment.
 


 
 

1025: Keys to Accurate Psychopharmacology in Primary Care Integration
Sharon R. Katz, MSN FPMH-APRN, CRNP

Abstract
Comprehensive clinical approaches to chronic medical issues, chronic pain, insomnia, drug and alcohol dependency, and multigenerational psychiatric disorders challenge the APRN. When working with medical professionals in integrated health care settings, accuracy in addressing co-occurring diagnoses, developing nursing based treatment plans and producing measured outcomes are increasingly projected to be linked to reimbursement. Tools such as labs, genetic assays, and mental health scales validate treatment approaches, provide holistic (frequently vitamin supplement) options and provide valuable data to other medical team members. These valuable keys will be explored, with case discussions to enhance the presentation. 
 


 
 

1031: Facebook, MySpace, Blog or Tweet, What You Say May Not Be Sweet: Professional Boundaries and Social Media
Nancy Dillon, Ph.D, RN, PMHCNS-BC

Abstract
PURPOSE: To help PMH RNs and APRNs become aware of risks associated with social media as they relate to professional boundaries and to identify strategies to maintain appropriate boundaries. SUMMARY OF EVIDENCE: The National Council of State Boards of Nursing has issued statements with guidelines. I have provided education to nurses who have corrective actions against their licenses because of difficulties associated with use of social media. DESCRIPTION: Few nurses have received education or training associated with professional boundaries at all, to say nothing of the risks associated with the use of social media. I Include strategies to stay safe, including the need for organizational policies. Practice changes include education of clients, families, how to establish privacy settings and how to label/name social network sites VALIDATION OF EVIDENCE: Feedback from participants  RELEVANCE/OUTCOMES: Relevance to practice - safety for nurses and clients as well as safeguards for organizations. IMPLICATIONS: Ongoing education and awareness.

 


 
 

1032: Stabilization Approaches to the Treatment of Complex PTSD and Dissociative Disorders in Adults
Kathy Steele, MN, PMHCNS-BC

Abstract
PURPOSE: Complex PTSD and dissociative disorders are often under-diagnosed and mis-diagnosed, and patients may be inappropriately treated with Evidenced Based Treatments for classic PTSD. In this workshop we will examine the necessary stabilization approaches needed for these patients to improve functioning in daily life and participate effectively in therapy. SUMMARY OF EVIDENCE: Research has recently shown evidence of a dissociative subtype of PTSD that is not responsive to current EBTs for PTSD. Rather these patients respond better to stabilization and regulation strategies instead of exposure based treatments. Additional research has indicated standard EBTs for PTSD are not generally effective for patients with Complex PTSD and Dissociative Disorders. DESCRIPTION: We will explore various stabilization skills and interventions such as learning to recognize, accept and tolerate inner experiences, emotional and relational regulation, addressing dissociation directly, managing flashbacks and somatic distress, activation of positive experiences, alternatives to avoidance strategies, and improving safety and reducing self harm, among others. VALIDATION OF EVIDENCE: Several ongoing studies indicate that stabilization skills for patients with Complex PTSD and Dissociative Disorders lead to significant improvement, as evidenced by decrease dissociation, self harm and depression, and improved functioning in daily life. In addition, directly addressing dissociation is shown to be effective and beneficial for patients.  RELEVANCE/OUTCOMES: APRNs have a unique opportunity to promote more effective assessment and treatment for this very large and traumatized population, present in virtually every setting. IMPLICATIONS: As stabilization approaches become better known these patients are likely to receive more adequate and effective treatment. Research continues to refine these interventions.

