2014 Annual Conference Thursday Abstracts


2031: Feasibility and Acceptability of Psychiatric Nursing Simulation for Nursing Students
Heeseung Choi, PhD, MPH, RN ; Sungjae Kim, PhD, RN

PURPOSE: The present study was conducted to assess feasibility and acceptability of the use of standardized patient experiences to teach therapeutic communication skills in undergraduate psychiatric nursing students. SUMMARY OF EVIDENCE: While nursing students entering their psychiatric nursing clinical rotation often express fear and concerns about their abilities to interact with psychiatric patients, students have limited opportunities to practice their communication skills and participate in direct patient care. In addition, psychiatric nursing simulation using standardized patients has not been incorporated in nursing curriculum in Korea yet.  DESCRIPTION: We provided two levels of psychiatric nursing simulation: 10-minute one-on-one communication simulation and a 20-minute complex case scenario (a alcoholic patient case). One-on-one communication simulation was designed to provide students the opportunities to practice therapeutic communication skills for clients experiencing common psychiatric symptoms, such as anxiety, depression, aggression, and suicidal ideation. A complex case scenario includes interactions with alcoholic patients, family members, and other healthcare members. VALIDATION OF EVIDENCE: Feasibility and acceptance of the simulation education were evaluated by open-ended questions assessing the benefits, learning experiences, and areas for improvement for simulation experiences.  RELEVANCE/OUTCOMES: A total of 79 senior nursing students participated in the simulation education and completed evaluation forms. Students were highly satisfied with simulation experiences and expressed a desire for more education using SPs and chances to practice with more diverse cases.  IMPLICATIONS: Psychiatric nursing simulation using SPs needs to be incorporated into psychiatric nursing courses to equip nursing students with therapeutic communication skills and competency in nurse-patient interactions


2031: A Systematic Review of Classroom Pedagogy in Undergraduate Psychiatric Mental Health Nursing Courses
Marian L. Farrell, PMHNP-BC, PMHCNS-BC, CRNP; George Byron Peraza-Smith, DNP, GNP-BC, CNE

PURPOSE: Present results of systematic literature review examining qualitative and quantitative evidence of classroom pedagogies used in undergraduate psychiatric mental health nursing courses. SUMMARY OF EVIDENCE: Search produced twenty-two articles for inclusion in the study. Most studies were placed in the Foundational Knowledge and Application categories using Fink's Taxonomy of Significant Learning (Fink, 2003)  as an organizational framework.  DESCRIPTION: CINAHL Plus, Medline, Ovid Nursing, PubMed, ERIC, Proquest electronic databases were used . MeSH search term combinations included: psychiatric nursing, mental health nursing, teaching, pedagogy, education, student, and classroom. VALIDATION OF EVIDENCE: Search of PMH nursing courses between 2000 and Jan. 2013 resulted in 254 documents; 102 duplicates were excluded leaving 152 articles. Inclusion criteria: primary research studies published in English; qualitative and/or quantitative designs; addressing classroom teaching and learning pedagogies in psychiatric mental health nursing courses.  Final review resulted in a 129 rejections, leaving 22 articles in the study.  RELEVANCE/OUTCOMES: Using Fink's (2003) framework, review revealed current pedagogy limited to Foundational Knowledge and Application. Little evidence found in Integration, Human Dimension, Caring, and Learning How to Learn categories for PMH undergraduate nursing courses.  IMPLICATIONS: Potential for insufficient depth of knowledge, skills, and competencies regarding PMH nursing in baccalaureate education. Faculty teaching PMH nursing may lack sufficient experience and depth to create significant learning opportunities in the Integration, Human Dimension, Caring, and Learning How to Learn categories. Further assessment and evaluation in PMH education at  the undergraduate level is needed. Curricular issues may include the level of the course and number of hours alloted to teach the content.


