Annual Conference Friday Abstracts

3011.1: Using Genetic Testing to assist with Treatment Decisions in the Outpatient Psychiatric Setting: Case Studies from the Clinic
Evelyn J Norton, APN, DNP, PMHNP-BC; Claire E Oliver, MSN, PMHNP-BC; Kristin E Katsenes, RN, BSN, PEL-CSN (IL)

PROBLEM STATEMENT: Psychiatric practitioners historically have used the hit or miss method of prescribing medications (Treatment as usual -  TAU) approach based on presenting symptoms and patient history.  Genetic testing is now available to give some indication of how an individuals genetic makeup will potentially affect pharmacodynamics and pharmacokinetics of the medications. SUMMARY OF EVIDENCE: According to one published study genetic testing accurately predicted those patients who were more likely to have poor depression outcomes due to gene-drug interactions. Treatment as usual subjects who had been prescribed medications that were genetically sub-optimal had almost no improvement in depressive symptoms over the 10 weeks of the trial. Other studies will be presented from the literature supporting the use of genetic testing in improving patient outcomes. DESCRIPTION OF PRACTICE OR PROTOCOL: TAU - Treatment as usual versus gene congruent medication selection. VALIDATION OF EVIDENCE: Observed anecdotal evidence in our practice and review of published studies from the literature to be presented. RELEVANCE OF PMH NURSING: Genetic testing in the clinic practice is now a routine part of the psychiatric evaluation for each client in our clinic. FUTURE IMPLICATIONS: Improved accuracy in prescribing and earlier remission of symptoms using gene congruent medications.


3011.2: Preventing the Ills of Too Many Pills: Using Collaborative Deprescribing
Joanne DeSanto Iennaco, PhD

PROBLEM STATEMENT: The therapeutic provider-patient relationship is key to successful psychopharmacologic management and treatment.  Dynamics involved in this relationship are important to understand to provide high quality care to patients.  Many patients end up with multiple agents being prescribing to manage their psychiatric symptoms.  Polypharmacy can be dangerous and result in adverse effects, interactions as well as overmedication of patients.  This presentation will use an approach that acknowledges the dynamics of the prescribing relationship to engage with patients in finding the best regimen for management of their symptoms and addresses principles that should be considered in deprescribing for patients. SUMMARY OF EVIDENCE: The evidence suggests that polypharmacy has become more prevalent over time, while evidence from high quality clinical trials supporting polypharmacy is less established.  Provider and team member’s response to symptomatic distress in patients may play a role in overprescribing or polypharmacy.  Countertransference prescribing has been described in the literature, particularly in vulnerable or demanding patients.  Recognition of these phenomenon are important to rational prescribing practices.      DESCRIPTION OF PRACTICE OR PROTOCOL: Deprescribing is the rational consideration of and minimization of prescribing so that medications are reduced to the minimum number and dosages required to maximally improve symptoms without causing symptom return, side effects or interactions. VALIDATION OF EVIDENCE: It is difficult to determine impact of individual agents when patients are on more than one medication of a class or on multiple medications across classes. RELEVANCE OF PMH NURSING: Awareness of the dynamics of the provider-patient prescribing relationship and principles of deprescribing support improved patient outcomes. FUTURE IMPLICATIONS: A singular focus on psychopharmacologic treatment can be detrimental.


3012.1: Psychotherapeutic Modalities for RN’s: Application of Behavioral Activation and Motivation on an Inpatient Psychiatric Unit
Dawn Vanderhoef, PhD, DNP, RN, PMHNP/CNS-BC; Rita Haverkamp, MSN, PMH CNS; Gregory Jones, RN

