Pre-Conference Abstracts

1011: 100 Years of Schizophrenia Genetics: Where Are We Now?

Nancy G. Buccola, MSN, APRN, PMH CNS-BC, CNE

Abstract
We have been looking for schizophrenia risk genes for almost 100 years and, until recently, the degree of success has been questioned. However, there has been tremendous progress in schizophrenia genetics in the last five years. We now have genetic findings that are changing our view of this disease from neurodegenerative to neurodevelopmental. Although knowledge is still incomplete, the emerging model includes both rare variants with large effects and common variants of small but additive effects. Replicated genetic findings are beginning to provide the opportunity for understanding disease pathophysiology; identifying ultra high-risk groups; validating animal models; developing new targets for medications; and understanding environmental risk factors. Using induced human pluripotent stem cells, we can now study schizophrenia using human neurons containing risk genes. There are implications for primary, secondary, and tertiary prevention. Nurses, as front line providers, will have the opportunity to implement practice changes that are inherent in these advances.

 

 
   


1012: Practical Alchemy: Psychiatric Nursing’s Role in Actualizing Interprofessional Collaborative Practice in Psychiatric Care

Margaret Slusser, PhD, PMH-CNS; Amy H. Edgar, RN, MSN, FNP(C)

Abstract
The Institute of Medicine’s (IOM) call for interprofessional collaboration in healthcare offers psychiatric nursing, at all levels, the opportunity to emerge as a leader in the growing field of Interprofessional (IP) Collaborative Practice. National momentum for increased attention to collaboration was propelled forward in 2011, when the Interprofessional Education Collaborative (IPEC) published core competencies for interprofessional collaborative practice. These competencies are intended to prepare health professionals to intentionally and effectively work together. They build on each profession’s discipline-specific competencies and link the five core competencies identified by the IOM. The Collaborative Practice Core Competencies have been endorsed by the American Psychological Association’s Educational Division. For psychiatry this may appear to be “old news” as an interdisciplinary model exists in most psychiatric settings. However, current practice does not reflect the IPEC core competencies that predict improved patient outcomes. In consideration of the complexities of treatment and rehabilitation, psychiatry must embrace true IP collaborative practice. Given the unique position of nursing in the delivery of care, psychiatric nurses are well situated to lead this vital transformation. This presentation will introduce the APNA membership to the IP Collaborative Practice Core Competencies and stimulate conversation about implementation of these competencies into Psychiatric Nursing practice.

 
   


1013: The Triad of Childhood Trauma, Mental Illness, and Substance Abuse: Applying Trauma-Informed Care

Linda Grabbe, PhD, FNP-BC, PMHRN-BC; Angela F. Amar PhD, PMHCNS-BC, FAAN

Abstract
Childhood trauma, mental illness, and substance abuse are a triad of significant societal issues that affect a vast number of individuals and families. The comorbidity of these problems presents significant challenges for the practicing psychiatric nurse. Recognition of the effects of child abuse and neglect and other early traumas, and an understanding of their contribution to the development and symptomatology of mental illness and substance abuse helps the nurse to integrate care and respond appropriately to this population. Trauma-informed care and trauma-informed systems can provide the critical interface for successful treatment interventions with this population. The purpose of this presentation is to describe the coexistence and interplay of childhood adversity, mental illness, and substance abuse and a treatment strategy, trauma-informed care. Examples of trauma-informed systems and ways to implement trauma-informed care in a variety of settings will be presented.

 
   


1014: Building Interprofessional Bridges in Graduate Nursing Education: Preparing Graduates for Leadership in Collaborations that Improve Mental Health Outcomes

Carole Shea, PhD, RN, FAAN; Pamela Lusk, DNP, RN, PMHNP-BC

Abstract
The IOM’s 2011 report on the Future of Nursing called for changes in nursing education to prepare nurses to practice as full partners with other health professionals. Given the impetus of the Affordable Care Act, now is the time for psychiatric nurses to capitalize on the Call to Action to establish collaborative interprofessional practices in mental health care. This workshop will present exemplars of faculty teaching and practice which demonstrate innovative interprofessional collaboration. Participants will have the opportunity to examine the issues and strategies involved in establishing full practice partnerships. They will also explore ways to redesign graduate curriculum to meet the need for new advanced leadership skills for interprofessional collaborative practice.