2032: The Newly Created Psychiatric Nurse Practitioner Role within the Sex Offender Division of the Judicial Branch
Jill Espelin, DNP, PMHNP-BC, CNE, APRN; Lucia DeVivo Catalano, MSN, APRN

PURPOSE: The Sex Offender Program has had in the past employed a psychiatrist to manage medications of the clients enrolled in the program. A proposal was initiated by an APRN to offer medication management at a more cost effective and holistic approach. The APRN proposal was accepted. SUMMARY OF EVIDENCE: Research shows that APRN's provide safe competent effective care more cost effectively. In order for clients to participate in the program with positive outcomes, psychiatric problems and illnesses need to be treated with both therapy and medication management.  DESCRIPTION: Stakeholders include clients, cognitive behavioral therapists, probation officers, and most recently, the APRN. This team ensures clients who are on probation after serving prison time for sexual offenses are fully participating in the program. Assessment and medication management by APRN ensures mental illness is treated. VALIDATION OF EVIDENCE: Routine positive feedback from cognitive behavioral therapists and probation officers are supporting evidence that the APRN's role of assessment and prescribing needed medication management to the clients in the program proves effective.  RELEVANCE/OUTCOMES: Psychiatric APRN is cost effective and holistic in providing medication management and assessment of mental illness, a co-morbidity of sexual deviant behavior. The team has cited examples of marked improvement in participation of some clients after assessment and appropriate medication management.  IMPLICATIONS: This new position has been successful, serving as an extra safety net. The Psychiatric APRN provides psycho-education as well as assessment and medication management, pieces that would be absent from a treatment team comprising of probation officers, social workers, and cognitive behavioral therapists.


2032: Integration of Mental Health into Primary Health Care Setting: What is the Role of Psychiatric Mental Health Nurses?
Michael Olasoji, PhD, RN, RPN, BNurs(Hons), PGDip MHN, MACMHN

PROBLEM: Primary health care (PHC) is the first level of contact for individuals connecting them to the national health system. The cost and accessibility of mental health care continues to be problematic. Family Physicians often lack the skills and time to provide adequate mental health care at the primary care level without specialist assistance. Psychiatric Mental Health Nurses (PMHNs) represent the largest percentage of the mental health workforce and any plan to reform the delivery of primary mental health will require active participation of PMHNs. This study explored the role of PMHNs working in PHC within the context of an Australian Government initiative that enabled FPs to engage the services of PMHNs within their practice.  FRAMEWORK: The framework of Donabedian’s structure-process-outcome model of quality care.  METHODS: The study had a three-phase mixed-method design. Data was collected through semi-structured interviews and survey of PMHNs and FPs. Framework analysis and statistical analysis were used to analyse the data.  RESULTS: The findings indicate that PMHNs are able to build connections with FPs in the primary care setting to deliver timely, accessible and effective care to people with a severe mental illness.  IMPLICATIONS: There is a need for PMHNs to continue to articulate their role as leaders in health care delivery and be more vocal and perhaps political in order to receive the recognition that their skills and expertise deserve.  FUTURE RESEARCH: This study highlights the need for policy makers to explore future mental health care delivery models which takes into account the significant role played by PMHNs.

2033: Going Back to School: APRNs Find Ways to Improve Access to Mental Health Care
Linda Lazar, MSN, PMHNP-BC, PNP-BC; Deborah S. Miller, MSN, PMHCNS-BC

PURPOSE: The purpose of this presentation is to explore different methods of providing mental health care in the school setting. SUMMARY OF EVIDENCE: The CDC estimates 13-20% of children under the age of 18 years have some form of mental health issue.  Only 21% of these children receive mental health services.  ADHD is the most common diagnosis in this age group, however many of these children have a comorbid conditions.  DESCRIPTION: Access can be a significant deterrent for parents who are trying to find mental health care for their child. Schools are often places where symptoms are seen and identified as needing intervention.  Parents and children are more comfortable going to a school setting vs. going to a mental health center.  There are different models of school based services. Some school based services offer only therapy and/or case management. Others provide the additional benefit of having medication management. VALIDATION OF EVIDENCE: We will review features of different school based programs in the Cincinnati, Ohio metropolitan area.  We will examine differences in appointment compliance between different school based programs, mental health service embedded in a primary care clinic and traditional outpatient setting.  RELEVANCE/OUTCOMES: School-based mental health programs in urban, suburban schools; and those with and without medication management were analyzed and compared.  IMPLICATIONS: Increasing compliance with treatment is key to addressing mental health issues in children and adolescents.  Early intervention may lead to lower incidence of chronic mental illness in the adult years. When there is chronic mental illness, these interventions may lead to less severity when started earlier in life.

