Annual Conference Friday Block 2 Abstracts

3031: Starting a Private Practice: Some Things to Consider
Allen Novak, MSN, APRN, Rx, PMHCNS-BC

PURPOSE: The purpose of our proposed 2 part presentation is to inform PMH APRNs about common private practice models as well as basic considerations that are essential for anyone entering private practice. SUMMARY OF EVIDENCE: It is well known that there is a critical shortage of psychiatric clinicians who can prescribe. This shortage has led to delay in follow up for individuals being discharged from inpatient mental health facilities as well as to an unacceptable wait time those who are trying to initiate outpatient treatment. PMH APRNs are uniquely qualified to provide economical, comprehensive expert care to individuals of all ages and across a spectrum of mental illnesses. While PMH CNS were among the first APRNs to practice independently, most PMH APRNs have worked in inpatient settings, outpatient settings where their practice was exclusively psychotherapy. The past decade has seen more APRNs enter physician-owned and managed private practices, but mentoring done exclusively by physicians has resulted in a medical model of care. VALIDATION OF EVIDENCE: Presentation will be led by members of the APRN Practice Steering Committee who have extensive experience in being in private practice IMPLICATIONS: As more PMH APRNs gain experience in private practice, they will be in a unique position to mentor less experienced PMH APRNs in how to start and run successful private practices of their own.


3032: Not Your Dad’s (or Mom’s) Cigarettes Anymore: Assessing Tobacco Use Accurately Supports Successful Treatment
Carol A. Essenmacher, DNP, C-TTS

PURPOSE: Effective treatment is founded on knowing and understanding the problem, in this case, tobacco and nicotine addiction. Individualized, effective care is also based on the nuances of the individual’s addiction “story.” This session provides participants with essential knowledge and skills to routinely complete an accurate tobacco and nicotine assessment. Insight into communicating effectively with patients to lower treatment resistance is presented. SUMMARY OF EVIDENCE: Nurses often report feeling a lack of confidence in delivering effective tobacco education and interventions. They are vulnerable to inaccurate myths about quitting and the use of medications (Duffy et al., 2014; Prochaska, 2013; Shahab et al., 2018). Yet when nurses are adequately educated and trained, they provide effective tobacco treatment interventions. VALIDATION OF EVIDENCE: Researchers (Duffy et al, 2012; Mendelsohn, 2013; Prochaska & Grana, 2014) document the lack of consistent dissemination and translation to practice of effective nursing interventions to treat tobacco use. This session will be evaluated via audience feedback and use of resources. IMPLICATIONS: Morbidity and Mortality amongst persons living with mental illnesses will be reduced as tobacco and nicotine dependence is effectively treated.


3033: Beyond the Straight Jacket: Time for a Reframe in Psychiatric Nursing
Lisa Burton, PhD, PMHCNS-BC

PURPOSE: The purpose of this presentation is to examine why the majority of nursing students are not interested in working in mental health; to emphasize why the skill set of psychiatric nursing is critical and to attract nurses to become mental health providers SUMMARY OF EVIDENCE: Nurses who do not choose psychiatric nursing as a specialty are still treating psychiatric patients with 50% of psychiatric patients having comorbid medical problems (Iacovides & Siamouli, 2008). VALIDATION OF EVIDENCE: Personal experience, attitudes towards psychiatry and negative career prospects (Ong et al., 2017) are reasons for rejected this specialty. With the current focus on mental health as it relates to mass shootings, there is an opportunity to interest nurses in our specialty. IMPLICATIONS: It is estimated that 46% of the American population will experience some form of mental illness in their lifetime (Galson, 2009). Mental illness is a terminal disease. There is a global shortage of all mental health professionals. (Yanchust et al., 2017). The need to train, retrain and retain nurses with psychiatric nursing skills should be a public health priority


3034: Dementia - A Case Study in Differential Diagnosis

PURPOSE: The purpose of this presentation is to build skills in differential diagnosis of dementia, especially Lewy Body Dementia, and to understand consequences of misdiagnosis to patients and families. SUMMARY OF EVIDENCE: Lewy Body Dementia is a common form of dementia with some characteristics of both Parkinson's Disease and Alzheimer's Dementia. Failure to correctly diagnose patients results in treatments that increase symptoms, shorten life spans, and alienate patients and families from the health care provider. VALIDATION OF EVIDENCE: Enhanced skill in differential diagnosis results in appropriate treatment strategies with reduced symptoms and side effects for patients, and reduced conflict and anxiety for families. IMPLICATIONS: Improved skill in diagnosis and treatment of LBD results in fewer treatment errors, improved patient/family/caregiver relationships and reduced conflict, mistrust and potential legal action.


