Annual Conference Friday Morning Abstracts

3001: Keynote Presentation: Life On Purpose: How Living for What Matters Most Changes Everything
Victor Strecher, PhD, MPH

Socrates said that an unexamined life isn't worth living. Aristotle went further to say that a purposeless life isn't even worth examining. Vic Strecher examines the importance of purpose to health and well-being, and ways of even worth examining. Vic Strecher examines the importance of purpose to health and well-being, and ways of creating greater life purpose. His presentation spans ancient philosophy to the latest scientific research.


3011.1: Is My Anxiety Normal? A Comparison of Normal Anxiety Compared to Anxiety Disorders as well as Good Health Practices and Treatments for Anxiety Experienced at the Primary, Secondary, and Tertiary Levels
Tresa Glaser, BSN, RN; Clarissa Riches, BSN, RN; Ariana McDonald, BSN, RN; Kay Brinkopf, BSN, RN

PURPOSE: Anxiety disorders are increasingly prevalent, having significant impact on the well-being of individuals and populations. According to the National Institute of Mental Health (NIMH), approximately 18.1% of American adults are affected by anxiety disorders with an even greater number experiencing normal everyday anxiety. Current barriers to treatment for anxiety include social stigmas, shame, and inadequate individual and provider education in appropriate treatment practices for anxiety. SUMMARY OF EVIDENCE: Early management of anxiety will reduce mental health burden in our communities (NIMH). VALIDATION OF EVIDENCE: Discussed practice recommendations are validated by Diagnostic and Statistical Manual of Mental Disorders (DSM) with additional support from NIMH and ADAA. Further support is gained from the “Transactional Theory and Research on Emotions and Coping” by Richard Lazarus and Susan Folkman. This theory emphasizes self-appraisals allowing for individual evaluation of anxiety leading to appropriate treatment. IMPLICATIONS: Individuals and healthcare professionals will recognize normal anxiety compared to anxiety disorders, allowing for proper assessment, diagnosis, and treatment.


3011.2: Using Mobile Health Technology to Assess for Distress
Veronica Decker, DNP, PMHCNS-BC, MBA, MS, RN, BSN

PURPOSE: Distress screening and treatment programs are now a requirement for accredited cancer centers across the nation. To help programs meet this requirement, we developed a novel distress management expert system software program to assess the patient’s distress and immediately recommend individually-tailored evidence-based psychosocial coping strategies and referrals. This program can be used with non-cancer patients too and maybe valuable in a busy primary care clinic. SUMMARY OF EVIDENCE: This program used a well vetted distress assessment tool as well as EBP coping strategies. Evidence from a pilot project indicates that it was feasible in an oncology practice with both NP and MD providers. VALIDATION OF EVIDENCE: The author has validated this program through a pilot project which was published in JCON February 2016. IMPLICATIONS: An automated program that provides a clinically validated tool for assessment of distress, as well as treatment and referral options may be the best option for busy practices.


3012.1: What is the Secret? Open the Medical Record!
Loralie Woods, MSN, RN-BC; Gretchen Smith, RN-BC; Diane Mcgrogran, LCSW, MSW; Vanessa Kurzon, MSN, RN

PURPOSE: Hospitalized patients and their families are not optimally involved in the decisions that impact their care. The implementation of an Open Medical Record Program (OMRP) has empowered patients to take an active role in their recovery. SUMMARY OF EVIDENCE: The Institute of Medicine advocates for unrestricted patient access to medical records. Furthermore, the Federal Health Insurance Portability & Accountability Act of 1996 stipulates that “patients must be able to see and get copies of their records”. In a descriptive study of psychiatric inpatients, 85% felt that open access to records helped them “take a more active role in treatment” and 71% felt more confident as a result. VALIDATION OF EVIDENCE: Metrics included whether nurses invited patients to participate in the OMRP. Secondly, leadership conducted structured rounding to ensure accountability & identification of barriers to the program. Thirdly, patients who participated in the OMRP were interviewed to evaluate knowledge and level of involvement with their plan of care. IMPLICATIONS: Psychiatric nurses using a patient-centered collaborative approach fosters patient engagement and healing. Open up the record, it is the right thing to do for our patients!


