Annual Conference Friday Block 1 Abstracts

3011.1: Pharmacogenetics Testing in Outpatient Mental Health Clinics
Tammie Gainey, PhD, APRN, FNP-BC, PMHNP-BC

ABSTRACT
PROBLEM STATEMENT: Pharmacogenetic testing is rapidly expanding in outpatient mental health settings. Very little is known about how these tests are actually being implemented and support precision medicine in the unique context of outpatient mental health practice. This study evaluated mental health clinicians’ perceived knowledge regarding pharmacogenetic testing, their attitude, receptivity towards, and confidence in pharmacogenetic testing, and how pharmacogenetic testing is being implemented to support decision making in outpatient clinics. THEORETICAL FRAMEWORK: Roger’s Diffusion of Innovation Theory (DOI) guided the proposed study. METHODS & DESIGN: The sample included 28 mental health clinicians who are currently using pharmacogenetic testing in outpatient mental health clinics. Participants responded to semi-structured open-ended prompts regarding knowledge, perceptions and implementation of pharmacogenetic testing in mental health outpatient clinics. Data were analyzed using a qualitative descriptive approach. IMPLICATIONS: Future research implications include shared decision-making around pharmacogenetic testing, medication adherence and tolerability, and setting guidelines for pharmacogenetic testing in mental health clinics.

 

3011.2: A Study of the Use of Psychopharmacologic Agents by Acutely Medically Ill Older Adults
Steven L. Baumann, APRN, NP

ABSTRACT
PROBLEM STATEMENT: What are the associations between commonly prescribed psychiatric medications that medically ill hospitalized older adults receive and adverse events? THEORETICAL FRAMEWORK: The concept of homeostenosis is used to explain the increased risk and incidence of adverse drug outcomes for psychiatric medications in medically frail patients. METHODS & DESIGN: This retrospective study utilized a computer algorithm employed by the hospital’s IT department to capture older adults (age 65 to 85) who received at least one of 12 commonly used psychopharmacologic agents while hospitalized for an acute medical problem on two medical/ surgical units (N = 271). IMPLICATIONS: Future studies should seek sample sizes greater than 300 to avoid the limitations of this study, to demonstrate efficacy differences between agent’s sample sizes over 1000 would probably be necessary, such as big data studies of similar patients from multiple hospitals could find the benefits and risks of one agent over another.

 

3012.1: Consent, Mental Illness & Stigma
Mary Jane Welch, DNP, APRN, BC, CIP

ABSTRACT
PURPOSE: People with serious mental illness (SMI) require treatment in either an outpatient or inpatient setting. They may also be eligible to participate in research that may improve the outcomes of their illness. There are often questions about the ability of patients with SMI to consent to treatment or research. Many well-meaning clinicians, advocates and policy makers make assumptions about one's ability to consent based on diagnosis. This approach engenders stigma and creates unnecessary barriers for those with SMI. SUMMARY OF EVIDENCE: Frequently a group will attempt to regulate access to care or research based on diagnosis alone. For example, a presidential commission in 1989 created a report that would have limited the autonomy of people with SMI simply based on their having a mental illness. Only vigilance and advocacy of practitioners prevented the report from becoming policy. VALIDATION OF EVIDENCE: There is a solid base of literature that supports an effective approach for evaluating the ability to consent. A literature search was conducted. IMPLICATIONS: Ongoing advocacy is required to limit stigma and protect the autonomy of people with SMI.

 

3012.2: My Voice Counts! Using Patient and Family Advisory (Partnership) Councils as a Vital Component of the Recovery Mode
Karen A. Federspiel, DNP, MS, RN-BC, GCNS-BC; Gail Bromley, PhD, RN

ABSTRACT
PURPOSE: University Hospitals (UH) adopted the Recovery Model, which emphasizes a maximization of the patient’s level of functioning rather than symptom resolution, to drive its care of patients. A component of this model emphasizes patient and family engagement, lacking in the inpatient unit current practice SUMMARY OF EVIDENCE: The Agency for Healthcare Research and Quality (AHRQ) advocates patient and family engagement to improve the patient’s overall health and outcomes through the use of Patient and Family Advisory Councils. A model from the Institute for Patient and Family-Centered Care (IPFCC) was identified and applied to form the Adult Inpatient Family and Patient Advisory Council. The term Advisory was later replaced by Partnership to emphasize the collaboration between the council and the unit. VALIDATION OF EVIDENCE: Benefits to patient care, patient and family engagement, innovations, patient advocacy and improved quality of life (for both patient and family). The surprising benefit to the members themselves, which has allowed them to experience further maximization to their functions as experts and advocates for Mental Health and its patients will be discussed. IMPLICATIONS: Expansion of the council to include other areas of psychiatry including outpatient and substance abuse units.

