Annual Conference Thursday Session Abstracts

2001: Psychiatric-Mental Health Nurses: the Whole Health Connection
Gail Stern, RN, MSN, PMHCNS-BC

Explore the elements of connection that psychiatric-mental health nurses use to create healing relationships. Hear examples of healing connections. Understand the science that backs up the importance of these connections to not only relieve suffering but create recovery and whole health. Expand your conceptual framework for the role of connections in our work and in our own lives. You will be challenged to think about how we might innovate and advance methods to create and support connections for the whole health!


2011: Ketamine Treatment:  Promise for the Future and How Nurses Impact Care
Paula S Bolton, MS, CNP, ANP-BC; Courtney Miller, RN

PROBLEM STATEMENT: To discuss the benefits of ketamine in the treatment of resistant depression and acute suicidality and the role nursing plays in the assessment, monitoring and management of patients seeking these services. SUMMARY OF EVIDENCE: Very few medications of late have shown the promise that ketamine has shown in the treatment of resistant depression and acute suicidality, yet the risks involved in treatment are yet to be discovered.  Safe administrations of ketamine and protocols developed to provide patient centered care are necessary and are being developed to guide practice. DESCRIPTION OF PRACTICE OR PROTOCOL: Our ketamine clinic is designed to evaluate patients considering their diagnosis, co-morbid conditions, what is known about ketamine efficacy and risks. Nurses serve as an integral part of the treatment team and work with clinicians and patients and families to assess, monitor and re-adjust treatment schedules. VALIDATION OF EVIDENCE: Patient centered care involves the application of what is known about ketamine treatment and the experience of working with patients with treatment resistant mental illness within a well-established neurotherapeutics program. RELEVANCE OF PMH NURSING: Nurses are uniquely positioned to work with patients in a ketamine clinic.   Integrating medical and psychiatric treatment, nurses assure that the patient is safely administered the treatment and that all aspects of care are being addressed. FUTURE IMPLICATIONS: Nurses are central to the ever-evolving field of neurotherapeutics and treatments that require monitoring of medical as well as psychiatric effects of treatment.


2012: Creating Safe Environments for the Hospitalized Psychiatric Population
Beth Rudisill, MSN, RN-BC

PROBLEM STATEMENT: As hospitalizations are on the rise for this challenging population, patients are being admitted to environments that may not be safe for this high risk patient group. SUMMARY OF EVIDENCE: Within the hospital setting, more deaths by suicide occur outside of psychiatric units. Safe environments and practice protocols must be created wherever the at-risk patient is receiving care. DESCRIPTION OF PRACTICE OR PROTOCOL: Patient safety is paramount for psychiatric nursing. Other nursing specialities caring for the psychiatric patient may not have the same focus when delivering care to assigned patients.Through bundling of orders and protocols that include temporary modifications to the environment, the emergency department and the intensive care setting are being transformed into safer spaces to care for the psychiatric patient. VALIDATION OF EVIDENCE: Identification of ligature safety risk and taking preventive actions must be our highest goal as psychiatric nurses. As regulatory agency compliance and avoiding risk management situations remains the driving force behind our practice, we must remember to create therapeutic relationships to achieve the desired outcome for our patients.      RELEVANCE OF PMH NURSING: Patient safety must be priority through the creation of reduced ligature environments and implementation of safety protocols to prevent patient injury or death. FUTURE IMPLICATIONS: As psychiatric admissions continue to increase and inpatient psychiatric bed availability continues to decrease, this at risk population will continue to receive care in areas that have not been deemed safe for at risk patients. It is imperative that environments be made safe and awareness is raised to decrease the risk of harm when delivering care to this vulnerable population.


2013: Permutations of the Silver Tsunami: Empowering Psych APRNs to Lead the Charge for Integrated Care in Long Term Care
Elizabeth Borntrager, PMHNP-BC

PROBLEM STATEMENT: A significant increase in admissions of residents with severe and persistent mental illness to long term care facilities has changed the overall landscape of the LTC patient population. Care is impacted both by intense federal regulations as well as availability and approach to care of providers. The purpose of this presentation is to review the current care provided to aging population in long term care and present how psychiatric NPs are in a unique position to lead integrated care models and improve health outcomes for this vulnerable population. SUMMARY OF EVIDENCE: Historically, psychiatric care provided in long term care has focused on a reactionary model of treatment or on band-aid coverage from non-specialized providers which has led to both under and over utilization of psychotropic medications and substandard care. DESCRIPTION OF PRACTICE OR PROTOCOL: Current practices vary wildly depending on the location and availability of services. On call or as needed psychiatric care only addresses the psychiatric emergencies and do little to prevent escalation or decompensation. Rural and small facilities are at the highest risk for having little or no specialized psychiatric treatment. VALIDATION OF EVIDENCE: Utilization of consistent onsite psychiatric providers working as part of an integrated team to address the mental health needs of residents in LTC is associated with improved level of functioning, patient satisfaction, and reduced mortality. RELEVANCE OF PMH NURSING: Because of our knowledge as clinicians, educators and advocates, APRNSs are in a unique position to be able to spearhead integrated care for residents in LTC. FUTURE IMPLICATIONS: Onsite integrated care in LTC led by APRNs can result in improved patient outcomes.


