Friday Abstracts: Block Two

3031: Reducing Avoidable Readmissions Effectively
Jeannine Loucks, MSN, RN-BC PMH;  Elizabeth Winokur, PH.D., RN, CEN

PURPOSE: Describe an innovative program aimed at providing recovery-oriented psychiatric services to individuals in crisis presenting to a community hospital emergency department. SUMMARY OF EVIDENCE: Psychiatric complaints are a component in one out of every eight emergency department visits (Owens, et al., 2010).  EDs are becoming primary care settings for individuals presenting with psychiatric crisis (Zeller, 2010). It is likely that hospital EDs will continue to see an increase in individuals presenting with psychiatric emergencies. Often ED nurses feel inadequately prepared to care for these patients but with proper education on psychiatric medications and supports they can successfully intervene with psychiatric emergencies. DESCRIPTION: The presenters will describe an exemplar program where ED staff have received specialized education on managing behavioral health psychiatric crises.  This specialized training has provided ED nurses with strategies to recognize and initiate psychiatric care protocols thus reducing risk for agitation or violence and delays in psychiatric care and stabilization. VALIDATION OF EVIDENCE: 1) Utilization of a Standardized Treatment Protocol using the Anxiety Agitation Severity Scale to initiate immediate care in the ED; 2) reduction in restraint usage and time. RELEVANCE/OUTCOMES: PMH nurses are in a unique position to inspire and collaborate with ED nurses in caring for behavioral health emergencies. IMPLICATIONS: Findings from this project suggest that ED nurses are interested in learning more about mental illness and resources.


3032: Assisting Undergraduate Students to Embrace the Art and Science of Mental Health Nursing:  A Long Way to go and a Short Time to Get There
Dawana Gibbs, RN, MSN, CNE;  Donna Turner, RN, MSN;  Brandy Shea Chambers, MSN, RN

PURPOSE: To share ideas and encourage other nurse educators to develop/reinvent effective methods of teaching PMH nursing. SUMMARY OF EVIDENCE: Special challenge for nursing educators  teaching students who grew up in a culture where communication has become more electronic and less personal. Issues pertaining to civility,insight and accountability have come to the forefront in the academic arena. DESCRIPTION: Educators must engage students' interest, increase their  insight, and spark empathy for clients with mental health needs.  Educators would be interested to hear ideas that have been effective and share their own ideas for improving the outcomes for PMH nursing education. VALIDATION OF EVIDENCE: Methods lead to consistent performance above the national mean on standardized testing (EAQ) scores in  mental health content.  Evidence of learning comes from observation of students in the clinical setting, reflections in students' journals, feedback from employers, and anecdotal stories from students who have graduated and gone on to practice in many settings. RELEVANCE/OUTCOMES: The nursing role in many settings has been diminished and disimpowered.  An interest, engagement and increased comfort level with PMH skills may provide impetus for nurses to enter the field and re-energize the PMH nurse's role. IMPLICATIONS: The current generation of up and coming nurses have some special learning needs in the areas of empathy, face-to-face professional communication, and civility. Educating and producing graduates who can provide competent, compassionate care for clients with mental health needs has become of critical importance given the future of health care.


3033: Evaluation of a Psychiatric NP Residency Program in  Integrated Care
B. Jamie Stevens, MSN, APRN, PMHNP-BC;  Joyce Shea, DNSc, APRN, PMHCNS-BC; Sarah Freiberg, MSN, APRRN, FPMHNP-BC

PURPOSE: The purpose of the presentation is to review outcomes for the first year of a PMHNP Residency Program in Integrated Care. SUMMARY OF EVIDENCE: The transition to practice for graduates of Nurse Practitioner (NP) programs can be challenging, even for the best prepared student. Since 2007, NP residency programs have emerged to facilitate this transition and to develop, through guided practice, the skills and competencies required of recently licensed NPs in a dynamic healthcare system. The Institute of Medicine (IOM) has recommended the establishment of nurse residency programs for graduates of advanced practice degree programs. To date, few of these programs have been established for Psychiatric NP’s and the existing programs do not focus on competencies specific to the integration of behavioral health and primary care. DESCRIPTION: An academic-practice partnership was established in 2014 between a FQHC and a private university to launch a twelve month PMHNP Residency in Integrated Care. The first resident will complete this program in Fall 2016. VALIDATION OF EVIDENCE: The program’s effectiveness in meeting the identified goals of improving patient outcomes, enhancing primary care providers’ satisfaction, and increasing the NP residents’ self-efficacy will be discussed from the point of view of the organization, the academic partner, and the resident. RELEVANCE/OUTCOMES: The rationale for focusing on integrated care competencies will be shared and results of the program evaluation will be described. IMPLICATIONS: Residency programs provide support to the novice PMHNP in the critical first year of practice, resulting in increased retention rates and improved health outcomes.