 

3013.1: The Use of Ketamine in the Prehospital Setting for Treatment of Excited Delirium
Joseph Wolf Schatz, MSN, CRNP, PHRN, PMHNP-BC

ABSTRACT
PURPOSE: The use of synthetic psychoactive substances has led to increased prehospital exposure to excited delirium for EMTs, paramedics, and nurses working in emergency medical services. SUMMARY OF EVIDENCE: A growing number of EMS agencies are now including Ketamine as a tool to help in managing patients with excited delirium. VALIDATION OF EVIDENCE: Specific attention will be provided to the IMCRASS tool, used to grade excited delirium and guide treatment. The pharmacology of Ketamine as an agent will be reviewed as will its unique properties that make it preferable in managing excited delirium in the prehospital setting. IMPLICATIONS: Exposure to this treatment protocol will allow for improved interdisciplinary collaboration between psychiatric nurses and EMS professionals.

 

3013.2: Simulation Training to Improve Mental Health Nurse Practitioner Resident Adherence to Veteran Affairs/Department of Defense Clinical Practice Guidelines for Post-Traumatic Stress Disorder
Charleen Angell, DNP, APRN, PMHCNS-BC; Amy Morton-Miller, DNP, PMHCNS, PMHNP-BC

ABSTRACT
PURPOSE: The purpose of this project was to develop a standardized training method for new mental health nurse practitioners focused on integrating the evidence-based Veterans Affairs/ Department of Defense clinical guidelines for the treatment of PTSD. SUMMARY OF EVIDENCE: Despite creation of the VA/DoD PTSD guidelines in 2004, studies demonstrate few veterans actually receive this standard of care. Major disparities exist among mental health nurse practitioners in their adherence to these guidelines. Known barriers to guideline adherence across disciplines include provider lack of awareness, provider time constraints, provider resistance due to skepticism about the evidence used to support clinical guidelines. VALIDATION OF EVIDENCE: Facilitator debriefing after each scene engages residents in evaluation of their ability to implement guidelines into clinical care of standardized patient. IMPLICATIONS: Simulation experiences are an innovative way to help novice providers integrate clinical practice guidelines into their clinical practice. In the future, similar simulations may be utilized to help decrease clinician barriers to clinical practice guidelines for other common psychiatric disorders.

 

3014.1: Adolescent Substance-use Patterns Vis-A-Vis Gender, Grade, and Depressive Mood
Heeyoung Lee, PhD PMHNP-BC; Lin Lu, BSN RN; Joshua Palmer, BSN BS RN; Brayden Kameg, BSN RN CARN

ABSTRACT
PROBLEM STATEMENT: Substance use during adolescence can affect biopsychosocial development and functioning. The purpose of this study was to examine whether or not demographic factors or mood symptomatology are associated with substance use patterns among adolescents. THEORETICAL FRAMEWORK: Social cognitive theory underlines the role of personal, behavioral, and environmental factors in human behaviors, which addresses substance use patterns and relevant intervention strategies. METHODS & DESIGN: Secondary data analysis of the National Youth Risk Behavior Survey elucidated five patterns of substance use: abstinent, 1st-step social experimenter, 2nd-step social experimenter, pill experimenter, and full experimenter. Latent class analysis, with gender, grade, and depressive mood as covariates, was used for additional comparison. IMPLICATIONS: The longitudinal relationship between depressive symptoms and increased substance use among adolescents warrants further study.