2014: Teen Vaping on the Rise: Contributing Factors and What Nurses Need to Know
Leigh Powers, DNP, MSN, MS, APRN, PMHNP-BC; Marie Smith-East, PhD Candidate, DNP, PMHNP-BC, EMT-B

PROBLEM STATEMENT: Teenagers in the United States report dramatic increases in use of vaping devices. SUMMARY OF EVIDENCE: In a single year, vaping nearly doubled among 12th graders from 11 percent in 2017 to 20.9 percent in 2018 (NIDA, 2018). More than 1 in 10 eighth graders report vaping nicotine in the past year, with significant increases in virtually all vaping measures among eighth, 10th and 12th graders. Most electronic nicotine delivery systems contain nicotine found to be harmful to the adolescent brain (HHS, 2016), which continues to develop until approximately 25. Using nicotine in adolescence can result in harm to brain regions modulating attention, learning, mood, and impulse control (CDC, 2018) as well as increase the risk for future addiction to other drugs (NIDA, 2018). DESCRIPTION OF PRACTICE OR PROTOCOL: PMH nurses need to understand current public perception, influences and marketing misinformation. Symptoms of addiction and evidence-based treatment strategies for use in practice with teens will be discussed. VALIDATION OF EVIDENCE: Current evidence consists of national surveys, qualitative interviews, clinical trials and peer-reviewed research. RELEVANCE OF PMH NURSING: It is critical for PHM nurses to understand the effects of vaping on overall health, the unique risks to the developing teenage brain, and future addiction issues. Clinical efforts must actively target this upward trend by increasing knowledge related to assessment and treatment. FUTURE IMPLICATIONS: Understanding the health, economic and policy factors associated with teen vaping is vital to combat continued increasing use. PMH nurses play an integral role at national, state and local levels in the prevention and intervention of teen vaping.

2015: Measuring Acute Care Nurses Competence when Providing Care to Psychiatric Mental Health Patients
Valerie Seney, MA, MSN, LMHC, RN-PMH-BC; Jacqueline Insana, MSN, RN-PMH-BC; Brittney O'Neale, MSN, APRN, ACCNS-AG; Kara Misto, PhD, RN

PROBLEM STATEMENT: Gap analysis revealed a low confidence rate amongst acute care nurses competency with working with patients who also have a psychiatric diagnosis. The purpose of the education was to provide knowledge and communication skills to acute care RNs to assist them in the care of psychiatric patients who present to medical facilities. SUMMARY OF EVIDENCE: A literature search showed acute care nurses often carried stigma and a lack of understanding of psychiatric disorders. Nurses were requesting additional education in order to provide the best care to their patients. DESCRIPTION OF PRACTICE OR PROTOCOL: There was a lack of mental health education within the new nurse residency orientation. Acute care nurse educators coordinated with behavioral health nurse educators at their sister affiliate to development a 4-hour training program for newly licensed acute care nurses. CNO approval obtained. VALIDATION OF EVIDENCE: Feasibility analysis showed buy-in from key stakeholders. Permission was granted to use the Behavioral Healthcare Competency tool for measuring perceived competence in acute care nurses. A pre and post survey was given to the acute care nurse residents to complete. RELEVANCE OF PMH NURSING: SPSS is used for data analysis and preliminary results show a significant increase in knowledge gained by acute care nurses. Participants verbally stated to educators increased satisfaction in understanding content. FUTURE IMPLICATIONS: Bridging the gap between acute care nurses and psychiatric nurses will benefit all of our patients and bring together the art and science of nursing. When patients do not feel the sting of stigma they are more apt to follow with the treatments they need to improve the quality of their lives.


2016: An Alternative Framework to Conceptualize Suicidal Ideation and Behavior
Sean P Convoy, PMHNP-BC

PROBLEM STATEMENT: Evidence establishing suicidal behavior as a significant health-related phenomenon is ubiquitous.  Despite the academic and clinical attention given to the phenomenon, suicide rates have increased 30% since 2000 according to the Centers for Disease Control. SUMMARY OF EVIDENCE: Much of the clinical practice guidelines (CPG) guidance associated with the identification and management of suicidal ideation and behavior is arguably too reactive and paternalistic in nature. DESCRIPTION OF PRACTICE OR PROTOCOL: This presentation will offer an alternative framework from which to conceptualize and address suicidal ideation and behavior in clinical practice.  This framework recognizes the “dirty little secret” that all too commonly healthcare delivery systems try to control that which they can only influence.  This concurrent session will explore how a concordant approach to suicide assessment and intervention can positively influence rapport, shift the locus of control to the patient, embolden patient self-efficacy and resist a patient-provider power dynamic. VALIDATION OF EVIDENCE: Role-playing scenarios will be employed to demonstrate the application of the strategies offered. RELEVANCE OF PMH NURSING: This framework offers a radically different approach to navigating suicidal ideation and behavior in clinical practice based squarely in pragmatism and mindful of a limited sphere of influence. FUTURE IMPLICATIONS: A novel approach to suicide assessment and intervention rooted in pragmatism and mindful of locus of control has the potential to influence the nursing workforce in relation to work-related stress, vicarious trauma, and moral injury & residue.


