Annual Conference Friday Abstracts

3025.1: Do Nurses’ Alcohol and other drug (AOD)-Personal Experiences and Education Impact their Willingness to Provide Care to Patients with Opioid Use-Related Problems?
Khadejah F Mahmoud, PhD(c), MSN; Ann M Mitchell, PhD, RN, AHN-BC, FIAAN, FAAN; Dawn Lindsay, PhD; Kathryn R Puskar, DRPH, RN, FAAN

PROBLEM STATEMENT: Opioid use-related problems are significantly linked to negative health, social, and economic consequences. Nurses have a major role in driving the response to the opioid epidemic. However, nurses’ low willingness to provide care to patients with opioid use-related problems is a major barrier to implementing opioid use-preventive measures. Exploring how nurses’ alcohol and other drug (AOD)-personal experiences and education shape their perceptions and consequently their willingness to provide care to this patient population is critical in developing interventions that target their willingness to provide opioid-related care. THEORETICAL FRAMEWORK: An adapted and expanded version of the Maudsley Alcohol Pilot Project theoretical framework was utilized. METHODS AND DESIGN: A nationwide online-survey targeting three national nursing organizations was conducted. A descriptive correlational design was used to explore nurses’ AOD-personal experiences and education impact on their willingness to provide care to this patient population. Analyses will include multiple linear regression. RESULTS: This nationwide survey targeted three nursing groups (Addiction-trained nurses, psychiatric-mental health nurses, and general medical-surgical nurses). We are currently in the data collection phase. Results will be presented at the conference. IMPLICATIONS (PRACTICE): Findings from this study will inform future substance use-related education within nursing schools and clinical settings to promote the transfer of opioid-acquired knowledge into clinical practice. IMPLICATIONS (RESEARCH): Findings from this study will inform the development of interventions designed to target nurses’ willingness to provide care to patients with opioid use-related problems.


3025.2: A Community Collaboration of HOPE- Heroin and Opioid Prevention and Education
Jessica Collins, RN-BC, BSN, LPC

PROBLEM STATEMENT: The opioid epidemic faced in the United States is a growing concern for healthcare providers and cannot be tackled alone. Lack of combined efforts to address the ongoing opportunities are lacking, leading to BH providers experiencing burnout. SUMMARY OF EVIDENCE: The CDC has supported that the best way to combat the epidemic is to build collaborative efforts that include and support healthcare and public safety. In 2017, nationally there were 70k drug overdose deaths of which 68% related to opioids. Use of MAT, Recovery Coaches, and collaborative community efforts are known to reduce risks. DESCRIPTION OF PRACTICE OR PROTOCOL: HOPE is a community collaboration between hospitals, MH agencies and law enforcement, facilitating community based programs that seeks to humanely prevent, treat and combat the opioid epidemic. It includes decreasing criminal charges and focuses on new access points to treatment. It initiates Medication Assisted Therapy in the Emergency Department and provides next day follow up for patients and families, through the use of recovery coaches. VALIDATION OF EVIDENCE: Outcomes are measured using data of # of referrals, # of overdose deaths in the community and staff engagement around the process. Ongoing evaluation to determine best practice will continue. RELEVANCE OF PMH NURSING: HOPE includes MAT as well as supportive engagement around the opioid epidemic for PMH nursing. The outcomes indicate a more collaborative system that identifies increased access to treatment as well as several pathways to obtain help for an opioid addiction. FUTURE IMPLICATIONS: The program could be replicated in other settings to increase access to treatment and decrease the number of opioid overdose deaths in our communities.


3026.1: Addressing the Gap: Wellness Check Service
Stephanie Lucchese, RN, CPMHN(C); Elaine Amsterdam; Ian Gibson, RN; Michelle Heath; Laura Imperio