 

3014.2: Exposure to School Violence, School Protective Factors, and Behavioral Functioning in Urban Adolescents
Linda M. McCash, PhD, ARNP-BC

ABSTRACT
PROBLEM STATEMENT: Students exposed to school violence such as physical fights, vandalism, and being a victim of a non-violent crime are at risk for lower behavioral functioning (e.g., decreased academic performance, substance use, absences, tobacco use, and earlier sexual behavior). THEORETICAL FRAMEWORK: The aims of this study were to test the following hypothesis: exposure to school violence and victimization direct effects on adolescent behavioral functioning and school connectedness indirect effects on adolescent behavioral functioning. This study used METHODS & DESIGN: A total of 66 participants were recruited using a convenience sampling method. Strength and direction of relationships between study variables were explored. Hierarchical multivariate analysis was computed to identify factors associated with adolescent behavioral functioning. IMPLICATIONS: Selection of a random sample of students can enhance diversity and differences between participants will increase rigor of study. Also, a larger sample is required to increase effect sizes (power) found in this study.

 

3015.1: Application of Mixture Modeling to Characterize Anorexia Nervosa: Integrating Personality Traits and Eating Disorder Psychopathology and Behaviors
Karen M. Jennings, PhD, RN, PMHNP-BC; Ross Crosby, PhD; Lindsay P. Bodell, PhD; Ann E. Haynos, PhD; Jennifer E. Wildes, PhD

ABSTRACT
PROBLEM STATEMENT: Alternative classification of anorexia nervosa (AN) based on personality traits or eating disorder (ED) psychopathology have been identified. Research suggests that varying patterns of ED psychopathology or personality traits may have meaningful scientific and clinical implications. THEORETICAL FRAMEWORK: However, previous studies employed statistical methods that assume either latent dimensions or categories, and do not provide information as to whether AN is best modeled as a discrete or continuous disorder. Furthermore, the clinical utility of a classif METHODS & DESIGN: Thus, the purpose of this study was to test whether AN is best modeled as categorical, dimensional, or hybrid categorical-dimensional based on ED psychopathology and personality traits, and to evaluate the clinical utility of the identified best-fitting model. Individuals with AN receiving intensive treatment (N = 194) completed questionnaire and interview assessments within two weeks of admission and discharge. Mixture modeling was used to combine dimensional and categorical components of ED psychopathology and personality traits to determine the best-fitting model of AN. IMPLICATIONS: Furthermore, varying patterns of ED psychopathology and personality traits may speak to differences in etiologic processes, course of AN, and implications for evidence-based or novel treatments.

 

3015.2: Mothers' Mental Health After Release from Incarceration
Ann E. Stanton, BSN, RN

ABSTRACT
PROBLEM STATEMENT: Over one million women are released from US jails and prisons each year. An estimated three-fourths of incarcerated women experience mental health issues; most are mothers of minor children; and few receive treatment prior to release. Untreated mental health issues in mothers leaving jails and prisons increase their risk for substance use, other risky behaviors, and homelessness; yet little is actually known about their mental health after release. THEORETICAL FRAMEWORK: This study explored the mental health experiences of mothers of minor children after their release from incarceration using a transitions theory-intersectionality framework. METHODS & DESIGN: This study used a cross-sectional, exploratory, narrative inquiry qualitative design using individual semi-structured interviews with twenty-five women who had been released from incarceration in the last five years and recruited from the community. Data were analyzed using both narrative and thematic analysis techniques. IMPLICATIONS: Future research can explore how mothers’ cope with their sense of overwhelm and anxiety after release, and explore factors that affect their engagement with mental health treatment services.

 

3016.1: Educator Challenges to Facilitate Nurse Practitioner Student Clinical Placement: Lessons Learned
Kathleen M. McDermott, DNP, RN, MSN, PMHNP BC; Christine B. Costa, DNP, APRN, PMHNP-BC

ABSTRACT
PURPOSE: Increased student enrollment and organizational requirements has resulted in a reduction in the availability and quality of clinical placements for graduate nursing students. The barriers to locating and retaining good clinical placement sites and preceptors are significant. SUMMARY OF EVIDENCE: Graduate students are unaware of the practical demands of clinical placement, advanced practice professionalism requirements, and the importance initiative to facilitate active learning opportunities which impact clinical experiences and retention of clinical sites/preceptors. VALIDATION OF EVIDENCE: Lessons learned from educator’s experience preparing graduate psychiatric nursing students for clinical placement at a university in Southern California will be presented. Relevant literature related to clinical placement challenges for educators will also be discussed. IMPLICATIONS: Organized graduate faculty-led clinical placement discussions prior to the start of clinical placement, are beneficial for both student, preceptor, and educator. Implementation of similar discussions may be facilitated through incorporation of increased organization involvement, student-instructor meetings, or integration into an elective course.