2033: Processes of Disease Management and Treatment Use in Adolescent Depression
Halima Al-Khattab, BSN, RN

PROBLEM: Untreated depression among African American (AA) adolescents is associated with serious concurrent and long-term negative outcomes including high-risk sexual behavior, substance abuse, poor academic performance and psychosocial functioning, and increased risk for suicide. Although effective treatments for depression are available, AA adolescents are two-thirds less likely to receive treatment than European American adolescents. Strategies are needed to help AA adolescents manage their depression and engage in effective mental health services. Initiatives to connect depressed AA adolescents to effective mental health services require a greater understanding of how they experience depression throughout adolescence, especially from their own perspectives. The purpose of this study was to develop a theoretical framework that describes how AA adolescents understand and manage their depression and its effects over the course of their adolescent years.  FRAMEWORK: The Response Styles Theory of Depression guided this study.  METHODS: Qualitative interviews were conducted during this grounded theory study with two groups of participants: AA young adults (18-to-21-year-olds) (n=20) who reported having experienced depression during adolescence (ages 13-17) and AA adolescents (13-17-year-olds) (n=6) in treatment for depression. The constant comparison method was used to analyze the data.  RESULTS: The completed framework describes how AA adolescents understand and manage their depressive symptoms over the course of their adolescent years.  IMPLICATIONS: The framework will facilitate the development of initiatives to help AA adolescents manage their depression and connect to mental health services.  FUTURE RESEARCH: Future research will include developing and testing interventions to improve the mental health of AA adolescents with depression.

2034: Transforming to a Recovery-oriented System of Care in an Psychiatric ICU: The Risks, the Rewards, and the Role of Nursing
Jennifer S. Birch, MA, RN, MSN, PMHNP-BC; Abbey Day, RN, BSN; Erik Lee, RN, PHN, MSN

PURPOSE: Recently, institutions developed initiatives to improve quality of care in the inpatient psychiatric unit setting. Patient-centered care (PCC) and recovery-oriented care (ROC) are two concepts upon which these initiatives are based. This presentation outlines one VA's psychiatric ICU's transformation from baseline practices to their implementation of PCC/ROC. The process is explored and outcomes are discussed. SUMMARY OF EVIDENCE: When unit structure is lacking and patients' needs are not met, violent incidents increase. Conversely, group programming and flexibility in unit policies prevent violence. CBT, motivational interviewing and psychoeducational groups are some of the evidence-based modalities implemented in this transition.  DESCRIPTION: PICU nurses transitioned to PCC/ROC by fundamentally altering their perspectives of the veterans in their care. They revised unit policies, implemented a nursing-led evidence-based group program, enhanced the physical environment, trained staff in PCC and ROC, instituted a peer support staff member, and began utilizing recovery language. VALIDATION OF EVIDENCE: Several tested and valid assessments and surveys, as well as in-depth interviews, were used to measure and evaluate outcomes from patient and staff perspectives alike.  RELEVANCE/OUTCOMES: The implementation of PCC/ROC has inproved care on this VA's psychiatric ICU, as evidenced by higher patient satisfaction scores, positive patient feedback, and a seclusion/restraint record significantly lower than the national average.  IMPLICATIONS: As inpatient units provide a critical service that cannot be interrupted, we need to find sustainability or risk fatigue and burnout. We hope to define best practices in PCC/ROC in psychiatric ICUs, and disseminate them in order to further quality of care for our veterans and consumers nationwide.



2034: Impact of Deployment on Women's Mental Health
Mary Ann Boyd, PhD, PhD, PMHCNS-BC; Wanda Bradshaw, BSN, MSN, RN-C; Marceline Robinson, BSN, MSN, PMHCNS-BC

PURPOSE: The purpose of this presentation is to describe the current mental health issues of women deployed to Iraq and Afgahnistan. SUMMARY OF EVIDENCE: Women comprise approximately 15% of the military population with an unprecendented number of reserve component military members deployed to Iraq/Afghanistan.  Military experiences of women are now being documented and include military sexual trauma and  combat exposure.  Evidence from the DOD and the Department of Veterans Affairs show an alarming increase of military women suicides during deployment from 5.1% in 2003 to 15.2% per 100,000 in 2008.  DESCRIPTION: Nursing assessment of suicide, depression, and PTSD will be described and emphasized throughout the presentation. VALIDATION OF EVIDENCE: Evidence is validated through peer-reviewed sources.  RELEVANCE/OUTCOMES: PMH nurses will be caring for women veterans who were deployed.  IMPLICATIONS: The mental health issues that have resulted from deployment experiences will need long-term attention for all health care providers.