PROBLEM STATEMENT: In Ontario Canada, mental health clients do not receive timely psychiatric support in the community and post-discharge from hospital, which results in clients utilizing the Emergency Department for mental health and addictions support. SUMMARY OF EVIDENCE: In partnership with a community based mental health crisis service, Wellness Check Services was implemented in the Emergency Department of an Inner-City Health hospital located downtown Toronto to address this issue. The aim of the Wellness Check Service is to provide clients who present to the Emergency Department for a non-emergent mental health or substance use concern with mental health support post-discharge until clients have made connections with both formal or informal support, and to prevent repeat Emergency Department visits. DESCRIPTION OF PRACTICE OR PROTOCOL: Staff working in the Emergency Department provided clients with information regarding the Wellness Check Service and written or verbal consent was obtained for clients to participate in the project. VALIDATION OF EVIDENCE: Verbal verbatim was captured from the clients and data from Emergency Department visits was utilized to determine the effectiveness of the project. Improving access to mental health care is a challenge for all Canadians; the importance of collaboration at all levels is of extreme importance. RELEVANCE OF PMH NURSING: This project contributes to Psychiatric Mental Health nursing because it provides a unique and innovative approach to providing clients with community mental health support post-discharge from the Emergency Department that is safe and client-centered. FUTURE IMPLICATIONS: This project provides a strategy to improve timely access to mental health care for Canadians.


3026.2: Transcending Depression and Anxiety in Older Lesbian, Gay, Bixesual, Transgender and Intersex (GLBTI) Australians
Phillip M Maude, RN PhD

PROBLEM STATEMENT: Higher rates of depression and/or anxiety have been observed in older LGBTI people compared to their heterosexual counterparts. Older LGBTI people have lived through discrimination brought about by legislation as well as historical mental health diagnostic labels from earlier Diagnostic and Statistical Manual (DSM) versions. Longt erm exposure to discrimination has been identified as a major contributor to this disparity. There is a growing awareness among researchers that disparity may be exacerbated by the experience of or the expectation of discrimination from health care service providers, as LGBTI people begin to access services. THEORETICAL FRAMEWORK: Nil  METHODS AND DESIGN: This study utilised a systematic approach consisting of a literature review, use of depression and anxiety rating scales and interviews with 40 older GLBTI people to understand their lived experience of depression and anxiety. The interviews explored coping strategies, including how family members and health professionals have helped.  RESULTS: LGBTI people who are experiencing or have experienced depression and anxiety in the past reveal the use of a range of coping strategies. These include consulting sympathetic LGBTI doctors, taking appropriate medication and accessing counselling services. Uptake of the latter, however, depends on how confident individuals feel about discussing their sexuality with strangers. Fear of discrimination, or even loss of privacy, can discourage use of services in smaller rural communities. IMPLICATIONS (PRACTICE): This review and the consultations with stakeholders informed an education pack developed for workshops for service providers, lectures for undergraduate students and in community forum for the LGBTI communities. IMPLICATIONS (RESEARCH): A need to explore ageing LGBTI experiences.


3027.1: Caregivers Online: Demographic Characteristics and Burden of Care
Jaclene A Zauszniewski, PhD, RN-BC, FAAN; Nirmala Lekhak, PhD, RN; Hanan Badr, PhD, RN; Kayla Herbell, PhD, RN

PROBLEM STATEMENT: Family caregivers of adults with disabilities/illnesses number nearly 40 million. While providing in-home care may reduce outside contact and increase isolation, social media is a way to maintain connections. This study examined demographics and burden of care in family caregivers of persons with various health conditions who were recruited online. THEORETICAL FRAMEWORK: Montgomery and Kosloski’s Caregiver Identity Theory, which suggests there is no single generic caregiver identity, provided the context for the study. METHODS AND DESIGN: This cross-sectional study involved 234 family caregivers who completed online measures of demographics (i.e. age, gender, and race/ethnicity) and burden of care (i.e. hours of daily care and years of caregiving). Caregivers were categorized by care recipient’s health condition into nine groups. Differences were examined using chi-square and analysis of variance. RESULTS: Caregiver groups differed on age (range=42-63 years; F=4.74; p<.001) but were similar in gender (95% women) and race/ethnicity (88% white). Caregiver groups differed on hours/day and years of caregiving (F’s=2.76 and 2.84; p<.01). Caregiving hours/day ranged from 5 (mental illness) to 16 (traumatic brain injury) hours/day. Caregiving years ranged 3 (cancer) to 10 (other chronic conditions) years. IMPLICATIONS (PRACTICE): The findings show that family caregivers use the internet to seek information and support, suggesting the opportunity for future interventions using online methods and social media. IMPLICATIONS (RESEARCH): The findings indicate a need for caution when recruiting caregivers for online research as sample demographics may not reflect the known demographics of caregivers. However, significant differences across caregiving groups on age and caregiving hours/day and year deserve consideration in planning future online caregiver research.