3012.2: Innovative Simulation Training for Managing Agitated Patients
Caroline Stewart, MSN, RN; Lesli Reeves, MSN, RN, PMHNP-BC

PURPOSE: Employees expressed concerns for more efficient opportunities to apply Crisis Prevention Intervention (CPI) verbal and physical de-escalation skills with agitated patients. Employees are trained annually in CPI and require refresher courses annually thereafter. The expectation is to apply skills learned in the training to crisis situations that occur on the unit. SUMMARY OF EVIDENCE: The clinical education staff was able to objectively debrief with staff after psychiatric crisis events. Common issues identified were difficulty with verbal and physical de-escalation, communication, leadership and teamwork. VALIDATION OF EVIDENCE: A post evaluation survey was completed by participant’s revealed improved communication with patients and teams and role clarity during crisis. Coaching during the “live” simulation experience helped the students establish a common language when physically de-escalating. IMPLICATIONS: RCDP simulation proved an effective teaching tool for improving verbal and physical de-escalation skills, improving teamwork and communication, and leadership. Further evaluation needed to assess effectiveness for reduction in restraints, staff and patient injuries and reduction of psychiatric emergency calls.


3013.1: Alcohol Infusion Program as Part of Recovery Curricula
Marian Farrell, PhD, PMH-NP, BC, CRNP

PURPOSE: The presentation describes infusion of concepts related to alcoholism and the Recovery Model throughout undergraduate nursing curriculum as it pertains to anxiety, mood, schizophrenia, and substance use disorders. Discussion of media and research as learning tools will be included,in addition to, reflection as a learning activity which helps students realize who they are becoming as both a person and as a nurse. SUMMARY OF EVIDENCE: Alcoholism is seen as an isolated topic, affecting "those people." VALIDATION OF EVIDENCE: Nurses need to improve their knowledge of alcoholism, potential co-morbidity. IMPLICATIONS: Nursing education needs to provide the foundation for understanding the complex disorder of alcoholism.


3013.2: Substance Use Disorder Among Nurses: Quality Improvement In Pre-licensure Nursing Education
Dina Stewart, BSN, RN, PHN

PURPOSE: To incorporate education about substance use disorder (SUD) among nurses into pre-licensure curricula to improve the student nurses’ knowledge, skills, and attitudes regarding SUD among nurses. SUMMARY OF EVIDENCE: As of September 2016, approximately 400,000 nurses in the United States experience SUD, posing a significant risk to patient safety. Nurses with SUD are under supported by employers and peers. Lack of education regarding SUD among nurses is a major risk factor; despite this, SUD is inadequately addressed in pre-licensure nursing programs. VALIDATION OF EVIDENCE: Attitudes regarding SUD were measured before and after the intervention using the Perceptions of Nursing Impairment Inventory (PNII). Additionally, knowledge was measured post module with a quiz. All students participated in a discussion regarding a case study. IMPLICATIONS: Content regarding SUD among nurses in pre-licensure nursing education introduces an important practice issue. Education regarding prevention and awareness of SUD in nursing improves nursing student attitudes toward nurses with SUD.


3014.1: Kids First: A Pilot Study of Mindfulness and Emotional Well Being for Preschool Children
Christine Moriconi, PsyD, LMFT, PMHCNS-BC

PURPOSE: Purpose is to develop awareness of use of mindfulness with younger children to promote mental health and the nursing role. Problem is that often issue of emotion regulation is not addressed leading to low self esteem, decrease in ability to concentrate and emotional and social learning. SUMMARY OF EVIDENCE: Well- being and mental health of children is dependent on parents and caregivers who are critical to their psychological , emotional health and development. Parents and teachers learning to regulate themselves with mindfulness skills will foster emotion regulation for preschool children and improve mental health. VALIDATION OF EVIDENCE: Questionnaires will be: Strengths and Difficulties Questionnaire (for children by parent and teacher), Five Facet Mindfulness Questionnaire (for parents and teachers), Perceived Stress Scale (for parents and teachers) IMPLICATIONS: Use as a sustainable intervention in all preschools but will begin with high risk families and students. Increase in emotion regulation will increase attention, stress management in family system and promote mental health.