2035: Impact of Primary Nursing in a High Dependency Psychiatric Care Unit in Singapore: Patients’, Caregivers’ & Nurses’ Perspectives
Kalaivanan Dakshnamoorthy, RN, RMN, B Sc Nursing ; Xie Huiting, RN, RMN, PhD; Ong Bee Cheng, RN, RMN, EMBA; Aziz Hamid, RN, EMN, MSN; Regina Lua Ubana, RN, RMN, MN, MHSM

PROBLEM: Primary Nursing, though associated with positive patient experiences, little is known about its impact on the management of acutely disturbed patients in psychiatric settings.  FRAMEWORK: Guided by Interpersonal Caring theory where therapeutic relationships may be developed between patients and nurses, Primary Nursing was introduced to the High Dependency Psychiatric Care Unit (HDPCU).  METHODS: In this mixed methods, comparative study, outcomes of care were compared between Primary Nursing, PN (n= 40) and Functional Nursing, FN (n= 40). Data from patients’, caregivers’ and nurses’ perspectives were obtained through surveys and focus group interviews. Differences in scores depicting mean perception, experience and satisfaction between PN and FN were compared using independent samples t-tests. Qualitative data from focus groups were interpreted through thematic analysis.  RESULTS: Patients receiving PN had significantly better perception and experience of nursing care,  t (38)=4.04, p<0.001 and t (38)= 4.18, p<0.001 respectively. They perceived nurses as being concerned about them and experienced nurses’ availability. Both caregive  IMPLICATIONS: Findings had contributed to the knowledge base about nursing care delivery in psychiatry. Valuable evidence supporting the utilization of PN in delivering intensive nursing care for acutely disturbed patients in HDPCU was gained.  FUTURE RESEARCH: Future research evaluating outcomes through randomized controlled trials or longitudinal studies with large sample sizes could facilitate further understanding of the effectiveness of primary nursing in various psychiatric settings and populations.


2035: Behavioral Health Nurses and the Initiation and Sequelae of Rapid Response Team (RRT) Calls
Kristy Loewenstein, MSN, RN-BC, PMHNP-BC; Marybeth McManus, MPA, BSN, RN-BC; Yankel Girshman, DO; Pafam Bhatia, MD; Joseph Whelan, BA, RN; Maira Barnes, MSN, RN-BC, CNE

PROBLEM: Rapid Response Teams (RRT) have been widely implemented in non-ICU settings as delays in providing care to patients whose conditions are deteriorating increases the likelihood of cardiac arrest/death, prompting the initiation of the RRT in inpatient psychiatry. FRAMEWORK: A literature search of RRT was completed.  No literature was found related to the use of RRT inpatient psychiatry.  Systematic reviews of rapid responses have varying conclusions, and have yet to include behavioral health sites in their review.  METHODS: A retrospective chart review was completed on 171 RRT patients. IRB approval for retrospective chart review and waiver of informed consent was obtained.  The demographic and clinical data will now be compared in univariate analyses, using chi-square and t-tests.  Variables statistically different will be entered in logistic regression to identify the independent predictors of medical hospitalization. Analyses will be performed using a statistical package.  RESULTS: Total subjects: 171; Subjects getting transferred to ED: 128 Of subjects getting transferred to ED (128)  - 14 have incomplete data  - 71 were not admitted to medicine  - 43 admitted to medicine  Univariate analysis has yet to be complete; conclusive results are pending.  IMPLICATIONS: This study will add to the body of literature concerning rapid responses, and analyze their use and benefit,  in inpatient behavioral health hospitals.  FUTURE RESEARCH: Raw data shows more than half of patients admitted from psychiatry to medicine have at least one Axis III diagnosis thus influencing future curricula for nursing education and research on the prevalence of and risk factors for patients with mental illness and medical comorbidities.

