Thursday Afternoon Session Abstracts

2031: "Psychopathophagia":  A Hard Syndrome to Swallow (Deliberate Foreign Body Ingestion)
Lisa Kongable, MA, PMH-CNS, ARNP, CNE

Abstract
PURPOSE: To educate psychiatric-mental health nurses about the intriguing and complex clinical syndrome and nursing care challenges involving deliberate foreign body ingestion (DFBI). SUMMARY OF EVIDENCE: Patients presenting with psychopathological swallowing behaviors are extremely challenging to care for and create astronomical costs for our health care system, not only financially, but emotionally. Although there is evidence of this syndrome existing since at least the early 1900s, it is still poorly understood and there has been little research devoted to the etiological factors or treatment measures for this specific patient population. DESCRIPTION: There is no clear evidence-based practice treatment approach for managing psychiatric patients who exhibit DFBI. Current practices involve patient and environmental safety and prevention of DFBI, emergency treatment, surgical removal of the object(s) if necessary, and follow up psychiatric care.  Inpatient psychiatric admission is considered a last resort, due to possibly contributing to further deterioration and repeated swallowing attempts. VALIDATION OF EVIDENCE: The majority of studies on DFBI feature the medical-surgical aspects of this disorder and are based on clinical case studies.  Based on the available research, there are four distinct diagnostic subgroups identified as being at risk for DFBI, including patients with pica, psychosis, malingering, and severe personality disorders. However, RELEVANCE/OUTCOMES: There are complex care challenges for psychiatric nurses working with patients who engage in DFBI. United multidisciplinary team approaches are essential to the effective care management aspects of this specific patient population. IMPLICATIONS: Further experience and research is highly needed to gain insight into this clinical syndrome and to determine best practices for nursing care.

 

2032: Inspiring Future Leadership with Inter-professional Training for Advanced Practice Psychiatric Nursing Sudents at a School/Community Health Center
Diana McIntosh, Ph.D., APRN, PMHCNS-BC

Abstract
PURPOSE: The World Health Organization (2010) states, “Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team.” Thus, it is imperative that psychiatric nursing students understand interprofessional practice, work effectively as members of clinical teams while students, and eventually lead collaborative efforts that best meet patient needs in any setting. SUMMARY OF EVIDENCE: In 2009 six national education associations of schools of the health, including nursing, formed a collaborative that created core competencies to guide curricula and promote interprofessional learning experiences that would help prepare future health professionals for enhanced team-based care of patients and improved population health outcomes (IPEC, 2010). DESCRIPTION: An Interdisciplinary training model, that includes case conferences, was created at a school/community health center that integrates physical and behavioral health. VALIDATION OF EVIDENCE: Interprofessional approaches have been found to improve patient care, satisfaction with care, cost-effectiveness, and provider learning (Mitchell et al., 2013). The successes and challenges of establishing interdisciplinary case conferences at a school/community health center were analyzed. RELEVANCE/OUTCOMES: A case example will guide psychiatric mental health nurses on how to apply interprofessional competencies, lead collaborative efforts and eventually better patient outcomes. IMPLICATIONS: This model can be used to inspire psychiatric nursing students to be leaders in interprofessional practice and truly transform healthcare.

 

2033: The Impact of Two Nursing Protocols on Continuous Special Observation
Richard Ray, RN, MS, PMH-BC

Abstract
PROBLEM STATEMENT: Continuous Special Observation (CSO) is commonly ordered for patients at risk to injure themselves or others and involves assigning staff to monitor patients at all times.  CSO is based on control and coercion. Two nursing protocols were developed as alternative interventions to CSO. The first, Psychiatric Nursing Availability (PNA) designed to treat patients having suicidal or self-injurious thoughts.  The second, Psychiatric Monitoring and Intervention (PMI) designed to prevent violent and impulsive behavior.  These protocols had their genesis in a nursing model based on Leadership and autonomous decision making. Objective: Identify the impact PNA and PMI had on the number of CSO and their duration. THEORETICAL FRAMEWORK: Nurses can treat high-risk patients using interventions based on engagement. METHODS & DESIGN: Nine year descriptive retrospective analysis of CSO, PNA and PMI.  The data was collected from the unit 15 minute rounding sheets.  Descriptive analyses were performed.  Interrupted time series analysis was used to determine how the protocols affected frequency and duration of CSO. RESULTS: Conclusion: PMI had the greatest impact on CSO. Implications: IMPLICATIONS FOR PRACTICE: interventions which increase nursing presence and engagement on the unit milieu can reduce the use of CSO. Nursing models which foster leadership and autonomous decision making can facilitate the implementation of interventions based on engagement. IMPLICATIONS FOR FUTURE RESEARCH: Researchers need to conduct replication studies using PNA and PMI in other settings

 

2034: Using Electronic Devices to Improve the Patient Care Experience on an Inpatient Behavioral Health Unit
John Wagner, MA, RN-BC

Abstract
PURPOSE: It is now possible to improve the patient care experience for those admitted to inpatient behavioral health units by allowing patients to have access to their Personal Electronic Devices (PED's). SUMMARY OF EVIDENCE: Qualitative research suggests that BHS inpatients allowed access to PED's (cell phone, tablets) during their admission feel less detached or isolated from family and friends at time of discharge than those with a PED's who were not able to maintain access to those devices. DESCRIPTION: Patients presenting to the BHS inpatient units were allowed to retain access to PED's devices, unless there was clinical or behavioral reasons to limit that access.  In the pre test phase, prior to our decision to  allow patient access to PED'S,  patients who came to the hospital with these devices were surveyed at time of discharge.  After we allowed patient use of these devices, and using a physical security patch to obscure the camera lenses, the post test group were allowed to use their PED's and the same survey was administered upon discharge. VALIDATION OF EVIDENCE: There was no existing literature on this subject as related to BHS units.   The pre and post test data was analyzed. RELEVANCE/OUTCOMES: Qualitative data suggests that patients allowed access to personal electronic devices felt less isolated and more in touch with family and friends than those who did not have access to these devices. IMPLICATIONS: This change in practice represents a significant change in inpatient BHS unit practice that will have a meaningful impact on patients and staff.