3014.2: A Clinical "Toolbox" for Intellectually Disabled Adults and Their Caregivers
Stacy Stark, MSN, RN; Ann Mitchell, PhD, RN, FAAN

PURPOSE: Purpose: The purpose of this project is to provide clinical resources to staff who work with patients with Intellectual Disabilities (ID) or Autism Spectrum Disorders (ASD). SUMMARY OF EVIDENCE: Summary of Evidence: Adults with ID/ASD admitted to general units (instead of a specialized unit) may have difficulties including: aggression, self-injurious behaviors, need for medications, seclusion, or restraint. Behavioral interventions have been shown to be effective for improving adaptive behaviors and social skills and reducing aggression (Dawson & Burner, 2011). VALIDATION OF EVIDENCE: Validation of Evidence: Eleven ID/ASD male patients, average age 29 years, were admitted to general adult units. Twenty-six (26) staff completed surveys and agreed that the Toolbox: provided new resources 14 (54%); improved quality of care 13 (50%); was useful in reducing agitation/aggression 11 (42%); and helped staff feel comfortable with ID/ASD patients 11 (42%). IMPLICATIONS: Future Implications: Implications can include extending to use with other behavioral health patients and to different care settings (medical/surgical, primary care).


3015.1: Exploring the Predictors of Motivation to Work with Individuals Who Use Alcohol: A Focus on the Nursing Profession
Khadejah F. Mahmoud, MSN, RN; Dawn Lindsay, PhD; Ren Dianxu, PhD; Kathryn R. Puskar, DrPH, RN; Ann. M. Mitchell, PhD, RN

PROBLEM STATEMENT: Substance use disorders are considered a public health issue, significantly contributing to economic burden and increased rates of mortality and morbidity in the United States. Unfortunately, nurses’ low motivation to work with individuals who use alcohol is considered a main barrier to screening for alcohol use problems. METHODS & DESIGN: A secondary analysis employing a cross-sectional design was used. A sample of 1202 undergraduate, graduate and professional nurses’ baseline data from five studies was used. Nurses’ personal and contextual factors were measured using Alcohol and Alcohol Problems Perception Questionnaire. RESULTS: Hierarchical regression revealed that personal factors (age, gender, professional status, ER workplace and group affiliation) contributed significantly to the regression model, (F (14, 1187) = 16.625, p< .05) and accounted for 15.4 % of the variation in Motivation. Meanwhile, contextual factors (role legitimacy, task-specific self-esteem and work satisfaction) contributed significantly to the model and explained an additional 31.9 % of variation in Motivation, (F (19, 1182) = 57.727, p< .05). When all independent variables were included in the model, they accounted for 47.3% of the variance in Motivation. IMPLICATIONS: This study’s findings may promote our understanding of nurses’ motivation to work with this patient population and facilitate future modification in education and training that can target it. Future studies can use this study as a basis to explore other factors that influences nurses’ motivation to work with individuals who use alcohol. 


3015.2: Alcohol Use Disorder, Psychosis, Obesity, and Diabetes: A Case Study of Complexity
Philippa Ashford, MSN, RN

PURPOSE: Psychiatric nurses face challenges pertaining to outcomes-driven treatment planning for patients with complex illness presentations. Such an example will be presented as a case study: a patient with alcohol use disorder, psychosis, obesity and diabetes. SUMMARY OF EVIDENCE: Clinical reasoning strategies, sound theoretical underpinnings, and application of evidence-based practices (EBP) are needed to support optimal treatment planning. The Outcome-Present State-Test (OPT) Model of reflective and clinical reasoning is based on complexity reasoning. The OPT model facilitates recognition of the relationships among various health-illness concepts and supports integration of multiple health concerns. Research reports demonstrate effectiveness for Acceptance and Commitment Therapy (ACT) for a number of psychiatric and medical conditions. Brief interventions using ACT have been demonstrated to be useful in treating patients with alcohol use disorder, psychosis, weight gain and diabetes. VALIDATION OF EVIDENCE: Evidence supporting this practice was evaluated based on a critique of existing studies, theoretical reasoning, and clinical outcomes. IMPLICATIONS: Research and education are needed to address continued refinement of clinical reasoning strategies and EBP to support the care of complex clinical presentations.