 
   


1015: Building an PMH-APRN business: Strategies to grow and shake the money tree

Sharon Katz, MSN PMH-APRN, BC; Kathryn Lindsay, MSN, RN

Abstract
The Affordable Care Act creates opportunities for psychiatric APRNs to develop unique community based services to improve role visibility of PMH APRN's. Through understanding of business and practice management standards, the viablity of the profession in today's healthcare market fortified. This presentation will outline the use of operational and clinical standards in developement of a successful plan to support the APRN as a business and clinical leader . A clinical practice that serves the needs of your community depends on critical understanding of business expectations and standards. Knowledge of NCQA standards, professional clinical practice guidelines, crosswalk billing codes, development of cohesive philosophy, documentation, credentialling with managed mental health insurance companies, need to be understood before the first patient is seen. Sharing business knowledge are two of experts in PMH outpatient development, Sharon Katz, PMH-APRN, CRNP and CEO of Collaborative Care of Abington and Kathryn Lindsay, MSN, RN Clinical Reviewer, Quality & Compliance for Magellan Health Services, SE CMC.

 
   


1016: Confluence of Prescribing and Psychotherapy Using DBT Principles

Barbara J. Limandri, PhD, PMHCNS-BC

Abstract
The first half of the workshop will focus on the assumptions, basic principles, functions and elements of DBT. Then the presenter will describe the consultative process of the DBT provider to the client, to family, and to the treatment team. This includes the phases of treatment and the basic skills the client learns in the groups and applies through individual therapy. The second half of the workshop will focus on integrating the prescribing role in the biosocial model of DBT including common medication challenges with clients and collaborating with the treatment team.

 
   


1021: The Significant Promise of Therapeutic Neuromodulation: Implications for Psychiatric Mental Health (PMH) Nursing

Mary T. Rosedale, PhD, PMHNP-BC, NEA-BC; Donna J. Ecklesdafer, MSN, RN; Theresa C. Kormos, PMHCNS-BC; Michelle A. Freedland, RN-BC; Michelle M. Knapp, RN, BSN

Abstract
Neuromodulation alters or modulates nerve activity by delivering electrical, electromagnetic or pharmaceutical means of modulating brain function. Emerging neuromodulation approaches provide new insights into brain function and therapeutic options for treatment of neuropsychiatric disorders. PMH nurses at basic and advanced practice levels translate neuromodulation findings into clinical practice, participate in and independently conduct research. In this workshop, we describe how PMH nurses translate research into practice in an evolving PMH nursing field. We examine proposed mechanisms of neuromodulation action and examine safety and efficacy of neuromodulation approaches for neuropsychiatric disorders. We specifically examine the safety and efficacy of deep brain stimulation (DBS), vagus nerve stimulation (VNS), electroconvulsive therapy (ECT), deep transcranial magnetic stimulation (TMS) which was recently approved by the Food and Drug Administration) TMS and transcranial direct current stimulation (tDCS). Finally, we describe how we can advance the science of neuromodulation in PMH Nursing. We discuss brain stimulation conceptually and more precisely, examine stimulation parameters, novel targets, identification of endophenotypes, incorporating technological advances around electrode and stimulator designs and employing biomarkers of inflammation and olfaction. We discuss how the rapidly evolving field of scientific advancements and therapeutic interventions fit into PMH Nursing work today and in the future.

 
   


1022: 'Mixing Models': Creating Synergy in a Transdisciplinary Environment.

Tammy Moore, MS, RN, NEA-BC; Grayce Sills, PhD, FAAN

Abstract
Much discussion has surrounded the application of the AACN Synergy Model in various professional nursing models of care.This presentation will utilize the tenets of the Synergy Model and present several 'transdisciplinary' models of psychiatric nursing care in 'mixing' the evidence to form a model that is relevant to the needs of psychiatric best practice. Including the evidence based approaches of trauma informed care, the recovery model and incorporating cultural competence psychiatric nursing can use the 'best of the best' to create a professional practice model. Challenges and successes will be presented in real life scenerios and outcome determinants will be discussed throughout the model presentation. Detailed case study presentations will highlight applicability of each model to patient care and provide opportunities for discussion that enhances the patient experience. Finally, the presentation will end with discussion of the importance of this transdisciplinary mixed model within the constraints of the accountable care organization as psychiatric nursing transitions from 'DRG' to 'pay for performance', recognizing the need to have a framework that enhances patient satisfaction with care while reducing the risk of 30 day readmission.