PROBLEM STATEMENT: The increased complexity of patient presentations admitted to inpatient psychiatric units requires RN’s to be armed with knowledge, skills and abilities of psychotherapeutic interventions. Given the variability of content nursing students receive in academic programs, and training offered by health care originations, staff RN’s are challenged with developing and staying abreast of evidence based psychotherapeutic skills. SUMMARY OF EVIDENCE: Motivational interviewing and behavioral activation are two EB practices that can be utilized by the psychiatric RN to engage patients and improve outcomes. MI was initially developed to work with persons with substance use disorders, but the evidence now demonstrates that MI works with all patient population and can improve health outcomes. Behavioral activation is another psychotherapeutic modality that psych RN can learn and feel armed with a new set of stills to activate patients. DESCRIPTION OF PRACTICE OR PROTOCOL: Many inpt psychiatric RNs do not receive training or education in any psychotherapeutic modality and struggle to engage very challenging patients. This session will allow nurses to learn two modalities, see the modalities demonstrated by experts and have a change to practice each technique. VALIDATION OF EVIDENCE: The participants of this session will leave with the knowledge, skills and abilities to utilize two EB modalities with patients during their next shift on the inpt unit. RELEVANCE OF PMH NURSING: Additional techniques in a psych RN's tool kit - MI and BA techniques. FUTURE IMPLICATIONS: Participants will leave with the basic level of knowledge and information on how and where to obtain more formal training in MI and BA.


3012.2: Therapeutic Use of Sensory Tools in Managing Adult Emotional Distress
Judy L. Toy, RN; Pauline Y Andan, RN-C; Abigail N. Plotkin Kleiman, MS, OTR/L; Bryan Geoffrey Anderson, LCSW

PROBLEM STATEMENT: Adult Partial Hospital Program (PHP) lacked a structured educational plan for patients to learn effective management of emotional dysregulation using sensory tools. This project examined the effect of a nurse-led education program with sensory tools on managing perceived distress among non-inpatient adults. SUMMARY OF EVIDENCE: Research evidence suggests sensory interventions reduce arousal levels. Prior quarterly AABH Patient Perception of Care Survey score for "degree to which the program helped you feel safe in the evening between sessions" was 3.78 (below national average, 4.30). Patients were unable to independently manage perceived distress at home and in-between program hours. DESCRIPTION OF PRACTICE OR PROTOCOL: The PHP Unit Practice Council of nurses, social workers, and occupational therapist created four internally-funded mobile sensory tools carts and a patient education program focused on the use and benefits of sensory tools. Nurses educated patients during the PHP intake process. VALIDATION OF EVIDENCE: Four-item survey on a 5-point Likert scale was developed to assess patient ability to self-regulate and manage distress after using sensory tools. Surveys were completed at four time points (admission and weeks 3, 5 and 7) during the seven-week PHP stay. RELEVANCE OF PMH NURSING: 125 patients participated in the survey from May to December 2017. Pre-post descriptive analyses revealed clinically significant increases in all scores. Patients’ ability to manage distress using sensory tools improved by 66% (average scores: pre 2.53, post 3.84). The AABH score increased from 3.78 to 4.34. No adverse events reported. FUTURE IMPLICATIONS: Nurse-led education, exposure, and availability of sensory tools provided an effective, innovative mechanism to enhance patient coping; thereby, helping patients feel safe at home.


3013.1: Suicide Prevention and New Technologies: How can we help Suicidal Adolescents Online?
Jessica Rassy, PhD

PROBLEM STATEMENT: Adolescents are frequently seeking answers to their mental health problems through Information and Communication Technologies (ICT). In some cases, they adolescents highly at risk of suicide choose to seek help through ICT as opposed to in person. The aim of this study was to understand and generate a theory on the ICT help-seeking process of adolescents at risk of suicide. The objectives were to: (1) describe the use of ICT by adolescents at risk of suicide seeking help and (2) understand the ICT help-seeking process of adolescents at risk of suicide. THEORETICAL FRAMEWORK: Grounded theory by Strauss and Corbin (2015) was used as a frame of reference. METHODS AND DESIGN: Grounded theory by Strauss and Corbin (2015) was used to collect and analyze the data through an iterative process. Theoretical saturation was reached with 15 participants. RESULTS: In order to deal with suicidal thoughts, the participating adolescents tried different help-seeking strategies that included distracting themselves, getting informed, revealing themselves and helping others. The use of these strategies resulted in emotional growth, getting help, getting temporary relief, having no changes or sadly, developing more suicidal thoughts or an actual suicide attempt. IMPLICATIONS (PRACTICE): Many of the results of the study can be integrated in the nurse's suicide risk assessment. These new findings allow for a deeper and more thorough understanding of adolescent's online help-seeking process and how nurses can intervenene to help them. IMPLICATIONS (RESEARCH): Future research should focus on developing and evaluation nursing interventions in suicide prevention using new technologies.