3016.1: Association of Maternal Self-Report and Observational Data During The Postpartum Period: The Case for Subjective and Behavioral Measures
Semira Semino-Asaro, PhD, RN, PMHCNS-BC

PROBLEM STATEMENT: Research focused on human behavior is strengthened by combining self-report and observational measures. THEORETICAL FRAMEWORK: Guided by Tronick’s Mutual Regulation Model, this analysis included behavioral measures (maternal gaze and affect) coded from videotaped interaction of mother-infant dyads during the Face-to-Face Still-Face procedure and maternal self-report data. METHODS & DESIGN: Convergences and discrepancies between maternal self-report data and objective behavioral measures were examined. RESULTS: Results indicated a significant negative association between the Life Stress subscale scores of the PSI and maternal affect (r = -0.25, p = .013) during the Reunion Play episode of the FFSF procedure indicating that as life stressors increased, the proportion of maternal positive affect responses decreased during Reunion Play; the time in which mother and infant attempt repair after a period of disengagement, represented by the mother’s still face. Regression analysis model comparisons using the predictors of parenting stress, depression, and anxiety scores indicated that only the model that included the subscales of the PSI was found to be a significant predictor of the outcome variable, maternal affect. IMPLICATIONS: This study demonstrates that the addition of behavioral data related to the FFSF paradigm has the potential to reveal whether maternal subjective experience captured by questionnaire responses come into play given the boundaries and constraints of a particular stressful and/or challenging relational condition.Collective results support the importance of mixed methods approaches in behavioral research.


3016.2: Improving Outcomes by Infusing Innovative and Creative Ideas into Caring for Older Adults - The Influence of Nurses Improving Care for Health System Elders (NICHE) on a Geriatric Psychiatric Nursing Unit
Kimberly Barnes-Ayers, BSN, MAEd, RN-BC

PURPOSE: The geriatric patient population is growing rapidly and the healthcare industry must be prepared to meet the needs of this silver tsunami. Our inpatient geriatric psychiatric unit had staff working on the unit who weren't prepared to optimally care for the geriatric patients. Our hospital is a member of the Nurses Improving Care for Health System Elders (NICHE). SUMMARY OF EVIDENCE: NICHE tools and principles can exert an important influence over the care provided to older adult patients by increasing the organizational support for geriatric nursing. (Bolts, et. al 2008). VALIDATION OF EVIDENCE: The effectiveness of the direct caregivers utilizing NICHE initiatives is reflected in employee engagement scores as well as patient/family satisfaction results. The number of patients requiring restraints dropped significantly over the past 3 years *(the length of time the direct care staff have been involved with the NICHE initiatives. IMPLICATIONS: We have tapped two more direct care providers, provided them protected time and support for them to become educated in the NICHE program and graduate as Geriatric scholars.


3017.1: A Greater Good: Collaboration Between Law Enforcement and Acute Care Hospital Systems
Inga Giske, MSN, RN-BC, NE-BC; Tyler Whitely, MHRT

PURPOSE: Share how we expanded a collaborative model of care in the community with Law Enforcement and Community Mental Health to include the Acute Care Hospital System. SUMMARY OF EVIDENCE: Individuals in crisis often interact with community mental health, law enforcement and acute care hospital systems. These three systems frequently have very different cultures and practices which can lead to a lack of collaboration and sharing or practices as well as lapses in communication resulting in negative outcomes for individuals in crisis. VALIDATION OF EVIDENCE: We do not have specific metrics we are tracking. However, we meet monthly to assess how work and communication is going as well as identify opportunities for further work. IMPLICATIONS: We continue to work to standardize assessments and safety planning to improve communication and handovers when allowed within HIPAA.


3017.2: The Prison Project: Attitudes Toward Prisoners in a Nursing Student Population
Tara Haskins, DNP, RN; Dewanna Blake, MSN, RN

PURPOSE: A maximum-security prison approached nursing faculty requesting participation in their annual resource fair. Having never utilized a correctional setting, faculty was curious about student perceptions and attitudes regarding the prison and inmates. Would participation in community service at the prison change the nursing students’ attitudes toward prisoners? Was there any correlation to the student’s demographics, degree of empathy and attitudes toward the prisoners? SUMMARY OF EVIDENCE: Literature searches revealed a dated precedent of nursing education in correctional settings. Past research regarding nursing empathy and attitudes towards prisoners suggested an opportunity to explore implications for nursing students working with prison populations. VALIDATION OF EVIDENCE: Student participation was voluntary. Anonymous pre and post surveys were collected with the inclusion of a control group for the intervention. Statistical analysis evaluated demographic and correlational statistics for the demographic variables, JES-HP scores and ATPS scores. IMPLICATIONS: Coordinated community projects in prisons provide students a clearer understanding of precautions, security and potential for violence in forensic populations. Students see first hand the role of the correctional nurse. Future research will be an expansion of the pilot study.


