Thursday, October 10 - APNA 27th Annual Conference Abstracts

The Experiences and Needs of Family Members of Adolescents with Disruptive Behavior Disorders
Ukamaka M. Oruche, PhD, RN, PMHCNS-BC; Claire Draucker, PhD, RN, FAAN; Halima Al-Khattab, RN, PhD Student; Hillary Cravens, MSN, RN; Brittany Lowry, MSW; Laura Lindsey, RN

Purpose and Background: Adolescents with Disruptive Behavior Disorders (DBDs), which include Oppositional Defiant Disorder and Conduct Disorder, present unique challenges for their families. Most studies of these families have focused on the experiences of mothers, and little is known about the experiences of fathers, siblings, and other family members. To inform family-focused interventions, problems and perceived needs of all family members need to be better understood. This study aims to describe the functioning of families of adolescents with DBDs, levels of emotional distress of adult family members, and experiences and perceived needs for support and/or treatment of all family members.  Methods: Multiple family members (e.g., parents/caretakers, siblings, and other significant family members) from 15 families of adolescents with DBDs are being recruited from a public mental health clinic. Data are gathered with self-report questionnaires and in-depth interviews. Survey data are being analysed with descriptive statistics and interview data are being analysed by standard content analytic procedures.Results: Preliminary results from eight families indicate difficult family functioning and above average levels of distress in adult family members. Content analyses of experiences and perceived needs for support and/or treatment are on-going.Conclusions: Implications for intervention development will be discussed.


2012: When is Monitoring of Restraint Episodes Misleading?

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

Psychiatric settings routinely monitor the use of seclusion and restraint, using the data to track performance and reduce use of containment measures. As settings move to being ‘restraint-free’ an unintended consequence may be the perception that aggressive behavior is no longer a problem in a clinical setting. In reality, aggressive behavior ranges from verbal to physical and the range of severity of behavior is wide. Restraint rates represent only events where interventions have not de-escalated behavior. In a new era of restraint free practice, it is useful to consider how aggression in psychiatric settings is measured and the implications of this data. Means of measuring and calculating rates of aggression and aggression exposure will be highlighted. Understanding worker and team strengths in intervening by quantifying characteristics of successfully resolved events offers a unique perspective on the important work done to de-escalate aggression and prevent the need for containment. Use of quantitative data offers the ability to set thresholds when aggressive behaviors are more frequent to trigger teams to consider how to best manage aggression. Re-evaluating measures and methods of monitoring aggression in inpatient settings informs efforts to further improve both patient care and worker safety.


2013: Enhancing Adherence in Psychiatric Treatment: Taking Psychotropic Medication and Keeping Appointments

Valerie N. Markley, MSN, PMHCNS-BC

Non-adherence to treatment is a common problem in many chronic disorders with even higher rates among clients with mental disorders. Non-adherence to treatment greatly compromises the effectiveness of available psychiatric treatment and is associated with higher rates of relapse, hospitalization, and increased health care costs. This presentation reviews major barriers and adherence enhancing interventions in the literature and reports on an intervention study in support of evidence based practice. The theoretical framework relies on Hildegard Peplau’s theory of the nurse-client relationship and Ludwig von Bertalanffy’s general system theory. This study focuses on using the therapeutic alliance along with a modest intervention in an attempt to increase clients’ adherence to treatment (taking medication and keeping appointments). The intervention consists of providers (medication prescribers) communicating with their clients living in the community via phone, email, or texting between office visits to extend concern for client’s well-being and check in regard to medication compatibility. The chi square test of homogeneity is used to evaluate the differences between two groups with one group receiving successful communication with provider between office visits and the other group not receiving successful communication and measuring the adherence of each group to psychotropic medication as prescribed.


2014: The Elephant in the Room: Reconciling Recovery Principles With Forced Treatment

Timothy L. Meeks, BSN, RN-BC; Janice Adam, RN-BC

Recovery principles have become an emergent treatment standard in psychiatric nursing. By incorporating recovery principles into practice, caregivers demonstrate a commitment to preserving patient autonomy and respecting human dignity. As more mental health facilities adopt these principles, conflicting views of recovery emerge. Definitions of recovery are in flux. Elements of recovery principles, particularly treatment self-determination and medication choice, can seem at odds with involuntary hospitalization. Commentary about high profile crimes involving persons with mental illness has focused media attention on alleged deficiencies in mental health systems. Of note, critics condemn treatment trends that encourage patients to guide their own care or avoid treatment altogether. Prominent recovery proponents remain equally adamant that psychiatric treatment should be compelled rarely. Meanwhile, the experience of many inpatient psychiatric nurses is that forced treatment is sometimes necessary to preserve community safety and ease human suffering. Recovery principles are not an 'all or nothing' treatment philosophy. This session focuses on adapting recovery principles to the challenges of involuntary settings. Case studies illustrate how recovery principles can be used with severely impaired individuals by providing choices and hope even when compelling treatment. The presenters hope to promote recovery-inspired treatment at all levels of care.


2015: Entering into Private Practice: Challenges and Opportunities

Grace K. Wlasowicz, PhD, RN, PMHNP-BC

The delivery of mental health treatment is at a critical juncture. With the implementation of the Affordable Care Act (ACA) and the prevalence of mental health issues in societal consciousness, unprecedented opportunities abound for psychiatric nurse practitioners to provide services in private practice settings. Additionally, as a result the ACA the number of patients having access to health care will increase while admissions to traditional psychiatric inpatient/outpatient beds become more competitive. Consequently, community providers will need to manage more critically acute mental health concerns without the support of an integrated health care team. The recent IOM report calls for APN’s to practice at their highest scope of practice. Although essential features of advanced practice such as mental status exams, diagnostic formulation, psychotherapy and medication management are integrated in NP curricula, business and operations management content are lacking. In private practice, the lone provider shoulders these responsibilities. Given the complexity of insurance mechanisms, reimbursement rates, changes in CPT codes and the DSM V, as well as state regulatory requirements, this presentation will include an overview of the unique opportunities and challenges facing community-based APN’s in private practice. A model of care that includes a plan for outcomes evaluation will be presented.


2016: Standardized Patient Simulations and Students' Self-confidence, Communication and Interpersonal Skills

Flor Bondal, PhD, RN, PMHCNS-BC; Cynthia Jarrard, MSN, RN; Martha Colvin, PhD, RN

The purpose of this presentation is to discuss a research project that assessed students' self-confidence, communication and interpersonal skills using standardized patients (SP). Standardized patient simulations allow students to practice, to make mistakes and be given feedback before practicing in the real world. Standardized patient simulations provide rich, well-controlled, and effective clinical experience equitably among nursing students. This research project did not only augment the clinical component of the course, but also improved students’ clinical skills. This project utilized a pre-test post-test quasi-experimental design. Using the Self-confidence and the Communication and Interpersonal Skills scales, students rated their confidence and skills in talking to patients in a clinical situation before and after standardized patient encounters. The students’ self-rating of their communication and interpersonal skills were also evaluated against the SP's rating of the students’ communication and interpersonal skills. Descriptive and inferential statistical results will be presented. The challenges, limitations and implications of this project will also be discussed.


Eye Movement Desensitization and Reprocessing (EMDR) for Posttraumatic Stress Disorder: An Update on Research and Practice
Linda Mabey, DNP, APRN-BC

Posttraumatic Stress Disorder is estimated to occur in 7 – 12% of the general population (Kessler et al., 1995; Kessler, 2000; Kessler et al., 2005), with higher rates (14%) in military veterans of the Iraq and Afghanistan conflicts (Eisen et al., 2012). The condition presents significant consequences for the quality of life and functional status of millions of individuals worldwide. EMDR is a treatment method for PTSD based on the Adaptive Information Processing Model, utilizing a specific 8-phase protocol. Each phase is carefully titrated to the patient’s ability to tolerate re-visiting trauma memories. Bilateral eye movements or other methods of bilateral stimulation are a key component of the protocol. Once highly controversial, EMDR has become more “mainstream” as evidence for its effectiveness has accumulated, including a 2007 Cochrane review which found EMDR to be an evidenced-based treatment for PTSD. This presentation will explain the EMDR treatment protocol, provide a brief review of the literature on EMDR, and utilize a case study to illustrate its use in clinical practice. Implications for nursing will be discussed, including the feasibility of including EMDR training in psychiatric nursing graduate education.


2022: Seclusion and Restraint Precipitants and Duration: Child vs. Adult

Diane E. Allen, MN, RN-BC, NEA-BC; Alexander deNesnera, MD

Nurses have taken the lead in collecting data from crisis debriefings and advocating for changes that eliminate the need for seclusion and restraint. A one-year study in an acute inpatient psychiatric showed that chilren, adolesents and adults are secluded and restrained for different reasons and for different lengths of time. Exploration of these differences has led to changes in staff training, treatment team approaches and the environment that may help to achieve the goal of eliminating the use of seclusion and restraint, especially for children.


2023: Problem-solving Based Peer Support Program for Medication Adherence – A Mixed Methods Study

Gayelene Boardman, RN, GradDipAppSc, MSN, PhD(c)

Many people with schizophrenia are reluctant to take their antipsychotic medications, and this might have adverse implications for their recovery. Numerous approaches have been used to enhance medication taking but have achieved mixed results. The aims of the study were to assess if consumers with schizophrenia have improved adherence after participation in a problem-solving based peer support program. The study used a mixed method comprising of a time-series design and semi-structured interviews to evaluate the effectiveness of a telephone-based problem-solving peer support program on individuals who were non-adherent with their oral antipsychotic medication. Peers contacted consumers by a weekly 20-minute telephone call for eight weeks. The findings showed that there were statistically significant difference in adherence, mental state and negative symptoms from baseline to post-intervention, and this was maintained at follow-up. Research has shown that peer support it is effective in reducing hospitalisations, improving social functioning and quality of life for consumers. Overall, the findings support the use of peer support as an adjunct intervention to promote adherence in consumers with schizophrenia.


2024: Leading Change from the Front Line; A Journey to Recovery through Therapeutic Milieu, Environment of Care and Violence Reductions Strategies

Carol M. Parke, RN, BA

Providing care in today’s healthcare infrastructure requires significant redesign to promote recovery through three elements of care. First, substandard environment of care provides challenging barriers to recovery-centered programs by reducing comfort levels and increasing stress thru poorly designed spaces. By offering a recovery centered therapeutic design, clients report entering a safe space thus reducing stress. Second, positive proactive prevention strategies partnered with therapeutic milieu reduce stress and provide nursing staff the opportunity to focus treatment on patient strengths and interpersonal relationships. Front line nursing members are able to direct energy on identifying work flow barriers, and testing solutions to improve the care delivery model. Third, providing evidence based violence reduction strategies and promoting staff develop allows nursing to stay one step ahead of stressful situations, drastically reducing violence and the use of restraint devices. With reduction in violence, the primary nurse offers individualized person centered care thru activities focusing on stress reduction, relaxation, and trigger identification. Interventions built on promoting strengths rather than symptoms offers connection to the client’s individual strength resulting in high quality positive outcomes. This session will present a model of evidence-based care based on the experience of behavioral health transformation being implemented in a health system.


2025: Integrated Care: What’s Missing in Current Practice Models?

Roberta Waite, EdD, APRN, CNS-BC, FAAN; Carla Groh, PhD PMHCNS-BC

Integrated care, health care that is comprehensive, continuous, coordinated, culturally-competent and consumer centered, is essential to improving the health of our most vulnerable patients including those affected by mental health concerns. Nurses are pivotal in leading integrated care initiatives (clinical, organizational and system) using a social justice orientation. Psychiatric nurses are adept at practicing in a “patient-centered” and “family-centered care” approach which promotes understanding the whole person (holistic care) including the person’s life situation within family and community contexts. That is, we understand that individuals are living bodies and effective care requires that we take into account a non-Cartesian view that emphasizes the embodied, enacted and contextualized nature of experience and perception of individuals. Understanding and proactively addressing how behavioral and emotional factors affect physical health is critical since on average 60 % of visits to primary and ambulatory care centers are psychosocial in nature.

This presentation will:

  1. Address how we currently prepare students to effectively work in systems of integration using a social justice approach.
  2. Discuss what’s absent from most practice models.
  3. Share examples of two nurse-managed centers that implement integrated care and describe their mission as it aligns with social justice principles.

2026: The Development of a Standardized Suicide Risk Assessment Protocol in the Emergency Department

Joanne M. Matthews, DNP, APRN, PMHCNS-BC

Standardized suicide risk assessment must be performed for all adolescent and adult emergency department (ED) patients regardless of the reason for their visit. Psychiatric specialty nurses need to support other non-mental health providers in the ED by developing standardized assessment protocols and provider training to increase identification of patients with hidden suicide risk. The Suicide Prevention and Resource Center (2010) reports that ten percent of ED patients have undetected suicidal ideation. The Joint Commission (The Joint Commission, 2010) emphasized the need for increased identification of suicide risk in ED patients. Suicide continuously ranks in the top five most frequently reported sentinel events in hospitals; 8% occurring in the ED (The Joint Commission, 2008). The development of a standardized suicide risk assessment protocol for the ED was led by a psychiatric mental health nurse utilizing the Rosswurm and Larrabee Model (1999) for evidence-based practice. The protocol incorporated four questions as developed by Wintersteen (2010) and the SADPERSONS Tool by Patterson (Patterson, Dohn, Bird & Patterson, 1983). Leadership by psychiatric mental health nurses is needed to continually move toward improving mental health in all populations. The ED is one place to start.


2031: Psychiatric Emergency: Neuroleptic Malignant Syndrome-A Simulated Experience to Improve Care Across the Healthcare Continuum

Cindy Parsons, PMHNP-BC

Neuroleptic Malignant Syndrome (NMS) is a rare, but potentially fatal complication associated with neuroleptic medications. Due to its critical nature, nurses must recognize NMS and implement clinical interventions to stabilize the patient immediately. Simulation has been defined as the “artificial representation of a phenomenon or activity that allows participants to experience a realistic situation without real world risks” (Larew et al. 2006). In psychiatric nursing the most common simulations have been low fidelity role plays, analyzing films or film clips. The symptoms of NMS are adaptable for high fidelity simulation, providing students with realistic exposure to NMS without the risk of a real life adverse outcome.This clinical simulation was developed through a collaborative effort between the PMH faculty and the simulation coordinator. Jeffries’ Simulation and Benner’s Novice to Expert Frameworks guide the curriculum integration. Student outcomes included• apply critical thinking skills in patient assessment.• initiating nursing actions to stabilize the patient.• applying knowledge of pharmacokinetics and clinical reasoning.• evaluate and reflect on their actions within the simulation and debriefing.This simulation can help foster the development of future high fidelity simulations. Future research can be directed toward evaluating clinical skill acquisition and learning outcomes.


2031: Meeting the Challenge of Developing Complex Simulations in Psychiatric Nursing Education

Susan Rick, DNS, RN; Cindy Zolnierek, PhD, RN; Tiffany Holmes, D.C.

The use of simulation in nursing education has expanded the options for clinical experience. Simulated experiences are especially needed in psychiatric nursing education, as practice settings that reinforce theoretical content are increasingly difficult to secure (Kidd, Morgan & Savery, 2012).The use of high fidelity simulation as a means to develop nursing skills and the competencies of clinical judgment is supported in the literature (Lasater, 2007). Simulation offers the advantage of exposing the students to clinical situations which occur infrequently and are potentially high risk.The purpose of this project was to design a complex simulation which would focus on the challenges of assessing a patient with complicated depression, first in the Emergency Room and then in ICU, where symptoms of serotonin syndrome were exhibited by high fidelity mannequins. Students were divided into small groups and given patient history and scenario information. They were then asked to assume various roles, requiring evaluation of assessment data, therapeutic communication, de-escalation of an agitated patient, administration of medication and identification of symptoms of serotonin syndrome. Scenario objectives and associated competencies were evaluated usinga likert scale instrument and open-ended questions. Sucessful simulation experiences offer one solution to the limited availability of clinical sites.


2032: Women in the Military: Mental Health Impact of Deployment

Mary Ann Boyd, PhD, DNS, PMHCNS-BC; Wanda Bradshaw, MSN, RN-BC; Marceline Robinson, MSN, PMHCNS-BC

Recruitment and the role of women in the military escalated following the elimination of conscription and the establishment of the All Volunteer Force in 1973. Fractured family separation arrangements, combat exposure and sexual trauma characterize the experiences of many deployed female military members. The suicide rate of deployed women unexpectedly increased from 5.1% in 2003 to 15.2% per 100,000 in 2008. Upon return, many women veterans face difficult parenting issues, health problems, and homelessness. Challenges are different for the active than for the reserve component members who may not have the support needed for a successful reintegration. In this presentation, the mental health issues of deployed women will be presented including suicide, PTSD, and depression and useful clinical strategies to address these issues.


2032: Development of a Practice Infrastructure for Non-Military Mental Health Professionals Caring for Military Connected Individuals

Christy Cook Perry, APRN, PMHNP; Andre Charlson, APRN, PMHNP

According to the U.S. Government Accountability Office (GAO), in 2010, the Department of Veteran Affairs provided health care to about 5.2 million Veterans (GAO), 2011). The need for mental health services is expected to rise in the military connected population due to the large number of service members deployed to Iraq and Afghanistan since September 11, 2001. According to the GAO study (2011), several barriers were identified that hinder veterans from accessing mental health care from the VA. Some barriers that were identified included logistical challenges, and concerns about receiving health care from the VA.In an effort to meet the needs of this growing population, our small private practice has opted to extend services to military connected individuals. We have educated our staff on the unique needs of the population and provided an overview of the program. A resource manual has been organized in order to provide population focused and appropriate care. This manual details the screening tools, evidenced based treatment guidelines, psychotherapy, benchmarks to evaluate effectiveness of treatment, patient education for the various mental health disorders, suicide assessment, post traumatic stress disorder and substance abuse. United States Government Accountability Office (2011). Report to the ranking member, committee on veterans


2033: Prescription Stimulant Misuse in Juvenile Corrections: Case Studies and Leading Change to Reduce Misuse

Linda F. Barloon, MSN, PMHCNS-BC, PMHNP-BC

Welcome to Texas, home of the nation’s largest state prison system – a nation where millions of adults are incarcerated and over two million youth come into contact with the juvenile justice system yearly. Rates for all psychiatric disorders, including ADHD, are higher in the incarcerated population than in the general population. Stimulant medication is the most commonly used and most effective treatment for ADHD and often prescribed for incarcerated juveniles with ADHD. Medications such as methylphenidate also have a high potential for abuse with an effect, when misused, similar to that of cocaine or amphetamine which makes them a commodity in the correctional setting where illegal drugs may be hard to obtain but prescription medications are available. The presenter who is a PMHNP working in juvenile corrections will present case studies describing stimulant misuse -- how incarcerated youth abuse and sell stimulants, threaten and assault others, and malinger in order to obtain them, and devise clever ways to divert medication. Detecting malingering and misuse will be presented as well as suggestions for effective interventions. In addition, the presenter will discuss how efforts to address this problem resulted in selective changes in the TJJD formulary to make stimulant use safer.


2033: Diagnosing Adult Attention-Deficit Hyperactivity Disorder: The Importance of Establishing Daily Life Contexts for Symptoms and Impairments

Charles Primich, MSN, PMHNP-BC;

This presentation will examine the complexity of diagnosing ADHD in adults with regard to the presence of symptoms and comorbidities common to mood, anxiety and other disorders. In adults, symptoms are often masked by the patient's learned compensatory mechanisms. Misdiagnosis, and subsequent treatment, can moderate common symptoms without relieving the core difficulties of inattention, hyperactivity, and impulsivity. This presentation will identify methods of improving diagnostic clarity. The literature reveals the importance of evaluating both retrospective and current symptoms and impairments in the context of the individual's life. Careful, nuanced assessment of the relationship between symptom expression and impairment in daily living offers diagnostic clarity. Symptoms common to multiple disorders will be distinguished by illuminating the context in which they arise and are experienced. Well supported assessments, sensitive to the context in which symptoms and impairments present, will result in greater diagnostic accuracy, better treatment outcomes and enhanced quality of life. Accurate diagnoses will contribute to the understanding of adult ADHD and remind both clinicians as well as the public that this disorder is often present in adults as well as children.


2034: Gravity, It’s Not a Suggestion, It’s the LAW! The Development of the WilsonSims Psychiatric Fall Risk Assessment Tool.

Steve C. Wilson, RNBC

In 2006 we were researching a psychiatric fall risk assessment for use on our unit. After much research we were not able to find one specific to our adult inpatient psychiatric population. We used the fall risk research we had gathered to develop an assessment tool of our own. The WilsonSims was developed by staff nurses working with our CNO and other departments within the hospital to produce this assessment. This tool has helped to reduce the fall rate on our inpatient psychiatric unit over 50%. Oaklawn Hospital is a small Midwestern hospital of less than one hundred beds. The ability to work across departments was instrumental in producing a product that has had a significant impact on the safety of our patients. Since we have shared the results of our validation study, many other hospitals have inquired about using this assessment tool on their own inpatient psychiatric units. We know of at least one that has IRB approval to study this tool and another that is in the proposal stage. We would like to share the process that made the WilsonSims Assessment possible. We believe that even a village has lessons our larger urban counterparts can learn from.


2034: Using a Comfort Room as an Intervention for Psychiatric Patients

Candace Cane, APRN-BC, DNP; Kent Alford, RN, BSN, MSNc; Melodie Hogan, LCSW-C

The national patient safety goal of reducing seclusion and restraints in psychiatric settings is important when working in an in-patient setting. The safety and security of the unit must be a primary goal at all times. The rights of the individual patients are also of the utmost importance. As needed (PRN) medications can be considered a form of restraint, and therefore need to be limited as often as possible. The clinical staff at a hospital in Northern Virginia has been using a comfort room, among other interventions, in an effort to decrease the use of both PRN medications and other restraints, including seclusion. Prior to use of the comfort room, the patient is asked to complete the Beck Anxiety scale, to gauge the patient’s assessment of their own anxiety. After the comfort room has been used, the patient completes the scale again. Patients have been reporting decreased anxiety, verbally and through use of the Beck Anxiety scale. The comfort room has been used successfully for patients with a variety of diagnoses.


2035: Problems Encountered and Insights Gained: Designing An Evidence-Based, Recovery-Oriented Program for Intensive Mental Health Treatment

Carol H. Rumpler, MS, PMHCNS-BC; William D. Burmeister, MSA, RN

Historically, it has been difficult to measure the therapeutic effectiveness of Acute Psychiatry Programs. The evidence-based, recovery-oriented nursing model utilized on this acute 20 bed inpatient psychiatric unit was implemented in February 2000 and continues today. The protocol defines therapeutic effectiveness, measures outcome behaviors, and provides evidence for modification or refinement of the inpatient mental health treatment program. Originally the conceptual model of care underlying the program was a biopsychosocial paradigm. More recently, the model of mental health recovery has been incorporated into the treatment program as well. Upon admission, patients are entered into the treatment program. A systematic evaluation protocol, utilizing a series of tools, is given to patients at admission and dischage intervals. The tools include: Symptom discomfort ratings, satisfaction with treatment, and completion of treatment outcomes as documented in the Veteran's Resource Book. Throughout treatment, the veteran compiles this personal resource guide. The resource book utilizes a cognitive-behavioral approach organized around biopsychosocial aspects of wellness, illness management, and mental health recovery concepts. Integrating and maintaining the treatment model necessitates a two-fold approach: keeping the patient involved and keeping the staff involved. In summary, patient outcomes determine clinical practice and clinical practice drives patient outcomes


2035: Motivational Enhancement Through Sharing (METS).

Regina Sawh, RN, BscN, MN; Keshcey Marcelle, RN, BScN, MA

Individuals with serious and persistence mental illness often struggle with treatment compliance, performing activities of daily living and independent activities of daily living, exhibit isolative behaviors and often lack motivation in goal setting. ME has been recognized in the mental health literature as an evidence based approach to care in enhancing medication medication compliance, improved social functioning, increased self-esteem and goal oriented behavior. Motivational enhancement through sharing (METS) utilizes motivational enhancement (ME) strategies in promoting a recovery oriented approach to care and promotes inpatient mental health nurses to work with clients from a strength base approach. METS was implemented on a 27 bed treatment resistant schizophrenia inpatient unit. METS consist of 8 modules, with sessions held twice a week. Participants were evaluated through observation and qualitative surveys throughout the 4 week duration of programming, also at 1 week post group and at a frequency of 2 weeks there after. Positive findings were noted in the following areas; increasing medication compliance, self reported feeling of empowerment, increase in “change talk” language and increase in goal setting behaviors


2036: Adherence to Clinical Practice Guidelines When Prescribing Second Generation Antipsychotics

Leigh Powers, DNP, MSN, MS, BS, APRN, PMHNP-BC

Psychotropic medications, such as second generation antipsychotics (SGAs), can improve patient outcomes by diminishing the intensity of psychiatric symptoms; however, these same medications may have adverse effects which can lead to metabolic syndrome and/or diabetes. A retrospective chart review at an urban community mental health center located in the southeast United States was utilized to investigate quality of care. One aspect was measured by looking at adherence rates of medical providers to the APA/ADA (American Diabetes Association) second generation antipsychotic (SGA) monitoring guidelines when prescribing SGA medications.The literature indicates provider self-report of adherence between 60-80%. Project results indicated an initial combined collection of fasting blood glucose (FBG) and fasting lipid profile (FLP) of 30%. The adherence rate from the literature was 26.9% for baseline glucose and 10% for baseline lipids (2). At the 3 month time point, 20% of FBG and FLP were checked and at one year 14%. To improve quality care, study results suggest there is a need for practice improvements. Future directions include identifying knowledge gaps between prescriptive guidelines and provider practice in addition to examining barriers, such as structural and process components in a clinical setting, to adherence for the patient, system, and payor.


2036: Nursing Care That Transcends Words: Simulation Based Learning Activities to Enhance Patient-Centered Care


Clinical preparation for nurses has evolved dramatically using high fidelity simulation and technology-based learning modalities. These modalities often do not address the ability of the nurse to actively support the emotional, cultural and familial needs of the patient. Recent research has shown a decline in empathy in undergraduate nursing students.Simulation scenarios can engage learners in purposeful activities of engagement, empathy and relational competencies that are necessary for an effective nurse-patient relationship that offers person-centered care. Participants have reported favorable and insightful benefits from simulations that focus on the value of silence and the use of active listening techniques. Using a combination of lecture, class discussion, role playing and video review, participants learn from their mistakes through small group discussion and self-reflection during the debriefing sessions. By using these relational competencies the nurse can avoid premature solutions-based care that may reflect stigma, lack of patience, and crucial misunderstanding of the patient’s needs. Learning to approach the patient with more curiosity and openness than personal value or judgement motivates the professional nurse to take the few minutes necessary to truly hear the patient’s story and focus care on patient-centered outcomes.


2041: Institute for Safe Environments Interactive Panel

Diane E. Allen, MSN, RN-BC, NEA-BC

The Institute for Safe Environments has been reorganized to provide an integrated structure designed to thoughtfully address issues that impact the safety of persons served as well as service providers. Leaders have been working to:1.Identify issues related to safe environments2.Explore current evidence related to issues 3.Recommend strategies to promote safe,evidence-based practices.This year, the Steering Committee has examined practices intended to promote safety and engaged members in discourse about how these practices relate to concepts of coercion, empowerment and recovery.


2042: Education Council Interactive Panel

Edna Hamera, PhD APRN; Pamela Lusk, DNP, RN, PMHNP-BC; David Sharp, RN, PhD; Barbara Warren, PhD, PMHCNSBC, FAAN; Carole Shea, PhD, RN, FAAN; George B. Smith, DNP, APRN, GNP-BC, NP-C, CNE; Barbara J. Limandri, PhD, APRN, BC

In recent years and under skilled leadership, the Education Council has become a vibrant force within APNA. In considering the needs of APNA membership, the Council has brought into prominence best teaching practices in psychiatric and mental health nursing. In this Interactive Panel, participants will learn about the structure of the Education Council within APNA and how the Council responds to the APNA Board, staff, and other Councils in meeting the educational needs of our association members. The three subgroups of the Education Council, graduate, undergraduate and continuing education each focus on issues important to constituents. The Graduate Education Committee will share examples of how to strengthen the teaching/learning of the “4th P” – psychotherapy in graduate programs. The Undergraduate Steering Committee will share the tool kit they are compiling for undergraduate faculty and the Continuing Education Steering Committee will share their suicide white paper, an emerging project on bipolar disorder, and methodologies for creating online programs. Participants will learn the benefits of involvement in the Education Council and how they can participate at different levels from beginning as a member of one of the steering committees, reviewing educational products throughout the year, and being mentored for a leadership role.


2043: Administrative Council Interactive Panel

Avni Cirpili, RN, MSN, NEA-BC

This is the annual Administrative Council Interactive Panel session. Members of the Administrative Steering Committee will discuss the work completed in 2013. Specific discussion will center around topics related to acuity, nurse sensitive indicators, informatics, and mentoring.


Research Council Interactive Panel – Change the World Through PMH Nursing Research!
Linda Beeber, PhD, PMHCNS-BC, FAAN

APNA is the only psychiatric nursing organization that provides pilot research funding for new investigators. Since 2008, through the generosity of the American Psychiatric Nurses Foundation, 18 APNA members have been funded to pursue research relevant to the care of individuals and families with primary mental health threats and concerns. This interactive panel will feature APNA members who have successfully applied for and “changed the world” with their projects. Experts from the Research Council will offer crucial tips on how to prepare a strong application, provide links to helpful resources and introduce you to the Council Community you can network with other Council members as you prepare your applications for the 2014 grant funds. Come with questions and get energized to get your proposal ready for submission!


RN-PMH Council Interactive Panel –The 2013 Scope and Standards of Practice: Update of Practice Standards
Amanda DuWick, BSN, RN-BC and; Kris A. McLoughlin, DNP, APRN, PMH-CNS, BC, CADC-II, FAAN

The Psychiatric Mental Health Scope and Standards of Practice are reviewed and modified by a group from the APNA and ISPN every five years and submitted to the ANA for publication. The Scope and Standards guide our practice and guide legislative bodies in defining what we do as nurses. This presentation will review the new 2013 PMH- Scope and Standards of Practice.