3035: Impact of Nurse Practitioner Scope of Practice Regulation on Psychiatric Mental Health Nurse Practitioner Practice
Bethany J. Phoenix, PhD, RN, CNS, FAAN; Susan A. Chapman, PhD, RN, FAAN; Christopher Toretsky, MPH

PROBLEM STATEMENT: Shortages of behavioral health providers, particularly prescribing clinicians, are widespread across the US. Although rapidly increasing numbers of Psychiatric Mental Health Nurse Practitioners (PMHNPs) can potentially increase access to behavioral health services, state limitations on scope of practice may restrict their ability to do so. THEORETICAL FRAMEWORK: Interest group theory is used to examine impact of NP scope of practice regulation on stakeholders including PMHNPs, health care agencies, patients and physicians. METHODS & DESIGN: Site visits and interviews were conducted with stakeholders including board of nursing staff, PMHNP practitioners and educators, behavioral health agency leaders and psychiatrists in five states with different levels of NP autonomy. Interviews focused on how state scope of practice regulations and other regulatory and agency policies impact patterns of PMHNP practice, education and compensation and their impact on health care access and quality. IMPLICATIONS: Future research could quantify how scope of practice regulation affects cost of behavioral health services and access to care.


3036: Thinking Outside the Box: Are we Ready for Teleprecepting to Expand Training and Practice Venues?
Deborah S. Johnson, DNP, APRN, PMHNP-BC

PURPOSE: to explore current and future utility of televideo technology in clinical training and preceptor development. SUMMARY OF EVIDENCE: Shortages of clinical sites with quality preceptors poses a significant challenge in APRN training. Rural communities struggle to secure providers, restricting their opportunities to train (and potentially recruit) new APRNs. Consequently, under-served communities have difficulty accessing psychiatric providers. Combined with geographic distance from urban communities and generally lower pay, many rural and/or remote communities are underserved versus more populated regions (OSHPD, 2014). VALIDATION OF EVIDENCE: A needs assessment of an underserved county revealed that contracted telepsychiatry was costly and not a long-term source of local psychiatric providers. Stakeholders proposed identifying local RNs and FNPs to be trained as PMHNPs with collaboration from the urban PMHNP program to provide education and local training. One strategy that emerged from the needs assessment was the use of televideo technology for clinical training and preceptor development. IMPLICATIONS: Pilot clinical guideline will be developed and implemented in California and replicated in other states to ensure that future clinical practice guidelines support successful implementation of telepsychiatric precepting.


3037: Protecting the Nursing Workforce through an Aggression Prevention Team (APT) and Behavior Alert (BA) Response
Debra Lee Fabert, MSN, RN, BC; Joseph Anderson, MBA

PURPOSE: Healthcare workers are victims of the highest numbers of workplace assaults (Department of Labor, 2011). The ANA petitioned OSHA to require mandatory programs to prevent workplace violence. Healthcare professionals are assaulted at a rate six times greater than all other occupations (Hackethal 2016). SUMMARY OF EVIDENCE: In 2015, a large academic health center noticed a 50% increase in violence with 191 security calls and 71 employee assaults.. Culture of Patient Safety scores were low, 3.39 out of 5. VALIDATION OF EVIDENCE: In our institution, 76% of assaults occurred against nurses and 64% were non-intentional due to altered mental status. The APT/BA response resulted in improved staff awareness and decreased assaults by 8%, which remained flat over a two year timeframe, while the rest of healthcare has seen a 50% assault increase (OSHA 2015). IMPLICATIONS: Nurses no longer need to be victims of workplace violence. Mental health professionals are uniquely positioned to assist healthcare facilities with proactive violence prevention.

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