3021: See Me, Hear Me: Diagnosing and Treating Anxiety in Racial & Ethnic Minorities with a Culture of Care
Teresa Combs, PhD, APRN, BC

PURPOSE: This presentation will provide an overview of symptom expression for anxiety in Racial/ethnic minorities. Recognizing the difference may result in more accurate diagnosis improved treatment and healthier outcomes. The sparse literature suggest that racial/ethnic minorities are under diagnosed with anxiety. SUMMARY OF EVIDENCE: White providers are frequently unfamiliar with the symptom nuances of anxiety among racial/ethnic minorities. Consequently these populations are at a greater risk for misdiagnosis. Misdiagnosis often result in inappropriate treatment mistrust and early termination of treatment. VALIDATION OF EVIDENCE: The evidence associated with this presentation was an extensive review of the literature (ROL) as well as current practice. Review of literature. IMPLICATIONS: That PMH nurses and NP’s make a deliberate effort to address cultural specific symptoms of anxiety when working with racial/ethnic minorities. That PMH nurses will employ the Culture of Care theory to frame their practice.


3022: Essential RN Competencies for the Induction and Maintenance of Opioid Replacement Therapy
Janet Standard, DNP, PMHNP-BC; Michelle Knapp, DNP, PMHNP-BC

PURPOSE: Approximately 3 million people in the United States are diagnosed with opioid use disorder (CDC, 2017). Statistics indicate that opioid overdose has overtaken car accidents as the leading cause of accidental death in the US. (CDC, 2017) The Comprehensive Addiction and Recovery Act was signed into law in 2016 to increase access to care for millions of people. While the scope of practice and availability of training for nurse practitioners has increased with the advent of the law, there has been no documented plan to escalate training for the registered nurse (RN) in opioid replacement therapy (ORT). SUMMARY OF EVIDENCE: Literature indicates that RN’s lack clearly defined roles in ORT. There is an urgent need to increase comprehensive education of nurses to ensure that they are adequately prepared to care for individuals in all phases of ORT. VALIDATION OF EVIDENCE: Integral parts of ORT assessment include procedures determining opioid use, interpretation of urine toxicology screenings, integration of the Clinical Opioid Withdrawal Scale and identification of patients with co-morbid medical and psychiatric conditions. IMPLICATIONS: Education in evidence based competencies of ORT will ensure that the RN becomes an integral part of the health care team in ORT.


3023: Utilizing Telehealth to Overcome Clinical Site Challenges
Stephanie Wynn, DNP, RN-BC, PMHNP-BC, COI

PURPOSE: As access to mental health care in rural areas is a problem across the nation, remoteness and limited specialties in clinics often cause barriers in their use as clinical sites.Telehealth was used by students and providers as an innovative, educational tool to improve satisfaction of care of clients in a rural clinical practice setting. SUMMARY OF EVIDENCE: Ensuring quality mental health nursing education for students in rural areas can be challenging.The distance of the clinical sites are often outside of the parameters allowed for student travel. Additionally, many rural health clinics do not have providers to offer mental health care. VALIDATION OF EVIDENCE: Clients completed the Telehealth Satisfaction Scale. Exploratory factor analysis of the data was conducted using the principal components analysis extraction method. Scores averaged 3.65 on a 4-point Likert scale, indicating high satisfaction. IMPLICATIONS: As telehealth increases its role in rural health care delivery, it will be increasingly important to develop evidence-based innovative telehealth strategies to prepare nursing students.