3013.2: Development and Psychometric Properties of a Newly Developed Behavioral Warning System for Children
Maureen Eisenstein, MS, RN.; Joohyun Chung, PhD MStat. RN. Biostatistician; Susan Lantz, MPA, BA, BSN, RN, NE-BC; Vareen O'Keefe Domaleski, EdD, MSN, RN,

PROBLEM STATEMENT: Despite the widely held recognition that a child or adolescent with mental illness should be treated in the safe and least restrictive care, there has been an increasing level of concern raised regarding the safety and effectiveness of using restraint/seclusion as a means of managing the aggressive behavior of child and adolescent psychiatric inpatients. Although prevention of aggressive behavior is essential, it is not easy to prompt an action plan without the early warning system for the prevention and management of behavioral emergencies. THEORETICAL FRAMEWORK: The modified the general aggression model (GAM) was used as a framework that accounts for the human interaction of cognition, affect, and arousal (Anderson & Anderson, 2008). METHODS AND DESIGN: The objectives are to develop and evaluate the Behavioral Early Warning Scales (BEWS). A two-phase methodological design was conducted to develop and evaluate the BEWS. Content validity was assessed by a panel of five experts who specialized in advanced psychiatric-mental health nursing. The content validity index calculated for the BEWS was .93,  A convenience sample of 25 nurses was used to establish inter-rater reliability/internal consistency and evidence of validity including explorative factor analyses. RESULTS: The tool is valid and reliable. This study provides the important value of use of warning system, in order to reduce or eliminate episodes of seclusion and restraint for pediatric patients with behavioral problems. IMPLICATIONS (PRACTICE): Most important, the key to optimal patient outcomes will be recognition of this tool, BEWS followed by an appropriate and timely nursing intervention before deterioration. IMPLICATIONS (RESEARCH): Outcome study after utilizing BEWS


3014.1: Increasing Knowledge, Skills, and Abilities: Taxonomy of Significant Learning (Fink)
Marian L. Farrell, PhD, PMH-NP, BC, PMH-CNS-BC, CRNP

PROBLEM STATEMENT: There is a lack of sufficient knowledge, skills, and abilities regarding illicit drug and alcohol use disorders among entry level and advanced practice nurses resulting in a negative impact on the quality of care for those impacted by illicit drug and alcohol use disorders. SUMMARY OF EVIDENCE: The lack of sufficient knowledge, skills, and abilities regarding illicit drug and alcohol use disorders among entry level and advanced practice nurses. DESCRIPTION OF PRACTICE OR PROTOCOL: Instituting a curriculum model that enhances knowledge, skills, and abilities regarding illicit drug and alcohol use disorders in multiple courses rather than in a module of one course will further develop the knowledge, skills, and abilities of entry level and advanced practice nurses. VALIDATION OF EVIDENCE: Measurement of knowledge with pre/post testing. Measurement of clinical outcomes in terms of addiction treatment. RELEVANCE OF PMH NURSING: Increased knowledge, skills, and abilities regarding illicit drug and alcohol use disorders among entry level and advanced practice nurses.  Improved quality of care for those impacted by illicit drug and alcohol use disorders. FUTURE IMPLICATIONS: Consistent curriculum content at both the undergraduate and graduate level results in increased knowledge, skills, and abilities among entry level and advanced practice nurses regarding illicit drug and alcohol use disorders.  Ultimately, resulting in improved quality of care for those impacted by illicit drug and alcohol use disorders.