 

2035: 2015 ASAM Guidelines for the Use of Medications in Opioid Addictions:  What Providers Need to Know about Implementing It into Practice
Jessica Estes, DNP, APRN-NP, FPMHNP

Abstract
PURPOSE: Opioid addictions continue to be a national problem and the new ASAM criteria provides additional resources for prescribing providers. SUMMARY OF EVIDENCE: In 2014 the DSM-V revised it's classification of substance used disorders resulting in the need to alter current guidelines on assessment and treatment of addictions.  In 2015, ASAM released the new prescribing guidelines for medications in opioid addictions.  Providers of all levels are responsible for management of addiction and should be following the current guidelines.  The ASAM research indication if for prescribers at any level (whether in psychiatry or primary care). DESCRIPTION: The ASAM reference indicates expected protocols for assessent, diagnosis, and treatment across the spectrum of substance abuse. VALIDATION OF EVIDENCE: ASAM is currently considered the premier organization for management and treatment of addictions.  Thier protocols are ht most widely used and implemented within insurance criteria for treatment, and within practice protocols.  Passport Health Care in KY implemented the prescribing guidelines in 2015. RELEVANCE/OUTCOMES: PMH practice includes the assessment and treatment of substance abuse and requires continued education on the most current resources and protocols available. IMPLICATIONS: If APRN's in psychiatry start to utilize ASAM criteria, it may support the case that we are appropriate prescribers for suboxone.

 

2036: Bullying:  A Crisis in the Lives of our Children - How can Psychiatric Nurses Help?
Sharon DiVItto, RN, MSN, MA, CS, APRN

Abstract
PURPOSE: This presentation will attempt to explore important issues confronting our children today. How do we identify the early warning signs of bullying and how do we intervene and educate children, families, school teachers, and those that witness bullying in our society? SUMMARY OF EVIDENCE: Every 7 seconds, a child is being bullied in school. 77% of the bullying is emotional and undetected by others. 71% of bullying is a problem in the schools. 90% of bullying is seen in 4th—8th grade. 90% of teens do not report bullying to their parents or teachers. In this presentation, We will discuss the definition, types, and characteristics of bullying see in the community. DESCRIPTION: Patients are referred to Emergency Mental Health Services for numerous reasons and we will discuss treatment interventions that will assist in maintaining a safe and healthy life. VALIDATION OF EVIDENCE: There are many incidences of bullying found in the literature and will be shared for discussion. RELEVANCE/OUTCOMES: Children and teens presenting in Psychiatric emergency rooms with suicidal ideation and attempts after bullying. We need to develop strong treatment interventions to help decrease the incidence of suicide attempts and psychiatric issues as a result of bullying. IMPLICATIONS: We need to develop strong protocols and laws that provide adequate identification of types of bullying, management and prevention of bullying. Assertiveness training groups may assist in educating victims and perpetrators of bullying and violence to stop this epidemic so children can live productive and successful lives.

 

2037: Building Collaborative Academic-Practice Research Teams
Douglas Taylor, BSN, RN-BC;  Amy Brzuchalski, RN, MSN; Charles Walker, RN, BSN, CEN

Abstract
PURPOSE: To describe how the Department of Defense’s (DOD) written and published policies increase military institutional stigma. To explain how institutional stigma within the military limit career opportunities for service members (SM) and create a barrier to mental health care. SUMMARY OF EVIDENCE: In a 2011 DOD survey of 39,877 DOD and Coast Guard (CG) members, one third of respondents felt their careers would be jeopardized if they sought mental health care.  RAND corporation identified over 200 DOD policies that potentially contribute to institutionalized stigma. DESCRIPTION: Institutionalized stigma in the military is inherently encoded within the written and published policies of the DOD, restricting, limiting, or inhibiting SMs opportunities based on a mental health diagnosis or treatment. VALIDATION OF EVIDENCE: DOD policies such as AR 601-1 Assignment of Enlisted Personnel to the US Army Recruiting Command, AR 40-501 Standards of Medical Fitness, and USCENTCOM PPG-TAB A (MOD 12) all outline mental health restrictions on training, career, and deployment opportunities. RELEVANCE/OUTCOMES: Military advanced practice psychiatric nurses (APPN) have unique ethical challenges with dual healthcare obligations. The military APPN is foremost duty-bound by the requirements of the DOD to conserve the fighting strength while balancing the SMs privacy and mental health needs with the mission requirements. IMPLICATIONS: Military APPNs should shape future military policies with language that decreases mental health stigma.  Military APPNs must also educate service members and leaders at all levels in order to ensure patient advocacy and safety for all service members.