3027.2: Reaching the Hard-to-Reach Patient with a Non-Traditional Behavioral Assessment Method: Another Look at Amazon MTurk
Veronica Decker, DNP, PMHCNS-BC, MBA, MS, RN, BSN; Jean Davis, PhD, DNP, EdD, FNP-BC, PHCNS-BC

PROBLEM STATEMENT: There is slim literature and understanding regarding therapeutic practices for hard-to-reach civilians and veterans in need of treatment for depression and cancer. These populations present unique care access challenges that must be met before effective tailored treatments can be implemented. THEORETICAL FRAMEWORK: Mental health professionals can learn a skills set for gathering information from this vulnerable population: Amazon’s Mechanical Turk (MTurk) behavioral research program. Participants of MTurk studies are called “workers” who are paired with experimental researchers or “requestors.” Requestors create online Human Intelligence Tasks (HITs) in the form of surveys for “workers” to get paid to complete. METHODS AND DESIGN: This online crowdsourcing platform will be used to obtain data. “Workers” (US community-dwelling veterans not hospitalized or institutionalized, aged 18+, and diagnosed with breast, colon, lung, prostate, and/or head and neck cancer between 2015 and 2017) will be asked questions regarding their experience of depression, pre-post cancer diagnosis. RESULTS: Results will provide preliminary information for designing a pilot study addressing unique whole-health needs of veterans with cancer and depression. IMPLICATIONS (PRACTICE): All mental healthcare professionals need to better understand links among depression, life-threatening illness such as cancer, and treatment, so they can provide optimal evidence-based care. Underused in mental health research, MTurk is a quick and handy online research platform that has the potential to impact our ability to reach vulnerable patient populations. IMPLICATIONS (RESEARCH): MTurk may prove extremely valuable with populations who feel stigmatized by mental health diagnoses, are hard-to-reach, or even in some way hidden from researchers and health care providers.


3031: Beyond the Powerpoint Lecture: Implementing Active Learning Strategies in Nursing Education
Kirby Williams, MSN, PMHNP-BC; Lyons Hardy, MSN, CNS, NP

PROBLEM STATEMENT: Core concepts of psychiatric- mental health nursing in nursing education are primarily covered in lecture -style format though evidence suggests that learners do not retain most information that is taught with this passive learning approach. Though evidence supports the use of active learning techniques, many nurse educators have not been introduced to these methods and styles of teaching. SUMMARY OF EVIDENCE: Research has shown that active learning techniques improve knowledge retention and create a deeper understanding of content because they shift the focus to the learners' needs and require active participation. There is little research that reviews how active learning can be used in didactic nursing education. DESCRIPTION OF PRACTICE OR PROTOCOL: Many nursing didactic courses are taught in a lecture style format with little learner participation. Less passive methods of learning are reserved for clinical teaching settings where students are involved in individual or group simulation and debriefings. VALIDATION OF EVIDENCE: In research on active learning that has been completed in other disciplines, students report more enjoyment in the learning process when these educational techniques are used. Practicing or observing role-playing activities may help them build confidence before they use the newly acquired skills.  Learning outcomes are enhanced through the interactive approaches. RELEVANCE OF PMH NURSING: Psych-mental health nursing education at the undergraduate and graduate level can benefit from using active learning techniques, because they can help instructors foster a more engaging, supportive, and meaningful learning environment. FUTURE IMPLICATIONS: By attending this presentation, nurse educators will learn multiple techniques that they will be able to incorporate into the classes they currently teach.


3032: Guardians of the Galaxy: Mobilizing Quality Improvement Teams to Reduce Restraint and Staff Injury
Yolanda Baugh, RN; Margie Balfour, MD, PhD