3014.2: Forest to Forest, Trees to Trees:  Using Backward Mapping to Develop a PMHNP Program
Maria Flordesol Culpa-Bondal, PhD, RN; Dean Baker, PhD, RN

PROBLEM STATEMENT: The growing demands for mental health access in the country was the impetus for a nursing school to propose the creation of a PMHNP concentration.  There was an opportunity for faculty to design an impactful program; we envisioned all our PMH nurse practitioner graduates passing their board exams and mitigating the mental health needs of our community and redefining the utilization of the mental health care, but where to begin? SUMMARY OF EVIDENCE: The framework of backward curriculum design proposes to create programs that consider the program outcomes first before developing the courses and its activities and assessments.  Instead, we will showcase to the audience a backward mapping process that takes the design beyond program goals and into the community landscape and the requirements of the certifying body, or from the forests, to the trees. DESCRIPTION OF PRACTICE OR PROTOCOL: We propose that by juxtaposing community issues with the requirements of the certifying body,  the program outcomes  will become evident. In a backward manner we mapped the needs, resources and capacities of our community to our program goals and course designs.  We will present the process, challenges and outcomes of this endeavor. VALIDATION OF EVIDENCE: Program Assessment data: course outcomes, service utilization, first time board pass rates, employment rates. RELEVANCE OF PMH NURSING: Achievement of  of program outcomes were above average.  The first cohort of students had a 100% first time certification pass rate and 100% employment rate. FUTURE IMPLICATIONS: Plan to revise program outcomes and the curriculum based on community demands and needs.


3015.1: Evaluation of a Mind-Body-Spirit Yoga Intervention for Rural Dwelling Adults Who Are in Outpatient Treatment for Opioid Addiction Group
Barbara Jones Warren, PhD, RN, APRN-CNS, PMH-BC, FNAP, FAAN; Kathy D. Wright, PhD, RN, PMHCNS-BC

PROBLEM STATEMENT: There is a high incidence of poor clinical and mental health outcomes for adults who are opioid addicted and reside in poor rural communities. The community of study had a 100% increase in overdose deaths within an 18 month time. Four out of ten poor rural counties had the highest death rates. Comorbid presence of depression, anxiety, and stress are factors in adults using opioids in order to alleviate their mental health symptoms and these counties reflected the presence of those symptoms. THEORETICAL FRAMEWORK: Sudarshan Kriya Yoga (SKY) has demonstrated efficacy for persons who are on medication-assisted therapy (MAT). SKY is a physiological intervention that reduces depression, anxiety, and stress related symptoms. METHODS AND DESIGN: A repeated measures (pre and post test design) and journaling were used for the study. We enrolled 10 participants in MAT with opioid use disorder from a rural treatment center. The intervention included 3 hours on 5 consecutive days of group training in SKY breathing techniques, social interaction, and emotion management. The Behavioral and Symptom Checklist and SF 36, and Perceived Checklist were used to collect data. RESULTS: The majority of participants attended all 5 sessions. Participants reported that SKY breathing reduced worry and anxiety. IMPLICATIONS (PRACTICE): The SKY intervention could provide a cost effective way to help reduce symptoms related to depression, anxiety, and stress for adults who are in MAT programs. IMPLICATIONS (RESEARCH): Further research is needed regarding the use of the physiologically based SKY intervention for adults who have the comorbid presence of opioid addiction and mental health symptoms of depressionand anxiety.


3015.2: Trauma-Sensitive Yoga for Women Veterans with PTSD who Experienced Military Sexual Trauma: Theoretical Psycho-physiologic Mechanisms and Demonstrated Effectiveness for PTSD Symptoms
Ursula Kelly, PhD, ANP-BC, PMHNP-BC, FAANP; Terri Haywood, MS, MPH