 

3016.2: Empirical Measurement of Psychiatric Performance Competency
Chase J. Boyer, MA; Michael J. Rice, PhD, APRN, FAAN; Tanya Sorrell, PhD, APN; Alyssa Spurling, MA

ABSTRACT
PROBLEM STATEMENT: Assuring students’ clinical psychiatric competence has been plagued with issues of validity and reliability over time. This project describes empirical development of a measure of psychiatric performance competencies for Psychiatric Nurse Practitioner Students. THEORETICAL FRAMEWORK: The model used for the project is based on modification of the theory of reason behavior used to change patients behaviors. The model was modified to address intentional clinical performance in nurse practitioner students. The measure was developed to mea METHODS & DESIGN: The competency scale was developed using National Organization of Nurse Practitioners specialty competencies and SAMHSA integrated care competencies. The scale contains 25 items with rating ranging from Novice Skill (1) to Solo Skill (10). The scores were standardized to training levels. Faculty, preceptors and students completed measure at midterm and end of term. IMPLICATIONS: The scale's performance should be tested with other training programs to establish the results.

 

3017.1: Physical Activity Preferences and Attitudes of Individuals with Substance Use Disorders: Clinical Applications and Motivating Change
Amanda J. Simonton, BSN, RN; Cara C. Young, PhD, RN, FNP-C; Richard A. Brown, PhD

ABSTRACT
PURPOSE: This presentation will explore physical activity (PA) as an intervention for individuals with substance use disorders (SUDs) and will review methods of motivational interviewing (MI). SUMMARY OF EVIDENCE: SUDs are a prevalent problem in the U.S.; even for individuals who enter recovery, relapse rates are high. Developing a SUD involves changes in behavior, social functioning, and neurobiology. Recovery should involve a holistic approach that addresses these areas including healthy lifestyle resources. Once such resource is PA. VALIDATION OF EVIDENCE: The effect of PA on mental health includes improvements in pain, mood, and craving. A recent literature review found those with SUDs are interested in PA, and PA has been shown to have a positive effect on quality of life in this population. Thus, PA may increase the likelihood of entering stable recovery and reduce relapse. IMPLICATIONS: Healthcare providers should consider lifestyle interventions to promote efficacious recovery. In the future, clinicians who utilize MI and encourage PA may improve recovery efforts.

 

3017.2: Relationship of Physical Health Screenings in Seriously Mentally Ill with Self-Efficacy for Health, Perceived Risk for Health Consequences, and Intended Follow-Up Care
Dawn Vanruler, PMHNP, CNP, MS; Kay Foland, PhD

ABSTRACT
PROBLEM STATEMENT: Morbidity and mortality occur at higher rates in individuals with serious mental illness (SMI) than those without SMI. These higher rates are worsening in degree, despite known and underutilized preventative strategies, such as physical health risk screening (HRS). This study evaluated the relationship of physical HRS with self-efficacy for health, perception of level of health risk, and intention to follow-up with care for identified risks. THEORETICAL FRAMEWORK: This study considers Protection Motivation Theory (PMT) factors related to HRS in individuals with SMI. METHODS & DESIGN: Correlational approach was used. The HRS tool, the Health Improvement Profile (HIP), was administered to 54 ambulatory SMI adult clients from the mid-Western United States. The HRS was tested for relationship to: self-efficacy for health, awareness of health risk (threat), and intention for follow-up care. IMPLICATIONS: HRS warrants further investigation as an intervention to improve intention to take health prevention behaviors in SMI.