 
   


1023: Social Bullying in Nursing Academia: A Phenomenological Study

Diane M. Wieland, PhD, MSN, RN, PMHCNS-BC, CNE; Ciara Levine, MSN, RN, PMHCNS-BC

Abstract
The background of the study includes the definition of social bullying, which is defined as persistent, demeaning, downgrading activities incorporating vicious words and cruel acts that undermine self-esteem. Bullying is malicious and psychologically damaging. Bullying pales to incivility and is not synonymous with horizontal violence. The purpose of the study is to describe the lived experience of nurse educators who have been socially bullied. Methods: descriptive phenomenology using Colazzi's methodology. A purposive sample of 16 nurse academics across the USA were obtained using snowball technique. Each participant was interviewed. Each interview was audioptaped and transribed verbatim. Data was analyzed using Colazzi's methods. Findings were several themes and sub-themes. Future implications for nurse educator mental health recovery, recruitment and retention were posed.

 
   


1024: Live Person Simulation Strategies in Undergraduate Psychiatric Nursing Education: A Multi-Institution Academic Panel Collaboration

Jill Lintner, MSN, PMHCNS-BC; Joyce Shea, DNSc, APRN, PMHCNS-BC; Ruth Fiedler, EdD, APRN-BC, CNE; Brenda Kucirka, PhD(c), RN, PMHCNS-BC, CNE; Sandra Gamble, MSN, BS, RN

Abstract
Peplau (1989) considered interpersonal competencies crucial for the nurse to assist clients with promoting and maintaining health and well-being. Developing and evaluating these competencies in nursing students can be challenging for faculty given limited clinical sites and high patient acuity. Furthermore, student’s dialogues with patients can be random and difficult to monitor without being intrusive. Psychiatric nursing faculty may utilize simulation to bridge the gap between theory and practice. Scenarios that incorporate reflective learning can be developed based on theories such as Mezirow’s Perspective Transformation Theory (Brown, 2008 ), which proposes that a students’ perspective can be transformed when confronted with a “disorienting dilemma.” However, faculty still face challenges including a lack of resources for simulation, identification of appropriate simulation strategies, and clear, consistent simulation evaluation methods.In response to concerns raised at the 2012 APNA Undergraduate Education Council meeting, faculty from several academic institutions collaborated to integrate their expertise with research on best practices in simulation scenarios for undergraduate psychiatric nursing students. The purpose of this presentation is to review the findings of this multi-institution panel, including providing examples of simulation scenarios using standardized patients, guidelines for best practices in simulation, and templates for student evaluation tools.

 
   


1025: Coding for Services: CPT, DSM-V and APNs

Sandra Cadena, PhD, APRN, PMHCNS-BC, CNE

Abstract
CPT Codes (Current Procedural Terminology), describe medical, psychiatric and health care delivery procedures performed by qualified health care professionals such as nurse practitioners, physicians, psychologists, and licensed clinical social workers. There have been significant changes in CPT coding in 2013 and it is anticipated that these changes will continue to be monitored and possibly revised in 2014 and 2015. To further contribute to complexity, the DSM-V (Diagnostic & Statistical Manual) was released in May, 2013 and utilization of the ICD-10 (International Classification of Diseases) diagnostic coding system will be mandated in 2014. With this avalanche of changes affecting the 'business of practice' for psychiatric nurse practitioners, a workshop providing hands-on experiences in case analysis, CPT code selection, and diagnostic code application is paramount for APNs concerned about reimbursement and payment policies.

 
   


1026: Geropsychopharmacology : Myth and Tradition vs. Evidence

Michael Rice, PhD, APRN, BC, FAAN

Abstract
Studies indicate that thirty three percent of the elderly residents in long term care are receiving antipsychotics of some form. The majority of those, often diagnosed with dementia, are frequently given atypical antipsychotics, such as Olanzapine, Risperidone and Quetiapine. Within six months after admission to a long term care home, 30.2% of all new residents receive at least one prescription for an antipsychotic, 37.1% for a hypnotic and 24.5% for an anxiolytic.