2017: Building Staff Collaboration and Patient Connections: Expanding the Role of the Psychiatric-Mental Health Nurse
Teresa Setnar, MSN, RN, CPN; Susan Orme, RN-BC

PROBLEM STATEMENT: Designed to improve access to care, a new scheduling model implemented in Outpatient Psychiatry produced an increased workload for psychiatric providers in 2018.  To meet best outcomes for patients and families, expansion of the RN role was critical. Executive, medical and nursing leaders worked together to increase RN staff to a 1:1 RN to provider ratio in order to manage those needs      SUMMARY OF EVIDENCE: Office visit appointment show rates increased from approximately 70% to 97% within the first few months of the scheduling model implementation. DESCRIPTION OF PRACTICE OR PROTOCOL: An interdisciplinary workgroup developed standardized workflows in which the RN would obtain comprehensive history assessments during new patient appointments. Ongoing work includes development and educational opportunities for the nursing staff to discharge patients from their clinic visits, thereby freeing up more time for the psychiatric provider. VALIDATION OF EVIDENCE: Measurement of RN to psychiatric provider FTE’s and the percentage of history assessments completed by the RN’s have been the two of the measures for this project. Knowledge, skill, and attitude surveys have also been obtained from RN’s and providers. Additionally, telephone call volume data is being monitored as a key indicator, as phone calls should decrease as direct patient care increases. RELEVANCE OF PMH NURSING: Expanding the role of the RN provided necessary support for the psychiatric providers, building relationships based on mutual respect, trust, and collaboration, and promoting job satisfaction and engagement among the nursing staff. FUTURE IMPLICATIONS: The PMH-RN has an important role in the ever expanding demands for psychiatric services, given the opportunity, education, and support.

2021: Exploring the Potential Use of Psychedelics for the Improvement of Persistent and Intractable Mental Health Symptoms
Carlton J Spotswood, BSN, RN-BC, PMHNP-S

PROBLEM STATEMENT: Psychotropics and therapy has only proven limited success in the treatment of significant and difficult mental health symptoms and disorders. Psychedelics were once a thought to be the "next big thing" in psychiatric treatment but cultural beliefs and a lapse in research caused stagnation developing significant growth. SUMMARY OF EVIDENCE: Researchers have now been able to restart significant research and technology is starting to catch up with what many have already known. With MDMA trials now being conducted in FDA stage III trials, changes are on the horizon. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently policies are not written outside of researchers but some cities and states have paved the way to limit restrictions.   individuals and private organizations have started to implement training programs readying themselves for what many believe are changes being made. VALIDATION OF EVIDENCE: Evidence collected from the early 1960s to present day research shows promise in this often controversial and even more misunderstood area of psychotherapeutics. RELEVANCE OF PMH NURSING: All areas of PMH nursing should be aware of the research published and continued to be conducted before judgement and preconceived notions cloud our personal beliefs. FUTURE IMPLICATIONS: The future of psychedelics not only look promising but many believe could be the most important findings in PMH in years, completely changing how we practice and treat some of the of the most debilitating and stigmatized illnesses known.


2022: Building Resiliency- from a Former State Hospital to a Safe, Healing Environment
Theresa R Searls, APRN-BC

PROBLEM STATEMENT: The purpose in addressing this topic is to share and discuss the successes and opportunities associated with the design and building of a new psychiatric facility for children and the move from a former state hospital building to the new facility. SUMMARY OF EVIDENCE: The changes in design, construction and later application resulted from: the philosophical evolution to patient and family centered, trauma informed care; new expectations for ligature proof inpatient facilities and the science associated with developing resilience in mentally ill children. DESCRIPTION OF PRACTICE OR PROTOCOL: The practice change involved the nursing staff in every element of design and post construction in the evaluation of the safety and functionality of the space.  Stakeholders include all bedside staff and clinical staff as well as support staff and administration. VALIDATION OF EVIDENCE: We measure outcomes and effectiveness by measuring patient behavior through the use of restraint, staff and patient injury and property destruction as well as staff satisfaction and retention. RELEVANCE OF PMH NURSING: Joint Commission standards of ligature free inpatient environments have compelled inpatient settings to reexamine their environments.  Additionally, creating restraint and seclusion free environments require the physical units to take a good deal of punishment. FUTURE IMPLICATIONS: Nursing practice needs to inform decisions about construction, design and the use of the physical environment. Knowing what works, what failed and what was completely different in our design and expectations taught lessons we wish to share with other clinicians.


