4011: Cognitive Behavioral Therapy with Children and Adolescents – Teaching the Basics to Advanced Practice Nursing Students
Pamela Lusk, DNP, PMHNP-BC

PURPOSE: Graduate nursing faculties are preparing advanced practice Psychiatric Mental Health Nursing students to evaluate and treat persons across the lifespan. Cognitive Behavioral Therapy (CBT) is a recognized evidence-based first line treatment for common child and adolescent mental health conditions, including anxiety and depression. CBT has been adapted to be presented in developmentally appropriate and appealing format for school age children 7-11 years of age, and also for teens 12-18 years of age. SUMMARY OF EVIDENCE: Evidence from current research supporting CBT as an effective treatment for these age groups will be presented. DESCRIPTION: Lessons learned teaching graduate nursing students the basics of CBT with children and adolescents, including lab/clinical practice opportunities will be the focus for this session. There will be a review of the basic concepts of cognitive behavioral therapy as developed by Beck and examples of how these concepts are incorporated into therapy with children and teens. Treatment manuals that present CBT for children and teens will be shared, and the delivery of the content in structured predictable sessions will be demonstrated. Skills building activities for the therapy sessions and homework assignments will be identified and demonstrated. VALIDATION OF EVIDENCE: Valid and reliable outcome measurement tools to evaluate the effectiveness of the CBT treatment program with children and adolescents will also be discussed. RELEVANCE/OUTCOMES: Content in psychotherapy for children and adolescents is important. IMPLICATIONS: As graduate programs for advanced practice psychiatric/ mental health nursing students prepare for evaluation and practice across the lifespan, evidence-based psychotherapies for children and adolescents will be important content areas.



4012: Integrating a FQHC Primary Care Clinic within a Mental Health Agency: Opportunities, Challenges and Lessons Learned
Carla J. Groh, PhD, PMHNP-BC, FAAN; Irva Faber-Bermudez, PMHNP-BC

PURPOSE: To share the process used for applying to become an FQHC and the logistics of implementing a nurse-managed model by partnering with an academic institution SUMMARY OF EVIDENCE: Significant evidence exists to support the value of integrating primary and behavioral health care in improving patient outcomes. Nurse-managed models continue to make value contributions in this area, and have demonstrated equal, or even better, patient outcomes compared with medical models of care. DESCRIPTION: Collaboration between a mental health agency and academic institution will be discussed, along with challenges in implementing the model from both perspectives. VALIDATION OF EVIDENCE: The FQHC opens March 3, 2014 with six-month evaluation data on patient outcomes available by October. Outcome measures include: BP, BMI, lipids, hemoglobin A1c, adherence to medications, symptoms management (physical and behavioral), and adherence to appointments. RELEVANCE/OUTCOMES: PMH nurses and the interdisciplinary team are well positioned to work collaboratively with advanced practice nurses (APN) in primary care as teamwork is a major component of PMH practice. Development of a collaborative practice has the potential to capitalize on the synergy that occurs, resulting in improved physical and behavioral outcomes. IMPLICATIONS: The success of the partnership between a community mental health agency and academic institution in improving patient health outcomes offers an alternative delivery model that can impact practice in a positive manner. Advantages to the community mental health agency of partnering with an academic institution are educational and staffing resources, students and faculty. The advantages to the academic institution include student clinical sites, real life experiences and research opportunities.



4013: Development of an Educational Program to Promote Integration of Infant Mental Health Assessment and Intervention into an Advanced Practice Registered Nurse (APRN) Operated Primary Care Clinic
Dorothy Henry Jordan, DNP, PMHCNS-BC; Martha W. Hernandez, DNP, PMHCNS-BC; Carolyn Cullen Williams, DNP, FNP-BC, PMHCNS-BC, PMHS

PURPOSE: Infant Mental Health (IMH) is significantly influenced by Adverse Childhood Experiences (ACEs). APRNs are in a key position for assessing, identifying and intervening with children at risk. Promotion of resiliency can reverse changes caused by exposure to adverse events in early childhood. In our setting of focus, we educated APRNs who are the sole providers for at risk families and children in an urban clinic. SUMMARY OF EVIDENCE: Our focused review of literature provided no evidence of APRN knowledge and integration of IMH screening in well baby exams in primary care settings. As a result, there is not only a lack of assessment for IMH, but also identification, intervention and appropriate referral for at risk children. DESCRIPTION: A convenience sample of APRNs was self-selected from a primary care clinic in an urban Southern city. A pretest/posttest design was used to assess areas of knowledge deficit and subsequent knowledge acquisition as a result of an IMH educational program. VALIDATION OF EVIDENCE: Scores from pre-post test were correlated. Data analysis focused on change in pre-post test scores and differences among APRNs based on area of clinical expertise. A coefficient analysis of the pre/post test was obtained to assess for validity of the instrument. RELEVANCE/OUTCOMES: Providing education to APRNs in this study will increase knowledge and preparation to assess and intervene with at-risk infants and families. IMPLICATIONS: By providing the education needed to support IMH care in primary care, providers will have the capability to promote improved quality of life for infants and families.