2036: Launching Professional Development via a PMHNP Residency: A Partnership between a VAMC and School of Nursing
Teena M. McGuinness, PhD, CRNP, FAAN; Savannah Wilhite, MSN, PMHNP-BC, CRNP; Kara Tucker Carter, MSN, PMHNP-BC, CRNP; Jessica R. Waldrop, MSN, PMHNP-BC, CRNP; Audry G. Gorman, DNP, PMHNP-BC, CRNP

PURPOSE: The purpose of the session is to describe a new residency for PMHNPs between the Birmingham VA Medical Center (BVAMC) and the University of Alabama at Birmingham School of Nursing (UAB SON) that is currently in its first year. SUMMARY OF EVIDENCE: A model pioneered by Federally Qualified Health Centers in 2007 proposes one year of post-MSN residency education. Additionally, the Institute of Medicine’s report on the Future of Nursing recommended residency training for new APRNs. The residency model proposed in 2013 by the VA is likely the first one for PMHNPs.  DESCRIPTION: Recent graduates with less than 12 months experience post-MSN were recruited for three PMHNP resident positions. This one-year residency emphasizes scientific foundation competencies for independent practice and patient care, competencies for psychiatric-mental health nursing, practice-based learning and improvement, interpersonal and communication skills, interprofessional activities, and systems-based practice. The program supports recently licensed nurse practitioners by embedding them with interprofessional teams providing care, mentoring from specialty team members with expertise, and didactic content shared in interprofessional classrooms that deepen existing skills. VALIDATION OF EVIDENCE: Knowledge, skills, and attitudes are evaluated at the end of each one-month team rotation via consultation with mentor and PMHNP residency director.  RELEVANCE/OUTCOMES: Veterans are America’s greatest resource; their mental health needs are of primary importance to their health. PMHNPs will gain clinical proficiency and develop professionalism via the residency program, leading to better care for veterans.  IMPLICATIONS: The pioneering efforts of residency training for PMHNPs at VAMCs in partnership with Schools of Nursing will serve as a model for future residencies.



2036: The RIDE: Graduate Students Team Up for Recovery-based, Interprofessional Distance Education
Marian W. Roman, PhD, RN, PMHCNS-BC; Lora H. Beebe, PhD, PMHNP, BC

PURPOSE: To provide recovery based mental health care,  health professions must collaborate for patients optimal wellness. Teams must include professionals outside mental health disciplines  Interprofessional Education (IPE) is  endorsed by the World Health Organization, the American Association of Colleges of Nursing to prepare future  professionals for collaboration  as health care teams. SUMMARY OF EVIDENCE: U.S. Health Resources and Services Administration (HRSA)  has made IPE a priority, supporting programs and curricular innovations for health professions students. integrated care  and  person centered recovery models  emphasize collaborative  health promotion as  treatment. We identified professions  we deemed essential  for recovery based care :  exercise, nutrition and pharmacy.  DESCRIPTION: Faculty, simulation and evaluation  consultants began team building  12  months before implementation . They developed and  implemented  a 6 week module of interprofessional learning, utilizing  patient simulation, asynchrous and synchronous team building and collaborative learning  strategies Capstone Project:   3 days  onsite collaboration with a community mental health center ( CMHC) wherein  student  teams helped clients formulate  personalized wellness  plans . VALIDATION OF EVIDENCE: Evaluation experts were included in  planning and implementation. . Evaluation  of outcomes were collected  from  all stakeholders, including CMHC staff and patients. Outcomes  were derived from IPE core values, content objectives of   modules and  perceptions of all  participants.  RELEVANCE/OUTCOMES: Conference date  is one week  after first cohort  completes  capstone   Preliminary findings   will be hot off the press!  IMPLICATIONS: Findings will inform  the remaining two years of  project. Dissemination of findings and long term follow up of participants will inform future education and practice of Psych Mental Health Practitioners.