2023: Disseminating The Integrated Cognitive Therapies Program (ICTP), a promising practice for Young People with Co-Occurring Mental Health and Substance Use Disorder
Susan E Caverly, PhD, ARNP

PROBLEM STATEMENT: The Integrated Cognitive Therapies Program (ICTP) is a promising practice combining Motivational Enhancement Therapy, Cognitive Behavioral Therapy, and Contingency Management in a manualized individual treatment for young people diagnosed with co-occurring mental health and substance use disorders.  Typically, this population experiences less than desirable outcomes when provided care as usual. SUMMARY OF EVIDENCE: ICTP is the extension of a project to bring ENCOMPASS, a model treatment developed in multi-site clinical trials, to clinical practice.  The result of that project evidenced, with adaptations,  positive outcomes in a community clinic setting.  The adaptations included addition of Contingency Management, Family Coaching, and diminished toxicology screening (the latter due to limited utilization of results.)  The model then further adapted for school and juvenile justice settings yielded similar results of MH symptom and substance use reduction. DESCRIPTION OF PRACTICE OR PROTOCOL: The practice follows a clinical protocol that includes10 session plans based in MET, CBT and CM.  Focus of care is on meeting youth where they are, skill development, and prosocial activity.  The dissemination of this model to school districts and juvenile justice required education and collaboration with funders, and local stakeholders. VALIDATION OF EVIDENCE: Outcomes are measured using standardized assessments applied at baseline, repeated at treatment nodals and at follow-up.  Measures include Timeline Follow-back, Multisymptom Anxiety Scale for Children, Child Depression Rating Scale, LEC/PCL-5 among others. RELEVANCE OF PMH NURSING: The ICTP treatment team is led by a PMHNP.  Outcomes reveal significant reduction in MH symptoms/substance use, and improved treatment adherence/completion. FUTURE IMPLICATIONS: Dissemination will require further adaptation of fidelity monitoring and supervision to extend this model beyond adjacent counties.


2024: Educating PMHNPs to Deliver Effective Integrated Care: Outcomes from a Three-Year Grant-Funded Initiative
Joyce M Shea, DNSc, APRN, BC; Kathryn Phillips, Ph.D., MA, MSN, ANP-BC; Bruce Jamie Stevens, MSN, PMHNP-BC; Karen Corcoran, DNP, PMHNP-BC

PROBLEM STATEMENT: The education of Psychiatric-Mental Health Nurse Practitioner (PMHNP) students need to include evidence-based, cutting-edge approaches to health care. The purpose of this presentation is to evaluate student and preceptor outcomes from an innovative grant-funded program that prepared PMHNP and Family Nurse Practitioner (FNP) students to deliver effective integrated care (IC). SUMMARY OF EVIDENCE: Approximately one in four adults experience some form of mental illness (MI) in a given year. The majority receive assistance from providers outside of behavioral health specialties, particularly in primary care settings. Those with severe forms of MI face an increased risk of serious medical co-morbidities and significantly shorter life spans than the general population. Experts have increasingly called for the integration of behavioral health and primary care to more effectively treat mental, substance-use, and general health problems. To date, there have been few reports of the effectiveness of educational programs that aim to prepare future healthcare providers in the provision of evidence-based Integrated Care. DESCRIPTION OF PRACTICE OR PROTOCOL: A grant-funded program was developed to provide coordinated clinical practicums for dyads of FNP and PMHNP students in community-based primary care settings along with carefully developed didactic experiences. VALIDATION OF EVIDENCE: Quantitative and qualitative data has been collected from both students and preceptors over the three-year grant period. RELEVANCE OF PMH NURSING: This innovative program has led to improvements in students’ overall levels of confidence in providing effective IC; both students and preceptors were satisfied with the grant program but had specific suggestions for improving processes. FUTURE IMPLICATIONS: Outcomes from the grant provide guidelines for creating a sustained focus on IC within PMHNP programs.


2025: Behavioral Health in Primary Care:  An Integrated Model
Patricia A. La Brosse, MS, PMHCNS-BC

