Saturday, October 12 - APNA 27th Annual Conference Abstracts


4011: Understanding Men's Healing from Childhood Maltreatment: Knowledge for Person Centered, Recovery-Oriented Mental Health Care

Danny G. Willis, DNS, PMHCNS-BC

Abstract
Childhood maltreatment (CM) of boys, in the form of physical, emotional, and sexual abuse and neglect is associated with long-term adverse health outcomes. However, little is known about men’s healing from all forms of CM and what facilitates and hinders healing. With few exceptions, research has focused on females or sexual abuse survivors. The purpose of this study was to describe the experience of healing from all forms of CM among male survivors age 18 and over, including facilitating and hindering factors. The study was guided by phenomenological, interpretive methods. Transcripts of interviews with 52 male survivors were analyzed to identify codes, discover themes, and generate a model of men's healing. Men described healing as a transformational process rife with challenges.

Healing was characterized by:

  1. Breaking through the veneer to experience emotions and enhanced self-awareness;
  2. Meaning-making to focus on living with less suffering;
  3. Making daily choices to support well-being;
  4. Utilizing complementary/alternative health practices to reduce stress; and
  5. Engaging in positive social interactions. Factors hindering healing are being analyzed.

These findings will also be presented. A model of men's healing from CM with facilitating and hindering factors advances knowledge for person centered, recovery-oriented mental health care.

 
   


4012: COPE for Children: An Evidence-Based and Feasible CBT Program for Anxious Children

Monique Sawyer, DNP, RN, PMHNP-BC

Abstract
Background: Anxiety is the most common mental health problem in children, yet less than one third seek treatment. Cognitive-behavioral therapy (CBT) is recommended as a first-line treatment, but is generally not utilized due to issues surrounding feasibility, training, and affordability.Purpose: This study sought to evaluate the effects of a brief, manualized CBT program provided to anxious children.Theoretical Framework: Cognitive Behavior Theory guided the program development as well as the study design. Methods: An 8-session CBT program entitled COPE for Children was implemented in a private psychiatric practice with nine anxious children. Anxiety, depression, and self concept were measured pre- and post-intervention using the Beck Youth Inventory. Findings: Results suggest that children may experience a reduction in anxiety after a brief, manualized CBT program. Evaluations indicated that the program was a beneficial experience for parents and children. Psychiatric providers acknowledged the feasibility of incorporating these 30-minute COPE sessions into busy practices. Implications: Advanced practice psychiatric nurses are in need of evidence-based treatments that also meet clinical demands and patient preferences. COPE for Children provides an evidence-based CBT program that can fit into busy practice schedules, remain brief and affordable for families, and offer an effective means of symptom reduction.

 
   


4013: Psychiatric Nursing in the Emergency Department Setting: Opportunities for Improving Quality of Care and Throughput Efficiencies in a Changing Healthcare Environment.

Timothy W. Jones, MSN, PMHNP-BC

Abstract
In recent years the country has seen massive mental health budget cuts resulting in decreased community mental health and substance abuse services, closures of crisis stabilization units and shrinking numbers of public and private inpatient psychiatric beds. Following deep cuts, Emergency Departments and acute hospitals have seen an influx of patients with acute and chronic behavioral health conditions. Sutter Medical Center, Sacramento (SMCS) was no exception to this as the volume of patients with behavioral health conditions visiting its EDs nearly quadrupled in the months following local mental health budget cuts. As a result quality of care suffered and lengths of stay extended. In an effort to address quality of care and lengths of stay faced by patients with behavioral health conditions, SMCS implemented a Behavioral Health Navigator Pilot by utilizing a psychiatric RN and NP to assess and provide consultation to ED physicians immediately after their triage assessments. The results of this effort produced a reduced average time for patients to be seen by a mental health professional from >5 hours previously to <30 minutes from arrival and a reduction in lengths of stay by 33%.