 


 
 

1033: Differential Diagnosis of Delirium in the Medically Ill Child - Diagnostic and Treatment Challenges
Nancy Noyes, MS, PPCNP-BC, PMHCNS-BC

Abstract
PURPOSE: Delirium is a serious psychiatric emergency requiring quick recognition and treatment interventions to prevent long-term cognitive sequelae. It is often not well understood, recognized, diagnosed or treated. Our psychiatry service may not be consulted with early mental status changes.. SUMMARY OF EVIDENCE: It is estimated that one in 10 critically ill children are at at significant risk for developing pediatric delirium. There is a limited awareness of delirium among healthcare providers . This can lead to increased risks of poorer long-term functional outcomes. DESCRIPTION: The PCAM-ICU is the first reliable and rapid assessment tool that can be used by the multi-disciplinary team to easily diagnose pediatric delirium. A thorough psychiatric evaluation of the child's mental status as well as medication regimen is necessary. Consultation with neurology may be important to further r/o other potential causes of mental status changes. VALIDATION OF EVIDENCE: The PCAM-ICU is a reliable assessment tool to diagnose delirium in children greater than or equal to 5 y.o. .Clinical outcomes will be measured by improved mental status changes and effective psychiatric interventions which may include psychotropic medications.  RELEVANCE/OUTCOMES: The primary mental health nurse or PMH-NP can be instrumental both in the education and early diagnosis and treatment of pediatric delirium.. This will improve long-term cognitive outcomes for the child. IMPLICATIONS: Further research is necessary to determine both the prevalence of pediatric delirium as well as the long-term cognitive effects related to the lack of early recognition, diagnosis and treatment.

 


 
 

1034: Using Screening, Brief Intervention, and Referral to Treatment in Practice: A Skills Building Workshop
Joanne Iennaco, PhD, PMHNP-BC, APRN

Abstract
PURPOSE: Alcohol and drug use cause significant medical, legal and social problems. Alcohol use results in over 100,000 deaths annually and 8% of those over 12 years use illicit drugs. Only a fraction of those needing treatment receive it. Often health care providers do not actively identify problem use. SUMMARY OF EVIDENCE: Screening, brief intervention, and referral to treatment(SBIRT)is an evidence based model for intervention with substance use problems. Brief interventions are effective in a variety of settings, reducing the negative consequences of substance use. DESCRIPTION: The program involves screening individuals for alcohol and substance related behaviors, and for use that is considered hazardous or harmful, completing a Brief Negotiation Interview (BNI), using motivational enhancement principles to promote change in substance use behaviors. An initial educational session familiarizes learners with the epidemiology of substance use. Screening methods are reviewed to identify individual with hazardous or harmful substance use. A video example of the BNI is presented followed by skills based practice sessions to allow nurses to use the skills learned with cases. VALIDATION OF EVIDENCE: Studies show the program is effective in reducing unhealthy alcohol use, 37% no longer exceeded NIAAA guidelines and reduced risk of alcohol related injury.  RELEVANCE/OUTCOMES: PMH RNs and APRNs have frequent contact with individuals whose alcohol and drug use are harmful. This program offers a model for intervention that is easy to implement. IMPLICATIONS: By helping health care practitioners learn brief models of intervention persons with substance use disorders are more likely to receive interventions that will reduce the negative consequences of substance abuse.

 


 
 

1035: Psychopharmacology Session
 

Abstract
TBD
PURPOSE: SUMMARY OF EVIDENCE: DESCRIPTION: VALIDATION OF EVIDENCE:   RELEVANCE/OUTCOMES: IMPLICATIONS:

 


 
 

1041: Differentiating Medical and Psychiatric/Mental Health Symptoms Using Physical Assessment Skills
Mary Ann Foley-Mayer, DMH, RN, PMHNP-BC

Abstract
PURPOSE: Psychiatric and medical symptoms frequently overlap and the practitioner needs to quickly assess and differentiate these symptoms to provide optimum treatment. This presentation will focus on recognizing, identifying and interpreting symptoms commonly seen in a out-patient office or hospital setting. I will discuss how to quickly assess and determine which symptoms need immediate treatment vs. those needing long term care. SUMMARY OF EVIDENCE: Practitioners often encounter clients in the hospital or out-patient setting that display symptoms of medical and/or psychiatric origin. The symptoms require rapid and accurate assessment to provide the best treatment. Physical assessment skills are imperative for the psychiatric/mental health nurse to achieve the appropriate diagnosis and treatment DESCRIPTION: I will use lecture, case studies and audio visual aids to identify symptoms as psychiatric or medical while encouraging discussion, symptom analysis, use of specific physical assessment skills and formulation of differential diagnosis and course of action. The presentation will focus on three main topics: Seizure vs/ psychogenic non-epileptic seizure, change in mental status: delirium vs depression and skin rash from medical cause v.s. rash from psychotropic medication VALIDATION OF EVIDENCE: Evaluation is determined by participation in the discussion and completion of a program evaluation. Current literature supports the need for psychiatric/mental health nurses to utilize physical assessment skills in their daily practice as many symptoms mimic medical or psychiatric illness.  RELEVANCE/OUTCOMES: The integration of medical and psychiatric care mandates the psychiatric/mental health nurse develop and incorporate physical assessment skills into daily practice. IMPLICATIONS: This presentation supports integrative practice and encourages psychiatric nurses to utilize physical assessment skills.