PROBLEM STATEMENT: People experiencing an acute mental health or substance use crisis present a complex challenge to health care systems – on the one hand, care must be taken to treat these vulnerable individuals in the least restrictive manner possible, while on the other hand, people in the throes of an acute crisis are at risk to cause harm to themselves or others, including healthcare staff. SUMMARY OF EVIDENCE: Thus, both restraint reduction and workplace violence prevention approaches are applicable to this problem.  In this session, we demonstrate how to employ these methods to reduce restraints and staff injuries in two crisis centers serving the most highly acute behavioral health patients, most of whom arrive directly from the field via law enforcement. DESCRIPTION OF PRACTICE OR PROTOCOL: A dedicated quality improvement team including front-line staff, key leadership, and data-driven decision-making employed  strategies such as data analysis to identify high risk patients/times, enhanced training, and the addition of peer support staff (people with lived experience with mental illness and/or substance use trained to engage with patients in a manner different than that of traditional clinical staff.) VALIDATION OF EVIDENCE: Restraints decreased by 50%.  Staff injuries did not increase (and trended towards decrease) despite an increased focus on injury reporting, and staff responses to AHRQ Culture of Safety Survey indicated an improved focus on safety. RELEVANCE OF PMH NURSING: While these interventions were developed for this specific setting, the methods can be applied to any setting. FUTURE IMPLICATIONS: In order to achieve this, organizations must support leadership buy-in, engaging front-line staff, and a data-driven quality improvement approach.


3033: Setting a New Standard: Developing and Operationalizing an Innovative Trauma-Informed Approach
Danielle Lee Milliken, MS, BSN, RN; Lisa R. Schneider, MS, BSN, RN-BC

PROBLEM STATEMENT: In the U.S. 1 in 5 children suffer from a mental illness with only 20% receiving treatment.  Prior to opening this unit, there was only 1 inpatient mental health bed for every 22,000 adolescents, and zero for children under 12 in Orange County, California. SUMMARY OF EVIDENCE: Historically inpatient mental health units have experienced high rates of seclusion/restraint, staff turnover, and patient/staff injury.  We believed that by applying trauma-informed care principles, these outcomes could be significantly improved. DESCRIPTION OF PRACTICE OR PROTOCOL: The unit was built with state-of-the-art materials to promote the safety of both patients and staff, including a 3600sqft outdoor area. The center offers a full seven-day programming schedule facilitated by a multidisciplinary team.  In alignment with patient- and family-centered care values, CHOC Children’s encourages family participation throughout the patient’s admission by encouraging their unrestricted presence at all times.  In addition, understanding the importance of comprehensive staff training and development is critical when opening a new unit.  Therefore, we provided a unique 9-week orientation training for all staff, including didactic and hands on experiences founded in trauma-informed care philosophies. VALIDATION OF EVIDENCE: Key quality metrics were identified and monitored. RELEVANCE OF PMH NURSING: The development and operationalization of this innovative unit has resulted in numerous positive outcomes including zero patient/employee injuries, <0.7% of patients have been placed in mechanical restraints.  <7% staff turnover.  5.9/6.0 employee engagement scores.  100% of RN's scored as "fully engaged". FUTURE IMPLICATIONS: Our goal is to change the way that pediatric mental health care is provided nationwide. We intend to prove that high quality, financially sustainable trauma informed care is achievable.


3034: Developing a Passion for Psychiatric Nursing in the Uninterested Undergraduate
Erica D. Kierce, DNP, PMHNP, PMHS

PROBLEM STATEMENT: The need for psychiatric nurses has never been higher than it is today. Despite this demand, undergraduate nurses' interest in a mental health careers remain stagnant. There is a need to inspire previously uninterested or undecided student nurses to choose a career in mental-health and improve access to high quality care. SUMMARY OF EVIDENCE: Current evidence suggests most students who choose mental health related careers do so because of pre-nursing school factors. Waiting for students to self-select mental health nursing has not increased the percentage of new nurses choosing mental-health. To meet the rapidly increasing demand for psychiatric nurses, a more proactive approach to psychiatric nursing education is indicated. DESCRIPTION OF PRACTICE OR PROTOCOL: To increase students interest in and selection of mental-health nursing as a career option three strategies were employed: 1. De-stigmatize each illness by aiding the student to normalize and self identify with some symptoms of the illness.  2. Provide clinical and simulation experiences to increase student comfort.  3. Provide relevant examples from practice and identify practical career options. VALIDATION OF EVIDENCE: Outcomes were evaluated by assessing the following both before and after the course: 1.  Students interest or desire to work in mental health related fields 2. Students personal beliefs and feelings towards working with individuals with mental health concerns  3. Students overall comfort with mental health related topics. RELEVANCE OF PMH NURSING: The experiences nursing students have at the undergraduate level can increase the likelihood of selecting a career in mental health. FUTURE IMPLICATIONS: Meaningful experiences in undergraduate education should be implemented to help meet the need for more psychiatric nurses.