3034: Transitioning to Teach:  Helping Clinicians and Administrators Enter Academia
Joan Masters, EdD, MBA, APRN, PMHNP

PURPOSE: The purpose of this presentation is to prepare clinicians and administrators considering a career in a teaching-focused college or university for the academic hiring process with particular attention to the academic job-talk and the sometimes controversial issue of hiring DNP graduates as faculty. SUMMARY OF EVIDENCE: The DNP degree was developed to prepare expert clinicians and administrators but the nursing faculty shortage, particularly in specialty areas such as psychiatric nursing, has created an opportunity for DNP graduates to enter academia. While the shortage is serious, full-time  tenure-track positions may still attract significant numbers of applicants. DESCRIPTION: There is a protocol in academia for applying for faculty positions but many applicants may be unaware of the finer points of this process; one reason is that these topics are rarely addressed in academic journals. VALIDATION OF EVIDENCE: The topics of the tailored cover letter, curriculum vitae, teaching philosophy, interview with the search committee, academic job talk and/or teaching demonstration, campus visit, and acceptance of an offer were extensively researched to create clear guidelines for potential faculty. RELEVANCE/OUTCOMES: The shortage of psychiatric mental-health nursing faculty jeopardizes the supply of future psychiatric mental-health nurses and nurse practitioners. IMPLICATIONS: The profession needs to demystify the faculty hiring process if we are to recruit more psychiatric mental-health nurses into teaching.



3035: Moral Distress and the Psychiatric Nurse:  Assessment and Intervention
Kathrynn Thompson, MS, RN, PMHCNS-BC

PURPOSE: Moral distress arises when the nurse’s ability to practice as a moral agent, using their accepted professional values and standards, is compromised (Varcoe, Pauly, Webster and Srorch, 2012). SUMMARY OF EVIDENCE: It has been studied across many specialty areas but very little has been written about moral distress and psychiatric nursing.  Incompetency in co-workers, lack of communication, organizational ethical climate and witnessing suffering that the nurse feels could have been prevented can lead to moral distress(Woods, Rodgers,Towers & La Grow, 2015) and can be can be generalized to the psychiatric setting. DESCRIPTION: The Nurse Ethics committee at an academic medical center decided to examine moral distress as a potential educational opportunity. A descriptive study was undertaken with the ultimate goal of developing interventions to decrease and/or deal with the results of moral distress. VALIDATION OF EVIDENCE: The descriptive study results were consistent with the current literature on the effects of moral distress on the nurse and the institution. Little has been written about ways to prevent or intervene in moral distress. RELEVANCE/OUTCOMES: Psychiatric nurses are at risk for moral distress. Identification of moral distress and subsequent interventions are vital to supporting nurses.. Developing interventions that promote resiliency in the nurse and address ethical issues is also necessary. IMPLICATIONS: Acuity continues to rise in healthcare organizations across the country. Moral distress should be an expected outcome for many of the nurses being asked to care for these patients.  A proactive approach to define, recognize and intervene early will improve nursing and patient satisfaction and the quality of patient care.


3036: Sexual Health Assessments with Special Attention to Sexual and Gender Minority Populations
Jeffrey "Frey" Seagrove-Nelson, MSN, APRN, PMHNP-BC

