3011: The Use of Simulation Training in Code 2000 Psychiatric Emergencies at the Veterans Affairs New York Harbor Healthcare System
Linda I. Kaplan, RN, MSN, CARN; Danielle Battinelli-Weng, RN, BSN

Abstract
PURPOSE: To train Residents, Nursing and Medical Staff to respond appropriately and safely to psychiatric emergencies throughout VA New York Harbor Healthcare System. SUMMARY OF EVIDENCE: It was hypothesized that staff’s level of confidence with seclusion, restraints and psychiatric emergencies would increase with the use of the simulation lab, and the opportunity to practice and learn skills in a safe environment with appropriate feedback.  Also, the injury rate for staff and patients would decrease.  There is much evidence-based research being done on the use of simulation learning.  Research indicates that the use of the simulation lab type training gives as good or better results than other traditional learning methods. (Dillon & Kaplan, 2009).  DESCRIPTION: Staff are trained in the Simulation Lab providing opportunities for a hands-on VALIDATION OF EVIDENCE: Use of debriefing, video recording/playback, role-playing using an interdisciplinary team.  RELEVANCE/OUTCOMES: Decrease in injuries/increase in confidence of staff at all levels to safely and effectively respond to behavioral disturbances.  IMPLICATIONS: The implications for psychiatric-mental health nursing are that the use of the simulation lab provides staff with the opportunity to practice the skills needed in the mental-health arena. Also, to research expanding the use of the SIM Lab to train in other MH Nursing practice areas.
 


 
 

3011: Aren't All Nursing Students Anxious? Failure to Recognize Anxiety Disorders and Psychopathology in Nursing Students
Brenda G. Kucirka, PhD, RN, PMHCNS-BC, CNE

Abstract
PURPOSE: This presentation will explore failure to recognize anxiety disorders among nursing students. SUMMARY OF EVIDENCE: The increase in severity of student mental health issues in higher education is well supported in the literature.  Anxiety among nursing students is considered by many faculty as "normal" regardless of  severity.  The perception that nursing school is stressful and students will experience anxiety as the “norm” creates a barrier to identification of and early intervention for the student with an anxiety disorder.  DESCRIPTION: Findings from a qualitative study on the faculty-student relationship in the context of student mental health issues supports this issue as significant for nursing education. Nursing faculty reported difficulty differentiating between “normal angst” related to the transition from high school to college or developmental stage and symptoms suggestive of a psychiatric problem.   Factors that contribute to underrecognition of student anxiety disorders will be explored along with strategies to address the issue. VALIDATION OF EVIDENCE: Current literature and findings from a doctoral dissertation exploring faculty student relationships in the context of student mental health issues provides evidence of the significance of unrecognized student anxiety disorders.  RELEVANCE/OUTCOMES: Psychiatric mental health nursing faculty are frequently consulted by colleagues to intervene with student mental health issues.  Providing education and establishing guidelines for nurse educators falls under the purview of psychiatric mental health nurse educators.  IMPLICATIONS: Future implications include establishing faculty development and educational programs on mental health and recognition of students with mental health issues and disorders. Additionally, research on strategies to strengthen coping skills and student resilience are implicated.
 


 
 

3012: Managing Treatment Failures In Depression, Bi-Polar Disorders and Personality Disorders: When Medication is Not Enough
Cynthia Taylor Handrup, DNP, APN, PMHCNS-BC

Abstract
PURPOSE: A perplexing problem facing PMH-APNs  is the patient failing to respond to the medication prescribed for their diagnosis and symptoms. A common cause of this is misdiagnosis. Patients often present with symptoms patterns that don't exactly match DSM criteria. Many patients fall between the cracks; misdiagnosis is a function of symptom overlap, while others may have more than one disorder. SUMMARY OF EVIDENCE: Bipolar often coexists with personality disorders, which hinder diagnosis and complicate treatment (Kirshman, 2005). Studies reveal over 50% co-morbidity in patients with Bipolar disorder. BPD is often misdiagnosed as Schizophrenia, Major Depressive Disorder, Dysthymia, Bipolar and PTSD (Paris, 2007).  DESCRIPTION: The clinician needs to factor in all elements of a thorough psychiatric evaluation to make an accurate diagnosis. Presenting symptoms, past symptoms, social, developmental and family history are all crucial elements to accurate diagnosis. Misdiagnosis and incomplete diagnosis can lead to mistaken expectations about a particular patient's treatment course and response. VALIDATION OF EVIDENCE: Sometimes psycho-pharmacology is just not enough to bring about a sufficient change in the patients symptoms and behavior (Lencer et al, 2011). There is abundant evidence that psychotherapy, in combination with medication, is more effective than medication alone (Lamberg, 2000, Clemens, 2009) as well as significant evidence that psychotherapy changes the brain (Nemeroff, 2003).  RELEVANCE/OUTCOMES: Many PMH APNs are not utilizing this evidence in their practice because it is not in their tool kit or they "don't have time".  IMPLICATIONS: PMH APNs roles are expanding due the ACA. We are on the forefront of MHC delivery in many urban and rural communities.


 


 
 

3012: Suicide Assessment and Prevention: A Clinical Practice Guideline
Shonda Phelon, DNP, APMHNP-BC, FNP-BC

Abstract
PURPOSE: The purpose of this project was to develop a suicide clinical practice guideline for use by family nurse practitioners in a primary care clinic. SUMMARY OF EVIDENCE: Literature review showed that there are suicide assessment protocols and guidelines available. However, there has been a lack of attention to the need for suicide assessment in primary care clinics. Review of the literature indicated that suicide assessment guidelines and protocols are needed in primary care.  DESCRIPTION: A clinical practice guideline was developed. The guideline included a teaching tool, an algorithm for suicide assessment and screening, and an algorithm for intervention. A pilot study of the guideline was implemented at a student health center with family nurse practitioners. VALIDATION OF EVIDENCE: The results indicated that a practice change occurred. The nurse practitioners had an improvement in comfort levels in assessment and referral of patients with suicide risk. After training on the guideline the nurse practitioners were more likely to evaluate patients for suicide risk than before the guideline was introduced.  RELEVANCE/OUTCOMES: The recommendations are that this guideline be implemented in other clinics with other primary care clinicians. The project made a difference in that the family nurse practitioners gained a better understanding of evaluating suicide risk and referral to mental health. Psychiatric nurses should not hesitate to consult with primary care to develop better practice strategies.  IMPLICATIONS: Psychiatric Nurse Practitioners are qualified to develop guidelines and interventions to assist primary care providers in treating individuals with psychiatric problems. Advanced practice psychiatric nurses should be key players in implementing integrated care strategies.
 


 
 

3013: Designer Drugs and Adolescent Use: What all Psychiatric Nurses Need to Know
Katharine Frances Drobile-Landis, RN, BC, BSN (BSN-DNP candidate)

Abstract
PURPOSE: The purpose of this presentation is to inform psychiatric nurses of the high incidence of this type of drug use.Provide training, identification, signs and symptoms of designer drugs, educate psychiatric nurses.   My future intent is to become a Psychiatric Nurse Practitioner and focus on Adolescent Substance Abuse. SUMMARY OF EVIDENCE: Using a systematic Review and data collection from the American Association of Poison Control Centers as well as published case studies of youths that have ingested designer drugs.  DESCRIPTION: Psychiatric Nurses need to become aware of the use of these designer drugs in the Adolescent population in order to provide better treatment of these patients as well as informing emergency departments the signs and symptoms of these drugs. VALIDATION OF EVIDENCE: Use of the Stetler Model, Instrumental use will focus education and results of Systematic Reviews, data collection from the American Association of Poison Control Centers and rates of current Adolescent use of designer drugs to supply various practitioners application of knowledge. RELEVANCE/OUTCOMES: The purpose of this presentation is to inform psychiatric nurses of the high incidence of this type of drug use, training on identification of signs and symptom in patients, using designer drugs and educate psychiatric nurses in supporting patients through treatment option and education regarding the risks of ingesting these drugs/ substances and therefore, reduce the devastation of designer drugs’ effects, which can be permanent.   IMPLICATIONS: Pose the possibility of creating new drug screening protocols, create an awareness of design drug use among Adolescence and train practitioners on the identification of these patients


 
 

3013: Understanding Self Injurious Behaviors in the Adolescent Population
Wayne Mitchell Steller, MSN, PMHNP-BC

Abstract
PURPOSE: The purpose of this educational session is to assist psychiatric nurses in recognizing adolescents and young adults at risk for self injurious behavior and being able to differentiate between non-suicidal self injurious behavior and a frank suicide attempt. These patients are often admitted to an inpatient psychiatric unit with around the clock 1:1 staff when the self injurious behavior was not a suicide gesture. SUMMARY OF EVIDENCE: Self injurious behavior is rare before puberty. The average age of onset being around the age of 16. Prevalence rates range from 5 - 74% in community adolescent samples, 12 - 35% among college students and 39 - 61% on inpatient adolescent psychiatric units. Anecdotal reports indicate the rates of self injurious behavior among the adolescent population is on the rise. Influences are multifactorial and include media and peer influences as well as the increased popularity of body piercing and tattoos.  DESCRIPTION: Improved assessment skills. Enhanced ability to craft nursing interventions and goals that accurately reflect the patient's clinical presentation. VALIDATION OF EVIDENCE: Utilization of research data and evidence based practice.  RELEVANCE/OUTCOMES: Enhanced assessment skills will enable the psychiatric nurse to develop a treatment plan that accurately assesses the etiology of the behavior and does not immediately categorize the patient as acutely suicidal.  IMPLICATIONS: A greater understanding of the underlying causes of self injurious behavior will enable the psychiatric nurse to provide more efficient and clinically appropriate treatment. When the skills psychiatric nurse is able to offer insightful assessment patients will get the treatment they need at the appropriate level of care.

 


 
 

3014: Hospitalization for Suicide Attempt: Continuity of Care and Transitions to Post-Discharge Behavioral Health Treatment
Alice C. Bernet, PhD, PMHNP-BC

Abstract
PROBLEM: Relatively high rates of suicide occur in the days following discharge from psychiatric units. As such, suicide prevention policies emphasize timely post-discharge behavioral health treatment (BHT). This study aims to determine factors related to the psychiatric admission affecting the timeliness of BHT.  FRAMEWORK: Andersen’s model of health behavior describes relationships among health system characteristics, health service use, and health outcomes. The independent variables reflect characteristics of the health system: the activation of a patient record alert, the discharging inpatient unit, and VA inter-facility transfer (IFT) during admission.  The number of days between discharge and the first BHT was the dependent variable.  METHODS: This VA observational retrospective cohort study described health system characteristics related to the inpatient admission for suicide attempt and the time to BHT (N=496). The median number of days to BHT was compared between veteran patient groups exposed to various system characteristics.  RESULTS: Patients with an IFT (n=39) had the first post-discharge BHT appointment sooner than patients returning to the same facility (median=1 day, vs. 2 days without IFT). Patients discharged from a psychiatric unit had post-discharge appointments sooner than patients treated on and discharged from a medical unit (n=37) (median=2 days vs. 6 days, respectively). The findings indicate that the timeliness of post-discharge BHT is related to system characteristics of the inpatient stay.  IMPLICATIONS: The differences in health service use may be related to variations in health provider practice surrounding the patients’ discharge experiences.  FUTURE RESEARCH: Future research is needed to test effective discharge practices towards the receipt of timely post-discharge care.

 


 
 

3014: Treating Combat Veterans with PTSD Using Group-Based Exposure Therapy
Laura M. Wells, BSN; Georgine R. Berent, EdD, RN-BC; Kelly Ruppel, PhD, RN, CNE

Abstract
PROBLEM: Veterans returning from combat zones in support of Operation Enduring Freedom and Operation Iraqi Freedom are often subjected to multiple deployments resulting in an increased risk for Posttraumatic Stress Disorder (PTSD) with limited success in traditional treatment options.  FRAMEWORK: Following Hildegard Peplau's Theory of Psychodynamic Nursing, establishing relationships with combat veterans suffering from PTSD begins the interpersonal process of recovery.  METHODS: A systematic literature review was employed  to identify and evaluate research studies that discussed a specific treatment of PTSD in combat veterans, Group-Based Exposure Therapy (GBET). Five research studies were reviewed and evaluated.  RESULTS: The five research studies yielded 170 subjects. Group-Based Exposure Therapy (GBET) demonstrated its effectiveness for combat veterans suffering with PTSD.  IMPLICATIONS: As more veterans return to civilian life, psychiatric mental health nurses must be prepared to meet the needs of not only the veterans but, their families. One way that nurses can support this vulnerable group is to employ proven treatment interventions.  FUTURE RESEARCH: Future research should focus on efficacy of this treatment within this population across a broader context. More studies are needed, and treatments expanded in the private sector.

 


 
 

3015: A Mid-Range Theory of Parental Postadoption Depression
Karen J. Foli, PhD, RN

Abstract
PROBLEM: Depressive symptoms in biological and adoptive parents have been linked to myriad difficulties for their children. Anecdotal accounts of adoptive parents experiencing depressive symptoms preceded the existing scant research related to parental depression following the placement of a child. No theoretical framework was available to provide researchers and practitioners a guide to approaching this problem.  FRAMEWORK: Through empirical research and examining the existing literature, I have formulated a mid-range theory of parental postadoption depression. This theory is based on unmet or unrealistic expectations of parents, conceived prior to the child’s placement. The  METHODS: The initial study used a grounded theory approach and revealed the major construct of the mid-range theory: parental expectations. More recently, regression analysis, content analysis and structural equation modeling have provided support for this theory using various data sets.  RESULTS: Data support parental expectations in several dimensions: expectations of 1) self as parent; 2) of the child; 3) of family and friends; and 4) of society. Guilt and shame are also pronounced themes.  IMPLICATIONS: The theory and supporting data translate into informed interventions and communication that reflect the unique dynamics of adoptive parents. Approaching parents in an informed, “adoption smart,” manner can add effectiveness to individual and family commun  FUTURE RESEARCH: To continue to test this theory, further studies should emphasize a prospective, longitudinal approach; examine buffers to depression and resiliency factors; and compare factors associated with postpartum depression and postadoption depression.

 


 
 

3015: Interventions for Grandmothers: Comparative Effectiveness of Resourcefulness Training, HRV Biofeedback, and Journaling
Jaclene A. Zauszniewski, PhD, RN-BC, FAAN; Carol M. Musil, PhD, RN

Abstract
PROBLEM: Over one million American grandmothers are currently raising grandchildren, which can be stressful and it may adversely affect their quality of life. Intervention research in grandmothers raising grandchildren has been limited in both scope and effectiveness. This pilot trial examined the effects of resourcefulness training, biofeedback, and journaling on perceived stress, depressive symptoms, and quality of life in 60 grandmothers.  FRAMEWORK: Nagai’s model for stress management and Zauszniewski’s resourcefulness theory informed the selection of the study outcomes.  METHODS: A pre-test post-test repeated measures design with random assignment to one of the three interventions compared their effects on outcomes over time.  Data were collected during four interviews; interventions took place between the first and second interviews. Changes in mean scores on measures of stress, depressive symptoms, and quality of life were examined for trends over time.  RESULTS: Comparative analysis revealed decreased stress over time with all three interventions (F(1,57)=37.16, p<.001); the greatest decrease in depressive symptoms with resourcefulness training (M=14.50 to 9.55); and improved quality of life in the resourcefulnes  IMPLICATIONS: The findings demonstrate the differential effectiveness of three interventions in grandmothers over time. While all three interventions may be effective interventions for reducing stress, resourcefulness training may be most beneficial in decreasing depre  FUTURE RESEARCH: Testing the comparative effectiveness of biofeedback with other self-management strategies that combine cognitive-behavioral and physiologic methods in a larger clinical trial with grandmothers raising grandchildren and other samples of family caregivers.

 


 
 

3016: Digital Story Telling as a Self-reflection Tool
Julie Dewitt-Kamada, DNP, PMHARNP; Carrie E. Holliday, PhD, PMHARNP

Abstract
PURPOSE: How do teachers insure that self-reflection, compassion and empathy are instilled in students involved in an on-line PMH DNP course?Creating a learning environment that endorses self-reflection is difficult when there is little face to face interaction between students and teacher. The search for teaching strategies that would promote PMH DNP values such as empathy, compassion and self-reflection led to the use of digital story telling as a teaching tool. SUMMARY OF EVIDENCE: For many years storytelling has been used in general education and as a tool to understand the human experience (Abma, 2003; Christiansen 2010; Haigh & Hardy, 2010; Hardy, 2007).  However, little is known about the value of using digital stories with PMH DNP students how it impacts their learning experience.  DESCRIPTION: A digital story is a short multimedia presentation that combines images with personal narration.Students were asked tell their story of what led them to choose a DNP program. VALIDATION OF EVIDENCE: Students provided written feedback about the assignment. Answers were reviewed using content analysis.Themes emerged from the data.  RELEVANCE/OUTCOMES: Overall the digital story telling promoted deep self-reflection for the students. Students found that creation of their meaningful story was crucial to their future role as a DNP.  IMPLICATIONS: Digital story telling is a teaching strategy that can enhance the on-line learning experience for the students and the teacher and a useful tool to create mindful, empathetic, compassionate practitioners.

 


 
 

3016: Simulation Pedagogy: Making it Interpersonal
Regina D. Owen, PMHNP-BC; Teresa Combs, PhD, APRN-BC

Abstract
PURPOSE: This curriculum intervention was to introduce students to the interpersonal process using standardized patients (SP) in a simulation center (SIM).  The first semester of the program, students engage in immediate immersion of the interpersonal interactive process. SUMMARY OF EVIDENCE: We noticed in the first year DNP PMHNP cohort, the students were not mindful and appeared challenged in engaging interpersonally with SPs at the SIM. Anecdotal reports supported the hypothesis that this was problematic, therefore preventing further student learning.  DESCRIPTION: The protocol begins with didactic content using Peplau’s Theory of Interpersonal Relations. This is followed by weekly clinical encounters with assigned SPs at the SIM. Following each encounter, students complete a self-evaluation, in addition to an evaluation from their assigned SP, their classmates, and course faculty. VALIDATION OF EVIDENCE: Evaluation of this intervention is accomplished with a questionnaire identifying self-utilization of the interpersonal process, classmate oral feedback, and evaluations from SPs and course faculty.  RELEVANCE/OUTCOMES: Results suggest students are confident interacting in clinical practicum and attribute it to the early immersion of employing Peplau’s Theory. Faculty found this early immersion ideal for use with students having diverse mental health experience.  IMPLICATIONS: The immediate immersion of Peplau’s Theory in a BSN-DNP PMHNP program is optimal and valuable.  This immersion process accelerates and supports the learning necessary for BSN students to transition from novice to accomplished independent clinicians. The application of this intervention will assist these future clinicians to provide the best care for military veterans, service members, retiree’s and their families.

 


 
 

3017: The New Confidential! Integrated Electronic Health Records and Privacy
Gail Rene Stern, RN,MSN, PMHCNS-BC

Abstract
PURPOSE: Electronic Medical Records are an exciting tool to improve the safety of patients and communicate with other members of the care team. The inclusion of Mental Health and Substance Abuse records in a "Single Patient Chart" requires us to examine our previous protection of this information.   This presentation will explore some of the new and profound ways information is shared well or potentially misused. SUMMARY OF EVIDENCE: As part of Healthcare reform, the use of Electronic Health Records is unavoidable.    As mental health, substance abuse and HIV information become a part of the electronic records, much has been written about how to manage protected classes of information.  We have over 11,000 employees  and we treat our own employees.  We addressed new rules and education for both our patients and our staff.  DESCRIPTION: The creation of a Confidentiality Committee included key stakeholders.  Activities of the Confidentiality Committee:  Literature updates, Access, Provider iinput, Policy  protections, Staff and Patient Education (Computer World Award!) and Enforcement activities. VALIDATION OF EVIDENCE: The presentaion will detail our methods for evaluating the effectiveness of our Confidentiality Activites through Reports, Audit and Action plans.  This involves our internal audit and compliance leadership, along with competency tracking.  RELEVANCE/OUTCOMES: The outcomes of this practice change impacts psychiatric nursing practice as we seek to make mental health a part of all healthcare. PMH nurses continue to lead in this advocacy.  IMPLICATIONS: Clearly, technology and communication will continue to evolve.  We need to hardwire a "watch dog" approach that is proactive and reacts swiftly when needed to advocate for our patients.

 


 
 

3017: Managing Patient and Staff Safety Through the Creation of a Hospital Wide Contraband Process
Kathy Holley, MS, BSN, RN; Mary Matzinger, MA, BSN, RN

Abstract
PURPOSE: In 2012 weapons were found in the belongings of a patient admitted from the Emergency Department in a Community Hospital.  These items were in the patient's possession for several hours while he was treated in the ED.  The inpatient psychiatry staff brought this concern to the attention of leadership which then facilitated the development of a hospital wide contraband/safety protocol for our facility. SUMMARY OF EVIDENCE: Increasing violence in healthcare settings along with our current experience led the management team to review our current process.  The team members identified that the safety risk was present in all areas of the hospital yet was only addressed adequately in the Psychiatric inpatient areas.  DESCRIPTION: All areas of the hospital were involved in the creation of their piece of the protocol.  Identified barriers and challenges were discussed as a team. Strategies included education- reading and hands on experiences. Visual cues, scripting, and equipment needs were also used to ensure the success of this project. VALIDATION OF EVIDENCE: Effectiveness was measured with unit based tracking logs, reports, manager rounding, attestation forms from caregivers, an ongoing task force, and a safety survey that was done in 2013.  RELEVANCE/OUTCOMES: Violence and safety concerns are not isolated to our Psychiatric units.  As PMH nurses we are experts and have the ability to effect change that can lead to improved safety in our facilities.  IMPLICATIONS: We have been working to integrate this protocol throughout our larger healthcare system.  With a recent  renovation to our ED we have regrouped to review temporary changes to the process.

 


 
 

3018: The Unique Role of the Psychiatric Nurse in Emergency Behavioral Health
Lisa A. Naugle, MSN, Psychiatric Consultation Liaison Nurse

Abstract
PURPOSE: The purpose of this presentation is to focus on the practice and challenges of staffing a 10 bed Psychiatric Transition Unit (PTU) solely with two registered nurses.The PTU serves as a specialized unit to care for emergency behavioral health clients. The presence of these nurses helps to facilitate communication with all those involved in the continuum of care for the patient. SUMMARY OF EVIDENCE: Psychiatric nurses are uniquely qualified to address both the psychiatric and medical needs of the patient. They model therapeutic interventions and effective ways of interacting with patients who are under duress. The psychiatric nurses familiarity with  criteria for admission to local and surrounding facilities aids in connecting the patient with appropriate services. The connection that is cultivated with mental health services and the insurance company representatives ensures individualized patient care.  DESCRIPTION: The PTU Psychiatric Nurse also works in the inpatient psychiatric unit. The Nurse in PTU does all psychiatric assessments, disposition planning and verifies insurance coverage and arranges precertification. VALIDATION OF EVIDENCE: This transition unit staffed by two psychiatric nurses is open 24 hours , 7 days a week and safely serves an average of two hundred patients per month. Average length of stay is four hours. Patients range in age from two years to ninety years old.  Literature supports psychiatric nurses employed in a behavioral crisis unit.  RELEVANCE/OUTCOMES: Patients have verbalized appreciation for the timely disposition factor.The nurses who staff the PTU have reported increased satisfaction scores due to consistent PTU work schedules.  IMPLICATIONS: Increased need for psychiatric nurses  in an emergency setting.

 


 
 

3018: Decreasing Psychiatric Admission Wait Time in the Emergency Department by Facilitating Psychiatric Discharges: A Quality Improvement Project
Pamela R. Stover, MN, RN, ARNP, PMHCNS-BC, PMHNP-BC

Abstract
PROBLEM: Psychiatric unit admissions at a Vancouver, Washington hospital are affected by a bottleneck of discharges on the unit. Regulatory and accrediting agencies recommend less than 4 hours’ wait time in the emergency department. The objective of this project  was to improve the psychiatric admission wait time from 10.5 hours and to increase the proportion of patients discharged by 11 a.m. from 19%.  FRAMEWORK: Jean Watson's theory of human caring  provided a foundation of caring as a reason for improving patients’ care and fostered caring for all patients and clinicians involved in the improvement process.  METHODS: This quality improvement project was a pre and post comparison of the impact of process improvements focused on changing discharge planning processes through the use of PDSA cycles, based on root cause analysis findings and on evidence-based discharge practices.  RESULTS: During the course of  27 PDSA cycles, wait time for admission improved to an average of 5.1 hours ( p = .006) and the proportion of discharges occurring by 11 a.m. increased to 46 % (p < .0001), from September 2013 through February 2014.  IMPLICATIONS: Improving discharge planning processes and facilitating earlier discharges in this psychiatric unit resulted in more timely admissions from the hospital's emergency department.  This QI project demonstrates that psychiatric units with similar context coul  FUTURE RESEARCH: Future research should include studies of the impact of complex psychiatric admission criteria and the impact of emergency department context on admission wait time.

 


 
 

3021: Texture Layering, "We See a Sea Story", and 55 Word Stories: Building Geropsychiatric Nursing Competencies and Enhancing Quality of Life through Creative Arts Programming
Joan L. Fopma-Loy, PhD, RN

Abstract
PURPOSE: Projected numbers of older adults with mental health issues and dementia create an urgent need for graduates with geropsychiatric nursing knowledge and skills, yet interest in working with these populations is limited. Innovative clinical experiences emphasizing person-centered care and relationship-building are necessary to address this gap. SUMMARY OF EVIDENCE: Theoretical formulations provide a framework for teaching person-centered care and quality of life concepts (Kitwood,1997; Lawton, 1994) , as well as assessment of needs underlying communication (Algase & colleagues, 1996; Hall & Buckwalter, 1987). Research suggests that creative arts approaches can both enhance the well-being of older adults with dementia and foster person-centered attitudes and practices among care staff ( Beard, 2011; deMedeiros & Basting, 2013 ). DESCRIPTION: Based on the needs and evidence, two evidence-based creative arts programs for persons with dementia founded in person-centered ethics and methodology, TimeSlips and Opening Minds through Art (OMA), are implemented by students and faculty in a senior level clinical course. Careful structuring of clinical conferences, student-faculty collaboration, and reflective journaling promote attainment of program goals and foster development of geropsychiatric nursing competencies. VALIDATION OF EVIDENCE: Multiple measures of evaluation (Elder and student weekly session evaluations, Creative Engagement Abilities Assessment measures, program evaluations, student journal responses, quality of visual art and stories created by elders, and course evaluations) are used.  RELEVANCE/OUTCOMES: Results suggest that these programs are effective means of fostering student learning and enhancing person-centered care. IMPLICATIONS: Teaching future nurses how to conduct and evaluate creative arts programs increases access to evidence-based interventions and enhances potential for quality of life.

 


 
 

3022: One Step Closer Toward Integration: Implementation of a Collaborative Care Model at a Rural Virginia Free Medical Clinic
Brenda J. Johnston, MSN, PMHNP-BC

Abstract
PURPOSE: The greatest opportunity for identification and treatment of mental illness occurs in the primary care setting; however, proving comprehensive medical and psychiatric care in this setting is challenging. Collaborative care models (CCMs) address these challenges by providing multidisciplinary coordinated services. CCMs have established a robust evidence base, however, evidence of implementation in a small practice setting is limited. This presentation will discuss conclusions following the implementation of a CCM at a free medical clinic in rural Virginia. SUMMARY OF EVIDENCE: During the pilot, screening tools were utilized, psychiatric practice guidelines were adopted, both patients and providers expressed increased satisfaction with the CCM and steps toward further integration were initiated. DESCRIPTION: Over a seven-month period, a CCM was developed and implemented in an attempt to improve medical and mental health outcomes for the FMC’s existing patient population. During the pilot program, a psychiatric mental health nurse practitioner (PMHNP) was utilized one day per week and a registered nurse (RN) served as a care manager. VALIDATION OF EVIDENCE: Donnabedian's Quality of Care Framework was utilized for the program evaluation and 17 patient satisfaction surveys were summarized using descriptive statistics.  RELEVANCE/OUTCOMES: PMHNPs are ideally suited for assisting primary care practices with the transition to collaborative care. IMPLICATIONS: The implementation of a CCM is feasible even in small practice settings.

 


 
 

3023: Transforming Psychiatric Mental Health Care in a Pediatric Hospital Setting
Bonnie A. Strollo, EdD, MS, PMHNP-BC

Abstract
PURPOSE: Approximately one in every four to five youth in the U.S. meets criteria for a mental disorder. The high prevalence of mental disorders in youth suggests that mental disorders occur among patients in pediatric hospital settings. The unique role of the Psychiatric Mental Health Nurse Practitioner (PMHNP) in a pediatric hospital setting will be reviewed to demonstrate how the gap between psychiatric education and practice can be bridged thus improving patient outcomes. The model of Relationship-Based Care will be used to illustrate how interpersonal relationships and professional communications skills coupled with formalized education can impact hospital length of stay and develop quality-improvement measures. SUMMARY OF EVIDENCE: The summary of 16 pediatric nursing staff who completed a 360 evaluation on the role of the PMHNP in a pediatric hospital will be shared. All the evaluations were highly favorable of the role and performance of this PMHNP. DESCRIPTION: Violence assessment and suicide assessment are utilized along with the protocol of How to De-escalate a Potentially Violent Patient. Another practice protocol is: How to Lead a Debriefing Session. VALIDATION OF EVIDENCE: Patient and family outcomes will be reviewed during two patient care scenarios.  RELEVANCE/OUTCOMES: The expanded role of the PMHNP in non-psychiatric settings can be utilize to help transform health care professional practices. IMPLICATIONS: The utilization of PMHNP can be optimized in medical care setting to help transform health care.

 


 
 

3024: Coming Home: Using Prolonged Exposure Therapy to Help Veterans Work through Symptoms of PTSD
Patricia Marie Hentz, EdD, PMHNP-BC

Abstract
PURPOSE: The purpose of this presentation will be to illustrate how Prolonged Exposure (PE) therapy can be used to reduce symptoms of PTSD among veterans. SUMMARY OF EVIDENCE: Prolonged Exposure (PE) therapy involves emotional processing of a trauma with the goal of decreasing symptoms of PTSD. The Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) has supported its use and as an evidenced based treatment for PTSD. DESCRIPTION: Prolonged Exposure (PE) therapy for the treatment of PTSD is based on emotional processing theory. The two primary approaches in PE include: imaginal exposure which involves recounting the memory in detail multiple times in order to emotionally process the memory and in vivo exposure which incorporates an exposure hierarchy aimed at helping the veteran decrease avoidance behavior. VALIDATION OF EVIDENCE: Effectiveness of Prolonged Exposure therapy is measured by pretest and post test measurements of PTSD symptoms, associated symptoms such as depression and anxiety, life style inventory as well as the clients subjective reports.  RELEVANCE/OUTCOMES: Prolonged Exposure therapy has demonstrated effectiveness in reducing PTSD symptoms. Case studies of veterans' experiences living with PTSD have shown that Prolonged exposure therapy has helped to decrease avoidance behavior, decrease hyper vigilance, decrease flashbacks and nightmares, and has improved social functioning. IMPLICATIONS: Prolonged Exposure therapy is an evidenced based approach that needs to be more readily available to veterans suffering from PTSD. In addition, there needs to be additional research on the effectiveness of the two approaches of PE, imaginary experience and in vivo experience.

 


 
 

3025: Decreased Alcohol Use in Pregnant Substance Users Receiving Motivational Enhancement Therapy
Robin Lynn Osterman, PhD, RNC-OB, CNS

Abstract
PROBLEM: Pregnant substance users consume alcohol at higher rates than pregnant women in general increasing the risk of fetal alcohol spectrum disorders (FASD). This study evaluated the efficacy of motivational enhancement therapy (MET) to decrease alcohol use in pregnant women attending substance abuse treatment.  FRAMEWORK: Guided by self-determination theory, MET may satisfy a pregnant substance user’s needs for autonomy, competence, and relatedness through a respectful relationship that supports the woman’s abilities resulting in decreased alcohol and substance use.  METHODS: In a randomized clinical trial of MET to decrease substance use in pregnant substance users (n = 200), 41 women who reported alcohol use in the previous 28 days at baseline were randomized to three sessions of MET or treatment-as-usual (TAU) over a 4 week period, with assessments completed at each of the first 4 weeks and at 1 and 3 month follow-ups.  Logistic generalized mixed model regressions determined treatment effects on alcohol use days over time.  RESULTS: Non-significant Treatment-related effects were found for alcohol use during treatment. During the 12 week follow-up, a significant Treatment-by-Time effect (p < .001) was found for alcohol use, with women in MET, relative to TAU, better maintaining low levels of alcohol use.  IMPLICATIONS: This study supports the use of MET to decrease alcohol use in pregnant substance users.  FUTURE RESEARCH: Future studies to replicate this finding and to assess the impact of MET on neonatal outcomes seems warranted.