3035: Psychiatric Emergency Team Dynamics: Emergency Response and Communication
Lori Harris, RN, BSN; Phillip Woods, BSN RN-BC

PROBLEM STATEMENT: Based on rising rates of seclusion, restraints and physical holds, as well as staff injury, a comprehensive discussion on team preparedness as well as a focus on descalation techniques facilitated a staff more prepared and confident to provide therapeutic intervention in the event of an acute psychiatric emergency. SUMMARY OF EVIDENCE: We have seen an increase in restraint, staff injury. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently deescalation training and Handle With Care training occurs during orientation and annually during competency review. These trainings are offered in a siloed approach and  without the benefit of mock interdisciplinary enactments of  patient situations and response. Our stakeholders include the patient and family and all members of the treating team ultimately resulting in a more satisfied result for patients, families and staff. Implementation will be accomplished through and online multidisciplinary  learning module followed by in person demonstration utilizing a superuser model. VALIDATION OF EVIDENCE: Outcomes will be measured by a reduction in restraints and assaultive behavior at the unit level. It will also demonstrate an increase in the comfort level of staff responding to scenarios. Data will be available at the time of presentation for preliminary discussion. RELEVANCE OF PMH NURSING: Inpatient units with a mixture of diagnostic criteria, struggle with effective and timely intervention in an acute patient situation such that staff feel competent and prepared to address safety. FUTURE IMPLICATIONS: We anticipate a reduction in both restraint and assault data as well as an increase in patient satisfaction and a decrease in patient injury. Outcome measures will be evaluated over time and compared to pre intervention data points.


3036: The Ultimate IPE (Interprofessional Education Program): Development and Implementation in a PMHNP Program for the Operational Setting.
Tarah Lewis, DNP, PMHNP-BC; Joellen Schimmels, DNP, PMHNP-BC

PROBLEM STATEMENT: In the complex world of military medicine, combat and operational stress includes physiological and emotional stresses encountered as a result of combat and mission demands during military operations. Combat and operational stress control are programs and actions taken to prevent, identify and manage adverse combat and operational stress in military units deployed in the operational setting.  Historically, combat and operational stress reactions account for up to half of all battlefield casualties. SUMMARY OF EVIDENCE: Educating behavioral health providers to work in this complex environment is challenging.  Use of outdated education principles contributes to these challenges and inhibits our ability to prepare the behavioral health warfighter we need for the mission. We needed to match our competencies in the forward deployed setting while focusing on patient and unit needs, and collaboration reaching beyond the silos of individual professions in our training. DESCRIPTION OF PRACTICE OR PROTOCOL: A longitudinal program was designed incorporating adult learning principles, experiential learning, peer groups and reflective practice.  Implementation of IPE at Operation Bushmaster (OBM) to include the School of Medicine, Graduate Nursing, Psychology, as well as PMH RN’s, and psychiatric technicians was initiated. VALIDATION OF EVIDENCE: Use of Kirkpatricks evaluation method. IOM interprofessional teamwork competencies measured impact of IPE. RELEVANCE OF PMH NURSING: Teaching APRN students as part of our wartime mission defining capabilities for behavioral health professionals is of critical importance. Integration of IPE during OBM improved student learning experiences and patient outcomes in the operational setting. FUTURE IMPLICATIONS: Continued IPE efforts and effective debriefs will enhance respect for unique cultures, communication, communication strategies, teamwork, roles and responsibilities of the team members.


3037: An Examination of the Quality of Evidence on Emotional Support Animals
Amy Ames, DNP, APRN, PMHNP-BC; Theresa De Porter, MD; Betz King, PsyD; Amy R. Johnson, LPC