PURPOSE: Sexuality is a central part of the human experience, yet sexual health is often a neglected area of clinical practice. This is especially true for individuals within sexual and gender minority groups who have historically not received adequate healthcare. SUMMARY OF EVIDENCE: Research into healthcare professionals' attitudes regarding sexual health suggests that although many understand the importance of sexuality, a majority either feel uncomfortable or otherwise fail in addressing these concerns. Compounding this issue, the underserved populations of sexual and gender minority individuals face unique health issues and still experience healthcare disparities. DESCRIPTION: Education on terminology related to sexual and gender minority populations and discussion models like Ex-PLISSIT combined with screening tools such as the Arizona Sexual Experience Scale (ASEX) can increase a provider's sexual health competence. VALIDATION OF EVIDENCE: The ASEX is a simple assessment tool and has been found to be a reliable, valid, and sensitive screener for sexual dysfunction regardless of gender/sex. Additionally, research into healthcare professionals' attitudes toward sexuality suggests that training and experience in areas of sexual health is positively correlated with comfort in discussing these concerns with consumers. RELEVANCE/OUTCOMES: Given the complex interplay of physiological and psychosocial factors, mental health professionals are uniquely situated to lead the larger healthcare community in adopting more inclusive and thorough sexual health assessments into clinical practice. IMPLICATIONS: An understanding of basic terminology related to sexual and gender minority populations paired with the implementation of tools such as the Ex-PLISSIT model and ASEX should yield positive outcomes with consumers in a variety of clinical settings.


3037: Assessing the Effectiveness of an Interactive, Adjunctive iBook Nursing Curriculum on Pre-licensure Nursing Students' and Nurse Practitioner Students’ Knowledge of OEF and OIF Veterans, Combat PTSD, and Mindfulness Practices
Erica Mumm, DNP, MSN, RN

PURPOSE: The purpose is to 1. bring awareness to the uniqueness of veterans healthcare needs, 2. bring awareness to the lack of education within nursing curriculum on these topics, 3. highlight the potential value of using mindfulness practices in the plan of care for veterans, and 4. share results of knowledge growth as a result of the curriculum module. In 2012 there was a call to action by the AACN to make veterans healthcare within nursing curriculum a priority.  However, very few schools of nursing have adopted this topic and there remains no uniform content on veterans health that could be universally adopted. SUMMARY OF EVIDENCE: Studies indicate a range from 11 to 20% to 21% to 30% of OEF and OIF veterans have PTSD. The long term sequelae and comorbidities of PTSD has yet to be reached. Stigma impacts the care that veterans seek. There is no universal nursing curriculum to educate students on this population. DESCRIPTION: Outreach to AACN, deans, and directors to assist with implementation and serve as stakeholders as well as students. VALIDATION OF EVIDENCE: Current literature states that the incorporation of holistic/CAM practices as well as veterans health is lacking in nursing curricula. A quasiexperiemental pre-post test design was used to asses the effectiveness of the iBook intervention. RELEVANCE/OUTCOMES: Knowledge scores were improved in all post-tests. Five out of seven constructs measured proved statistically significant. Participants ranked the module "valuable." IMPLICATIONS: Implementation of a universal curriculum. Increased knowledge and confidence for nurses/nurse practitioners. Increased community outreach and intervention.   Less stigmatized, holistic care offerings for veterans.


3041: Institute for Safe Environments Interactive Discussion Panel
Diane Allen, MN, RN-BC, NEA-BC;  Michael Polacek, MSn, RN-BC

PURPOSE: The Institute for Safe Environments Interactive Discussion Panel provides an opportunity for APNA members to discuss safety concerns, share information about current practices and learn from each other. SUMMARY OF EVIDENCE: ISE Steering Committee members continue to be thought leaders who strive to engage members in exploration of issues related to Key Elements of Safe Environments. DESCRIPTION: In 2016, the ISE Steering Committee embraced a charge from the APNA Board of Directors to lead a Violence Prevention Task Force to recommend best practices and provide resources to members. VALIDATION OF EVIDENCE: In the past year, ISE members produced and published works about nurse-patient engagement, the use of constant special observation and the role of psychiatric nurses in hospital emergency rooms. RELEVANCE/OUTCOMES: Safety and violence prevention continue to be critical issues for APNA members and the public at large. IMPLICATIONS: The future of Psychiatric Nursing depends upon forums such as those provided by the APNA - where nurses can contribute ideas toward creation of safe practice environments


3042: The Institute for Mental Health Advocacy Annual Interactive Panel 2016
Kathryn Brotzge, MSN, PMHNP -BC