PROBLEM STATEMENT: Evidence-based psychotherapeutic treatments for PTSD are limited in scope and are unacceptable and ineffective for as many as 50% of Veterans, particularly women Veterans who experienced military sexual trauma (MST). THEORETICAL FRAMEWORK: Our premise is that yoga, through its effects on the central nervous system, will reduce PTSD symptoms via psychophysiological mechanisms rather than the cognitive mechanisms of psychotherapy. METHODS AND DESIGN: In this randomized controlled trial, women Veterans (n=80) with PTSD who experienced MST were recruited in a VA Health Care System in the southeast U.S. Participants were randomized to TSY or cognitive processing therapy (CPT). The protocol-driven interventions were provided in 60-75 minute group sessions, for 10 (TSY) and 12 (CPT) weekly sessions. Data were collected at four time points, baseline through 3-months post-intervention. Measures: PTSD Symptom Checklist (PCL-5) and the Clinician Administered PTSD Scale (CAPS-5). Multilevel mixed models were used to analyze the differences between the groups over time.  RESULTS: PTSD symptom severity decreased significantly (p < .001) in both groups, with progressively lower scores at each time point for both self-reported (PCL-5) and clinician assessed (CAPS-5) PTSD symptoms. There were no significant differences between TSY and CPT groups in changes in PTSD symptoms over time. IMPLICATIONS (PRACTICE): These early study findings support TSY as a cost-effective, scalable PTSD intervention that could be implemented in VA Health Care Systems nationwide. IMPLICATIONS (RESEARCH): Additional research is needed to evaluate the differential benefits of TSY as an alternative, precursor, or adjunctive treatment to psychotherapy for PTSD and to identify individual-level predictive factors of effectiveness to support  personalized treatment recommendations.


3016.1: The Impact of a Dementia Simulation on Participants Empathy
Daniel Eaton, RN, DNP

PROBLEM STATEMENT: Empathy is often thought of as an essential component of a healthcare professional's character and is relevant to the delivery of nursing care (Digby, 2016).Yet it is difficult for someone to understand what someone living with dementia is going through. By developing a better understanding of what it is like to live with dementia, the healthcare professional can make changes to the care they provide and develop a better understanding of the thoughts and emotions a person living with dementia experiences. SUMMARY OF EVIDENCE: This research was conducted as an evaluation of the impact of a dementia simulation on participant’s empathy scores.  The Dementia Live® simulation was purchased by the researcher using professional development funds and offered to participants at the research site.  Posttest empathy scores significantly increased after completion of the Dementia Live® simulation. DESCRIPTION OF PRACTICE OR PROTOCOL: Implementation of the Dementia Live simulation. VALIDATION OF EVIDENCE: The sample demonstrated a mean increase in empathy score of nearly 7 points when compared with pretest scores (p=0.00006).   Empathy was evaluated using The Jefferson Scale of Empathy HP version.  Pretest-posttest format was used.  The Dementia Live Simulation® has been shown to have a positive impact on participant’s empathy in this pilot testing.  Research participants were those currently working with persons living with dementia and employed at a continuing care retirement community.  Future research is underway with additional populations. RELEVANCE OF PMH NURSING: PMH nurses frequently have to work with persons living with dementia and provide support and education to other healthcare workers. FUTURE IMPLICATIONS: The simulation can be easily implemented in a variety of settings.


3016.2: Can You Help Me? A Refugee Simulation Experience
Nina Harvey, DNP, MSN, FNP-C; Stephanie Wynn, DNP, RN-BC, PMHNP-BC, FNP-BC, COI

PROBLEM STATEMENT: Frequently, the psychiatric-mental health (PMH) issues of refugees who flee to the U.S. are overlooked. The need for innovative cultural competence learning activities in nursing education in this area is heightened. However, access to clinical sites providing a comprehensive experience of this concept is limited. An academic-clinical partnership was developed to provide a simulation experience to influence positive changes in PMH practice with refugees. SUMMARY OF EVIDENCE: Due to limited finances and social resources, many refugees rely on free community-based clinics to receive continuing care. Negative attitudes and stigma towards refugees and patients with mental illness, related to a lack of cultural competence, acts as a barrier to refugees receiving adequate PMH care, thereby increasing morbidity and mortality in this population. DESCRIPTION OF PRACTICE OR PROTOCOL: Undergraduate nursing students were assigned to roles as members of a refugee family. Some were labeled with a mental illness. As many refugees arrive with few resources, students completed allocated tasks based on limited knowledge of available assistance programs as well as a low-income. VALIDATION OF EVIDENCE: Quantitative survey scores as well as qualitative data provided evidence that simulation experience highlighting the difficulties encountered by refugees, especially those with mental illness, is an effective way to teach cultural competence. RELEVANCE OF PMH NURSING: Removing barriers related to attitudes, understanding, and empathy of refugees with mental illness provides students the ability to deliver quality care. FUTURE IMPLICATIONS: As refugees expand in the community, it will become increasingly important to bring forth awareness of the need to develop evidence-based strategies to transform the practice of PMH providers delivering care to these individuals.