 
   


4014: Utilization of Standardized Patients as a Teaching Methodology for Psychiatric Mental Health Nursing Education

Kirstyn M. Kameg, DNP, PMHNP-BC; Janene L. Szpak, DNP, PMHNP-BC

Abstract
Simulation with the use of standardized patients (SPs) is becoming an increasingly popular teaching methodology in nursing education. This can be attributed to the challenge of evaluating student performance in addition to difficulty with securing appropriate clinical sites. It may also be difficult for a faculty member to evaluate the student in the clinical setting, particularly in the psychiatric specialty secondary to issues of confidentiality in addition to the presence of another person disrupting the therapeutic relationship. SPs can be incorporated in the program as a means of evaluating student performance. Additionally, utilization of SPs permits faculty the ability to standardize learning experiences for students and coordinate the experience with the didactic portion of the course. This presentation will provide an overview of the literature on incorporating SPs in psychiatric nursing education with an emphasis on Psychiatric Mental Health Nurse Practitioner (PMHNP) education. The International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice will be reviewed to guide SP scenario design and implementation. Lastly, practical information on developing SP scenarios and rubrics to evaluate student performance will be addressed.

 
   


4015: Improving Shift Report: Developing a Best Practice for Inpatient Psychiatric Nurses

Joanne Matthew, MSN, PCNS

Abstract
Current literature recognizes that hand off communication and bedside nurse to nurse reporting are linked to improvements in safety outcomes, patient satisfaction and nursing workflows. The research regarding handoff communication, however, has been conducted primarily on medical-surgical units found in general hospitals and this has made it difficult to replicate in the psychiatric setting. The Quality Council for Nursing Practice at Butler Hospital, a psychiatric hospital in Providence Rhode Island, recognized a need to improve handoff communication and decided to focus on shift to shift report. The Nurse Quality Council reviewed the literature and identified a paucity of psychiatric application and decided that a modified bedside report would be beneficial and began a process of redesign. This included a brief verbal report using “SAFE-M” followed by walking rounds by the outgoing and incoming nurses. This new process is thought to result in improved nurse and patient satisfaction and patient safety. The success of this nursing initiated protocol suggests other practices found to be successful in the medically acute care settings may be useful once modified for the psychiatric setting. The presenter will describe the process of redesign, the final protocol, implementation process and share evaluation data.

 
   


4016: The Caregiver Sustainability Model: Understanding the Lived Experiences of Caring for a Family Member with Schizophrenia

Anlee Birch-Evans, PhD, PMHCNS-BC

Abstract
The purpose of this hermeneutic phenomenological research study was to describe and construct how family caregivers have survived and sustained while caring for their family member diagnosed with schizophrenia. The study gathered seventeen audio-taped interviews with purposively selected caregivers of family members with schizophrenia. The philosophical underpinnings of Ricoeur guided the researcher’s interpretation of the actual lived and human experience of caring for a family member diagnosed with schizophrenia. Transcripts were analyzed for common themes, differences, and patterns. Insight was gained regarding factors that foster certain caregiver's ability to defy the odds in surviving and sustaining while committing the patient in times of crisis, quality of resources, medication management, and violent and bizarre behavior. The research study yielded four dichotomous themes: Beginning/Settling In; Getting through the Day/Disruption; Isolation/Inclusion; Frustration/Satisfaction. A sustainability model was formulated that succinctly describes the cyclic movement of the lived experience on a continuum of surviving and sustaining. Caregiving is not static, it occurs on a continuum with periods of just getting through the day, feelings of depression, frustration of care delivery, and settling in to the inevitability of the diagnosis and finding satisfaction within the context of the role as caregiver.