 

3021: A Guide to Finding the Lee Side: Navigating the Unknown Waters of Opening a Private Practice
Ashley Altman, ANP-BC, RN; Ronald Lee Tyson, DNP, DMin, PMHNP-BC

ABSTRACT
PURPOSE: Starting a private practice can be overwhelming. Through our own experiences, we hope to help other advanced practice nurses gain skills and insight into successfully running an empathic and financially sound private practice. SUMMARY OF EVIDENCE: Sadly, there are not enough mental health providers to meet the needs of most communities. Many APRNs continue to work as part of physician-owned practices or large group organizations. This often limits their autonomy as well as their compensation. A solution to meeting these needs are NP-led private practices. However, there are few guidelines in place, causing many APRNs to feel overwhelmed and discouraged from stepping out on their own. VALIDATION OF EVIDENCE: We have measured our growth through specific quality outcomes, patient panel growth, patient retention, staff satisfaction, and financial status. IMPLICATIONS: By providing a theoretical framework and practical structure for a successful NP-led practice, other APRNs can feel more confident in doing the same in their communities.

 

3022: Using an Experiential Learning Approach to Enhance Nurses Understanding of a Dialectical Behavioral Therapy-Informed Model of Care
Dawnelle Romero Baca, RN-BC, BSN, MS; Charolette Collins, RN, BSN

ABSTRACT
PROBLEM STATEMENT: Implementation of nurse led-psychoeducational “PLEASED” skill groups assists patients during opiate addiction recovery to master skills to promote basic self-care needs, therefore reducing emotional vulnerabilities which can lead to relapse. Because “PLEASED” curriculum was designed in reflection of organizational needs, an effective, innovative, hospital-wide training strategy was needed along with a reliable, valid pre-post efficacy tool. THEORETICAL FRAMEWORK: Nurses maximize their role as both caretaker and educator through the use of PLEASED skills rooted in Dialectical Behavior Therapy (DBT) Informed model. By applying Knowles’ 5 Assumptions of adult learners and Kolb’s 1984 Experiential Learning theory, nursing staff were trained in DBT-informed care through a series of highly interactive, tailor-made games, activities, and teachings. METHODS & DESIGN: Primary data was collected and analyzed from six independent trainings in which an experiential learning model was used. Each training consisted of 15-20 RN’s and Mental Health Technicians who completed pre/post measurements of separate but interrelated factors to determine learning outcomes and learner perceptions. Patient satisfaction scores were also utilized to determine efficacy of implementation of training content. IMPLICATIONS: Continued longitudinal and comparative study to evaluate continued efficacy and persisting trends is needed.

 

3023: On a Mission: Taking on Stigma about Mental Health and Illness
Pamela J. Worrell Carlisle, RN, MA, CHPN, PhD; Alison Rushing, PhD RN; Rose Mary Gee, PhD RN; Ellen Hamilton, DNP RN

ABSTRACT
PURPOSE: This presentation describes processes used by baccalaureate educators on a mission to reduce stigma among students in a mental health nursing course. The presenters include a review of factors contributing to stigma in general and specifically in Psychiatric/Mental Health Nursing (PMHN) students; detail revisions in pedagogy; and specify multi-dimensional evaluation methods and findings. SUMMARY OF EVIDENCE: The shortage of mental health professionals nationally is due, in part, to stigma held by student nurses. Historically, PMHN has been the lowest ranked specialty by new graduates. PMHN educators lament that students arrive with negativity and bias expressed via statements like, “This is not real nursing.” or “I’m not going to work with crazy people”. Faculty made it a mission to convince students they will care for persons with mental health alterations in every healthcare setting and to humanize these individuals in students’ eyes. VALIDATION OF EVIDENCE: Assessment strategies included an expanded course evaluation, increased reflective writing in both didactic and clinical, and analysis of HESI scores. Tracking of students choosing PMHN topics in subsequent course projects was initiated. IMPLICATIONS: We anticipate that more students will eventually select careers in PMHN and, for now, individuals with mental health disorders will be valued and treated with more compassion wherever they are in the healthcare system.