 
   


1031: Evidence Based Practice Skills Boot Camp

Joanne D. Iennaco, PhD, PMHCNS-BC, PMHNP-BC, APRN

Abstract
Clinical practice generates questions that require clinicians to engage in the process of completing an evidence based review to answer clinical questions. Despite the current focus in practice and education on evidence based practice, many do not feel confident in their ability to ask answerable questions, search for evidence, decide whether identified evidence is valid and can be applied, and implement evidence in their own clinical settings. This session will engage participants in practice answering a question of their choosing using tips and techniques designed to make evidence based methods easy and understandable.
1. Asking clinical questions: Methods to Focus a question; Determining specificity or broadness required to answer the question; Identifying the best kinds of evidence to answer the question.
2. Searching for evidence: Deciding where to look for evidence; Discussion of common databases; Identification of search terms; Finding the best combination of search terms.
3. Analyzing the evidence: Using Inclusion, exclusion and quality criteria; Common research design hazards; Interpreting quantitative results; Calculating number needed to treat; Summarizing the results.
4. Implementing the evidence: Identifying key results; Identifying differences in population and values in your setting; Engaging others in implementation planning; Developing a plan to implement results.

 
   


1032: Developing Self-Care Through Caring Science: An Integrative Evidence-Based Approach

Joseph Giovannoni, MA, MSN, APRN Rx, PMHCNS-BC

Abstract
Forensic nurses and healthcare professionals who are exposed to vicarious trauma, work with violent offenders, domestic violence, and sexual assault are susceptible to higher level of stress. It is essential for these professionals to treat their patients with human dignity, and motivate them to comply with their treatment plan while remaining non-confrontational, empathic, attentive, caring, and directive. The stress of working with difficult mental health patients, forensic patients can compromise one's health, job performance, and an effective patient/client relationship. Cultivating the Practice of Loving-Kindness with Self and Others, centering oneself, and engaging in self-care development can lower stress and facilitate a professional authentic presence which promotes a healing environment, and a positive human interaction with clients.

 
   


1033: Traumatically Brain Injured (TBI) Child/Adolescent, Young Adult, Aging Person: Practicing Recovery Principles

Vanessa Genung, PhD, RN, PMHNP-BC, LCSW-ACP, LMFT, LCDC; Nichole Sieracki, PhD

Abstract
You think it will never happen, certainly not to you or your loved ones. However, a traumatic brain injury (TBI)/acquired brain injury (ABI) can occur to anyone, any time. According to the World Health Organization, traumatic brain injury (TBI) is the leading cause of death and disability in children and young adults around the world and is involved in nearly half of all trauma deaths. Differentiating between mild, severe, and catastrophic brain injuries requires neurologic and neuropsychological testing. TBI/ABI has a sequelae of physical, cognitive, and behavioral symptoms. Reportedly, individuals with TBI/ABI have an 80% chance of developing mental illness. Many TBI/ABI victims experience problems with anger, aggression, impulsivity, poor concentration, impaired judgment and insight, depression, substance abuse, PTSD, and executive skills deficits. Many may also experience a reduction in family and social support over time. However, as often misperceived or believed, not all persons who experience TBI/ABI or resulting mental health illness engage in criminal activity. Armed with this knowledge, the PMH/RN/APRN can lead the change to help the injured brain recover, prevent or reduce resulting mental health issues, promote person centered rehabilitation, and provide family education. Case examples of child/adolescent/young adult demonstrate these recovery principles.