PROBLEM STATEMENT: - Articulate the  PMHCNS role in the integration of behavioral health services in a primary care clinic.  - Family Medicine Clinic in a teaching hospital with limited resources to provide behavioral health care for identified patients.  In 2013, clinical and administrative leadership approached PMHCNS to discuss concerns regarding geriatric patients. SUMMARY OF EVIDENCE: - Behavioral Health integration into primary care can increase access to services, reduce stigma, and maximize resources.  Multiple agencies and organizations have supported the importance of establishing integrated care models.  - Integration represents a more holistic approach than traditional consultative and referral models.   Multiple models were reviewed to determine best fit for Clinic. DESCRIPTION OF PRACTICE OR PROTOCOL: - Multiple integration models exist.  - Meetings with geriatric clinical and administrative staff to develop structure for referral and treatment by PMHCNS. BH support team identified. Review of diagnoses.  Referrals began. VALIDATION OF EVIDENCE: - Data from SAMHSA, NIMH, NAMI, CDC and other sources validate utilization by describing successful models of integrating behavioral health into primary care.  - Outcomes and effectiveness are measured using PHQ9, as well patient self-report of depression and anxiety symptoms compared to previous appointments.  Ultimate effectiveness is measured by patient discharge from services. RELEVANCE OF PMH NURSING: - Describes models that can be implemented, or modified, to provide behavioral health services in primary care settings.  - In 2015 referral base expanded to include all adult patients enrolled in Family Medicine Clinic.   Weekly clinics offered. FUTURE IMPLICATIONS: - Expand to include Internal Medicine Clinic.    - Collaborate  with information systems to develop data gathering process.    - Can  replicate in other settings.


2026: Suicide Assessment in Older Adults
Marcia Walmer, DNP

PROBLEM STATEMENT: The baby boom cohort, those individuals born between the years 1946 in 1964 will have "aged out", turned 65 by the year 2030. As the largest U.S. birth cohort, they will account for 20% of the population or 78 million citizens by the year 2035, outnumbering those under 18 for the first time in history. Mental health providers must be prepared to competently assess and address the mental health needs of older adults, including a thorough and accurate suicide assessment. While older adults carry some significant risks for suicide, providers fail to recognize the signs and symptoms of their multi morbid presentations, thus overlooking patients who may be susceptible to or at high risk for suicidal idealization, suicide attempts, or death by suicide. SUMMARY OF EVIDENCE: IOM (2008, 2012, 2014), the USPSTF (2014), and the USHHS  (1999) discuss needs assessment and interventions MH issues in older adults. DESCRIPTION OF PRACTICE OR PROTOCOL: Many providers fail to consider age related variations in older adults when assessing for SI.  Several standardized rating scales with suicide sub scales currently exist for the assessment of suicidal ideation in older adults. VALIDATION OF EVIDENCE: An overview of geropsychiatric suicide assessment based on EBP standards will be presented that address the unique age related biopsychocosical variations among older adults. Valid and reliable assessment measures suitable for a variety of practice settings will be presented. RELEVANCE OF PMH NURSING: PMHNP's are at the forefront of psychiatric patient care. Providers that work across the spectrum will undoubtedly face suicide assessment in an older adult patient. FUTURE IMPLICATIONS: Reduced mortality / morbidity through improved assessment.


2027: Use of Measurement-Based Care to Inform Clinical Decision Making during Psychiatric Client Encounters
Ann Lewis, APRN, DNP, PHMNP-BC, LMHC; Stacia M Hays, APRN

PROBLEM STATEMENT: Measurement-based tools are under utilized in psychiatric care even though they have been shown to improve client outcomes. Use of these tools has the potential for improved detection of disorders, recognition of improvement or worsening of symptoms allowing for more timely medication adjustments, includes clients in their own care and potentially increases life expectancy. Examples of MBC are PHQ-9, Suicide Intensity Scale, AIMS, GAD-7. SUMMARY OF EVIDENCE: Research indicates one of the main reasons for failed remission of psychiatric symptoms is inadequate or less than optimal dosing. Use of MBC can improve client outcomes and quality of life. DESCRIPTION OF PRACTICE OR PROTOCOL: Clinical judgement alone is the main method of evaluating psychiatric symptoms. Measurement-based tools are used by 18% of psychiatrists in the U.S. and 32% of APRNs in Florida. There is was no definitive data on Psychiatric APRNs use before my study. VALIDATION OF EVIDENCE: Research & development of psychiatric drugs use MBC in RCTs to determine outcome and effectiveness. Research studies report that clinical judgement alone can detect deterioration of symptoms in only 21% of clients.  A descriptive study was designed utilizing a survey sent to all APRNs in FL about their use of MBC. RELEVANCE OF PMH NURSING: Use of MBC could detect early deterioration of symptoms and improve client outcomes across all settings. MBC needs to be utilized in every day practice. MBC is utilized in many other areas of patient care. FUTURE IMPLICATIONS: Improved client outcomes, less disability from psychiatric disorders, increased life expectancy, more involvement of clients in their own care, improved continuity of care.