2037: Building Relationships through Collaboration: An Interprofessional Project Impacting Substance Use in Rural Areas
Kathy Puskar, DrPH, RN, FAAN ; Ann M. Mitchell, PhD, RN, FAAN; Holly Hagle, PhD; Susan A. Albrecht, PhD, RN, CRNP, FAAN; Dawn Lindsay, PhD; Linda R. Frank, PhD, MSN, ACRN, FAAN; Irene Kane, PhD, MSN, RN, CNAA, HFI; Heeyoung Lee, PhD, APRN-BC; Marie Fioravanti, DNP, RN; Piper Lincoln, MA; Kimberly S. Talcott, MPA

PURPOSE: Adults 18 or older with mental illness are more likely to meet criteria for a substance use disorder than individuals who do not have mental illness (National Survey on Drug Use and Health, 2013).  Substance use is associated with increased medical, criminal and other societal costs and exacerbates both physical and mental health conditions. SUMMARY OF EVIDENCE: Residents of the tri-state area of Ohio, Pennsylvania, and West Virginia report higher than U.S. average of having at least one major depressive episode, past year use of nonmedical pain relievers, past month alcohol use, and past month tobacco and cigarette use (NSDUH, 2010).  DESCRIPTION: To address these issues, a nurse-led interprofessional collaboration was formed to strengthen treatment capacity in the tri-state rural areas.  Strategies for implementation included creating an easily accessible, 100% online education intervention for the interprofessional workforce using evidence-based practices to reduce patient health risks.  Stakeholders and participants were identified through the partners of the nurse-led collaboration team. VALIDATION OF EVIDENCE: Outcomes were measured via online survey pre and post intervention.  RELEVANCE/OUTCOMES: All subscale scores on the Alcohol and Alcohol Problems and Perceptions questionnaire increased pre-(n=46) to-post-(n=9) intervention with highest scores on the Role Support subscale. Five of six subscales on the Drug and Drug Problems and Perceptions questionnaire increased pre-to-post. All participants responded that they are likely (25%) or very likely (75%) to collaborate effectively, communicate effectively, and share in decision making with their interprofessional team during their daily practice.  IMPLICATIONS: Webinars provided reinforcement of interventions learned via self-study through interprofessional communication and community connections.



2037: An Education Program to Address Patient and Colleague Substance Misuse in Anesthesia
Ann M. Mitchell, PhD, RN, FAAN; Michael Neft, DNP, MHA, CRNA; John M, O'Donnell, CRNA, MSA, DrPH

PURPOSE: The most serious occupational safety issue associated with the practice of anesthesiology is substance abuse (Tetzlaff, 2010).  In response, the Council on Accreditation of Nurse Anesthesia Educational Programs recently required that graduates demonstrate knowledge of wellness and chemical dependency in the anesthesia profession SUMMARY OF EVIDENCE: Anesthesia professionals are at a heightened risk for abuse of and dependency on certain classes of drugs (NCSBN, 2011; Wright 2012) including inhalational anesthetics, opioids, and benzodiazepines.  DESCRIPTION: Student registered nurse anesthetists (SRNAs) attended an in-class session on the evidence-based practice of Screening, Brief Intervention, and Referral to Treatment (SBIRT).  SRNAs were trained to use SBIRT with patients and impaired colleagues, completed an online booster, and participated in simulation sessions reinforcing concepts. VALIDATION OF EVIDENCE: SRNAs were surveyed pre and post training/simulation about their knowledge of SBIRT, attitudes and perceptions of working with patients who use alcohol and other drugs, and were also surveyed during simulation regarding their reactions to both patient and impaired colleague substance use.  RELEVANCE/OUTCOMES: Out of six total subscales on the Alcohol and Drug Problems Perceptions scales, five subscales increased pre, post, simulation - with the Role Adequacy subscale receiving the highest positive perception.  During simulation, students and faculty rated students’ SBIRT competency higher in a patient interview scenario than in a scenario with an impaired colleague.  IMPLICATIONS: Nurse anesthesia students and professionals can benefit from chemical dependency tools, education and resources.