 

2041.1: Restraint Reduction Education in a Critical Care Unit:  Inclusion of Mitigation of Nurse Stress/Therapeutic Communication
Constance Noll, MA, MSN, PMHNP-BC, CRNP;  Janet McMillan, DSN, RN, PMHNP-BC

Abstract
PURPOSE: Significant restraint reduction (RR) occurs by changing safety paradigms. Cultures persist considering restraints as safe, particularly non-psychiatric areas. In critical care areas, RR remains controversial for multiple reasons. Critical care unit observations of variations in nursing practice and patient outcomes with restraint use, led to planning an educational intervention. SUMMARY OF EVIDENCE: Less injury, better patient outcomes occur with RR. Inpatients experience significant stress and physiological/metabolic vulnerabilities causing agitated behaviors; particularly yelling, attempting to leave, and resisting care. This triggers staffs' response with restraint use in the name of safety. Evidence reveals a potential gap, mitigation of nurse stress and therapeutic communication in challenging situations, as part of an education strategy for RR. DESCRIPTION: Nurses may apply restraints emergently after exhausting less restrictive measures. Dynamics involved in the nurse/patient relationship are therefore crucial in these events. Multidisciplinary and leadership key stakeholders were engaged, and champions identified for reinforcement of educational efforts towards a culture of minimal restraint use. VALIDATION OF EVIDENCE: Three educational offerings included mitigation of nurse stress and traditional topics such as de-escalation, restraint use and injury, and restraint alternatives. To measure effectiveness, a pre and post intervention measurement of restraint volumes and an RN survey (The Perceived Stress Scale, PSS-10) was administered in a three month period. RELEVANCE/OUTCOMES: Presented results will include analysis of changes in volumes of restraint use and nurses' self assessment of stress. IMPLICATIONS: Results are relevant to psychiatric nurses involved in integrating psychiatry/mental heath within medical specialties, and psychiatric consultation/liaison services. Psychiatric nursing therapeutic communication fundamentals are essential for all nursing practice.

 

2041.2: Use of a Tidal Model Informed Program to Improve Patient Satisfaction and Decrease Chemical Restraints on an Adult Inpatient Psychiatric Unit at a Community Hospital
Phyllis Cratty, RN, BSN;  Brittany Chabak, LCSW, MPH

Abstract
PURPOSE: Past attempts to implement a recovery model of patient care on our inpatient unit have yielded negligible results. Lack of structured programming, low patient satisfaction ratings, and high utilization of chemical restraints demonstrated a need for practice change. SUMMARY OF EVIDENCE: Studies of the Tidal Model, a recovery model of nursing care designed for inpatient psychiatric hospitals, have demonstrated improved patient satisfaction and decreased patient aggression. The Model emphasizes the role of nurse-patient relationship in exploring each patient’s lived experience and individualized path in recovery.  We selected the Tidal Model as the basis for our practice change, incorporating its elements of narrative therapy, solution-focused discussions, and patient education into our program. DESCRIPTION: Practice change was initiated by the Nurse Manager in collaboration with the interdisciplinary team. A consistent patient schedule was established with four Tidal Model informed groups daily. Nurses facilitated medication groups and developed therapeutic nurse-patient relationships by engaging in recovery-focused one-to-ones with each patient. Innovative guided journals, developed by nurses and reflective of Tidal Model principles, were provided to patients. VALIDATION OF EVIDENCE: Effectiveness was measured by an analysis of patient satisfaction scores from exit surveys and from PRN logs completed by nurses. RELEVANCE/OUTCOMES: Research suggests therapeutic nurse-patient relationships and interdisciplinary collaboration supporting a person-centered environment improve the quality of patient care. Practice change yielded an 18% increase in patient satisfaction and 40% decrease in chemical restraints. Both are statistically significant (p=0.00009 and p=0.001) suggesting effectiveness of our Tidal Model informed program. IMPLICATIONS: Revise training procedures for unit employees and expand programming to include evenings and weekends.

 

2042.1: Never Let a Stumble be the End of Your Journey:  The Road to Decreasing Falls on a Gero-Psych Unit
Ann Evans, MSN, RN;  Bonnie Underwood, BSN, RN

Abstract
PURPOSE: Falls continue to be a challenging patient safety issue on an inpatient geriatric psychiatry unit.  Falls are the leading cause of death among the hospitalized older adult, and falls with serious injury continue to be in the Top 10 sentinel events as reported to The Joint Commission. SUMMARY OF EVIDENCE: Fall rates were consistently above the National Database of Nursing Quality Indicators (NDNQI) benchmark of less than 9 per 1000 patient days.  The fall rates on this geriatric psych unit was 20.3 in fiscal year 2013, 17.2 in fiscal year 2014, and 14.1 in fiscal year 2015.  The falls rate continued to be significantly higher than the NDNQI benchmark in fiscal year 2016, with a beginning rate of 14.8. DESCRIPTION: The unit staff and leadership team were becoming discouraged with the high fall rates despite the constant addition of strategies.  The unit leadership team conducted a detailed falls analysis and introduced increased group programming, a validated psychiatric patient falls assessment tool, staff assignment to common areas, and a change in treatment team time. VALIDATION OF EVIDENCE: Fall rates were measured against the NDNQI benchmark as reported monthly. RELEVANCE/OUTCOMES: Immediately following implementation of these strategies, the unit succeeded in going 52 days without a single fall. In addition, the fall rate for January was zero.  There were 3 falls in February with a fall rate of 8.  The unit is currently 13 days without another fall. IMPLICATIONS: Implementing a few non-traditional strategies made the largest impact on the unit's fall rates.  This may help other units think outside the box

 

2042.2: Screening for Depression at a Nurse-Managed Diabetic Community Health Center: A Retrospective Study
Lynn Ives, MSN, RN-BC;  Jessie Reich, MSN, RN, ANP-BC, CMSRN; Kathryn Farrell, MSN, RN; John Brennan, MSN, RN, CNHA

Abstract
PROBLEM STATEMENT: Reduce the falls and injuries while elevating the practice of nursing support staff (NSS) on a psychiatry unit whose patients have decreased cognition due to aging and/or mental illness.  Also to facilitate interprofessional collaboration to create an innovative process surrounding falls prevention. SUMMARY OF EVIDENCE: Older-adult psychiatry patients have the highest risk of falls and injury throughout the hospital.  NSS are aware of patients’ unsteady gait and decreased cognition but had no process to independently prevent falls and injuries. DESCRIPTION: An interprofessional team consisting of nurses, physicians, PT/OT and NSS examined ways to prevent injury falls.  An internal certification program was developed for NSS promoting  independence in preventing injury falls.  Workflow was changed to include: Assistive equipment readily available; NSS encouraged to report findings related to cognition and gait immediately to team including physicians; NSS worked in tandem with nurses identifying patients at increased risk due to low MoCA and take action to prevent falls; Frequent toileting rounds, q 15 minute checks, assistive devices and “falls plus” signage was initiated on patients who met criteria for increased surveillance. VALIDATION OF EVIDENCE: Rapid Cycle PDSA used to tailor program to ensure participation;  Falls and injury rates tracked monthly and quarterly and benchmarked nationally RELEVANCE/OUTCOMES: NSS is engaged in the process and empowered as an integral member of the team; Falls with injury rates decreased from 4.12% to 0% for the past 5 months. IMPLICATIONS: Low cost, high reward program to elevate the NSS to practice to their potential and reduce injury falls. NSS became highly recognized by the interprofessional team

 

2043.1: Developing a Tailored Tobacco Treatment Program for Individuals with Schizophrenia:  A Mixed-Methods Study
Chizimuzo Okoli, PhD, MSN, MPH, RN; Dia Mason, MA, EdS; Peggy El-Mallakh, PhD, RN, PMH APRN-BC; Heather Robertson, MPA

Abstract
PROBLEM STATEMENT: Among those with mental illnesses (MI), individuals with schizophrenia have the highest tobacco use prevalence. The development of tobacco treatment programs seldom involve input from those with schizophrenia or those who treat them THEORETICAL FRAMEWORK: Best practice clinical guidelines advocate combining behavioral and pharmacological approaches to optimize smoking cessation. The tobacco dependence clinic program is a manualized program (based on clinical practice guidelines) developed for individuals with substance use disorders and MI. Tailoring this program to the unique needs of smokers with schizophrenia can enhance its effectiveness. METHODS & DESIGN: A mixed-method design employing individual interviews and a questionnaire was used to elicit the views of tobacco treatment specialist (n = 6) and current (n = 8) and former (n = 4) smokers on best approaches for treating tobacco dependence among those with schizophrenia. Thematic analysis was used for the narrative data and Kruskal-Wallis non-parametric tests were used to examine differences in the ratings of tobacco treatment program components by the three groups of participants. RESULTS: Participants identified unique cessation challenges for individuals with schizophrenia and crucial program elements to be considered in aiding tobacco cessation. Participants rated program components such as addressing coping skills and relapse prevention higher than using medications. IMPLICATIONS FOR PRACTICE: Tailored tobacco treatment for those with schizophrenia should include program elements that support both addiction and mental health recovery IMPLICATIONS FOR FUTURE RESEARCH: This study provides a method to adapt/tailor best practices in tobacco treatment to the unique needs of individuals with MI

 

2043.2: Educating Undergraduate Psychiatric Mental Health Nursing Students in Screening, Brief Intervention, Referral to Treatment (SBIRT) and Motivational Interviewing to Improve Rates of Substance Abuse Screening and Enhance Therapeutic Communication Skills
Cathy Koetting, DNP, CPNP, FNP-C,; Patricia Freed, Ed D, RN

Abstract
PROBLEM STATEMENT: We sought to increase clinical opportunities for our students to work with adolescents.  Previous feedback showed students wanted more time to learn motivational interviewing (MI) skills in a non-threatening environment. THEORETICAL FRAMEWORK: This research study is based on a concept known as scenario/simulation based eLearning. This type of learning immerses learners in real life, scenarios allowing them to gain skills for future use.  As information is offered within a contextual setting, scenario eLearning allows learners to easily manage difficult concepts within their working memory, and commit it to their long-term memory. METHODS & DESIGN: Actual data collection will occur in April 2016.  The study is a one group pre- test post- test design which assesses pre and post- test knowledge regarding risky drinking limits and student confidence practicing MI skills.  Paired T tests will be used to analyze the data from each student’s pre and posttests data along with a group analysis. RESULTS: Our research goal is to provide quantitative data showing use of an eLearning scenario can provide an excellent clinical alternative setting for skill acquisition by increasing student knowledge and confidence levels using MI skills with adolescents IMPLICATIONS FOR PRACTICE: This study will show that students’ knowledge about risky drinking will improve and students will can become more confident in their MI skills through this type of methodology. IMPLICATIONS FOR FUTURE RESEARCH: This is the first part of a three semester study using an eLearning scenario.  Due to limited clinical access nationwide, this type of online interactive clinical simulation this methodology may augment clinical experiences.

 

2044.1: Acceptance and Commitment Therapy as an Adjunctive Treatment for Pain
Schuyler Ellis, BSN, RN;  Madison Worley, BSN, RN; Jane Mahoney, PhD, RN, PMHCNS-BC

Abstract
PURPOSE: Pain negatively impacts suicidality, mood, emotional regulation, sleep and quality of life. Concerns about opiate misuse challenge psychiatric nurses to identify effective adjunctive interventions for pain management. Acceptance and Commitment Therapy (ACT) is focused on the creation of a meaningful life in spite of a problem, such as pain, by promoting changes in perspective through flexible, mindful, and values-directed behavior. This presentation will describe an evidence-based practice (EBP) project related to the use of ACT as an adjunctive treatment for pain. Implications for practice will be discussed via a case study. SUMMARY OF EVIDENCE: Researchers report ACT has a relatively small, but valid, effect size on the physical and multi-dimensions of pain (Veehof et al. 2011; Ost, 2014). DESCRIPTION: The nurse explains the goal of ACT is to improve the pain experience rather than eliminate pain. Intervention includes: engaging in the acceptance of pain; being present with the pain through awareness of pain thoughts and beliefs; observing rather than reacting to these thoughts; identifying values that could make life worth living; setting the direction for the future; and taking action. The ACT matrix is used to create a picture of values, behaviors that interfere with goal attainment, and future steps to reach goals. VALIDATION OF EVIDENCE: Systematic search using PubMed and Cochrane Library databases provided relevant research. Standard EBP criteria were used to determine reliability and validity of research results. RELEVANCE/OUTCOMES: ACT is a viable intervention for PMH nurse working with chronic pain patients. IMPLICATIONS: Research is needed to develop the evidence-base for adjunctive treatments for pain management.

 

2044.2: Mindfulness Meditation as an Adjunctive Treatment for Chronic Pain
John Benson, BSN, RN;  Erica Cuscina, BSN, RN; Stephen Morocco, BSN, RN; Jane Mahoney, PhD, RN, PMHCNS-BC

Abstract
PURPOSE: Chronic pain often co-occurs with depression, anxiety, somatization disorders and suicidality. Primary pain strategies have limited efficacy and often devastating side-effects, including opiate dependence. This problem led nurses to engage in an evidence-based practice project to review and critique the literature pertaining to mindfulness as an adjunctive treatment for chronic pain.  Nurses asked: among patients with chronic pain, is mindfulness meditation plus standard of care superior to standard of care alone in reducing pain intensity and increasing quality of life? SUMMARY OF EVIDENCE: Research suggests that mindfulness meditation can yield reductions in pain intensity and improvements in quality of life (Gotlink et al., 2015). Mindfulness meditation plus the standard of care has been demonstrated to be superior to standard of care alone in a review of thirteen randomized controlled trials (Lakhan & Schofield, 2013). The effect of mindfulness on pain can be understood through Gate Control Theory. DESCRIPTION: Nurses assess pain and effectiveness of pain strategies; collaborate with the patient to determine alternative strategy preference; introduce mindfulness during low stress times; set reasonable expectations about mastery of mindfulness; join with patient in practicing mindfulness; encourage mindfulness practice throughout day; and evaluate the effectiveness of the intervention. VALIDATION OF EVIDENCE: Studies were critiqued for evidence level, reliability and validity using standard criteria. Analysis of outcomes measures for pain intensity and quality of life informed effectiveness of mindfulness. RELEVANCE/OUTCOMES: Mindfulness offers a practice improvement for psychiatric mental-health nurses who care for patients with chronic pain. IMPLICATIONS: Mindfulness should be a nursing pain intervention and integrated into undergraduate education and continuing education.

 

2045.1: Inappropriate Placement of Delirium Patients on the Psychiatric Unit
Michelle Geiss, RN-BC, BSN; Jill Chamberlain, RN, PhD; Shannon Davis, RN, MSN; Lindsey Oyler, RN, BSN; Ashley Raiufer, RN-BC, BSN; Lorna Scoggins, RN-BC, MSN; Tamsyn Weaver, RN, BSN; Carrie McCormick, RN, BSN; Deborah Edmonson, RN-BC, BSN

Abstract
PURPOSE: Due to limited resources, emergency departments across the nation are dealing with overcrowding of patients’ diagnosed with psychiatric illness which often are on waiting lists to be accepted for a psychiatric admission.  It is imperative that these patients are appropriately assessed for medical conditions that might mimic a psychiatric illness such as delirium.  Inappropriate placement of on psychiatric units often need emergent transfers due to unforeseen medical events, thus causing a potential for poor outcomes. SUMMARY OF EVIDENCE: Changes in a patient’s co-existing medical conditions is often the contributing factor to delirium.   Delirium can present with behavioral changes such as agitation and psychosis, which can lead to diagnostic challenges and incorrect placement of these patients in the psychiatric unit. DESCRIPTION: Currently, there is no standardized tool that assists healthcare professionals in the emergency department that will assist in distinguishing between delirium and psychiatric illness. VALIDATION OF EVIDENCE: Between the years of 2011-2015, over 80 psychiatric admissions records were reviewed at our organization by a team of mental health, emergency and medical unit nurses that either had an emergency response or medical transfer due to inappropriate placement.  57% of inappropriate placement of patients were due to delirium. RELEVANCE/OUTCOMES: Inappropriate placed patients on the psychiatric unit often require more care due to their medical condition, thus leaving less time/bed placement for other patients with true psychiatric illnesses and needs. IMPLICATIONS: From this initial review, the project team is developing an assessment/screening tool that will assist in appropriate placement of patients to the psychiatric unit.

 

2045.2: Personalized Medicine:  Using Psychogenomic Testing in Your Practice
Sheryl LaCoursiere, PhD, PMHNP-BC, FNP-BC, APRN

Abstract
PURPOSE: The purpose of this presentation is to inform the audience of currently available testing in psychogenomics, and how results can be used to guide pharmacologic therapy. SUMMARY OF EVIDENCE: Evidence related to psychogenomics is increasing. Measurable variations in genes are cross-references to predict pharmacologic response, both pharmacokinetic and pharmacodynamic. DESCRIPTION: Current practice includes a trial and error approach when selecting psychopharmacological agents. For instance, use of testing in guiding treatment decisions can predict less health care visits, less medical visits, less disability claims over once year, and decreased medication cost (Winner, 2014) VALIDATION OF EVIDENCE: Evidence is validated in current literature by measurement of outcomes. Numerous authors mentioned above have shown the benefits of psychogenomic testing. Costs have slowly decreased, which allows more use by psychiatric patients, and has resulted in increased coverage by insurers. RELEVANCE/OUTCOMES: Psychogenomics relates to PMH nursing that it can be used to guide medication decisions. PMH nurses who are able to understand the purpose behind testing are in a better position to intervene, either monitoring medication, or at an Advanced Practice level, ordering them. Many chronic psychiatric patients have been trialed on numerous psychotropic medications, both in the same class and in different classes. IMPLICATIONS: The future is bright for psychogenomic testing. Tests are increasingly covered by insurers, both governmental and commercial. Many medications with the likelihood of poor effect can be eliminated, and ones with potential for good effect trialed. As costs to perform these tests lessen, more patients will have the opportunity to avoid side effects, and decrease morbidity.


2046.1: Characteristics of Great Nurse Leaders:  A Systematic Review
Vickie Hughes, DSN, MSN, CNS

Abstract
PURPOSE: What are the characteristics of great nurse leaders? THEORETICAL FRAMEWORK: Leadership Theory METHODS & DESIGN: Systematic Review of the literature published in peer reviewed journals between February 2006 and February 2016 as determined by Pubmed, CINAHL, and Health Source Nursing /Academic Edition electronic search engines. RESULTS: Several characteristics of great nurse leaders are identified within the literature such as social intelligence, strong moral compass, passion, interpersonal connectivity, and flexibility just to name a few. IMPLICATIONS FOR PRACTICE: Effective leadership strategies can be learned.  This research identifies traits and behaviors of highly effective nurse leaders that promote enriching and innovative work environments. IMPLICATIONS FOR FUTURE RESEARCH: Identifies gaps within the literature and areas to target for future nurse leader research studies.

 

2046.2: Being the Legally Responsible Clinician In Charge of Patient Care - Clinical Leadership in UK Psychiatric Mental Health Nursing
Paul Veitch, RN, MSc, PGcert

Abstract
PURPOSE: UK psychiatric nurses can now take full legal responsibility for civilly committed patients. The role is based on changes to mental health law in response to consumerism, equality and problems in recruitment of psychiatrists. This advanced practive role represents a very significant clinical leadership role for nurses. SUMMARY OF EVIDENCE: In England & Wales (UK) nurses can now take responsibility for ‘the overall care and treatment’ of patients detained in hospital, a responsibility previously the province of medical colleagues (attending physicians) only. A handful of nurses nationally have this role and this session describes their experience, competencies and function .  A reform of the primary mental health legislation and governmental efforts to create new ways of professional working, facilitated this major change in nursing responsibilities. DESCRIPTION: Named nurses in this role become legally responsible for all aspects of care and treatment of civilly committed inpatients. They lead, direct and are accountable for their decisions before the courts. VALIDATION OF EVIDENCE: The role is new and a challenging area to research. The presentation will detail UK experience and will outline research proposals into the effectiveness of the role. A paper (in press) describes the role and implications for nursing. RELEVANCE/OUTCOMES: Psychiatric ?nurses with such responsibility are at the forefront of major change and in a position to demonstrate effectiveness and therefore the future of this development. IMPLICATIONS: Nurses taking on roles previously the province of medical colleagues is not new, but this development has far reaching implications for patients, the nursing profession and for healthcare organisations world wide.

 

2046.2: Being the Legally Responsible Clinician In Charge of Patient Care - Clinical Leadership in UK Psychiatric Mental Health Nursing
Paul Veitch, RN, MSc, PGcert

Abstract
PURPOSE: UK psychiatric nurses can now take full legal responsibility for civilly committed patients. The role is based on changes to mental health law in response to consumerism, equality and problems in recruitment of psychiatrists. This advanced practive role represents a very significant clinical leadership role for nurses. SUMMARY OF EVIDENCE: In England & Wales (UK) nurses can now take responsibility for ‘the overall care and treatment’ of patients detained in hospital, a responsibility previously the province of medical colleagues (attending physicians) only. A handful of nurses nationally have this role and this session describes their experience, competencies and function .  A reform of the primary mental health legislation and governmental efforts to create new ways of professional working, facilitated this major change in nursing responsibilities. DESCRIPTION: Named nurses in this role become legally responsible for all aspects of care and treatment of civilly committed inpatients. They lead, direct and are accountable for their decisions before the courts. VALIDATION OF EVIDENCE: The role is new and a challenging area to research. The presentation will detail UK experience and will outline research proposals into the effectiveness of the role. A paper (in press) describes the role and implications for nursing. RELEVANCE/OUTCOMES: Psychiatric ?nurses with such responsibility are at the forefront of major change and in a position to demonstrate effectiveness and therefore the future of this development. IMPLICATIONS: Nurses taking on roles previously the province of medical colleagues is not new, but this development has far reaching implications for patients, the nursing profession and for healthcare organisations world wide.

 

2046.2: Being the Legally Responsible Clinician In Charge of Patient Care - Clinical Leadership in UK Psychiatric Mental Health Nursing
Paul Veitch, RN, MSc, PGcert

Abstract
PURPOSE: UK psychiatric nurses can now take full legal responsibility for civilly committed patients. The role is based on changes to mental health law in response to consumerism, equality and problems in recruitment of psychiatrists. This advanced practive role represents a very significant clinical leadership role for nurses. SUMMARY OF EVIDENCE: In England & Wales (UK) nurses can now take responsibility for ‘the overall care and treatment’ of patients detained in hospital, a responsibility previously the province of medical colleagues (attending physicians) only. A handful of nurses nationally have this role and this session describes their experience, competencies and function .  A reform of the primary mental health legislation and governmental efforts to create new ways of professional working, facilitated this major change in nursing responsibilities. DESCRIPTION: Named nurses in this role become legally responsible for all aspects of care and treatment of civilly committed inpatients. They lead, direct and are accountable for their decisions before the courts. VALIDATION OF EVIDENCE: The role is new and a challenging area to research. The presentation will detail UK experience and will outline research proposals into the effectiveness of the role. A paper (in press) describes the role and implications for nursing. RELEVANCE/OUTCOMES: Psychiatric ?nurses with such responsibility are at the forefront of major change and in a position to demonstrate effectiveness and therefore the future of this development. IMPLICATIONS: Nurses taking on roles previously the province of medical colleagues is not new, but this development has far reaching implications for patients, the nursing profession and for healthcare organisations world wide.

 

2047.1: The Connection Between Food And Mood - What The Research Is Telling Us
Joanne Evans, MEd, RN, PMHCNS-BC

Abstract
PURPOSE: Nurses receive extensive education on the use of medications for the treatment of depression and other mood disorders. This is overshadowed by the growing body of research demonstrating the significance of healthy food as an additional or alternative treatment modality. SUMMARY OF EVIDENCE: A NIH - AARP study found that consumption of sweetened beverages may increase the risk of depression when consumed by the older adult. Research shows mercury in fish is related to suicide and depression as well as other mood disorders. Arachidonic acid, found in animal food, increases depression. DESCRIPTION: Patients traditionally are treated with medications for depression as well as other mental health symptoms.  Rarely is there a discussion about the implications of their diet. VALIDATION OF EVIDENCE: Tryptophan, in carbohydrate rich foods, has  been shown to improve depression, hostility and mood disturbance. Research shows that a higher consumption of vegetables may decrease the odds of developing depression by almost 62%. Consistent studies show populations eating diets high in carbohydrates and low in fats and protein have better moods and less anxiety. Research shows those who eat more fruits and vegetables, high in antioxidants, kill free radicals in the body and protect against depression. RELEVANCE/OUTCOMES: Approximately 40,000 Americans commit suicide each year and depression is one of the leading causes.  There is limited education for nurses focusing on nutrition and the impact it has on client's mood. IMPLICATIONS: In addition to pharmacology, it is imperative that nurses learn about nutrition as an additional treatment modality for depression and other mood disorders.

 

2047.2: Does a Mindful Eating Intervention Decrease Binge Eating Episodes?
Sharon Beck, LCSW, RN, DNP student;  Ruth Milstein, DNP, PMHNP-BC, LMHC

Abstract
PURPOSE: Binge eating is the most common eating disorder, with few evidenced-based interventions. The purpose of this presentation is to inform nurses of a novel application of mindfulness-based stress reduction for the treatment of binge eating that has been shown to be effective with self-identified female binge eaters taking psychotropic drugs. SUMMARY OF EVIDENCE: In a focused literature search, mindful eating practices have been shown to decrease binge eating in frequency and intensity in studies for the last ten years. There is also extensive research showing patients taking psychotropic drugs have difficulty in managing food intake and weight gain. DESCRIPTION: A nine week group mindful eating intervention was designed, and a convenience sample of self-identified binge eaters participated in the group, referred by clinicians in the group practice hosting the intervention. VALIDATION OF EVIDENCE: Prior to the intervention and post-intervention, the Binge Eating Scale, as well as the Beck Depression and Anxiety Inventories were administered. Following the intervention, scores were averaged on the BES, BAI, and BDI, and paired t-tests were performed. Satisfaction surveys were administered, and qualitative interviews were held post intervention. RELEVANCE/OUTCOMES: The changes were statistically significant in the BES and BDI to a greater than 95% confidence level. Satisfaction surveys and qualitative interviews showed high satisfaction with the intervention. IMPLICATIONS: Mindful eating interventions may be another tool in clinician "toolboxes" to decrease binge eating in psychiatric patients gaining weight on psychiatric drugs.

 

2051: APRN Council Interactive Session
Kathryn Johnson, PMHNP-BC; PMHCNS-BC;  Sattaria (Tari) Dilks, DNP

Abstract
PURPOSE: The purpose of this interactive panel discussion is to share the results of the APRN Steering Committee's efforts of the past year and to engage APNA's APRN community in a dialogue about issues of concern to their practice. SUMMARY OF EVIDENCE: N/A DESCRIPTION: N/A VALIDATION OF EVIDENCE: N/A RELEVANCE/OUTCOMES: PMH-APRNs are faced with many barriers to practice.  Many APRNs live and work in restricted practice states that necessitate collaborative agreements with physicians in order to practice.  There is a shortage of psychiatrists and an even greater shortage of psychiatrists who are willing to act as APRN collaborators.  Many APRNs may work in relative isolation from their colleagues.  Insurance constraints often necessitate seeing clients for short time intervals. IMPLICATIONS: Information shared will serve to guide next steps for APRNs working toward barrier-free, full-practice that includes psychiatric evaluation, prescription of medications and psychotherapy.