2031.1: Teaching and Assessing PMHNP Student Clinical Competencies Using Two Types of Simulations
Beverly Baliko, PhD, PMHNP-BC; Phyllis Raynor, PhD, APRN, PMHNP-BC; Shelly Eisbach, PhD, PMHNP-BC

PROBLEM STATEMENT: This presentation describes a series of simulations that enable graduate psychiatric-mental health nursing students to build advanced practice competencies at a distance and without incurring additional costs. SUMMARY OF EVIDENCE: Online graduate programs, while providing flexibility for students, create challenges for faculty who wish to directly evaluate student progress. Through effective use of available technologies, distance education programs can provide students with robust virtual experiences for learning professional competencies. DESCRIPTION OF PRACTICE OR PROTOCOL: During their first clinical course, PMHNP students engaged in a series of text-based exercises that allowed them to practice the critical thinking and reasoning processes underlying the comprehensive diagnostic interview. Each question represented a discrete step in a patient visit to a psychiatric clinic and added more information to the clinical scenario. Instructors provided individual feedback and offered opportunities for questions and discussion. The online scenarios prepared students to apply new skills in a diagnostic interview with a standardized patient using telehealth technology available in the Clinical Simulation Lab. VALIDATION OF EVIDENCE: Encounters were recorded and reviewed by students and faculty. Students completed competency self-assessments, received written feedback on their skills from the standardized patient and the clinical faculty, and discussed their experiences in small clinical group conferences. RELEVANCE OF PMH NURSING: These exercises created a supportive environment in which students engaged in progressive development of clinical competence and confidence to prepare for future practice. Faculty were able to interact frequently with students, facilitate learning, and confirm that students met clinical objectives. FUTURE IMPLICATIONS: Similar exercises in remaining core courses will allow students to demonstrate mastery of newly learned skills.


2031.2: Engaging Psychiatric Nurse Practitioner Students through an Integrated Team Based Simulation Experience
Jennifer S Graber, EdD, APRN, PMHCNS-BC; Robbi K Alexander, Phd, APRN, PHMCNS-BC; Susan Conaty-Buck, DNP, APRN, FNP-C

PROBLEM STATEMENT: Engaging graduate students in active learning experiences is essential to developing critical thinking and problem solving skills. Few simulations allow advanced practice graduate students to address complex patients presenting with chronic illness, pain and mental illness using a team based learning strategy. DNP, FNP, and PMHNP faculty jointly developed a standardized patient scenario for students in the final semester. SUMMARY OF EVIDENCE: Research shows that students who are actively engaged in simulated learning experiences demonstrate improved student and professional outcomes as well as better client outcomes when taking into consideration the whole well-being of the client. Simulated experiences developed by faculty, using problem based learning methodology, help engage students and improve the ability to work more effectively during actual delivery of care. DESCRIPTION OF PRACTICE OR PROTOCOL: Faculty from various NP/ DNP tracks collaborated to develop a scenario that applies to all students in each advanced practice specialty. After completing the simulation, students met in small interprofessional groups, discussed patient care strategies and challenges faced from their discipline view. Faculty members were available during this time for debriefing. VALIDATION OF EVIDENCE: Advanced practice graduate students reported various benefits of this engaging simulation to address complex patient needs and collaborate with interprofessional colleagues to better address the whole health of the client. Analysis of videos allowed faculty to recognize the need for additional program integrative care delivery and interprofessional collaboration. RELEVANCE OF PMH NURSING: Simulated learning outcomes included improved problem solving, critical thinking, persistence, and adaptability. FUTURE IMPLICATIONS: When utilizing advanced simulation techniques, students learn to critically think, communicate, negotiate, collaborate, and lead in interprofessional roles.


2032.1: Integrating Whole Health and Human Connection into Safety Planning
Audrey Voss, MSN, CPHQ, RN-BC; Sarah Waterwall, BSN, RN-BC

PROBLEM STATEMENT: This presentation illustrates a safety planning process that fosters human connection and whole health. SUMMARY OF EVIDENCE: Safety planning is a national best practice. After noting an increase in non-suicidal self-injury, a Nursing Quality Work Group completed a literature review, evaluated quality data, and systemically improved the hospital’s safety planning. DESCRIPTION OF PRACTICE OR PROTOCOL: Input from nurses served as the catalyst. Implementation strategies included rapid cycle pilot testing of a quality improvement initiative, which ultimately spread throughout the hospital. Safety planning begins at admission, is regularly reinforced and revised, and reviewed at discharge with patients through collaboration with staff. Staff and patients collaboratively identify triggers, coping skills, barriers, ways to overcome barriers, and support systems. Nurse-led safety planning groups build on hope, universality and learned resourcefulness. Skills are practiced, leveraging patients’ strengths and thereby improving whole health. Safety planning transcends nursing and has improved interdisciplinary collaboration. VALIDATION OF EVIDENCE: Safety planning aligns with APNA recommendations. The hospital has seen a 31% decrease in non-suicidal self-injury and an 80% decrease in suicide-related behaviors. Through evaluation of findings and ongoing improvement cycles, the initiative bolsters not only safety indicators, but also patients’ satisfaction and treatment engagement scores. RELEVANCE OF PMH NURSING: Safety planning focusing on whole health and human connection offers psychiatric mental health nurses and interdisciplinary teams an innovative model of care in supporting all patients, including but not limited to suicidal individuals. FUTURE IMPLICATIONS: Future nursing research can provide continued support of this model and explore how to effectively incorporate interdisciplinary teams into safety planning.