 


 
 

1042: Caregiver Occupational Stress First Aid (COSFA): A Potentially Life-saving Tool
Jean Fisak, MSN, PMHCNS-BC; Sean Convoy, PMHNP-BC, DNP

Abstract
PURPOSE: Responding to patient's in crisis is required for PMH nurses but there lacks a mechanism to respond to to a crisis injury for peers. COSFA has action steps to recognize and react to stress injuries for peers. SUMMARY OF EVIDENCE: Initial care of physical injuries and illnesses were practiced in a systematic way during the 11th century. More recently, these same principles of physical first aid, developed over the centuries, have also been applied to the premedical care of injuries and illnesses. COSFA requires a set of skills designed to address a certain type of problem in a certain situation—the ability to perform a quick and accurate assessment, to find the best way to meet the specific needs indentified, and to identify when more than first aid s needed to ensure that such further treatment is received quickly. DESCRIPTION: There is no other tool in the Department of Defense or civilian sector that uses a tool designed to respond laterally to a stress injury or psychological crisis. VALIDATION OF EVIDENCE: A combat operational stress assessment was conducted in 2010 within Navy medicine that showed the effectiveness of COSFA. Currently evidence- based methods are being developed to further assess programmatic outcome  RELEVANCE/OUTCOMES: PMH nurses are at the tip of the spear for change. Implementing the COSFA model within their organization could provide a common language with the goal of early intervention during a crisis. IMPLICATIONS: COSFA is a designed to recognize stress reactions and injuries and early intervention strategies that could be potentially life saving.

 


 
 

1044: Marijuana and Mental Health: Risks and What Nurses Need to Know
Matthew Tierney, APRN

Abstract
PURPOSE: Marijuana is the most commonly used illicit drug in the US, and adolescent onset of use is common. Cannabis use among adolescents has been increasing while adolescent perception of the associated harms has decreased. Laws to decriminalize cannabis are increasingly passed in many states, including laws that allow marijuana use for recreational as well as medicinal purposes. Ignorance of the mental health risks of cannabis, coupled with increasing cannabis use and decreased perception of harm, create the potential for an increase in the incidence of mental health problems due to this drug. Nurses must understand the risks and educate the public. SUMMARY OF EVIDENCE: Cannabis is not harmless. It poses particular risks to mental health, especially for adolescents due to their specific stage of neurodevelopment. DESCRIPTION: Scant information on the known risks of cannabis use is disseminated in public or health care domains. VALIDATION OF EVIDENCE: Recent research defines the psychiatric and neurological risks posed by cannabis use, especially with early-age onset before neurodevelopment is complete. In particular, cannabis appears to increase their risk of developing a psychotic illness later in life.  RELEVANCE/OUTCOMES: Nurses must learn the objective information about particular harms cannabis use poses to healthy neurological development, and the risks it poses for mental health problems. IMPLICATIONS: We can expect more Americans, including adolescents, to use cannabis. Nurses are in a unique position to learn and disseminate knowledge about the risks cannabis poses to mental health, to educate patients and families, and effect the mental health of the population in a positive way.

 


 
 

1045: Doctor Shopping: What You Need to Know to Understand, Identify and Manage It
Julie Worley, PhD, FNP-BC, PMHNP-BC

Abstract
PURPOSE: SUMMARY OF EVIDENCE: DESCRIPTION: VALIDATION OF EVIDENCE:   RELEVANCE/OUTCOMES: IMPLICATIONS: