1011: Does Stigma Toward Students with Mental Health Problems Exist Among College Faculty?
Ann Caughill, EdD, APMHCNS

Abstract
Concerns about a worsening of mental health problems among college students in recent years have been noted in the literature and media. Literature support is strong for the negative impact of stigma on persons with mental disorders. An educational intervention for college faculty was implemented that provided information about mental disorders, mental distress and how to assist distressed students. The study was designed to test the hypotheses that both knowledge and attitude would improve as a result of education, using the researcher-developed measures of knowledge assessment and attitude survey. A research question was included that asked the relationship between knowledge and three domains of attitude, including stigma, role perception and acknowledgment of stressors. Difficulty in obtaining the expected sample size led to a change from a complete online educational format to an adapted version presented face to face. Data analysis involved t-tests and correlation coefficient computations. Results of the study failed to prove the hypotheses but did demonstrate a statistically significant relationship between knowledge and role perception. Although hypotheses were not confirmed, data results helped to identify implications for education and research.

1012: Calling the Circle to Transform Health Care
Kristen Lombard, PhD, PMHCNS-BC

Abstract
Relationship and understanding are part of the foundation for challenging the effects of stigma, yet the health care milieu is often entrenched in ways of being that do not support relationship building or sustained change. Paradigmatic shifts which emphasize caring collaboration are being called for by accreditation bodies, administration, patients and nurses themselves. The PeerSpirit Circle is a non-hierarchical, intentional, and relationship-centered practice of collaboration. It emphasizes a safe container, authentic presence and mindfulness. Circle research supports it as providing a meaningful contribution to the evolution of the nursing profession and health care.
The purpose Dr. Lombard’s progressive study was to give voice to the experiences of nurses who have sat together in PeerSpirit Circles. Her research was guided by Gadamerian philosophical hermeneutics. The findings inspire a deeper understanding of barriers to congruence between values and action in nursing, and nurses’ need to acknowledge, honor, support and protect each others’ vulnerability. Such care is needed as we seek to comprehend judgment and stigma from the inside out.
This Pre-conference workshop will be an introduction to the PeerSpirit Circle via sharing my research findings on this model of collaboration, reviewing the circle guidelines and providing an experience for psychiatric nurses.

1013: Beyond the Bundle: Effective Fall Prevention Strategies for the Geriatric Psychiatry Unit.
Kathleen Frybarger, RN, BSN, MA; Catherine Brennan, BSN, MS

Abstract
Geriatric Psychiatry Units are often considered negative outliers when it comes to the number of total falls and injury falls that must be reported to national databases such as the National Database of Nursing Quality Indicators(NDNQI). While there are no current national benchmarks for Geriatric Psychiatry Units, these units are struggling to meet the expected standards.
Despite this "stigma", Geriatric Psychiatry Units are committed to quality and excellence in nursing care. This presentation looks at the interventions considered to be the "standard" in fall prevention, often known as "falls bundles" and how they may be utilized for success for Geriatric Psychiatry Units. Additionally, the presenters identify innovative practices they have incorporated into daily patient care that go "beyond the bundle". Working in collaboration with psychiatrists and physical therapists, the nursing team has developed the "second generation" of interventions that facilitate fall prevention as well as incorporating simple admission assessment tools that readily identify patients eligible for physical therapy and occupational therapy services. Time will be spent on identifying potential barriers associated with implementing these new strategies in the participant's daily practice. Lastly, home safety is identified and incorporated into the plan of care involving both family members and community resources.
 

1014: Ethnopharmacology and Healthcare Literacy: Culturally Diverse and Inclusive Processes Barbara Jones Warren, PhD, RN, CNS-BC, PMH

Abstract
This session will describe the role of ethnopharmacology for persons from culturally and ethnically diverse populations and discuss the evidence for using recovery-based ethnopharmacologic strategies. Complementary and alternative therapies involved in the health, healing, and illness viewpoints of clients will also be addressed. Case-based strategies will be used to guide discussions and develop interactive involvement during the session.

1015: A Neuroscience Relationship-Based Framework for Psychiatric Nursing
Kate Wheeler, Ph.D., APRN, PMHCNS-BC, PMHNP-BC, FAAN

Abstract
The confluence of recent theory and research on learning, trauma, infant development, and attachment validates the centrality of relationship that has been a hallmark of psychiatric nursing. A relationship-based model with a hierarchical treatment framework for psychiatric nursing practice is presented through a synthesis of this theory and neurobiology. Phases of treatment are delineated with therapeutic communication strategies and specific interventions for each phase described. Even when psychiatric nursing practice does not allow for the development of long-term psychotherapeutic relationships, the moment-to-moment nurse–patient relationship through implicit and explicit communication potentiates change in the patient’s state. It is largely the right brain-to-right brain connection through relationship with another that allows for an ambient environment so healing can occur. The presence of the nurse in the healing relationship restores harmony, connection, and integration towards healing. Healing outcomes are reflected on a cellular level in the connection and integration of neural networks as manifested by an enhanced coherence of relationship with others. This framework, embedded within a holistic nursing paradigm, provides a compass for basic and advanced levels of practice in all settings for the many roles of psychiatric nurses, and offers a potential heuristic for nursing education.

1021: Sharing Your Clinical Expertise: How to Develop a Topic for a Continuing Education Presentation
George Smith, DNP, APRN, GNP-BC; Barbara Limandri, DNSc, APRN, BC

Abstract
Continuing education is critical to the continued expansion of knowledge and skills for practicing nurses. The amount of information available to today’s psychiatric nurse is staggering. This expanded knowledge explosion has created enormous difficulties for clinicians in accessing and processing the large volume of information circulating in the literature, internet, conferences, meetings and other arenas. Today, continuing education is available in many formats from simple presentations with slides to sophisticated interactive platforms. An experienced practicing psychiatric nurse is an ideal source of knowledge and expertise for developing a continuing education program. However, many clinicians do not feel adequately equipped to take an idea from practice and to develop that idea into a presentation that would benefit others. This workshop will provide “hands on” activities and exercises to guide the clinician in developing a continuing education program. Different presentation formats will be reviewed. In this workshop the participant will produce an outline, objectives and a framework for creating a program. This workshop is intended to access and cultivate the rich expertise of the APNA membership to share that knowledge with other members. Participants will be able to submit their programs to the APNA eLearning Center.

1022: Creating a Culture of Storytelling: Releasing and Hearing the Voices of People in Recovery
Joan King, RN, MSN, CS

Abstract
As recovery transformation sweeps across the country with health care reform right on its heels, activating the voice of people in recovery is a critical component of this transformation. As a group, people with behavioral health conditions have been stigmatized and treated as "other" not only by society in general but sometimes, inadvertently by the professionals committed to aiding in their healing. Storytelling provides a time tested and unique way to both release the "heroic journey" of the person living with a challenge and for the caregiver to see with new eyes through the story.
The workshop will explore the role of storytelling in healing throughout history, identify key components of a "culture of storytelling" and draw direct practice implications for psychiatric nurses in any setting. Drawing on the experience of training over 100 people in recovery and staff working with them, concrete activities, attitudes and approaches will be shared. To truly hear another's story and allow it to transform practice and life is to confront and dismantle stigma head on.

1023: Behavioral Health Integration: Evolution, Experience, and Excitement!
Gail Stern, MSN, PMHCNS-BC

Abstract
Behavioral Health Integration and Psychiatric Nurses- Evolution, Experience and Excitement!
The time to be excited is NOW! Prepare yourself (and your organization) for the new care and service delivery options of Integrated Care. Healthcare reform presents us all with the platform to better deliver care to people living with mental illnesses and addictions. Electronic health records give us the platform to coordinate , collaborate and integrate care in expanded ways. Integration provides access to our communities: to provide prevention, early identification and interventions not previously possible. Research opportunities are available to develop and measure integration activities!
This session will detail the integrated healthcare models that have evolved, especially over the past decade. We will outline the key elements of each model so that participants leave the session with a solid understanding of the core activities that support and challenge each model. Examples of Psychiatric Nurses involved in Integrated Care today will be presented along with the positive outcomes of that care. Through our examples, participants can experience how to strategize and position psychiatric nursing involvement in integrated initiatives and home grow these models today!

1024: Brain Circuitry Basics: A Prescribing Primer for Physiology, Pathology, and Psychopharmacology of Mental Health Vanessa  Genung, PhD, RN, PMHNP-BC, LCSW-ACP, LMFT, LCDC; Margit Gerardi, PhD, RN, WHNP; Mariko Clark, RN, MSN

Abstract
As the field of psychiatry advances and more is understood about the intimate workings of the brain, psychiatric symptoms are progressively more often attributed to malfunctioning brain circuitry. It is becoming increasingly more important for the PMH/APRN prescriber to understand how psychiatric disorders are linked to neuronal activity and the processing in these circuits, and to know what are considered best practice treatments. In this presentation, the structure and function of the brain and central nervous system are conceptualized. The connection between brain circuit activity and mental health behavior is explained. The psychopathology of major mental disorders is delineated. Major brain neurotransmitter and receptor functions and dysfunctions are defined. Brain circuits will be outlined along with the neuropsychopathological disorders that occur when they malfunction. The mechanism of action of antidepressant, anxiolytic, antipsychotic, and stimulant medications and their relationship to treating mental health symptoms and pathology is detailed. Psychotropic medication prescribing activities can be accomplished with more specificity to ameliorate the presenting psychiatric symptom. Best practice prescribing treatments are presented for major mental health diagnoses. Armed with that knowledge, PMH nurses will have a better understanding with which to deliver care to mentally ill persons.

1025: Motivational Interviewing: Applications for Psychiatric Nurses
Edna Hamera, PhD, APRN

Abstract
Motivational Interviewing is an evidence-based method for facilitating change behaviors. It is based on two theories: cognitive dissonance and self-perception theory. Festinger’s Cognitive dissonance theory proposes that when individuals become aware of discrepancies between beliefs and behaviors they are motivated to resolve the discrepancy. Bem’s Self-perception theory proposes that hearing oneself argue for change increases motivation for change. The research on Motivational Interviewing has primarily focused on health promotion and prevention behaviors specifically with addictive disorders. Beginning evidence supports that it may be useful in motivating individuals to more fully engage in psychotherapy. The art of Motivational Interviewing includes essential communication skills: opened ended questioning, affirmations and summaries and detecting and mediating resistance. More complex skills include eliciting rather than waiting for change talk, knowing when to progress to a change plan and consolidating client commitment. This workshop will review the theory, the evidence for Motivational Interviewing and demonstrate beginning and complex skills with opportunity for practice.

1031: Magic Mirror on the Wall: Using Reflective Practice and the Theme of Hope to Reduce the Stigma of Mental Illness and Mental Health Nursing: An Innovative, Student-Centered Approach to Preparing the Next Generation of Psychiatric Mental Health Nurses
Kris Lambert, PhD, RN

Abstract
Mental illness is prevalent yet remains misunderstood and undertreated. Research has identified stigma as a key factor in the continuing struggle to raise awareness and remove the false beliefs held by the majority of the public. Multiple anti-stigma campaigns have been launched employing the use of social marketing strategies, educational initiatives with the stated outcome of reducing stigma and discrimination. Yet, real transformational change occurs at the level of the individual. To this end, a curriculum redesign plan was instituted during the mental health rotation in a BSN Program. Using a student-centered pedagogical approach to learning, including reflective discussion board, film, art, music, multimedia schemes and community involvement, students are immersed in the use of reflective practice and recovery model framework; thereby shifting the concept of stigma from an external force exerted on individuals with mental illness, to an internally focused exploration, identification and healing opportunity for students. Reflective practice has the potential to permit students to learn from their practice and become more intentional and authentic in the care they provide; thereby transforming the attitude and perceptions associated with stigma. The unexpected outcome of dispelling the myth of the mental health nurse as "less than” is also presented.

1032: Using Principles of Acceptance Commitment Therapy to Facilitate the Development of the Therapeutic Relationship
Maryanne Jones Godbout, DNP-c, PMHCNS-BC

Abstract
The therapeutic relationship is not a series of techniques but rather a “way of being” in the relationship rather than “doing” in the relationship. Critical to the therapeutic use of self is the ability to be fully present with non- judgmental acceptance and compassion even when the interaction elicits uncomfortable emotions. Acceptance and Commitment Therapy (ACT) is mindfulness-based cognitive approach based upon the Relational Frame theory of human language and cognition. Psychological flexibility is the main goal of ACT. A core conception of ACT is that psychological suffering is caused by experiential avoidance and cognitive entanglement resulting in psychological rigidity. The potential exists for psychological rigidity to hinder the development of therapeutic use of self. This session will present didactic material of the core concepts of ACT and experiential use acceptance and mindfulness strategies and behavior-change strategies. The focus will be the therapist factors in an interpersonal encounter. The overall objective is to facilitate the ability to recognize emotional cues, tolerate anxiety, enhance self –awareness and empathy and an understanding of typical communication patterns that promote the development of the therapeutic relationship.

1033: Preventing Behavioral Emergencies on Non-psychiatric Care Settings
Della Derscheid, RN, CNS, PhD(c)

Abstract
Four years and is available 24/7/365 for two academic acute care hospitals.
The presence of violence in the healthcare setting is well documented in the literature. (2002 WHO, APNA 2008, ANA 2010, ENA, 2010) However, there is very little written describing the use of a behavioral emergency response team and it’s effectiveness in managing violence.
It is our goal to do so.

1034: Military Mission, Culture, and Psychopharmacologic Considerations CDR Sean P. Convoy, PMHNP, BC;  CDR Jean F. Fisak, NC, USN, PMHCNS-BC

Abstract
This presentation will review service specific military missions and cultural considerations associated with military service, examine common stressors and the influence of mental illness stigma within the military, and introduce service specific prevention/intervention models. Additionally, the presenters will summarize rules of engagement for prescribing psychotropic medications to military service members.

1035: Cognitive Behavior Therapy in Nursing Practice
Sharon Freeman-Clevenger, PhD, PMHCNS-BC 

Abstract
Cognitive Behavior therapy (CBT) has been scientifically tested and found to be effective for a wide variety of clinical disorders in over three hundred clinical trials. CBT is focused on the present, is time-limited, and more focused on problem-solving solutions for current problems, than other psychotherapies. Through a process of collaborative empiricism, patients learn specific skills that identify distorted thinking, and inaccurate or dysfunctional beliefs. Through homework, involving behavioral and/or cognitive experiments, patients learn alternative ways of relating to others resulting in changes in behaviors, emotions and distressing thoughts. The Cognitive Model is based on the theory that identifying distressing thoughts, evaluating these thoughts for how realistic the thoughts are, and actively changing distorted thinking results in improvement in symptoms. Basically, when we think more realistically, we feel better.
This workshop will review the Cognitive Model, provide an overview of the structure of a typical CBT session and demonstrate the use of CBT in real world situations.

1036: Pushing the Point: Integrating Acupressure and Chinese Medicine in Psychiatric Nursing Practice
Jaclyn Engelsher, APRN, DOM; Adam Margolis, MSN, MSTOM, ANP-BC, L.Ac.

Abstract
With the rising costs of care, decreased reimbursement for services and shortage of mental health clinicians, patients and providers are increasingly researching and incorporating integrative therapies as part of a holistic care plan.
A review of the literature revealed a growing evidence base for the integration of Traditional Chinese Medicine (TCM) therapies with allopathic medicine. This has prompted nursing schools across the country to include education on TCM in their curriculums, encouraged hospitals and clinics to add TCM therapies to their list of psychiatric services, and resulted in development of new protocols for addiction, PTSD, and pain management.
Acupressure, a component TCM, is a non-invasive, integrative modality that can help alleviate common symptoms such as stress, anxiety, depression, mental fatigue, and insomnia, while reducing barriers of cost, time, and deleterious medication side effects frequently found in PMH treatment.
A basic understanding of TCM theory is necessary for nurses to teach and use acupressure effectively in the inpatient and outpatient settings. The session will review the function and energetics of common acupoints easily integrated into Psychiatric/Mental Health nursing practice, provide a live demonstration of acupressure techniques, and include supervised practice time to develop beginning skills and experience the benefits.

1041: Finding Our Voice: Building Advocacy Skills to Advance Psychiatric Nursing
Ruth Staten, PhD, ARNP-CS, PMHCNS-BC; Beth Phoenix, PhD, RN, CNS

Abstract

Psychiatric nurses must become effective advocates for our profession and our patients to reduce stigma around mental illness, promote quality care, affect health policy and improve access to mental health services. This interactive workshop will begin with a brief overview of agency (exertion of power on behalf of patients and nurses) and advocacy, followed by hands-on, interactive practice with developing advocacy messages for different situations. From Silence to Voice (Buresh & Gordon, 2006) will be used as a resource to guide development of three types of advocacy messages:
•Anecdotes—stories that demonstrate how psychiatric nurses’ professional expertise is utilized to create positive outcomes for patients, their families or the public;
•Elevator speeches—brief persuasive statements explaining the value of our work;
•Bumper stickers—short catchy messages that make a point.
The session will conclude with a discussion of how we can continue to use the advocacy materials developed during the workshop.

1042: Cultivating Mindfulness and Self-compassion: An eight week program for patients with depression and/or anxiety
Nasrin Falsafi, RN, PhD, PMHCNS-BC, AHN-BC

Abstract
The connection between mind and body is well documented. Both depression and anxiety have symptoms that affect the body and mind. Self-regulation and calming down are essential methods to cope with anxiety and/or depression. Mindfulness practices such as sitting meditation, walking meditation, mindful eating are practices that help one to calm the mind and body. There is an increased interest in adding sensory-motor processing interventions to traditional treatments for depression, and anxiety . Body awareness practices such as yoga has been promising in using the body to calm the mind. More recently the concept of self-compassion is being used with anxious and depress clients. It is indicated that self-compassionate individuals experience greater psychological health than those who lack self-compassion. This presentation will introduce participants to a variety of mindfulness- based practices that can be used with clients suffering from depression and/or anxiety. Mindfulness practices including sitting meditation, mindful eating, walking meditation, body awareness, and loving kindness meditation will be discussed and practiced. The application of these practices in an eight- week program for patients with depression and/or anxiety will be discussed.