2032.2: Effect of Hospital Safety Officers on Adult Behavioral Health Inpatient Services
Karen Hogan, DNP, MSN, RN, NE-BC; Celedonia Manrique, MSN, RN

PROBLEM STATEMENT: Improvement in safety on high acuity adult behavioral health inpatient units needed: 1) Significant number of Code Violets 2) Significant number of assaults on staff and patients 3) Above benchmark seclusion and restraint rates SUMMARY OF EVIDENCE: Crisis interventions, such as Code Violets, can be dangerous to patients, visitors, and staff.  Concern about safety of patients, visitors and staff is a recurring topic at unit-based councils and staff meetings.  Violent events on behavioral health units have recently resulted in nursing staff and security staff injuries requiring evaluation and treatment in the emergency department, leading to increased Workers' Compensation claims.  An increase in destruction of hospital property by disruptive patients has led to significant financial investment for replacements. DESCRIPTION OF PRACTICE OR PROTOCOL: Dedicated security officers were added to the two 18-bed adult behavioral health units in late 2015.  Behavioral Health leadership collaborated with Cleveland Clinic Police Department to analyze data related to Code Violet events, calls for security, and assaults on the units.  In August 2016, security officers were provided 24/7; however, there was not a significant enough reduction in assaults and Code Violet.  The concept of a Hospital Safety Officer (HSO), with significant clinical education, was developed to address the security and clinical needs. VALIDATION OF EVIDENCE: Several articles from 2011 to 2018 were reviewed regarding reducing workplace violence incidents.  Effectiveness is being measured through reduction in assaults and Code Violets, along with Workers' Compensation claims. RELEVANCE OF PMH NURSING: Available literature describes specific ways to evaluate and minimize workplace violence, a HSO is one intervention. FUTURE IMPLICATIONS: Determining specific content for HSO education, for effectiveness.


2033.1: The Association between Adverse Childhood Experiences and Adult Mild Traumatic Brain Injury-Related Symptoms
Hyunhwa Lee, PhD, MSN, APRN, PMHNP-BC; Laura BS Salado, BS; Jacob White, MS; Jonica Estrada, BS

PROBLEM STATEMENT: The purpose of our current study is to examine the association between Early life adversity (ELA), such as childhood abuse experience, and mild traumatic brain injury (mTBI) symptoms in adults. THEORETICAL FRAMEWORK: Based on the Stress-Diathesis Theory we propose that ELA such as childhood abuse experience may be associated with the presentation of post-injury symptoms in mTBI by affecting pre-injury vulnerability. METHODS AND DESIGN: Participants were recruited from a local university for a translational clinical research protocol for mTBI where cognitive, psychological, visual function, postural balance performance, and blood global DNA methylation were assessed. The Adverse Childhood Experience (ACE) Questionnaire was used to examine participants’ ELAs. RESULTS: Twenty-five volunteers participated (M=25.0 years of age; SD=5.96), including 12 females (48%). Majority of the participants reported ELAs (72%) with the mean ACE score of 3.3 (SD=3.89; ranged from 0 to 13). Using the median ACE score (2), low ACE (scored 0 to 1; n=15) and high ACE (2 or higher; n=10) groups were identified. No demographic or mTBI variables were statistically different between the two groups. High ACE group reported significantly poorer depression (p=.013), anxiety (p=.015), sleep disturbance (p=.049), and cognitive performance – picture sequence-episodic memory test (p=.011) as well as higher blood global methylation (p=.032). After controlling for the mTBI injury, high ACE groups still showed significantly poorer depression, (p=.020), anxiety (p=.023), and cognitive performance (p=.018). IMPLICATIONS (PRACTICE): Understanding the interaction between biological predisposition and previous traumatic stress is critical to provide effective care for mTBI. IMPLICATIONS (RESEARCH): Larger samples will be required to ensure the association between ELA and mTBI symptoms.


2033.2: Cumulative Trauma and Priorities for Support in Mothers of Adolescents in Residential Treatment Centers
Kayla Herbell, PhD, RN

PROBLEM STATEMENT: Mothers of children in residential treatment centers (RTCs) experience the highest rates of intimate partner violence (IPV; emotional, physical, and/or sexual abuse by a partner or ex-partner) in the child welfare system; yet, little is known about these mothers coping styles or needs for support. This study explored from mothers perspectives a) how adolescent symptoms, RTC admission, and IPV (during or after the RTC) interact; b) mothers needs and priorities for help and support. THEORETICAL FRAMEWORK: The ecological framework created by Heise (1998) guided the inquiry of this study.        METHODS AND DESIGN: This qualitative study involved 15 women who completed a 1-hour semi-structured phone interview. Data were managed in NVIVO and analyzed using qualitative description. RESULTS: The following themes emerged from the interviews: "Our children beat us, our children manipulate us, and we can't fight back," "The loneliest journey I've ever been on," and "By supporting the parents, you are supporting the child." Women reported stigmatization, disempowerment, and “grieved the loss of their child" when their child would yet again require RTC. Women coped by compartmentalizing the multiple traumas they sustained from caregiving as well as in their personal lives (i.e., IPV).  All women reported that they regularly shared their stories with others in online support groups. IMPLICATIONS (PRACTICE): Mothers of children in RTCs are an understudied and vulnerable population. Supportive, online interventions for this population to share their experiences is critical to maintaining their health. IMPLICATIONS (RESEARCH): Nurses within the child welfare system may move toward a family-centered approach to account for parenting factors that may influence child outcomes.