2038: The Tidal Model: A New Perspective for Psychiatric Nurses
Julie M. Brandy, PhD, RN, FNP-BC

PURPOSE: Developed in 1998, the Tidal Model allows for a creative and flexible approach to the delivery of psychiatric nursing care.  The focus of this model is to emphasize the lived experience of each individual patient. SUMMARY OF EVIDENCE: The Tidal Model states that all individuals are defined by their life experiences, and is focused upon holistic assessment of the life experience as defined by the individual.  There are no value judgments made about the person's life.  By providing a respectful, safe and supportive environment for the person to share their story, the nurse provides a "hopeline" that serves to line the person with the recovery process.  DESCRIPTION: The Tidal Model has a strong emphasis on empowerment for patients, and challenges nurses to reflect upon how their actions encourage this important aspect of care. Nurses using this model will collaboratively care with their patients, not place patients in a dependent role. VALIDATION OF EVIDENCE: Originally developed to be used in the acute psychiatric setting, the usefulness of the Tidal Model has been demonstrated across the continuum of care.  This model has been used as the basis of nursing care delivery in acute, community, rehabilitation, and forensic settings.  RELEVANCE/OUTCOMES: The Tidal Model has been successfully utilized in research and practice in the United Kingdom, Northern Ireland, Canada and New Zealand.  IMPLICATIONS: At this time, the Tidal Model has not been influential on the research and practice of psychiatric nursing in the United States, but appears to have a great deal to offer our discipline in the future.



2038: Interprofessional Model of Geropsychiatric Care in a Program of All-inclusive Care for the Elderly
Pamela Z. Cacchione, PhD, CRNP, BC, FAAN; Barbara Hegarty, MSN, FNP, PMHCNS; Lisa Eible, MSW, LCSW; Steven Huege, MD

PURPOSE: To demonstrate a successful  interprofessional geropsyciatirc practice model imbedded in a Program of All-Inclusive Care  (PACE) program. SUMMARY OF EVIDENCE: The behavioral health team participates in the weekly primary care team meetings. Targeted interventions to decrease innappropriate use of antipsychotic medications was implemented. Antipsychotic use in this population decreased from 14 % to 11.2% over four months.  This number is decreased even further to 7.6% when the members with serious mental illness are removed from the list.  DESCRIPTION: Members are routinely screened for cognitive impairment and depression.  Referrals to the Geropsychiatric team can be made by all including: van drivers, caregivers, chaplain, nurses, nurse practitioners and physicians. There is immediate dialogue with the primary care provider following the consultation by geropsychiatric team.  Typical referrals include dementia related behaviors, delirium and psychosis. VALIDATION OF EVIDENCE: Additional successes by the Geropsychiatric team include community outreach for resources to meet our members’ needs for alcohol rehabilitation; policy and procedure development for non voluntary (302) admissions and voluntary (201) admissions; caregiver and professional staff education programs on behavioral disturbances in our members with dementia.  RELEVANCE/OUTCOMES: Interprofessional team care of mental health issues is essential and effective within a PACE program.  IMPLICATIONS: Team work takes effort and patience. Challenges remain in addressing substance misuse issues in the population. New efforts are being implemented to address this growing concern.


2041: The 6th Annual Institute for Mental Health Advocacy Interactive Panel
Margaret Halter, PhD, APRN

PURPOSE: The Institute for Mental Health Advocacy provides advocacy education and support for the American Psychiatric Nurses Association. SUMMARY OF EVIDENCE: Nurses are essential in providing advocacy and leadership for health policy initiatives. Many factors influence political involvement, but education is thought to be the essential determinant. DESCRIPTION: The American Psychiatric Nurses Association developed the Institute for Mental Health Advocacy (IMHA) in 2009. Its purpose is to inform psychiatric nurses about legislative, regulatory, and policy matters affecting mental health and help coordinate organizational responses. VALIDATION OF EVIDENCE: With 20 Steering Committee members and nearly 200 Advisory Panel members, the IMHA disseminates information regarding advocacy issues and updates on essential resources. Feedback is regularly solicited regarding advocacy issues. Quarterly Policy Forums provide expert information from member leaders in policy initiatives. Grassroots initiatives related to psychiatric nursing practice and psychiatric care are shared at the annual conference.  RELEVANCE/OUTCOMES: An intentional focus on advocacy issues by the American Psychiatric Nurses Association supports the ability of psychiatric mental health nurses to provide advocacy and leadership for health policy initiatives. Furthermore, the increased visibility of psychiatric nurses as policy leaders expands their influence in promoting quality patient care and in supporting professional practice issues. IMPLICATIONS: The political climate of healthcare reform puts additional pressure on healthcare providers and associations to navigate increasingly complex legislative issues. The Institute for Mental Health Advocacy will continue to provide essential advocacy support for psychiatric nurses and the American Psychiatric Nurses Association.