4014: Peer Support Specialists' Impact on the Care of Veterans on an Acute Inpatient Psychiatric Unit
Allison Mason Johnson, BSN, MHA, RN

PURPOSE: The Veterans Administration (VA) is the nation's largest mental health provider & is a leader in implementing peer support services.The first Peer Support Specialists began November 2013 at Houston VA Medical Center,Inpatient Psychiatric Unit. SUMMARY OF EVIDENCE: Crossing the Quality Chasm establishes fundamental redesign and is directly applicable to mental health. A recommendation made “to promote patient-centered care, all involved in care for mental or substance conditions should support the decision-making abilities and preferences for treatment and recovery of persons with mental and substance problems and illnesses. DESCRIPTION: The integration of Peer Support is growing & has gained acceptance much to the dismay of some staff. The areas of trust, scope of practice & confidentiality should be considered. The VA has developed a program for inpatient and outpatient services, management and co-workers. VALIDATION OF EVIDENCE: Data will give evidence of outcomes related to addition of Peer Support Specialists. Outcomes measured in five measurements of patients' Press Ganey discharge survey. Increasing Peer Support notes in patient charts each month correspond with data that shows a marked increase in the patient satisfaction areas: Time in Therapeutic Activities; Helpfulness of Staff; Introduction to Unit; Helpfulness of Staff; & Sensitive to Emotional Needs. RELEVANCE/OUTCOMES: Peer support is relevant to mental health, it focuses on positive qualities not negative consequences which are a part of a patient's experience. Peer Support is built on respect, responsibility, wellness and recovery rather than on illness. IMPLICATIONS: Care must be taken to maintain EBP,boundaries & training.Special attention should be taken with adolescent populations due to behavior escalation.



4015: The Role of Spirituality in Gay and Lesbian Elders' Lives
Dawn Marie Miller, PhD, ARNP, PMHNP-BC

PROBLEM: Despite a rapidly growing interest in spirituality among the population in general and the many mandates to include it as a critical aspect of health care, little is known about the  meaning or role of spirituality in the lives of elder gays and lesbians.  FRAMEWORK: In this qualitative study, data were analyzed using van Manen’s hermeneutic phenomenological methodology.  METHODS: Snowball sampling was utilized to identify participants for the study. Ten participants were interviewed utilizing semi-structured interviews.  RESULTS: Five essential themes were indentified: Belonging, Accepting, Guiding, Serving, and Journeying to Integrity. Findings from this study suggest that, in many cases, awareness of a strong spiritual connection to others, God, a Higher Power, or to nature, the cosmos, or the universe keeps these individuals emotionally and mentally grounded, centered, and empowered to thrive in a world that is often rejecting and exclusive of them. IMPLICATIONS: In order to improve the quality of nursing care for this population, it is essential that nursing curricula and practice begin to incorporate knowledge and discussion about the essential role of spirituality in the lives and health of this population.  FUTURE RESEARCH: There is a pressing need for further research to more clearly elucidate the role of spirituality in the health and well-being of all individuals, including those that are gay or lesbian.



4016: How to Lead Effective Therapeutic Groups: Development of an Orientation Module through a Nurse Driven Collaboration Between Educators and Bedside Nurses.
Jennifer K. Barut, MSN, RN-BC; Johnny J. Woodard, BSN, RN-BC

PURPOSE: Educators will share innovative strategies to engage the bedside nurse in collaborative development and operationalization of a recovery and evidence-based orientation module on leading therapeutic groups. SUMMARY OF EVIDENCE: Therapeutic groups are a mainstay of psychiatric-mental health care. Facilitation of effective therapeutic groups requires education that is often lacking in undergraduate education. Nurses expected to lead groups may find themselves ill-prepared, leading to dissatisfaction for the patient and nurse. DESCRIPTION: In the psychiatric hospital of a large academic medical center, nurses are required to lead therapeutic psychoeducational groups. Nursing staff expressed feeling inadequately prepared by orientation practices of “watch one, do one, teach one” and identified a gap in knowledge and practice. This led to the development of a shared governance taskforce to address the need for education on therapeutic group facilitation. Nursing staff conducted literature reviews to identify best practices in group education and optimal delivery methods for adult learners. This resulted in a collaborative, staff-driven educational module that included didactic, activities, and an interactive video tool with staff actors. VALIDATION OF EVIDENCE: Nursing staff were surveyed regarding perceptions of orientation effectiveness for leading therapeutic groups. Survey results indicated 42.3% of respondents regarded current orientation as “slightly” or “not” beneficial, while 42.3% did not recall receiving any orientation. Additionally, 48% of nursing staff reported feeling poorly prepared to lead effective therapeutic groups. RELEVANCE/OUTCOMES: Preliminary results post-implementation of the orientation module indicate improved perception of preparation and support the effectiveness of the education. IMPLICATIONS: Ongoing taskforce efforts will surround building nursing competencies for group facilitation.