PURPOSE: The annual Institute for Mental Health Advocacy will review the guidelines of advocacy through APNA.  Participants will learn the tools available on the APNA website. Discussion will be shared on advocacy for consumers and family.  The role of the APRN and RN in advocacy will be reviewed.  Participants will share discussion on current  legislative issues. SUMMARY OF EVIDENCE: The past years, participants have shared successful forms of advocacy.  Members have returned to their communities and worked with making local changes.  APNA continues to be a key player in advocacy nationally and locally thru membership.  Other agencies seek review by APNA on issues relating to policy and position statements. DESCRIPTION: Advocacy is completed through grass root efforts.  Knowledge is provided to participants for advocacy.  Tools are provided through the APNA website to enhance efforts of members.  Tools and education give participants the basics for advocacy. VALIDATION OF EVIDENCE: Review of past topics and outcomes by participant feedback after each session.  Outside agencies continue to seek the view of the IMHA thru APNA.  Participants and presenters provide review of past techniques used and successes. RELEVANCE/OUTCOMES: The PMH nurse's role includes advocacy.  Advocacy for our consumers, their family and psychiatric nurses.  Advocacy is a key component of nursing.  Continued sharing of knowledge continues to improve our nurses. IMPLICATIONS: Advocacy will continue to be an important part of nursing.  New trends and new instruments will continue to change how advocacy occurs.  Changes in legislation and administrations in government will change with each election.  Nurses advocate at the bedside and in the state house.


3043: Parents’ Self-Help Training for Improved Attention Deficit Hyperactivity Disorders (ADHD) Outcomes
Danny Willis, DNS, RN, PMHCNS-BC

PROBLEM STATEMENT: N/A; this is the Research  Council Interactive Panel on propsoal writing THEORETICAL FRAMEWORK: N/A; this is the Research Council Interactive Panel on proposal writing. METHODS & DESIGN: N/A; this is the Research Council Interactive Panel on propsoal writing RESULTS: N/A; this is the Research Council Interactive Panel on proposal writing IMPLICATIONS FOR PRACTICE: N/A; this is the Research Council Interactive Panel on proposal writing IMPLICATIONS FOR FUTURE RESEARCH: N/A, this is the Research Council Interactive Panel on proposal writing.


3044: Supporting and Mentoring Nurse Leaders
Kathy Lee, MS, PMHCNS-BC, APN;  Avni Cirpili, RN, DNP, NEA-BC

PURPOSE: Nurse Leaders work in an environment of constant change, escalating challenges,and competing priorities.   Nurse Leaders at all levels manage recruitment and retention within health-care's multigenerational workplace .  The Nurse Leader's role has evolved into a multi-layered responsibility.  This interactive panel wll equip Nurse Leaders with strategies to develop committed, resilient, and expert new leaders. SUMMARY OF EVIDENCE: This topic was selected after personal observation of challenges faced by new (and existing) Nurse Leaders, coupled with current literature about resilience. DESCRIPTION: Literature supports the need for resiliency in today's health care workplace.  Experienced leaders must be able to support new leaders.  During this interactive discussion leaders will share current best practices and explore innovative ideas. VALIDATION OF EVIDENCE: Successful implementation of strategies for supporting Nurse Leaders is crucial to assuring high quality leadership now and in the future.  Presumably, adequate support will encourage current leaders to retain their positions, while encouraging emerging leaders to assume formal leadership positions. RELEVANCE/OUTCOMES: PMH Nurse Leaders should be experts in offering support to others.  This interactive discussion intends to focus that skill to defining how we can assist other leaders achieve professional and personal success. IMPLICATIONS: New and existing Nurse Leaders require support and mentoring to gain skills needed to assure excellent patient care.   Support must include tangible elements such as educating about financial, staffing, coaching, and performance management.  Equally important, the Nurse Leader must be well versed in  resiliency and implement interventions that promote it in new leaders.  Without support, Nurse Leaders will experience significant difficulty navigating the turbulent waters of health care.

3046: Officer Involved Shootings - Why so many?
Nina Beaman, EdD, MSN, RN-BC (PMH), RNC-AWHC, CNE

PURPOSE: There has been a significant increase in officer-involved shootings necessitating an examination of the root causes of this phenomenon (both from sworn officers violence towards civilians in the community and from civilians towards officers) and brainstorming session about how to establish safe and and mentally healthy communities. SUMMARY OF EVIDENCE: I will present case studies and examine possible reasons for the increase in officer involved shootings. DESCRIPTION: This will be an interactive session where the participants will be asked to share best practices in their local areas to improve community mental health and decrease office involved shootings. VALIDATION OF EVIDENCE: A literature review of officer involved shootings and violence. RELEVANCE/OUTCOMES: Psychiatric nurses live in communities and are advocates for decreasing community violence. IMPLICATIONS: Brainstorming about ways to decrease community violence and sharing best practices can provide participants with best practices to use in their own communities.

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