 
   


4021: Pilot Study: Use of Mindfulness, Self-compassion, and Yoga Practices with Uninsured and Low-income Patients with Anxiety and/or Depression

Nasrin Falsafi, RN, PhD, PMHCNS-BC, AHN-BC

Abstract
Background: Anxiety and depression are among the most common mental disorders. More cost-effective treatments and adjunctive therapies are needed, particularly for uninsured/low-income patients. Mindfulness, self-compassion, yoga practices help calm the mind and body. Adding these modalities to current treatments may decrease the use of medications and/or psychotherapy. Objectives: This study explored the effectiveness of mindfulness, self-compassion, and yoga practices in coping with anxiety and/or depression in these populations. Methodology: A sample of 20 patients was recruited from two free clinics. Participants received 8 weeks (1.5 hours/week) of mindfulness, self-compassion, and yoga training. Participants completed four questionnaires that asked them about their symptoms of anxiety, depression; psychological well-being, and self-compassion. Questionnaires were completed four times: at the beginning (pre), at the end of the 4th session (mid), at the end of the 8th session (post), and four weeks after the completion of the training (follow-up). Findings: Analysis of data indicated that depressive symptoms decreased significantly from pre to post and pre to follow-up (p < .05). Anxiety symptoms decreased significantly from pre to post (p < .05), and decreased significantly from pre to follow-up (p < .10). Self-compassion and general wellness significantly increased (improved) from pre to follow-up (p < .05). Conclusions and Implications: The use of mindfulness, self-compassion and yoga practices in coping with anxiety and/or depression in these populations, was effective. The study has implications for cost-effective treatments for patients, and healthcare insurance savings.

 
   


4022: The Evolution of a Pediatric Behavioral Assistance Resource Team (BART)

Andrea LeClaire, MSHA, BSN, RN, NEA-BC; Aaron Van Dam, BSN, RN; Mindy Stephens, BA, RN, RN-BC

Abstract
Pediatric nurses working in medical/surgical settings are not often experienced in dealing with aberrant behaviors of children/adolescents who are in imminent danger of hurting themselves or others. The Behavioral Assistance Resource Team (BART) was created as a means of providing rapid response and support for these situations. The BART members are trained in Satori Alternatives to Managing Aggression (SAMA). The BART team is available 24 hours per day, seven days per week. Notification to the team is via an activation of a Code BART. The team provides acute de-escalation services and instruction to the interdisciplinary team, documentation, criteria to determine appropriateness of release from restraint, and steps to safely remove the restraints. Current focus includes changes to the electronic medical record to improve documentation, BART response checklist, and increase in holds instead of restraints. Since October 2010, BART has responded to 182 calls hospital-wide. (from 18 calls in 2010 to 89 in 2012). Of these, 54% resulted in no hands-on interventions. The top two diagnoses were Autism and dual medical/psychiatric diagnosis. The restraint documentation compliance on the medical units improved from 39% in early 2011 to 92% in 2012. Further data analysis has been completed for unit and patient demographics.

 
   


4023: Moving Out of the Shadows: Transforming the Image of Psychiatric Nursing in an Academic Medical Center

Avni Cirpili, RN, MSN, NEA-BC; Jennifer K. Barut, MSN, RN-BC; Brooke Weaver, RN, BSN

Abstract
Psychiatric nurses in a large academic medical center transformed the image of psychiatric nursing by taking an active role in the hospital, organization and community. Leaders created a dynamic vision of the future of psychiatric nursing organization-wide that empowered nurses to take action and lead change. An environment was created that encouraged strong professional identify through: expectation of psychiatric certification by all nurse leaders, promotion of membership in APNA (20% increase) and increasing nursing’s community involvement. A redesigned shared governance structure empowered nursing by ensuring their involvement in decision-making. Evidenced-based practice was established as the new status quo and acquisition of new knowledge was emphasized through dedicated psychiatric nursing grand rounds with CE’s, bringing in national speakers, and sending nurses to national conferences. Nurses have subsequently presented at national conferences, completed an evidence-based fellowship program and submitted IRB applications. Nurses were drivers of patient and family centered practice changes including increasing family visitation times, creating a Patient and Family Advisory Council, implementing discharge phone calls and initiating primary nursing. These changes, led by nurses at all levels, advanced and transformed psychiatric nursing from being in the shadows to a position of leadership in the medical center and community.