PROBLEM STATEMENT: Psychiatric APRNs are likely to encounter client requests for certification of an emotional support animal (ESA), yet little evidence exists on the efficacy of emotional support animals on mental illness or standards of practice. The purpose is to summarize the existing knowledge around ESAs, highlight gaps in the literature and to make recommendations that support APRNs making decisions about ESAs. THEORETICAL FRAMEWORK: The breadth of the APRN knowledge base is what informs their practice, and that ultimately the individual nurse is responsible to practice competently, based on research and evidence and within their scope.  Tanner’s Model of Clinical Judgment is utilized. METHODS AND DESIGN: A comprehensive literature review of Emotional Support Animals was conducted. The findings were identified, evaluated and summarized. Gaps in knowledge were highlighted. RESULTS: The results conclusively indicate an alarming lack of guidelines or supportive evidence for ESAs as a recommended treatment. Additionally, very little is available on the psychiatric professional's role in the recommendation of ESAs. IMPLICATIONS (PRACTICE): APRNs are required to apply their acquired knowledge, skills to each situation and be able to adapt that knowledge and skills to different circumstances. In the absence of an evidence base, nurses should apply existing nursing ethics and standards of competence to evaluate whether ESAs are a prudent treatment recommendation. Ethical considerations for inadequate education about ESAs are discussed. IMPLICATIONS (RESEARCH): The ESA certification process has progressed far more rapidly than the creation of guidelines and competencies, necessitating extensive further research into the efficacy of this treatment and best practices.


3041: An Innovative Psychodynamic Model for Collaborative Case Supervision:  Bringing Together Experienced PMHNPs Faculty, VA PMHNP Residents, and DNP PMHNP Students Monthly for in Person and Remote Supervision
Joy Lauerer, DNP, MSN, APRN, BC; S.Akeya Harrold, DNP PMHNP; Janet York, PMHCNS BCN, CNS, NP

PROBLEM STATEMENT: Case supervision remains inconsistent with a gap in literature and evaluation specific to implementation of Psychiatric Mental Health Nurse Practitioner (PMHNP) supervision. Literature has focused primarily on psychologists, physicians, social workers, and psychoanalysts. PMHNPs lack resources and time allotment for therapeutic process supervision. Many times PMHNP students and residents lack access to more experienced PMHNPs for case review and supervision. SUMMARY OF EVIDENCE: Supervision originates from the traditional apprentice model, where a craftsman would take a trainee under his/her wing in order to teach him/her a craft. Peplau regarded clinical supervision as important for the psychiatric mental health nurses. The shift to biological psychiatry in the 90's and then the prescribing model as a primary focus for PMHNP's might suggest that the need for clinical supervision is decreased. However, the authors believe in a holistic model that supports the growth of the PMHNP with a clinical supervision model. DESCRIPTION OF PRACTICE OR PROTOCOL: Several disciplines have supervision models, with psychodynamic models being the most prominent. There is a lack of  development and implementation and emphasis regarding PMHNP specific clinical supervision. VALIDATION OF EVIDENCE: Research emphasizes the use of support ,self awareness, insight for PMHNP Competencies.  The Veterans Administration competencies for PMHNP residents include professionalism, communication and self awareness . The national professional speciality standards also includes self awareness competencies. RELEVANCE OF PMH NURSING: This practice has resulted in a robust monthly discussion of difficult clinical cases managed by PMHNP students and residents. FUTURE IMPLICATIONS: There is a need for theory development and practice evaluation for PMHNP's in clinical supervision related to therapeutic process.


3042: Reducing Patient Violence Against Nurses on Inpatient Psychiatric Units
Victoria Waterfield, RN, LCSW

PROBLEM STATEMENT: The purpose of this paper is to expand evidence-based strategies to prevent patient violence against nurses on adult inpatient psychiatric units. Violence and aggression occurs commonly in mental health settings internationally, resulting in significant physical and psychological trauma and increased healthcare costs. SUMMARY OF EVIDENCE: An APNA continuing education seminar, "What We Don’t Know CAN  Hurt Us! A Comprehensive Model for Managing Violence and Aggression on Psychiatric Inpatient Units," recommends nursing and security/polic ecollaboration. Collaboration with other professionals will provide another source of support for safe inpatient environments. This quality improvement project will add to the body of literature about violence prevention and response. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently, security walk on the unit three times every 24 hours. Beginning April 1, 2019, hospital security walks on the unit will increase to daily, twice between 0700 and 1530 and twice between 1530 and 2330. The rationale is to increase patient and staff sense of security by knowing that professionals trained to manage violence are available as needed. Stakeholders include nurses, patients, unit staff, hospital administrators and human. ALIDATION OF EVIDENCE: The strategy was endorsed by training provided by the American Psychiatric Nurses Association. Effectiveness will be measured by comparison of nurse assaults between January 1 and June 30, 2019. RELEVANCE OF PMH NURSING: If a reduction in patient violence is noted after the intervention, correlation may be concluded. Inpatient psychiatric units may become a safer places to work. FUTURE IMPLICATIONS: Incidents of violence against nurses, institution costs, absenteeism are expected to decrease.  More nurses may be attracted to a psychiatric speciality. Further research is indicated.