3017.1: Workforce Diversity in the Field of Eating Disorders among an International Sample: A Mixed Methods Study
Karen M Jennings, PhD, RN, PMHNP-BC

PROBLEM STATEMENT: Healthcare professions’ profiles rarely reflect national profiles of social, linguistic, and ethnic diversity. THEORETICAL FRAMEWORK: Although diversity initiatives have increased within healthcare and the field of eating disorders (ED), more information is needed about what diversity looks like in the current ED workforce and perceived barriers to increasing diversity in this field. Thus, the purpose of this mixed-methods study was to examine diversity in the field of ED across demographic and professional variables inclusive of different identities and backgrounds. METHODS AND DESIGN: Participants (N=512) were recruited from ED and discipline-specific professional organizations and snowball sampling. Participants completed an online survey and responded to open-ended questions about perceived barriers to increasing diversity. RESULTS: Among participants, mean age was 41.1 (SD=12.5) years, 89.6% (n=459) identified as women, 73% (n=365) identified as white/Caucasian, and 49.4% (n=253) resided in the U.S. Compared to women, men were more likely to be older and have a PhD/MD, background in Medicine, and history of military service. Researchers were more likely to be younger and have a PhD/MD and background in Clinical Psychology compared to clinicians. Three themes emerged from the data about perceived barriers to increasing diversity: stigma, bias, stereotypes, myths; field of ED pipeline (access/financial burden, outreach/recruitment, research priorities/exclusivity), and homogeneity of current field (mentorship, selection bias, existing structure). IMPLICATIONS (PRACTICE): Barriers to increasing diversity must be addressed to prepare a culturally-appropriate healthcare and ED workforce and yield new perspectives that enhance scientific knowledge. IMPLICATIONS (RESEARCH): Although limited, workforce diversity exists; and, efforts to increase diversity globally continue to be necessary across all domains.


3017.2: Nurse Suicide in 17 U.S. States, 2015
Teena McGuinness, PhD, PMHNP-BC, FAANP, FAAN; Patricia Patrician, PhD, RN, FAAN

PROBLEM STATEMENT: Suicide is now the 10th leading cause of death in the U.S. From 2008-2017, suicide rates increased 21%, from 11.6 to 14 per 100,000 people. Suicide rates for health care providers are hypothesized to be higher than other occupations due to the job strain and burnout. Despite the National Academy of Medicine’s Clinician’s Resilience and Well-being Initiative (2017) promoting the prevention of stress, anxiety, and suicide, a shortage of data has limited our understanding of nurse suicide. THEORETICAL FRAMEWORK: Unfortunately, nurse suicide data are not tracked by employers or professional nursing associations resulting in a scarcity of information. Indeed, the most recent data on nurse suicide is over 20 years old. METHODS AND DESIGN: Data were extracted from the National Violent Death Reporting System (NVDRS) that were available from 17 participating states based on death certificates, coroner, and law enforcement reports. The CDC’s National Institute for Occupational Safety and Health Computerized Coding System was used to code the data and reviewed by industry and occupation coding experts for accuracy. RESULTS: Analysis of 2015 data on suicide by major occupational group reported rates of 25.6 and 9.0 males and females, respectively, per 100,000 population working in the “Health Care Practitioners and Technical” category who died by suicide in 2015. As far as actual count, there were 394 nurse suicides reported by the NVDRS for 2015 (225 females and 169 males). Rates of suicide by RNs will be reported. IMPLICATIONS (PRACTICE): The number of suicides is high for RNs. IMPLICATIONS (RESEARCH): Implementation of evidence-based approaches to prevent suicide are warranted.