4017: Neurobiology of Addiction
JeanAnne Johnson Talbert, DHA, APRN-BC, FNP, CARN-AP

PURPOSE: Thanks to scientific research, we now understand that addiction is a disease that affects both the brain and behavior. By identifying biologic and environmental factors as well as genetic variables that contribute to the development and progression of the disease, we can treat those with addictions more effectively. This course will review the functions of the brain, how drugs work in the brain, and explore why some people become addicted to drugs while others do not. It will explore whether we can predict if a person will become addicted, and review the biological and environmental factors that increase the risk of addiction. The course will conclude with how we can use the science of biology in treating our addicted patients. SUMMARY OF EVIDENCE: Functions of the brain, how drugs work in the brain DESCRIPTION: How we can predict if a person will become addicted, and the biologic and environmental factors that increase the risk of addiction VALIDATION OF EVIDENCE: Evidence based practice, current research. RELEVANCE/OUTCOMES: Nurses are taking care of the addicted patient more and more. It is important to have an understanding of the biology of addiction in order to try to prevent stigma and bias. IMPLICATIONS: Research continues to demonstrate that addiction is a neurobiological disease. If we treat addiction as a disease, the stigma and patient bias may diminish.



4018: Boston Marathon Explosions Disaster Mental Health Response - Role, Recovery & Resilience
Christine Tebaldi, MS, PMHNP-BC

PURPOSE: Describe disaster mental health preparedness, response and recovery and the role of psychiatric mental health nurses. SUMMARY OF EVIDENCE: Disaster Psychiatry/Disater Mental Health is a well defined role in emergency preparedness and disaster response. Utilizing the prinicples of psychololgical first aid, criticial incident stress debriefing and crisis management, coupled with rapid response and early intervention, long-term effects of potentially traumatic events are often mitigated. DESCRIPTION: Provide enhanced psychological first aid and foster resilience during the entire disaster response continuum. VALIDATION OF EVIDENCE: Reduction of immediate emotional distress and mitigation of long-term consequences. RELEVANCE/OUTCOMES: PMH nurses are critical members of the disaster response workforce. Additionally, PMH Nursing has a vital role in integrated care settings where those affected by disater and potentially traumatic events will seek routine and specialized care. IMPLICATIONS: As knowledge has increased regarding the psychological impact of traumatic and disaster-related events, the contributions of disaster mental health providers in response to events such as the shootings in Newtown, CT and Aurora, CO and the Boston Marathon Explosions has heightened the awareness more than ever. These events and more have had a significant impact on local communities and have contributed to national outrage and debate. PMH Nursing is well positioned to be an advocate and interprofessional partner ensuring effective accessible mental health care not only in the wake of tragedy, but in everyday standard and integrated care models.



4021: Riding Out the Perfect Storm in Psychiatric Nursing Education
Carole A. Shea, PhD, RN, FAAN; Linda D. Oakley, PhD, RN

PURPOSE: There is a “perfect storm” bearing down on the way we teach and practice psychiatric nursing! This seminar will discuss the challenges and present an overview of some new models and strategies to guide curricular choices for the effective professional development of psychiatric nurses. SUMMARY OF EVIDENCE: The list of forces that impact our teaching and practice is formidable: Expanded access to care through the Affordable Care Act, parity for mental health services, and workforce scarcity issues; pressure to provide integrated care and work in collaborative interprofessional teams; recent discoveries in neuroscience, the brain and advanced technology; the use of evidence-based therapies and recovery models; new skill-based, behavioral health core competencies; different regulations for licensing and certification; and increased variation in the patient population (i.e., more elders, veterans, immigrants). DESCRIPTION: Some faculty are heeding the call for change by embracing the new competencies, developing alternatives for clinical placements, joining interprofessional teams, and engaging in evidence-based research. VALIDATION OF EVIDENCE: However, the new ideas and innovations cannot just be added to the already bulging curricula. Therefore, some of our treasured learning activities have to be discarded. Making sound decisions in the process of curriculum revision is imperative. RELEVANCE/OUTCOMES: The perfect storm calls for new directions in how we educate and prepare nurses for transformative behavioral health care practice.