3043: Caring for Pediatric and Adolescent Behavioral Health Patients on a Pediatric Medical Unit: Proactive Approaches to Reduce Stigma, Decrease Escalation, and Improve Outcomes
Steffanie Schweitzer, APRN, PMHNP-BC

PROBLEM STATEMENT: Demand for inpatient psychiatry services continues to outpace availability, leading many patients to board on medical floors while they await services, usually in patient rooms with little to no stimulus, which can contribute to verbal and physical escalation. Nursing staff report challenges and knowledge deficits in meeting the unique needs of behavioral health patients. SUMMARY OF EVIDENCE: A needs analysis conducted on a medical surgical unit with a high proportion of behavioral health patients showed high levels of stigma surrounding behavioral health patients, poor understanding of the influence of trauma, need for de-escalation techniques, and behavioral interventions to promote positive interaction between patients and staff. DESCRIPTION OF PRACTICE OR PROTOCOL: Educations sessions focused on the influence of trauma on biology, skills to support suicidal patients, rapport building patient questionnaire, and a reward-based behavioral intervention system. Key stakeholders include psychiatric nursing staff, medical nursing staff, psychiatry, crisis support services, employee safety, and child life services. VALIDATION OF EVIDENCE: Outcomes were measured using preliminary needs analysis, pre/post surveys after each intervention, pre/post scale Perception of Prevalence Scale. RELEVANCE OF PMH NURSING: This QI project demonstrated an increase in knowledge regarding the role of trauma, best practices for supporting patients with suicidal ideation, improved de-escalation techniques, and the importance for frequent, positive reinforcement. An increase in perceived confidence of skills for nurses increased with a decrease in perceived aggression. FUTURE IMPLICATIONS: This QI project will serve as a useful tool for psychiatric and medical units, including emergency rooms, needing additional education, strategies,and interventions for behavioral health patients to achieve the best outcomes for patients and staff.


3044: Learning and Teaching Outcomes of an Undergraduate Simulation Assignment in Mental Health Nursing
Linda Denise Oakley, PhD, RN; Zhiyuan Effy Yu, BSN, RN, PhDc; Katherine Stahl, MSN, RN-BC, PHN

PROBLEM STATEMENT: Nurse educators now must prepare nurses able to meet patient mental health care needs in all care settings.   Yet despite annual reports of the rapid increase in need for timely mental health nursing care in all settings, few programs identify this care as essential professional knowledge or require clinical course content designed to develop the necessary clinical judgment and self reflection to notice mental health distress and take appropriate nursing action. SUMMARY OF EVIDENCE: To address this gap, nurse educators responsible for undergraduate classroom courses in mental health must strive to incorporate active-learning and team problem-solving assignments that, combined, require planning, presentation, performance, and evaluation of mental health nursing actions.   Because of the enormous resource requirements, nurse educators also must evaluate the learning and teaching effectiveness of simulation assignments. DESCRIPTION OF PRACTICE OR PROTOCOL: Guided by the essentials of baccalaureate education in nursing and Tanner's clinical judgment model, we revised our first simulation assignment by changing the setting and nurse encounter from a clinic visit to a home visit. VALIDATION OF EVIDENCE: From week-2 to 14 students (N=152) in groups of 8 worked through the assignment steps to plan, perform, present, and evaluate one 20-minute follow-up home visit with the patient, a relative, and the peer support worker. RELEVANCE OF PMH NURSING: Digital poster presentation of the simulation and individual reflections on nursing actions during the visit were graded. Evaluation of learning and teaching effectiveness included immediate and follow-up student debriefing with comments and feedback. FUTURE IMPLICATIONS: Student comments stated learning ("...listening will make all the difference") and teaching shortcomings we immediately incorporated into the course.