 
   


4024: Successful Preparation of PMHNP Graduates in Full Scope of Practice: Using Evidence Based Practice, CBT, Simulation Lab & Distance Linked Curriculum to Empower Basic Proficiency in Short Term Therapies for PMHNP-DNP Students

Kathleen T. McCoy, DNSc, PMHNP-BC, PMHNP-BC, FNP-BC, FAANP; Pamela Lusk, DNP, PMHNP-BC

Abstract
The challenges of providing an adequate and relevant didactic/clinical experience to PMHNP students in life-span psycho-therapeutic modalities are a priority to nurse educators and students. Concerns continue as industry devalues therapies and encounter time shrinks. Cognitive Behavioral Therapy (CBT) is supported by evidence to quickly assist patients with anxiety and depression. Evidence also supports simulation and distance linking methods to optimize adult learner student mastery and experience. Learning skills during a program of study positions graduates to optimize their potential upon degree conferral, as advantageously 'ready' and proficient on a basic level in brief therapy modalities. CBT requires an astute and disciplined approach and is largely reimbursable. Didactic, workshop, and simulation experiences are modeled after the work of Beck and Melnyk. Through on-campus, in context experiences in a simulation center, class experiences begin. Lessons are reinforced through on-going distance linking technologies. Using evidence based methods ST therapies, simulation, standardized patients and distance linked technology provides continuity of exposure and purposeful skill development. Through integration of evidence, this program has potential to positively affect graduates upon their degree, and potentially change policy regarding use of PMHNPs as highly marketable graduates, practicing at the full scope of practice upon degree conferral.

 
   


4025: Promoting High Quality Person Centered Care Through Transfer of Accountability at the Bedside in Inpatient Mental Health Settings

Nicole Kirwan, RN, BSCN, MN, CPMHN(C); Sheryll Pahati, RN, BSCN; Naomi Cavali, RN, BSCN; Stephanie Lawrence-Mulhern, RN, BSCN

Abstract
Transfer of accountability refers to the communication of information between clinicians about a patient relevant to his or her condition and care at transition points. Transfer of accountability can occupy a significant amount of psychiatric-mental health nursing time each day in inpatient psychiatric settings, yet has commanded limited attention in the psychiatric-mental health nursing literature. Increasing client acuity and decreasing lengths of stay have heightened the need for effective and efficient transfer of essential information by psychiatric-mental health nurses at change of shift and upon patient transfer from one are to another. This presentation will discuss the development, implementation and evaluation of best practices in transfer of accountability at the bedside to promote patient safety in an academic health science center Inpatient Psychiatric Program. Structures, processes and tools that were designed to promote safe, effective transfer of accountability between psychiatric-mental health nurses will be shared. Strategies that were successfully utilized to engage patients in transfer of accountability at the bedside and promote high quality person centered care will also be detailed. The impact of redesigned transfer of accountability processes on reducing information loss, increasing information accuracy and decreasing time spent unproductively will be highlighted.

 
   


4026: Effective Patient Education: 'How Should I Say This?'

Kathleen Lenaghan, MSN, RN-BC

Abstract
Providing patient education is an important part of nursing care. Unfortunately, we don't always do it well. Health information is complex and at times difficult for anyone to understand. This issue becomes even more complex in patients with mental health concerns. The way we communicate impacts patients' abilities to be active participants in their own care. There is a growing body of evidence that points to the advantages of a 'less is more' approach to our patient teaching. In this session we will explore health literacy and its impact on patient outcomes. Common patient education pit falls will be described. Practical steps that psychiatric nurses can take to make their health communication clearer, simpler, and more effective will be discussed.