4022: Primary Care within a Community Mental Health Center: An Innovative Approach to Whole-Person Care
Laura Sidlinger, DNP, APRN-C

PURPOSE: Mental health care consumers are challenged by navigating the traditional primary health care system. Uncontrolled chronic diseases and acute illnesses are common problems. By managing health needs earlier in the disease process, the patient can be empowered to delay, prevent, or reduce complications. Improvement in physical health has the potential to positively influence the mental health of the consumer. SUMMARY OF EVIDENCE: Many barriers to care exist for both the consumer and provider. Through expanded models of care coordination, these issues are being addressed and consumers are receiving high quality primary care. DESCRIPTION: Through a collaboration between a local hospital, university school of nursing and community mental health center, a part-time primary care clinic was established within the mental health center. VALIDATION OF EVIDENCE: Anecdotal evidence and survey results will be presented. RELEVANCE/OUTCOMES: Because of high response, clinic services were expanded after five months of operation. To decrease the patient load of the mental health professionals, the primary care clinic is assuming follow-up care of stable mental health consumers. This further reinforces the concept of whole-person care and the mind/body/spirit connection. IMPLICATIONS: This example of a primary health care clinic within a community mental health center is a replicable model to address the physical health needs of mental health consumers. As health care reform shapes our delivery systems, patient-centered medical homes housed in mental health centers are a viable solution for this population.



4023: Finding Acceptance - Understanding Lesbian, Gay, Bisexual and Transgender Youth through Best Practices
Barbara J. Valerius, MSN, RN

PURPOSE: The purpose of this presentation is to educate clinicians working with youth who have identified as Lesbian, Gay, Bisexual and/or Transgender in order to promote understanding and support their ability to be accepted by their families and peer groups. In addition, understanding these youth will enable clinicians to support their ability to develop/enhance self-confidence, strengthen self esteem and become self advocates as they transition from youth to adulthood. SUMMARY OF EVIDENCE: 10 National websites. Review of 24 articles published in journals and textbooks on LGBT youth. DESCRIPTION: Understanding LGBT youth is essential to their identity development. The LGBT youth population continues to grow in visibility. In the interest of seeking acceptance in a diverse population, understanding the issues facing these youth will allow clinicians working with them to strengthen family and peer relationships through best practices. Supporting relationships through family therapy and promoting peers' understanding of various transitions and issues faced by these youth in adolescence will support LGBT youth finding acceptance. VALIDATION OF EVIDENCE: Comprehensive review of the literature within the past 5 years. RELEVANCE/OUTCOMES: Research suggests that acceptance supports health and well being. Educating clinicians to support LGBT youth and assist their families and peers in understanding their sexual orientation will enhance their ability to support these youth through transitions and issues that impact health and well being. IMPLICATIONS: As the LGBT youth population continues to grow in visibility, understanding their sexual orientation and identity development allows clinicians to support families and peers in understanding and accepting them, providing the opportunity to maintain health and well being.



4024: Problems Encountered and Insights Gained: The Importance of Mental Health Recovery in Designing an Evidence-Based Program for Intensive Mental Health Treatment
Carol Hawthorne Rumpler, MS, PMHCNS-BC; William D. Burmeister, MSA, RN

PURPOSE: Historically it has been difficult to measure therapeutic effectiveness of an inpatient program. Therapeutic effectiveness has been defined by several variables: management of symptoms, satisfaction with treatment, and recovery strategies. In 2000, these variables became the framework for the development of the evidence-based, recovery-oriented program that was implemented. SUMMARY OF EVIDENCE: In 2006, the concept of mental health recovery was incorporated into the treatment program. The dimensions of wellness (SAMSHA, 2006) reflect quality of life behaviors essential to recovery. The Veteran compiles a personal recovery plan in the Veteran's Resource Book. The resource book utilizes a cognitive behavioral approach organized around the dimensions of wellness, illness management, medication education, and mental health recovery. DESCRIPTION: Every Veteran participates in the treatment programming and works with the primary nurse who mentors the Veteran's recovery. VALIDATION OF EVIDENCE: A systematic evaluation protocol, utilizing a series of tools is given to patients at admission, during the stay, and at discharge. These tools include: Symptom Discomfort Scores (pre/post intervals), Satisfaction with Treatment (discharge) and completion of an individualized mental health recovery plan as documented in the Veteran's Resource Book. RELEVANCE/OUTCOMES: Mental health recovery has become a vital construct for mental health treatment. Nursing has 24 hour clinical responsibility for intensive mental health care. The nursing model of primary care underpins the program. Nursing staff is accountable for the program and monitors treatment effectiveness through ongoing data collection. IMPLICATIONS: Lessons Learnedand Insights Gained: Integrating and maintaining the treatment model necessitates a two fold approach: keeping the Veteran involved and keeping staff involved.