2034.1: My Patient Needs More Than Medical Care! Piloted Scenarios -  Nursing Students Caring for Medical-Surgical Patients WIth Mental Illness
Jeanette Avery, PhD, MSN, CNE

PROBLEM STATEMENT: The purpose of this presentation is to discuss piloting three high-fidelity simulation scenarios built for junior level BSN students to provide simulated experiences of caring for medical-surgical patients with mental illness (MSMI). SUMMARY OF EVIDENCE: The complexity of nursing care can increase with MSMI patients, yet, few nurses are prepared for this complex population. Simulation providing nursing students the experience of caring for the complexities of MSMI patients can emphasize needed skill development - especially therapeutic communication. DESCRIPTION OF PRACTICE OR PROTOCOL: Often psychiatric nursing is a separate course offered later in the curriculum and the co-morbidities of mental and physical illnesses are not integrated in earlier courses with adequate assessment skills or effective interventions. VALIDATION OF EVIDENCE: High-fidelity simulations can mimic a real medical-surgical clinical setting in a safe and judgement-free zone. Nursing students who provide care for MSMI patients can begin a normalization and de-stigmatization towards mental illness. They learn to care for physical and mental health intersections with vital assessment skills, therapeutic communication, prioritization and clinical reasoning.  Ninety percent of the participants indicated the simulated experiences will assist them to better manage their care of MSMI patients. RELEVANCE OF PMH NURSING: With MSMI patient simulations students can safely learn to care for the complexities of those who intersect physical and mental health with development of strong assessment skills and therapeutic communication as well as prioritization of care with sound clinical reasoning. FUTURE IMPLICATIONS: Simulated experiences with MSMI patients could be designed for early placement in nursing curricula, especially with the most frequent co-morbidities of mental and medical disorders, and with interprofessional collaborative teams.


2034.2: Reducing the Stigma of Mental Illness among Undergraduate Nursing Students: a Holistic Approach
Joshua Baker, RN-BC

PROBLEM STATEMENT: Stigma associated with mental illness increases anxiety, stress, and fear.  This is experienced by nursing students and is disruptive to the learning environment, student nurse-patient relationship, and can offset a student nurse’s career trajectory. SUMMARY OF EVIDENCE: Literature suggests attitudes of the student nurse towards individuals with mental illness are: fearful, avoidance, intolerant, and overall negative.  These negative attitudes directly influence care provided in prelicensure nursing programs and carry into nursing practice and have career lasting impacts on nursing professionals.   Effective holistic interventions in nursing education can reduce and eliminate negative attitudes towards mental illness. DESCRIPTION OF PRACTICE OR PROTOCOL: Stakeholders identified were nursing students in a BSN program.  Students experienced educational interventions during psychiatric nursing content of the BSN curriculum.  Changes to curriculum were targeted to reduce stigma and streamline learning experiences.  Changes targeted both the didactic and clinical curriculum; including restructuring of lecture topics, interactive computer based training aides, live simulation experiences, therapeutic communication, de-escalation, and crisis intervention training, all prior to the hands-on clinical experience. VALIDATION OF EVIDENCE: A literature search was conducted using EBSCOhost, PubMed, and CINAHL. The John Hopkins Nursing Evidence Based Practice Model was used to critically appraise the level of evidence. Interventions were selected based on ease of implementation, best practice outcomes, and fiscal feasibility; the desire was maximum impact with minimum burden to the university. RELEVANCE OF PMH NURSING: Decreasing stigma associated with mental illness among nursing students improves patient care, nursing careers, and all aspects of the profession of nursing. FUTURE IMPLICATIONS: Continuation of education interventions will be utilized to improve outcomes and learning in the undergraduate program.

3141 Fairview Park Drive, Suite 625
Falls Church, VA 22042
© 2019 American Psychiatric Nurses Association. All Rights Reserved.
Contact Us|Terms of Service
Toll Free: 855-863-APNA (2762)
Fax: 855-883-APNA (2762)
AMERICAN PSYCHIATRIC NURSES ASSOCIATION and APNA-Logoare registered in the U.S. Patent and Trademark Office as trademarks of the American Psychiatric Nurses Association.
The American Psychiatric Nurses Association is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.