 

2052: Interactive Education Council Session
Barbara Warren, PhD, RN, PMHCNS-BC, FNAP, FAAN

Abstract
PURPOSE: The Education Council, a member-driven council that seeks to identify strategies and opportunities to meet the issues of psychiatric/mental health nursing education. SUMMARY OF EVIDENCE: PMH nursing content based competencies identified in the  Scope and Standards of PMH Nursing Practice DESCRIPTION: Basic knowledge, skills, & attitudes needed by PMHNP to provide psychotherapy   Individual, group, & family psychotherapy learning & training opportunities VALIDATION OF EVIDENCE: Bipolar Disorder PMH nursing roles in integrated care Self- care practices for PMH nurses Responding to cultural differences RELEVANCE/OUTCOMES: Educational strategies within PMHN IMPLICATIONS: Continuing to develop member-led ideas and competencies within PMHN

 

2053: What are your Recovery Resilience Innovations?   Recovery Interactive Panel
Genevieve Chandler, PhD, RN

Abstract
PURPOSE: To showcase our membership’s creativity collaborating with our patients to develop resilience.  Applying the ABCS of resilience framework : Active coping, Building strength, Cognitive awareness and Social support, (Chandler, Roberts, & Chido, 2015) will demonstrate APNA membership nurse-patient recovery innovations. SUMMARY OF EVIDENCE: Change through Solution Focused Nursing is promoted by joining the patient by getting to know the person in addition to the diagnosis, building skills and resources to recover and adapt and extending an opportunity to practice new skills and connect to social supports (McAllister, 2007).  Nurses collaborate with patients to build on what has worked in the past, to recognize the moments work now and design a future that is preferred. The ABCS of resilience provide solutions. DESCRIPTION: From a brief panel presentation modeling recovery innovations to promote resilience the audience will be divided into small groups to describe nurse patient collaborations that develop resilience. Each group will address the ABCS of resilience. VALIDATION OF EVIDENCE: The small group outcomes will be recorded. Each person will leave with a list of Recovery Resilience Innovations. Participants will be asked for written feedback on their experience. RELEVANCE/OUTCOMES: Mental heath challenges are inevitable.  Recognizing our resilience promotes recovery.  Describing and sharing nurse-patient collaborations that promotes resilience is the first step to developing the evidence needed to move nursing science forward. IMPLICATIONS: The outcomes of the interactive panel will form the basis of a publication on recovery resilience innovations.

 

2054: Addictions Council Interactive Panel
Matthew Tierney, MS, ANP-BC, PMHNP-BC;  Carol Essenmacher, DNP, C-TTS

Abstract
PURPOSE: The purpose of the Addictions Council Interactive Panel is to convene a forum where psychiatric nurses can discuss addictions-related issues with the goal of increasing their knowledge to enhance understanding and, ultimately, practice in this area. SUMMARY OF EVIDENCE: Substance use and addictive disorders are present throughout the lifespan, in all US populations. Recovery from these illnesses is possible: patients, families and communities can and do get better.   Unfortunately, substance use disorders are seriously undertreated. SAMHSA’s 2014 National Survey on Drug Use and Health estimates that 21.4 million US citizens (about 6% of the population) have substance use disorders related to illicit drugs or alcohol.  At-risk populations also include 175 million people who use tobacco products, and nearly 218 million people who use alcohol.  Despite these numbers, in 2014 only 2.4 million citizens received treatment for illicit drug use, and 2.7 million received treatment for alcohol use disorders. DESCRIPTION: For various reasons, including lack of knowledge and skill, many providers, including nurses, do not provide effective evidence-based substance use treatments, despite the clear benefits to improved patient outcomes, to cost savings, and to morbidity and mortality rates.  But they can! VALIDATION OF EVIDENCE: Considerable evidence supports substance use treatments and resulting improved outcomes. RELEVANCE/OUTCOMES: Psychiatric nurses can and should apply knowledge of substance use and addictive disorders to support health and recovery. IMPLICATIONS: This Interactive Panel seeks to foster discussion, disseminate treatment information, and empower psychiatric nurses to provide leadership in addressing substance use and addictive disorders, thus closing existing treatment gaps.

 

2055: Child and Adolescent Council Interactive Panel
Diane Wieland, PhD, MSN, PMHCNS-BC, PMHNP-BC, CNE

Abstract
PURPOSE: The purpose of the Interactive Panel of the Child-Adolescent Council is to describe the Council goals, to present findings of the work groups, to allow times for work groups to discuss issues of the council and to provide a continuing education on trauma. SUMMARY OF EVIDENCE: An overview of trauma in childhood will be provided. Each work group will provide an overview of how trauma impacts each group's work. A survey of child-adolescent nurses who are in the council will be summarized. Action plans will be discussed as to self-care activities and other means to address trauma, led by members of the council. DESCRIPTION: Trauma informed care is often used in treatment. Childhood trauma is often very painful to listen to by the nurse. Child and adolescent work group leaders will discuss the impact of trauma in child and adolescent treatment settings (inpatient, self-care, evidence based, special populations). VALIDATION OF EVIDENCE: A survey of child-adolescent nurses will be summarized. Models of trauma informed care will be provided. Evidence in nursing practice will be discussed. Trauma in special populations will be highlighted. RELEVANCE/OUTCOMES: More information is needed to address trauma by PMH nurses, and to reduce secondary traumatic stress in nurses. IMPLICATIONS: There is the possibility of a white paper and a formalized research project that could be outcomes of this session.

 

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