4025: Possibilities, Partnerships and Healing
Noel E. Holdsworth, DNH, PMHNP-BC, CTS

PURPOSE: To enhance emotional intelligence of the nurse, and then to describe how to use that to manage the growing trend of having to do more with less using partnerships to promote healing. SUMMARY OF EVIDENCE: There is evidence that emotional intelligence of the caregiver is correlated to patient satisfaction surveys and outcomes DESCRIPTION: Learning to do more with less, and still feeling good at the end of the day requires partnerships that provide validating, educating support. VALIDATION OF EVIDENCE: Emotional Intelligence assessment and competency tools. RELEVANCE/OUTCOMES: With healthcare changes, we all are being challenged to do more with less. IMPLICATIONS: More education and training is needed to develop both emotional intelligence and better partnerships in healing.



4026: Transforming Psychiatric Mental Health Care to Recovery Oriented Practice with an Inter-Professional Team
Celeste M. Johnson, DNP, APRN, PMH CNS

PURPOSE: The purpose of this project was to provide formal recovery education to assist inpatient psychiatric clinicians to become increasingly recovery oriented. . SUMMARY OF EVIDENCE: Recovery oriented programs that incorporate broad-based clinician training and program changes at the unit level have decreased S/R in psychiatric settings (Lebel, Huckshorn, & Caldwell, 2010; Scanlan, 2009). However, there is limited training and education for mental health clinicians on how to translate recovery concepts and principles into practice (McLoughlin, Wick, Collazzi, & Puntil, 2013). DESCRIPTION: The intervention for this project was APNA’s 6-hour, evidence-based, instructor-facilitated curriculum to teach recovery oriented principles and their application to practice to an inter-professional team. VALIDATION OF EVIDENCE: The Recovery Self-Assessment-Revised (RSA-R) Provider version (O’Connell et. al, 2005) was used pre- and post-education program to measure changes in clinicians’ perceptions of recovery practices on their unit. In addition, quality measures were compared pre-intervention to post-intervention. RELEVANCE/OUTCOMES: The findings of this project support the use of APNA's curriculum with inter-professional teams to shift facilities toward recovery-oriented practices. In addition, the findings support the use of the RSA-R as a facility self-assessment and re-assessment to measure the impact of education on practice. IMPLICATIONS: This project is the first known pre/post assessment of recovery oriented practices using APNA's Recovery to Practice curriculum with an inter-professional team. Further projects are needed to validate the effectiveness of APNA's RTP as an educational intervention to change practice to recovery oriented.



4027: Drugs in Prisons: The Ticking Time-Bomb
Isaac Daramola, MACNP, MACN

PURPOSE: Australia recently identified major inequalities in healthcare provision which led to a demand for national reforms.These reforms have targeted disease prevention, early intervention and recovery. In the mental health sector in particular, mental illness has carried with it a great burden of stigma. SUMMARY OF EVIDENCE: Disease prevalence, health complexities and rising costs place enormous pressure on health services to seek creative ways to respond. In the Victoria Prison System, recent studies identified over 60% of adult male prisoners with drug-related acquired brain injury (ABI). Narcotics remain a major problem in Australian prisons and drug related ABI is yet to be routinely identified clinically. DESCRIPTION: This presentation aims to reveal the impact of ABI on behavioural remediation and potential dangers of community reintegration of offenders with mental illness whilst having an undetected ABI. VALIDATION OF EVIDENCE: This presentation will focus on drug-related ABI in Prisons, with particular emphasis on ABI cases not caused by head trauma. Further, it will examine the consequences of undetected drug-related ABI in Prison populations on public safety, rehabilitation efforts and re-offending. Also a showcase of the study methods carried out in two maximum security prisons in Australia. RELEVANCE/OUTCOMES: Better understanding of drug-related brain injury on offender rehabilitation, Early intervention, Advanced Nurse Practitioners roles. Global implications for future practice and future crimes. IMPLICATIONS: The future implications of continued undetection of ABI has dangerous implications for public health and safety. The current scale of undetected drug-related ABI in prison health services is enormous and a global research generalizability may suggest greater scales in American prisons.