 
   


1034: A Toolkit for Innovative Teaching Strategies in Psychiatric Mental Health Nursing

Grace K. Wlasowicz, PhD., RN, PMHNP-BC; David M. Sharp, RN, PhD; Todd Hastings, MS, RN, Doctoral Student

Abstract
Psychiatric mental health faculty are often transitioned from advanced practice roles with scarce preparation for teaching and often lack adequate mentorship. The challenges new faculty face in nursing programs are numerous. These include changing landscape of technology, distance learning, diversity shortages, varying placement and emphasis of the psychiatric content in the curriculum, and devaluation/stigma of psychiatric content. Innovative teaching strategies are critical to meet challenges of the ever evolving nursing curriculums. This pre-conference workshop will provide an introduction to a variety of adaptable teaching strategies including: reflective journaling, simulation, case studies, integration of movie clips, problem-based learning and lesson planning. Each strategy will be briefly introduced with active audience participation that offers attendees opportunities to explore and develop a toolkit for innovation in their current teaching roles. A structured format will offer participants opportunities to utilize creative strategies to engage students in PMH content as they move from classroom to practice. Role playing will be implemented to engage learners to initiate content related to student centered learning and inter professional collaboration. The workshop will conclude with participants sharing innovative teaching strategies and planning the use of student centered teaching strategies within the psychiatric mental health curriculum.

 
   


1035: Introduction to the DSM-5

Margaret Halter, PhD, PMHCNS-BC; Barbara J. Limandri, PhD, PMHCNS-BC

Abstract
The APA has spent about two decades preparing for the DSM-5. Evidence based literature was used to reflect the most accurate and relevant psychiatric diagnoses. This version contains some departures from the previous edition, including the removal of Axes I-V. Both basic and advanced practice nurses are expected to understand the diagnoses and advanced practice nurses will use these new diagnoses and criteria in clinical practice.

 
   
1036: Understanding Sleep and Antidepressants: Lessons from Research Literature and Clinical Practice
Joseph M. Holshoe, MSN, PMHNP-BC

Abstract
Sleep disturbance, particularly, insomnia, is one of the most common chief complaints in the primary care setting, and disturbed sleep patterns are the most common psychiatric symptom across mental health diagnoses. In fact, Insomnia affects 80-90% of hospitalized patients and 50-70% of psychiatric outpatients. Antidepressants, commonly used to treat depression and sleep disturbance, have varied effects on sleep, with some significantly disrupting sleep architecture, total sleep and sleep efficiency. This presentation will explore new recommendations for treating mood-induced sleep disturbances as “co-morbid disorders,” review basic principles of sleep architecture in non-psychiatric and psychiatric populations, review the literature on antidepressants and their effects on sleep, explore the concept of drug-induced “sedation” versus fatigue from drug-induced fractured sleep, discuss clinical experiences with antidepressants in sleep disturbed populations, and explore how this knowledge can guide treatment for psychiatric RNs and APRNs.
 
   


1041: Engaging Inpatient Psychiatric Nurses in Defining and Promoting Evidence Based, High Quality, Patient Centered Care

Judy L. Sheehan, BSN, MSN; Joanne Matthew, MS, PMHCNS, BC

Abstract
“Inpatient Psychiatric Nursing”, published in April 2012 by Springer Publishing, was awarded second place by AJN as 2012 Book of the Year for Psychiatric Mental Health Nursing. The project included administrative, academic and staff nurses engaged in caring for the psychiatric in-patient and was the first publishing experience for most of these nurses. This work grew from a forum of Butler Hospital nurses who convened over a two-year period to identify and explore successful interventions used in the inpatient psychiatric acute care setting. The methods used for incorporating the expertise of staff nurses as content experts in this project, offers a road map for engaging inpatient staff in the transformation of the health care system and promotion of high quality person centered care. The presenters offer this program as a “How to” workshop for identifying potential inpatient projects, obtaining support from institutional leadership, selecting and recruiting content experts and writers, training primary authors to work with the content experts, outline the process for participants and suggest strategies for rewarding the participants. It is important to note, that any royalty from this publication is being placed in a scholarship fund for psychiatric nurses to attend continuing education conferences in the future

 
   


1042: Standing like Tree, Moving like Water - Applying Tai Chi Chuan, Its Ideas and Methods to Promote Physical and Mental Fitness Participation for Individual Living with SPMI

Zibin Guo, Zibin Guo PhD; Miriam Zwitter, PhD; RN

Abstract
The benefits of Tai Chi Chuan practice in improving physical and mental health and promoting fitness participation among the general population has been well documented. This session introduces the 4-postures Tai Chi program that was developed according to the characteristics and fitness need of individuals living with SPMI, and discusses the methods and process of developing and implementing this innovative approach to promote the sense of wellbeing and fitness participation among a group of individuals living with SPMI. The discussion is based on the preliminary observations generated from authors’ participatory and ethnographic experience in a HRSA funded project which intends to identify an effective intervention strategy to promote fitness participation for people living with SPMI. Session participants will also participate in the learning of this short form of Tai Chi Chuan program which can be practiced in either in sitting and/ or standing forms. Participants will be trained in methods for incorporating this form of Tai Chi Chuan into either clinical or community based programs promoting fitness participation for people living SPMI.