3024: Developing the Next Generation of Psychiatric Mental Health Nurses: A Program for Nursing Students as Mental Health Assistants/Technicians
Sally Ann Corbo, Ed.S, PMHCNS-BC, NEA-BC

PURPOSE: Financial constraints and labor agreements have limited the opportunities for students as interns / externs. This session will present a unique program to train students as MHA/MHT's in psychiatric settings. SUMMARY OF EVIDENCE: Professionally we need to create opportunities for students to experience psychiatric nursing as a career path. Nursing students with an interest in psychiatric nursing have limited opportunities as interns/externs. Hospitals and facilities often have per diem positions that are unfilled and staffing in the summer could be supported by students looking for summer employment. VALIDATION OF EVIDENCE: Qualitative interviews from participants and retention data will be shared. IMPLICATIONS: The program can cultivate the next generation of psychiatric mental health nurses.


3025: When Food Controls a Mother's Love: Recovered Anorexic Mothers Feeding their Children
Carrie Eaton, MSN, RNC-OB, PhD(c)

PROBLEM STATEMENT: There are invisible wounds in a recovered anorexic mother that can resurface when faced with feeding a child everyday. Recovered anorexic mothers often have ongoing concerns and dilemmas around food that are difficult to verbalize, yet there is stigma associated with asking for help. THEORETICAL FRAMEWORK: The concept of parental behavior on child development. METHODS & DESIGN: This study utilized Colaizzi's (1978) descriptive phenomenological method underpinned by the philosophy of Edmund Husserl.  An unstructured interview process consisting of an open-ended question started the interview and was helped to facilitate the collection of rich data and poignant experiences. RESULTS: Using Colaizzi's procedural steps of analysis, six themes of meaning were explicated in the pilot study. These six themes, when combined as a whole, described the true essence of the journey of recovered anorexic mothers who are faced with feeding their children everyday. The themes from the comprehensive dissertation are yet to be determined. IMPLICATIONS: For moms with a history of anorexia nervosa the process of forging a healthy relationship with feeding their children requires healthcare providers to extend emotional support, dietary guidance, counseling referrals when needed, and most importantly, an educated and non-judgmental attitude.Future research warrants an in-depth look at of the children of parents with a history of an eating disorder. In addition, research will benefit from expanding the population outside of anorexia to include the impact of other eating disorders.


3026: Prevention of Sexual Violence with Bystander Education
Kerry Peterson, PhD, DNP, PMHCNS-BC, PMHNP-BC, RN

PURPOSE: Sexual violence is a serious and prevalent public health problem among adolescents and young adults, especially on college and university campuses. It is important that mental health nurses be knowledgeable about sexual violence and evidence-based strategies to address the problem. SUMMARY OF EVIDENCE: It is estimated that one in five women experience attempted or completed sexual assault while in college. Sexual violence results in numerous negative physical and mental health outcomes with potential long-lasting implications. Due to the high prevalence and substantial impact on health and well-being, it is necessary to address sexual violence at all levels of prevention. VALIDATION OF EVIDENCE: Evidence suggests that bystander education programs have significant value for sexual violence prevention. This presentation will provide an overview of bystander education theory and concepts, review of selected evidence-based bystander programs, and discussion of strategies that mental health nurses can utilize for sexual violence prevention efforts. IMPLICATIONS: Bystander education is a promising and innovative approach to sexual violence prevention with significant implications for mental health nursing practice, policy, and future research.


3027: Creation and Implementation of a Crisis Stabilization Service in a Community Safety Net Hospital in Chicago, IL
Evelyn Norton, DNP, APRN, PMNP-BC; David Martucci, BSN, MS, MBA Candidate

PURPOSE: Sinai Health System consists of four hospitals located in the economically depressed, high crime areas of Chicago. Holy Cross Hospital on the city's south side is developing a new approach to mental health care. The high levels of violence, poverty, and substance abuse have led to a need for mental health services in the area. Partnering with multiple agencies including law enforcement, the goal is to link people with needed mental health services, and provide immediate crisis intervention while reducing inpatient admissions, decreased boarding time in the ED and decriminalizing mental health care. SUMMARY OF EVIDENCE: Boarding rates of people with MH issues in the ED were increasing. A lack of community resources to provide mental health care. The ED setting is not a therapeutic environment for mentally ill persons. VALIDATION OF EVIDENCE: Looking at decreased boarding time in the ED, time to reaching a therapeutic space, door to diagnostic time with provider, decreased LOS in the inpatient environment, and percent deferred to a less restrictive level of care.. IMPLICATIONS: The CSU is expanding and being moved from the 6th floor to across from the ED

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