4028: Bridging the Gap between Crisis and Care: How to Effectively Integrate a Psychiatric Emergency Care with Outpatient Management in a Community Hospital
Jeannine S. Loucks, MSN, RN BC PMH; Laura Derr, RN, BSN, CEN; Brenda Talley, RN, BSN

PURPOSE: Psychiatric complaints are a component in one out of every eight Emergency Department visits (Owens, et al. 2010). With the closing of many inpatient psychiatric beds, Emergency Departments are becoming primary care settings for individuals presenting with psychiatric crisis (Zeller, 2010). The overarching goal of the program is to create a system to rapidly decompress the ED and provide aggressive 24 hours intervention resulting in disposition and sustained linkage between a psychiatric medical home and emergent management process for episodic mental health crisis. SUMMARY OF EVIDENCE: It is projected by the year 2020 that psychiatric disorders projected to rank second only to cardiovascular illness with regards to the number of years of life lost due to premature mortality and productive years lost due to disability (Kessler, et al. 2009). It is likely that hospital ED's will continue to see an increase in individuals presenting with psychiatric emergencies. DESCRIPTION: Psychiatric patients are screened and then ED nursing and ancillary staff implement psychiatric care protocols designed to stabilize the crisis and initiate a connection with the outpatient care continuum. VALIDATION OF EVIDENCE: Clinical, safety, and fiscal program outcomes have been identified as measures of success. RELEVANCE/OUTCOMES: Initial system outcomes demonstrated a reduction in median and 90th percentile length of stay from 8 to 6 and 19 to 15 hours, respectively. IMPLICATIONS: This innovative program has successfully created positive changes for patients that include rapid stabilization, reduction in inpatient hospitalizations, and recovery oriented treatment in the least restrictive environment.



4031: Dual Certification in Primary and Psychiatric Mental Health Care for Advanced Practice Nurses: A Health Care Delivery Innovation
Debra A. Johnsen, MSN, FNP-BC; Suzanne Perraud, PhD, PMHCNS-BC

PURPOSE: Our purpose is to present a model of interprofessional post-graduate education aimed at preparing advanced practice nurses (APNs) in psychiatric-mental health care. This intervention is designed to address workforce shortages of providers for Medicaid recipients with severe mental illness and to familiarize care providers from different professions to each other's roles and responsibilities. SUMMARY OF EVIDENCE: Mental illness is a significant public health problem; 9.6 million people have severe mental illness and many of those have secondary medical problems. The Affordable Care Act expects to add 34 million insured Americans, stressing an already challenged system of care. DESCRIPTION: While this portends a looming need for integrated care of the mentally ill Medicaid population, there is a paucity of literature relating to models for the efficient care of these individuals. This College is addressing this need by offering an online PMHNP postmaster's certificate for currently certified family, adult/geriatric, and pediatric APNs. VALIDATION OF EVIDENCE: Literature review and stakeholder and focus group interviews validated current workforce shortage. Process evaluation of program development and short and long term outcome evaluation is underway and will be presented. RELEVANCE/OUTCOMES: PMHNPs can lead the way in transforming health care for the underserved. A program preparing dually certified APNs who are educated alongside other practitioners offers an innovative solution to workforce shortages of caregivers for this vulnerable population. IMPLICATIONS: This collaborative educational model can be replicated and should help to meet the urgent need for primary care and mental health care providers, for removal of scope of practice barriers and for reimbursement reform.



4032: How Effective is a Nurse Managed Clinic for Integrated Behavioral Health Care?
Marsha Snyder, PhD, PMHNP, BC

PURPOSE: The purpose of this presentation will be to present evaluation of psychological services provided by advanced practice psychiatric nurses and graduate students within a primary care clinic located at an urban academic medical center. SUMMARY OF EVIDENCE: Integrated healthcare delivery plays an increasingly important role in healthcare reform. Integrated health­care delivery leads to higher quality care at a lower cost while maintaining or improving the recipients’ health and satisfaction, however few studies have been conducted to test the efficacy of such an integrated approach and little is known regarding outcomes of nurse managed integrated behavioral and medical healthcare services. DESCRIPTION: Integrated Health Care provides behavioral health services to serious mentally ill persons with in two community based nurse managed medical clinics and to community residents who receive health care services within a university based clinic. Services include assessment, crisis intervention, psychotherapy, and medication management. VALIDATION OF EVIDENCE: Evidence of the impact of behavioral health services on primary care patients’ emotional adjustment and progress on behavioral goals will be reported through satisfaction surveys; intake and follow-up measures of depression, anxiety, and insomnia. RELEVANCE/OUTCOMES: The goals of the Integrated Health Care is to improve access to quality health care for all patients, including those who are undeserved and members of vulnerable populations, and to develop and implement a model of nurse-managed care that integrates both physical and mental health assessment and treatment. IMPLICATIONS: This presentation highlights both the potential benefits of nurse managed care and also the need to continue research on the effectiveness of integrated models of care.