1043: Critical Incident Stress Management: Caring for the Caregiver
Nancy Dillon, PhD, RN, CNS

Abstract
The MN Department of Human Services, State Operated Services, is a geographically dispersed provider of a continuum of services, acute and sub-acute, to adults and children with psychiatric, chemical dependency, development disabilities and other diagnoses.
This organization had, historically, provided on site de-briefing services following a critical incident in which either a staff person or person served had been assaulted or injured. Employees had been trained in de-briefing and used quite effectively. When the system de-centralized the program was no longer functional: staff had moved on, finding a resource person was challenging and required the de-briefer to travel long distances along with providing coverage for the person responding. The need to develop a new way of providing these services was identified by the author and a physician colleague who were conducting reviews of incidents. The author developed and facilitated a work group representing various employee groups, sites and populations served to review current best practices, identify strategies and a process to use to ensure that staff is supported. We will report on the work group outcomes, processes developed, successes and challenges

1044: Autism Spectrum Disorders and Psychopharmacology: Planning for Success while Managing Expectations Julie Carbray, PhD, PMHCNS-BC

Abstract
This presentation will identify key symptoms of autism spectrum disorders (ASD) and review best practices for psychopharmacologic management of ASDs in children and adolescents. Evidence supporting the use of atypical antipsychotics, antidepressants, stimulants and non-stimulants, and complementary treatments will be reviewed. Clinical pearls, expectations for treatment, family psychoeducation, and collaborative problem solving around treatment goals will also be highlighted offering the context for work with children and adolescents with ASDs.

1045: Psychopharmacotherapy in Psychotherapy Practice
Lisabeth Johnston, PhD, APRN-BC

Abstract
Prescribing needs in the context of a psychotherapy relationship have become integral to psychiatric APRN treatment. This can create a conflict between the non-directive accepting role used to successfully treat patients in psychotherapy and the didactic, structured and sometimes authoritarian position traditionally taken in pharmacotherapy assessment and prescribing. This dual role of psychotherapist and pharmacotherapist can require a "shift in gears"(Gutheil, 1982)that can be difficult for APRN and patient and must be negotiated in a way that the patient feels trusting and safe.
Mintz (2005) stated that there has been much emphasis on what to prescribe and too little focus on how to prescribe. Bailey (1999) described the therapeutic alliance as vital to successful prescribing practice. The therapeutic alliance can be used in both components of the therapeutic work to achieve an integration of psychotherapy and pharmacotherapy treatments.
This presentation describes the role of the therapeutic alliance in integrating prescriber/psychotherapist roles at initial, working and termination stages of a psychotherapy relationship. The prescriber role in psychotherapy is elucidated from both the integrated and the split models of prescribing (Beitman, 1991, Riba and Balon, 2005).
APRNs can improve patient outcomes,demonstrate leadership and give direction in the field by improving these techniques.

1046: The Neurobiology of Therapeutic Neuromodulation: Implications for Psychiatric-Mental Health Nurses
Berry Anderson, PhD, RN; Mary Rosedale, PhD, PMHNP-BC, NEA-BC; Donna  Ecklesdafer, MSN, RN; Sonya Williams-Joseph, MSN, PMHNP-BC

Abstract
Emerging brain stimulation techniques are providing new insights into brain function and therapeutic options for the treatment of mood and other disorders. Recent advances in ultra-brief pulse wave electroconvulsive therapy (ECT) shows a reduction in side effects with similar efficacy as traditional ECT. Transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS) are FDA approved for the treatment of depression, but they continue to be refined. While deep brain stimulation (DBS) remains a research technique for mood disorders; movement disorders and OCD are approved uses. Transcranial direct current stimulation (tDCS) is showing promise in treating mood disorders and pain. Nurses play a vital role in each of these brain stimulation techniques by providing the treatment, managing the implanted devices, and caring for patients before and after the procedure.
The course presenters will discuss various brain stimulation methodologies with a focus on mechanisms of action, safety, and efficacy. We will explore the emerging roles of psychiatric nurses in brain stimulation development, clinical application, and research.