 

3024: Caring for Youth with Gender Dysphoria: Appropriate Screening, Referrals, and Treatment Modalities to Reduce Health Disparities
Brayden Nicole Kameg, BSN, RN, CARN; Donna Nativio, PhD, CRNP, FAAN, FAANP

ABSTRACT
PURPOSE: The purpose of this project is to explore evidence-based practices and guidelines to aid healthcare providers in the provision of care to youth with gender dysphoria. SUMMARY OF EVIDENCE: Healthcare providers who encounter children are often the first line of contact for individuals with gender dysphoria, which occurs when sex assigned at birth is incongruent with one’s true, expressed gender identity. Because those with untreated gender dysphoria are at-risk for a variety of negative outcomes, including mood symptomatology, suicidality, and substance misuse, it is critical that healthcare providers are adept in the provision of holistic, patient-centered care. VALIDATION OF EVIDENCE: Those with gender dysphoria should be screened for mood symptomatology, suicidal ideation or intent, and substance misuse with validated screening tools, including the Patient Health Questionnaire-9, the Drug Abuse Screening Test, or the Alcohol Use Disorder Identification Test. Those with positive screens must be supported and provided intervention with consideration to their unique challenges and barriers faced. IMPLICATIONS: Healthcare systems and academic settings must ensure that clinicians and students are provided with education to effectively care for those with gender dysphoria.

 

3025: Spiritual Care in Psychiatric Mental Health Nursing: What is it? Are we Providing it? How does it fit into the Recovery Model of Care?
Melissa Neathery, PhD(c), CNE, RN

ABSTRACT
PROBLEM STATEMENT: Spiritual care is integral to holistic and culturally-competent nursing care that promotes whole health. However, current research is lacking that identifies how and if spiritual care is being provided by PMH nurses. What are the barriers and facilitators to providing spiritual care? Is spiritual health being integrated into recovery-oriented practice? This research project addressed these issues. THEORETICAL FRAMEWORK: This research was based on Watson’s Theory of Caring and the Recovery Model of Care. METHODS & DESIGN: This cross sectional descriptive study surveyed 200 participants at the 2017 APNA Annual Conference and asked about personal characteristics, spiritual perspectives, spiritual care, and recovery-oriented practice using validated instruments. Data were analyzed using descriptive, correlational and regression statistics. IMPLICATIONS: Future research should identify what significantly contributes to spiritual care and patient outcomes.

 

3026: Behavior Genetics 101 for Psychiatric Mental Health Nurses in 45 Minutes
Kosuke Niitsu, PhD, APN, PMHNP-BC

ABSTRACT
PURPOSE: The purpose is to outline the fundamental concepts of behavior genetics and how genetic variations contribute to individual differences in behaviors. SUMMARY OF EVIDENCE: Recent advances in genetic and genomic science are rapidly increasing our understanding of precision mental health and individualized response to interventions. However, the literature indicates a lack of understanding and misconceptions about foundational genomic concepts. VALIDATION OF EVIDENCE: Due to the complexity of behavior genetics and small effect sizes that genetic variations contribute to behavior, findings in the literature are mixed. For example, the literature indicates scientific findings of the association between the serotonin transporter gene promoter polymorphism and antidepressant response in individuals with mood disorder are not consistent. IMPLICATIONS: PMH nurses need to keep their knowledge updated with the most current evidence in behavior genetics based on the fundamental concepts discussed in this presentation.

 

3027: Got Trauma? Debriefing in the Workplace
Francine RB Pingitore, PhD, PMHCNS-BC, CGP

ABSTRACT
PURPOSE: The purpose of this topic is to discuss the importance of debriefing after traumatic events that impact nurses in the hospital setting Traumatic events that occur in the hospital include, but are not limited to the death of patient, violent patients, aggressive families and medically challenging patients. While traumatic events often occur in the hospital, there are also significant events that take place in the community such as violent crimes, natural disasters & terrorists attacks that can directly impact nurses working in the hospital setting. SUMMARY OF EVIDENCE: Traumatic events are on the rise, in our hospitals as well as in our communities. Debriefing after traumatic events provides an opportunity for nurses to process their feelings around the traumatic events. Debriefings offer an opportunity for all staff to receive support and can also positively impact communication and teamwork. VALIDATION OF EVIDENCE: Debriefing after a traumatic event is considered a best practice. This topic has been investigated and discussed in the nursing literature as well as other related fields. IMPLICATIONS: Traumatic events are on the rise. It is critical that debriefing become common practice, allowing for nurses, as well as all interdisciplinary team members, an opportunity to process their feelings around these experiences. Debriefings are often supportive, helpful and healing.

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