4033: Self-care for Secondary Trauma Experienced by Child and Adolescent Nurses
Diane M. Wieland, PhD, MSN, RN, PMHCNS-BC, CNE; Joy A. Lauerer, DNP, PMHCNS-BC, RN; Susan Dawson, EdD, RN, PMHCNS-NP, BC

PURPOSE: This presentation will describe secondary trauma, also known as secondary stress, burnout and compassion fatigue. Research findings and literature on this topic will provide evidence-based information. A survey developed by members of the Child-Adolescent council will be presented. with the results of the survey summarized. Methods to promote self-care will be discussed. SUMMARY OF EVIDENCE: Secondary trauma is defined by Wicks (2006) as the stress caused by pressures on health care professionals who care for others in need. Burnout can have negative effects on the nurse and the care provided to patients. DESCRIPTION: Psychiatric nurses recognize the intensity of their work and that burnout can occur; however what current practices are in place to reduce trauma and promote self-care are yet to be explored. VALIDATION OF EVIDENCE: The literature on overcoming secondary stress (burnout, secondary trauma) is noted in books such as Wicks (2006) and literature and instruments by Malsach. Nurses often ignore that they are victims of compassion fatigue. The Malsach Burnout Inventory measures this concept. RELEVANCE/OUTCOMES: Child and adolescent psychiatric nurses are exposed to secondary trauma by working directly with patients and families and through reading patient histories, all of which expose issues such as child abuse, neglect, and sexual abuse. Such information psychologically wounds the nurse. Without means to address these feelings, the nurse may decide to leave the workforce. IMPLICATIONS: Nurses interested in this specialty area need to be prepared for the secondary trauma they may experience. Self-care for nurses is not promoted in the workplace but is critically needed.



4034: Developing an Innovative Advanced Psychiatric Mental Health Nursing Curriculum: A Journey of Therapeutic Engagement
Trish Jones-Bendel, MSN, RN; Jeanette Rossetti, EdD, RN; Kelly Bryant, MS, RN

PURPOSE: Preparing psychiatric mental health nurses to provide holistic person centered care promoting self-management and recovery following the Tidal Model principles presents an opportunity for consistent practice and clearly articulation of the nurses' role on the interdisciplinary team. SUMMARY OF EVIDENCE: 2010 Future of Nursing articulated the need for nurses to practice to the full extent of their education and training as an equitable partner. The President's New Freedom Commission on Mental Health encourages mental health care provision. The Tidal Model supports both of these recommendations. DESCRIPTION: All RN's from a Midwestern Behavioral Health Hospital attended an innovative advanced nursing course to integrate a new model of care into their professional practice. Using a cohort model, the three-part continuing education series was inclusive of eighteen hours of didactic education. VALIDATION OF EVIDENCE: Focus groups were utilized for evaluation purposes. Results indicating the experience of and the impact of the curriculum on psychiatric nursing practice, as well as the interdisciplinary health care team, will be presented. RELEVANCE/OUTCOMES: Professional nurses will have improved self-efficacy and increased empowerment integrating a holistic care model which promotes self-management, recovery, and caring WITH instead of FOR their patients. IMPLICATIONS: Nurses must lead the interdisciplinary team in delivering mental health care services. Academic preparation has been restructured into overarching curriculum concepts. Nurse leaders must assume greater ownership of nurse preparation to empower nurses in using a recovery approach to care.



4035: Building Connections With The Practice of Caring Science: Transcending Boundaries-Uniting In Human Caring
Joseph Giovannoni, DNP, PMHCNS-BC, APRN

PURPOSE: The author will present a 40-minute video reflection of a transcultural journey with Dr. Jean Watson making connections with the global community in Nepal, Bhutan, and Tibet. The purpose is to demonstrate how Caritas Consciousness makes personal and professional connections. SUMMARY OF EVIDENCE: Dr. Jean Watson's theory of nursing identifies 10 Caritas Processes ™ that are continuously being assessed and measured in nursing and health care science. DESCRIPTION: The practice of the 10 Caritas Processes ™ guides nurses to develop caring connections with patients and caring professional to professional relationships. VALIDATION OF EVIDENCE: The audience will vicariously experience this journey and will be engaged in identifying the practice of Jean Watson’s 10 Caritas Processes™ reflected in this journey and how it facilitates connections within the global community. RELEVANCE/OUTCOMES: The participants who apply Caring Science in their practice will make meaningful connections with patients and colleagues. IMPLICATIONS: Building connections and engaging in transpersonal teaching, and learning within the context of caring relationships requires letting go of any attachments to the drama of our egos. Caritas consciousness and the practice of the 10 Caritas Processes ™ connects people in human caring and facilitates the effectiveness of best practices.