 
   


4031: Attitudes, Efficacy and Potential Barriers Associated with Expanding the Role of the Adult/Adolescent Sexual Assault Nurse Examiner to Care for Younger Patients

Carol A. Marchetti, PhD, RN, PMHCNS/NP-BC, SANE

Abstract
Background: Sexual Assault Nurse Examiners (SANEs) in Massachusetts are certified to care for patients, 12 years and older, who have experienced a sexual assault (SA). Pediatric victims require specialized skills and are at increased risk for mood and anxiety disorders, PTSD, suicide, and other psychiatric disorders. Marchetti, Fantasia, & Molchan (2012) found that the majority of SANEs supported pediatric cross training, although they described concerns about the emotional toll of caring for younger patients, as well as the necessity for education and training. Purpose: Describe the attitudes, perceived barriers and self-efficacy of SANEs about pediatric cross-training.Theoretical Framework: Self-efficacy provides a framework for developing a measure of SANEs' knowledge and skills about cross-training to care for young children. Self-efficacy is a robust measurement construct that is predictive of measurement variables such as task preference, effort expenditure, persistence, and performance outcome.Methods: An electronic survey will be used to collect data from a convenience sample of MA SANEs who will be recruited by email. Analyses will include descriptive statistics, reliability analyses, item and total score analyses, and correlation and contingency analyses using Chi Square.Implications: Findings will inform PMH clinicians, educators, research, and policy makers who are considering expanding care to younger patients.

 
   


4032: An Introduction to the Neurobiology of Autism Spectrum Disorder

Jason F. Earle, PhD, PMHNP-BC

Abstract
The recently published Nursing of Autism Spectrum Disorder: Evidence Based Integrated Care Across the Lifespan (2012) made a groundbreaking contribution to the nursing care of individuals with autism spectrum disorder (ASD). Of particular note was the comprehensive discussion of etiology. However, as thorough as this discussion was, little attention was given to new work in the neurobiology of ASD made possible by functional magnetic neuroimaging. This presentation will introduce the key research programs in this exciting area: the social brain hypothesis exemplified by Pelphrey and colleagues, the joint attention hypothesis exemplified by Mundy and colleagues, the social motivation hypothesis exemplified by Dawson and colleagues, and the information processing/under-connectivity hypothesis exemplified by Minshew and colleagues. The presentation will also focus on the key insight stemming from these research programs that problems during early brain development cause ASD. Fortunately, growing research on early intervention programs for children with ASD demonstrates that these issues can be significantly improved. This argues for the important role of psychiatric nurses in the early detection of ASD and our support of policies that increase child and family education about and access to early intervention programming.

 
   


4033: Managing Patient Acuity in an Inpatient Psychogeriatric Setting While Controlling the Use/Cost of Observers: Development of the Milieu Manager Role

Erin Johnson, RN; Joyce Parks, RN-BC, PMHCNS-BC

Abstract
BackgroundFaced with growing patient acuity and rising cost of observers, a nursing-led quality improvement pilot was designed for an inpatient psychogeriatric service. Pre-intervention, bed occupancy averaged 88% and 10 days/month beds were closed to new admissions. Cost of observers rose to > $290,000/year.PurposeThe purpose was to decrease observer costs and improve bed access while creating a safe, therapeutic, healing environment. Additional outcomes included: patient satisfaction and nurse engagement.Theoretical framework and methodsAfter reviewing the literature, a new role was created: the milieu manager. Using Donabedian’s framework, the role’s structure, daily process and outcomes were defined. The milieu manager offered daily education and activity groups including most patients on observation. Positive Psychology theory was used to identify and manage problems.FindingsPost-intervention, bed occupancy increased to 92.9% with no bed closures. Sitter cost decreased to < $1000. Patient satisfaction, measured by the Press-Ganey Instrument, improved from the 60th to the 89th percentile. Nurse engagement, measured by the Gallup Workforce Audit, improved from the 50th to the 71st percentile.Future ImplicationsInnovative nursing roles tailored to the environment can demonstrate outcomes benefiting patients, nursing and the healthcare organization.