 
   


1043: Open Heart/Open Book: Co-authoring with Families and Patients on an Inpatient Unit to Write the Recovery Story

Melissa Elliott, BSN, MSN, PMHCNS-BC

Abstract
Our brief-stay inpatient unit affords only one opportunity for a family psychotherapy session, so we must maximize these minutes and extend their therapeutic reach. Narrative Therapy approaches, only rarely described in the nursing literature (Tuyn, 2009, Aloi, 2009), have informed the structure for this session, now employed over 40 times.

Steps of this session:

  1. Elicit and record the family’s full description of who this person is- competencies, characteristics, sparkling stories- apart from the illness.
  2. Elaborate this description with the patient’s phrases, including what shines through even in the presence of symptoms.
  3. Elicit from family and patient the earliest signs of relapse.
  4. List the habits they say support recovery.
  5. Invite them to articulate a mutual commitment to sustain recovery, including actions to support health and actions to take at first signs of relapse.
  6. In the EMR, enter a progress note, having the family and patient edit it for accuracy. Give copies of this note and of their signed commitment to each participant in the meeting along with an extra one to go to the outpatient clinician. We've learned that these documents are kept in pockets, purses and posted on refrigerators to give guidance and encouragement.
 
   


1044: Turning the Classroom: Using Team-based Learning to Engage Students in a Psychiatric-Mental Nursing Course

George B. Smith, DNP, APRN, GNP-BC, CNE

Abstract
Educators in psychiatric mental health nursing courses are confronted with continued challenges in the classroom to engage students in their own learning while providing opportunities to work with teams. There is a dearth in the nursing literature on classroom pedagogies based on evidence. The literature in medicine, humanities, and social sciences demonstrate the use of team-based learning (TBL) as effective teaching tool. TBL relies on the theory of engagement which describes learners as active constructors of new ideas or concepts, based upon their past knowledge and current understanding. Team-based learning offers a structured, student-centered learning method that focuses on active learning strategies. Students form teams of 5-7 students and remain with their teams for the entire course. In team-based learning students’ engagement occurs in two interrelated, mutually strengthening areas: within course content (individual) and within teams (group). Instead of being passive learners, students actively interact with teams and in class discussions. The course content was sectioned into six (6) main content areas. Team based learning involves a three step cycle: pre-class preparation, Readiness Assurance Test, and application of course concepts. This teaching strategy has shown positive outcomes on ATI Prediction Scores, positive classroom evaluations and a perceived student satisfaction.

 
   


1045: Mental Health Unit Design: Promoting Safety and Therapeutic Benefit Through Careful Planning

Edward A. Herzog, MSN, PMHCNS

Abstract
The expense and work involved in designing a new unit or remodeling an existing unit are significant, and, coupled with current budgetary constraints, mean that design and remodeling opportunities are strictly limited. Failure to make the best possible use of such opportunities can mean the difference between a safe, therapeutic unit and a unit design and furnishings that are quickly regretted but long endured.Options and philosophies for unit design and furnishing are many. Architects and equipment designers bring much experience and skill to the unit design process, but can be lacking in knowledge and appreciation of the day-to-day consequences of their work from a nursing and patient perspective. Nursing input and feedback is thus essential when designing or remodeling a psychiatric unit. However, for most nurses, mental health unit design is a skill most often acquired via on-the-job training and trial and error experience, risking results that may be less than optimal. This presentation presents a wide range of design considerations and options for architectural features and unit furnishings, from room design to 'nurse down' technologies. Case studies of successful and not-so-successful designs will be presented and critiqued, and audience members will also be encouraged to share their experiences and recommendations.