4036: Creatively Using Simulation to Connect the Education for Mental Health Professionals
Krista Kipper, BSN, RN, CHSE;  Candice Walsh, BS, RN-BC

PURPOSE: Simulation-based learning is a valuable learning strategy. Simulation can realistically portray mental health situations for healthcare professionals to bridge the gap between learning and applying new skills in everyday practice which can lead to the identification of gaps in system processes. SUMMARY OF EVIDENCE: Simulation-based methodologies are effective strategies used to teach new and current concepts for diverse staff populations.  With nursing staff being hired with minimal clinical experiences, simulation provides an avenue to implement best practice, current policies, safety obstacles, procedures, and system processes for effective teamwork.  DESCRIPTION: We have creatively incorporated simulation-based learning strategies in our mental health courses for all of our staff using methods are fiscally responsible to address the topics of: - safety management - code management - development of a psychiatric emergency response team - system process improvement. VALIDATION OF EVIDENCE: Current literature supports the benefits of continuing education and simulation-based learning strategies for staff to learn and maintain competency of skills and professional growth. RELEVANCE/OUTCOMES: Literature supports simulation-based learning as an effective strategy for nursing students and professionals in mental health.  In our organization, simulation and debriefing discussions related to evidence-based practice have proven to be valuable.  In our current training courses, pre and post-evaluations measurements show staff report increased engagement during simulations because the format builds critical thinking skills, confidence, and teamwork. IMPLICATIONS: The incorporation of simulation in education for students and professionals is beneficial in maintaining staff competency in the complex skills required to provide quality care, especially with the growing diversity of new staff with minimal experience.



4037: “I can’t quit right now!” A Harm Reduction Approach to Tobacco Use in Residential Treatment
Valerie Mendralla, RN, MPH

PURPOSE: More than 1 in 3 adults (36%) with a mental illness smoke cigarettes, compared with about 1 in 5 adults (21%) with no mental illness (CDC vital signs, Feb 2013). Have you heard the myth that addicts should focus on treatment for drugs or alcohol and worry about tobacco cessation later? SUMMARY OF EVIDENCE: Recent research points to the effectiveness of treating ALL substance abuse, including tobacco, while in treatment. However, not all residential treatment facilities have become tobacco-free. This session will illustrate the efforts done by a 16-person women’s residential treatment facility in northern Illinois (WRS). The facility is housed within the Lake County Health Department and receives federal funding for mental health. WRS treats approximately 100 women throughout the year in this 60-90 day program. DESCRIPTION: Techniques utilized include patient education from nurse, nicotine replacement therapies (patch, gum and lozenge), weekly tobacco dependency group, routine carbon monoxide testing, pack checks, customized assessment and evaluation tools, referral to the Illinois Tobacco QuitLine and local partnerships for follow up after treatment. VALIDATION OF EVIDENCE: Through a harm-reduction approach, the facility has seen over half of all clients treated decrease their cigarette usage and carbon monoxide levels from admission date until discharge date. RELEVANCE/OUTCOMES: This session is intended to equip the psychiatric nurse with techniques, data and ideas to implement this type of harm-reduction within their place of employment. IMPLICATIONS: WRS has been actively engaging their client in reducing tobacco use since July 2013 and is pleased to share the successes and set-backs of their initiative.



4038: An Alternative to Emergency Departments for Individuals in Mental Health Crises: "The Living Room" Program
Michelle Heyland, MSN, APN, PMHNP-BC

PURPOSE: Due to the lack of appropriate community-based mental health services, individuals experiencing mental health crises often utilize emergency departments (EDs) for relief of their acute distress. An alternative service venue is needed not only to help individuals in crisis but also to ease the overcrowding and inappropriate use of EDs. SUMMARY OF EVIDENCE: Anecdotal reports in the literature suggest that EDs do not meet the needs of individuals in crisis as effectively as alternative models. These reports indicate that when in crisis, individuals recognize the need for a safe space where autonomy is respected and a client advocate is present. DESCRIPTION: Two years ago, “The Living Room” model of crisis care was started in a Community Mental Health Center. Staffed by a therapist, a psychiatric nurse, and peer counselors, “The Living Room” is uniquely positioned as a recovery-based community crisis respite program serving as an alternative to EDs. VALIDATION OF EVIDENCE: On average, over the past 18 months, anywhere between twenty and thirty clients a month have received help in “The Living Room” and have subsequently avoided an ED admission. RELEVANCE/OUTCOMES: Outcomes of the program support not only financial benefit to the state but also an emotional benefit to those in crisis. IMPLICATIONS: Outcomes support the effectiveness of “The Living Room” model and thus encourage further establishment of similar programs in the community. Recognizing that presenting to EDs when in mental health crisis may be a difficult trend to break, similar programs should also be considered for establishment in EDs themselves which could avoid unnecessary inpatient psychiatric admissions.