 
   


4034: Is the 4th “P” Lost? Innovative Educational Pedagogies to Maintain the Role and Scope of PMHNPs

Susie Adams, PhD, PMHNP-BC, PMHCNS-BC, FAANP; Sattaria S. Dilks, DNP, APRN, PMHNP-BC, FNP-BC; Dawn M. Vanderhoef, PhD, DNP, PMHNP/CNS-BC

Abstract
Psychotherapy, counseling and therapeutic communication are central to the role of PMH-APRNs. Preparation in at least two counseling modalities is an ANCC certification requirement, one of the NONPF PMHNP competencies, and part of the ANA Scope and Standards of Advanced Practice Psychiatric Nurses. Yet the mental health care market's emphasis on diagnostic and medication management skills has diminished the perceived value of psychotherapy and counseling skills among PMHNP students, recent graduates and some faculty. PMH-APRN educators are in a unique position to demonstrate the centrality of interpersonal communication and psychotherapy skills in the role of PMHNPs and effecting patient outcomes. Learn about a variety of educational strategies from low-tech, low-cost to more resource intensive approaches that engage the student in learning and refining their diagnostic interviewing, therapeutic communication and psychotherapy skills from a trio of nurse educators with experience in different PMH-APRN programs. Role-plays, patient simulations, unfolding, interactive case-based learning, variations of supervision from face-to-face, online synchronous, online asynchronous, immediacy of feedback, and formative and summative appraisal of student competencies are presented. Engaging students in meaningful learning experiences that build their confidence and understanding of brief psychotherapy and motivational interviewing can shift the current perceived value of these skills.

 
   


4035: Managing the Milieu for Acutely Ill Psychiatric Inpatients: Safe and Respectful Person-Centered Care

Karin F. Taylor, PMH CNS BC; Patricia D. Sullivan, RN, MS

Abstract
Psychiatric hospitals face great pressures to provide safe care for growing numbers of acutely ill, violent and disorganized patients. Constant observation (CO) for safety by assistive or agency staff has resulted in escalating high costs and an increasingly chaotic environment. While observation is viewed as a safe intervention by staff, many patients find the practice to be intrusive (Bowers and Park, 2001). Importantly, literature does not support the effectiveness of formal observation in reducing risk to patient safety (Stewart, Bowers &Duncan, 2009). The least trained staff often passively “watch” patients. Due to increasing number of CO’s, patients in the Psychiatry Emergency Department awaiting admission experienced extended stays due to bed closures. The Milieu Manager is an experienced RN assigned to the inpatient milieu, providing focused monitoring, assistance with problem solving, support and manipulation of the environment to create situations where patients can be successful. This role resulted in a marked expense decrease by reducing numbers of CO’s for non-suicidal patients. Occupancy has increased, improving access for ED patients. Staff and patient satisfaction increased. Role actualization, milieu utilization as a therapeutic tool, and safety/statistical data will be presented. Implications include quantification of milieu and nursings’ value in financial oversight.

 
   


4036: Partnerships to Integrate Care: Community Mental Health Center, School of Nursing and Primary Care Practice Partner to Provide Wellness Services to the Severe Mentally Ill Population

Miriam S. Zwitter, PhD RN; Jeanne Hopple, PhD RN, ARNP-BC, ACNP-BC, FNP-C

Abstract
Care of the severe mentally ill (SMI) population consumes the highest percent of mental health care dollars in the United States. Many SMI clients develop medical co-morbidities including diabetes, hypertension, hyperlipidemia, obesity and poor physical conditioning. Research indicates SMI clients have poor access and quality of care compared to the general population. Contributing factors include lack of preparation of providers to build skill sets and comfort in working with this population. In order to better address these complex health concerns, a wellness center was operationalized as part of a community mental health center in a medium size city in southeastern United States. A partnership between the community mental health center and the School of Nursing created the opportunity to address complex needs of the SMI clients. Primary care support is provided through partnership with a family practice clinic serving this same population. Family nurse practitioner students increased their knowledge, skills and comfort in working with this population through service. Wellness services provided include assessments, screenings, health coaching, teaching, nutrition classes and Tai Chi. This presentation is a report on the Wellness Center planning and implementation. Successful strategies, evaluation methodologies and lessons learned will be discussed.