 


 
 

3026: Soothing Rooms: Reducing Restraint Trauma in Patient and Nurses
Amy Kirsch, MSN, BSN, BA, RN; Eve Dano, BSN, BS, RN; Barbara Connors, MS, BSN, RN

Abstract
PURPOSE: The purpose in addressing soothing room use is to inspire its employment in calming escalating patients. The problem too often is that psychiatric inpatients escalate and harm themselves and/or others, requiring the use of restraints. SUMMARY OF EVIDENCE: The summary of evidence indicates that restraints are traumatic for patients and nurses, putting both at risk for physical harm (LaBel, Huckshorn & Caldwell, 2010). Moreover, restraints can trigger memories of past abuse, further damaging the nurse-patient relationship (Varcarolis & Halter, 2010). In contrast, significant positive effects were reported after the use of a sensory room for patient stress reduction (Champagne & Sayer, N/A). Implementation of a soothing room both reduces restraint likelihood and helps patients regain self control. DESCRIPTION: Current practices at a regional Midwestern hospital offers inpatients the use of soothing rooms featuring sensory objects, music, chalkboard, art therapy, and games, with staff monitoring every 15 minutes (A. Brechlin, 2012). Stakeholders include patients, families, staff, and the community, as patients learn to implement these self-soothing techniques in other venues. VALIDATION OF EVIDENCE: In gathering subjective data, adult and adolescent patients complete a written evaluation rating their stress levels before and after their soothing room experience. This feedback, as well as a 35% reduction in restraint usage, validates the new standard of care.  RELEVANCE/OUTCOMES: Given the evidence, the relevance for mental health nursing is clear. Implementation of soothing rooms benefits both patients and nurses by reducing restraint usage and its associated trauma both short and long term. IMPLICATIONS: Future implications are a change in nursing practice based on the evidence.

 


 
 

3027: Leading Through Turbulent Times Using Relationship Based Care
Lisa S. Davis, BSN, MEd, RN-BC

Abstract
PURPOSE: Leading an inpatient team of nurses during turbulent times presents many challenges, both clinical and operational. Leaders need a structure to assure that we don't go from fire to fire but that we keep focused on improving patient outcomes. SUMMARY OF EVIDENCE: Relationship Based Care is a care delivery system which is the outgrowth of primary care nursing and caring theories of Watson, Leininger and Swanson. Literature supports RBC as a way to improve patient outcomes and RN satisfaction. DESCRIPTION: In order to continually improve patient care on our unit we utilized RBC as our care delivery system. RBC gave us focus during turbulent times as our clinical and operational decisions were based on the tenets of RBC, the healing environment and the relationship with the patient and family, the team and self care. VALIDATION OF EVIDENCE: Our results were measured by our restraint and staff assault rates, our retention and recruitment data, the NDNQI measurement of job enjoyment and meeting budget.  RELEVANCE/OUTCOMES: Psychiatric nurses are part of the therapeutic milieu. In order for the milieu to be therapeutic nursing staff must have healthy relationships with patients and families as well as the team. We must also be mindful of self care in order to prevent burnout and maintain therapeutic boundaries. We have had success using RBC demonstrated by trend lines moving in the appropriate direction for our identified outcomes. IMPLICATIONS: Psychiatric nursing will continue to be faced with the challenge of improving patient care while managing costs. RBC is the care delivery model that will produce positive outcomes.

 


 
 

3028: The DSM-5: What Psychiatric Nurses Need to Know
Margaret Halter, PhD, APRN

Abstract
PURPOSE: The purpose of this presentation is to provide psychiatric mental health nurses with a summary of essential changes to the Diagnostic and Statistical Manual (DSM) in its 5th revision. SUMMARY OF EVIDENCE: The DSM-5 represents the first major revision in two decades. After the International Classification of Diseases, the manual is the 2nd most widely accepted psychiatric classification system in the world. DESCRIPTION: In this session participants will explore structural changes such as ordering diagnostic categories by interrelatedness. Diagnostic changes, including the removal or addition of certain categories and diagnoses, are presented. VALIDATION OF EVIDENCE: The impact of the revised criteria on who is being diagnosed and treated is explored by synthesizing research conducted since the manual's introduction in May of 2013.  RELEVANCE/OUTCOMES: Psychiatric nurses require a common diagnostic language to communicate with other clinicians, plan care, and engage in research. This presentation assists psychiatric nurses in assimilating the revisions into their knowledge base. IMPLICATIONS: Societal forces such as pharmaceutical influences and research funding and prioritization are likely to impact the way we view psychiatric diagnoses. The forces will be considered and discussed.