2042: APRN Council Interactive Session
Kathryn Johnson, PMHNP-BC, PMHCNS-BC

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. RELEVANCE/OUTCOMES: PMH APRNs are faced with many barriers to practice. APRNs work in relative isolation from colleagues. This open dialogue session will serve to inform PMH APRNs about issues common to all PMH APRN practice, about various state and national developments and suggest possible solutions. IMPLICATIONS: Information shared at the open discussion will serve to guide next steps for APRNs working toward barrier free, independent practice.


2043: APNA Child and Adolescent Council Interactive Panel
Julie Anne Carbray, PhD, FPMHNP, PMHCNS, BC

PURPOSE: The purpose of this interactive panel is to present the activity of the past year of the Child and Adolescent council and to engage council members in contributing to the counci . In addition, 1) opportunities for feedback into council activities 2)opportunities to network with others within the council and 3)opportunities to inform council members of activities and needs to shape council goals for the upcoming year. SUMMARY OF EVIDENCE: Evidence will be drawn from APNA archives of annual meetings, published work on the child and adolescent mental health nursing workforce, APNA Child and Adolescent council Survey results, and the "white paper" on Child and Adolescent Psychiatric Nursing (2008). In addition, we will collect APNA data on council membership and present to members an overview of the topography of council membership and Child and Adolescent mental health nurses across the states. IMPLICATIONS: Future directions for the council will be presented.



2044: Creating a "Culture" of Recovery: Connecting Cultural Contexts and Recovery for Psychiatric Mental Health Nurses
Jennifer K. Barut, MSN, RN-BC

PURPOSE: This presentation will offer PMH nurses opportunities to provide feedback and guide the Steering Committee in leading the work of the Council, report results of taskforces, and connect participants in collaborative processes to share knowledge and build resources for Recovery-oriented practices. SUMMARY OF EVIDENCE: Culture influences how clinicians and patients perceive illness, engage in treatment, and pursue goals of recovery. The President’s New Freedom Commission on Mental Health(2003) called for transformation of mental healthcare, with consumers and families at the heart of change. “Creating a recovery culture begins with shifting assumptions about individuals from a deficit focus to a strength-based focus; assessing people and organizations through the lens of possibility and strength.” (Prescott&Harris,2011,p.1) Recovery embodies culturally competent care, i.e. the knowledge, values, and practices that support recovery for people across different cultures, languages, and environments. DESCRIPTION: Taskforces develop resources for PMH nurses to promote the development of a Culture of Recovery through culturally-aware, strength-based, recovery-focused and trauma-informed care. VALIDATION OF EVIDENCE: Resources will initially focus on specific populations: homelessness, adolescents, the nurse as consumer and professional, and environments: inpatient, outpatient and education.  RELEVANCE/OUTCOMES: Development of sustainable Cultures of Recovery must be respective of diverse needs of individuals, recognizing and striving to eliminate cultures of stigma for persons experiencing mental illness. The Recovery Council provides resources to help the nurse promote recovery for the person experiencing mental illness as well as engage healthcare professionals, systems and environments in Recovery-oriented processes. IMPLICATIONS: Recovery resources will enhance practice, support research, and promote education of professionals in support of persons with mental illnesses.

2045: Tobacco Dependence Council Interactive Panel: Virtual Nursing Academy of APNA Champions for Smoking Cessation
Daryl L. Sharp, PhD, RN, PMHCNS-BC, NPP; Susan W. Blaakman, PhD, RN, NPP-BC

PURPOSE: This interactive panel will feature the work of our Virtual Nursing Academy (VNA) of APNA Champions for Smoking Cessation each of whom was selected via a competitive call for applications in December 2013. Funding for the Academy was provided by the Smoking Cessation Leadership Center in partnership with APNA. The overall goal of this grassroots initiative including specific aims will be described. Each Champion will describe his or her project and report findings, conclusions and recommendations. The session will be comprised of podium and poster presentations, and will include discussion with the audience regarding the projects described. Next steps for the Virtual Nursing Academy and the Tobacco Dependence Council also will be discussed. SUMMARY OF EVIDENCE: Although the prevalence of tobacco use in the general population has decreased over the pa



The American Psychiatric Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.