3045: Igniting Early Adopters: Implementing Collaborative Care for Depression
Yvonne T Porterfield, MSN, PMHCNS-BC

PROBLEM STATEMENT: Our organization recognized the need to improve access to mental health services. We describe a project to implement collaborative care for depression in primary care. SUMMARY OF EVIDENCE: Over 90 RCTs confirm that collaborative care improves access and clinical outcomes for patients with depression. Research into successful implementation is less robust and shows that the process of innovation is complex. We used concepts from diffusion of innovation and quality improvement to implement the program. DESCRIPTION OF PRACTICE OR PROTOCOL: Brought together champions for depression quality improvement and educated them about the collaborative care model and presented the research evidence.  Then engaged a small group of early adopters to apply real world testing of the model and collected preliminary data. We also used existing groups such as physician groups as local communities of practice to promote broader adoption. VALIDATION OF EVIDENCE: Identified essential elements for successful implementation and developed a rubric for evaluating degree of implementation of each element. We correlated patient outcomes (significant improvement and remission of depression) to the degree of implementation at each of 17 sites. RELEVANCE OF PMH NURSING: We met with stakeholders at each site to assess degree of implementation and discuss next steps to add additional elements. Three sites have implemented the full model. At least three additional sites are actively planning full implementation in 2019-2020. FUTURE IMPLICATIONS: Psychiatric nurses apply science from many different areas to advance the health of our patients. There are many models and theories of change used in implementation. More research is required to identify the most effective models for implementing innovative programs for mental health care.


3046: Addressing the Unique Mental Health Needs of America's Veterans: A Guide For Community Providers
May Linn Nara, DNP, PMHNP-BC; Amy R. Morton-Miller, PhD, PMHNP-BC/PMHCNS-BC, CNE

PROBLEM STATEMENT: Currently, the massive influx of returning veterans from recent worldwide conflicts has created a critical need for more mental health services for these individuals. VA Medical Centers have responded with increased and enhanced services. Yet, many veterans never present to the VA system and instead are seen by community providers. They may live far from a treatment center,  may have private health insurance or they may not wish to seek care through the VA. It becomes imperative for community providers to understand and address the unique mental health treatment needs of veterans. SUMMARY OF EVIDENCE: Mental health providers often have little understanding of military culture and of how this culture influences the perceptions, desires, and mental health needs of veterans. Without this understanding, veterans can often feel disenfranchised and misunderstood, leading to  errors in treatment planning and/or early termination of treatment. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently, PMH nurses working in community settings have limited to no exposure to veteran issues in school or in practice. Yet, there is a large current influx of new veterans presenting to  community providers necessitating the need for more education and training. VALIDATION OF EVIDENCE: Recent surveys of providers and anecdotal reports indicate providers typically have little to no education regarding the specific needs of this population. RELEVANCE OF PMH NURSING: With specific focus on  military culture, PTSD,  and moral injury, this presentation will address the learning needs of  community psychiatric nurses providing care to this population. FUTURE IMPLICATIONS: The needs of this population will become better understood, ultimately leading to improved treatment outcomes for this deserving population.


3047: Mindfulness in Individuals with Anorexia Nervosa
Julie P Dunne, PhD, PMHNP-BC, RN

PROBLEM STATEMENT: Mindfulness may enhance physical and psychological wellness but research on its usefulness in anorexia nervosa (AN) in limited. The purpose of this study was to determine the relationship between mindfulness, eating disorder symptomology and indicators of health in persons with AN. Furthermore, this study assessed for unique variance in eating disorder symptomology accounted for by mindfulness and other indicators of health. THEORETICAL FRAMEWORK: Buddhist and Western conceptualizations of mindfulness were considered in this research. It was theorized that mindfulness , or lack thereof, may be related to certain cognitions and behaviors associated with anorexia nervosa. METHODS AND DESIGN: A cross-sectional and descriptive study was conducted. Sixty female, individuals with anorexia nervosa participated. Additional data from the participants’ charts were also collected. Data were analyzed using SPSS. RESULTS: Mindfulness was significantly, inversely correlated with eating disorder symptoms. Mindfulness significantly and inversely predicted shape concern and weight concern but not eating concern or restraint. When considering indicators of health and certain demographic variables, only anxiety and pain significantly predicted eating disorder symptoms among this sample. IMPLICATIONS (PRACTICE): Level of mindfulness may be related to eating disorder symptomology in acute anorexia nervosa (AN). Nurses and nurse practitioners may be able to support individuals with AN by recommending mindful interventions that reduce shape and weight concern, such as breathing and body awareness meditation practices. IMPLICATIONS (RESEARCH): Additional research should examine the mechanisms of actions of mindfulness and variance between subtypes of anorexia nervosa. The role of pain and anxiety on eating disorder symptomology and mediating or moderating effects of mindfulness should also be studied.

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