3021.1: Adolescent Pregnancy and Depression: An Opportunity and Obligation for Intervention
Sarah Cox, MSN, PMHNP-BC

PROBLEM STATEMENT: The purpose of this presentation is to enhance practical knowledge for clinicians working with pregnant and postpartum adolescents, a vulnerable population that requires specialized assessment and intervention. SUMMARY OF EVIDENCE: One quarter of pregnant adolescents meet criteria for major depressive disorder, and half of those adolescents who experience perinatal depression will go on to have another pregnancy within two years. Follow-up rates for mental healthcare are low in this population, and the adverse effects of untreated depression on mother and baby are well-documented, yet best practices are not well-defined. DESCRIPTION OF PRACTICE OR PROTOCOL: There are currently no treatment guidelines specific to adolescents with mental illness in the perinatal period. Examination of guidelines for treating depression in pregnant adults and non-pregnant adolescents reveal common recommendations to utilize CBT and IPT as first-line therapies, and to use SSRI’s, especially escitalopram, sertraline, and citalopram, when psychotherapy alone is insufficient. VALIDATION OF EVIDENCE: Various treatment guidelines of American psychiatric and obstetric organizations are growing outdated, however more recent international reviews and guidelines, such as that of the Canadian Network for Mood and Anxiety Treatments, provide evidence-based recommendations relevant to pregnant women and adolescents. RELEVANCE OF PMH NURSING: Pregnant and postpartum adolescents require multi-faceted interventions which psychiatric nurses are ideally suited to provide, whether that is the registered nurse providing home visits or case management, or the advanced-practice nurse providing psychotherapy and medication management. FUTURE IMPLICATIONS: This review of the evidence for best practices indicates a need for more up-to-date and population-specific guidelines for young women with depression, as well as the need for treatment guidelines originating from the nursing perspective.


3022.1: Ligature Free: Is it Possible?
Charlene Moore, RN, MS, CNML; Matthew F. Gwaltney, RN

PROBLEM STATEMENT: While it is the right thing to do for our patients, becoming ligature free/resistant is a regulatory mandate. This stems from the large amounts of suicides in inpatient units all across the country. This is as well as continues to be our most pressing issue in psychiatric nursing.  We must use every ounce of our ability to keep our patients safe which includes a safe environment.  Having a ligature free or resistant environment that promotes a ligature. SUMMARY OF EVIDENCE: 2018 Patient Safety Goals from The Joint Commission mandated that inpatient units become ligature free.  During our process, they changed the language to read ligature resistant. Our environment is that of a medical surgical unit that was converted into a psychiatry unit. The building environment presented huge challenges from existing doors, windows, and layout. We utilized the Behavioral Health Handbook provided by TJC and chose acceptable items. This presentation will discuss lessons learned as well as provide our own experiences. DESCRIPTION OF PRACTICE OR PROTOCOL: These practice changes occurred: New electronic beds that have ability for patient to call for assistance on Medical Psychiatry; Culture change in the way staff look at the environment including processes to escalate when ligature point is found; Complete renovation of rooms, bathrooms for safety; Psychiatry team members, providers, visitors and patients were all stake holders. VALIDATION OF EVIDENCE: Measured by existing dashboard items related to patient harm. RELEVANCE OF PMH NURSING: Practice to provide the safest environment for behavioral health populations. FUTURE IMPLICATIONS: Regulations will continue to increase. This should assist in reducing inpatient harm to patients.


3022.2: Self-Management Strategies: An Innovative Nursing Approach to Working with Patients at Risk for Suicide in an Adult Inpatient Psychiatry
Nadia Ali Muhammad Ali Charania, PhD, RN; Ilze Sturis Hallman, DNP, PMHNP-BC, PMHCNS-BC, GNP

PROBLEM STATEMENT: The Joint Commission’s Sentinel Event Alert #56 (2016) indicated that identifying and managing suicide risk must be health care organizations priority.  The purpose of this paper was to critically appraise the need and relevance of self-management strategies (SMS) as an innovative framework and propose exemplars of how it could be used by psychiatric-mental health (PMH) nurses working with patients at the risk for suicide in an adult inpatient psychiatry. SUMMARY OF EVIDENCE: There was a call for innovative approaches to effectively prevent suicide (Hogan, 2018). The questions remained what innovative framework nurses need to consider.  Self-management have been used in chronic conditions with limited focus on SMS. There was paucity of literature on SMS as a framework for working with patients at risk for suicide. DESCRIPTION OF PRACTICE OR PROTOCOL: Current practices of working with patients at risk for suicide is not framed with the focus on SMS, hence, there is a need to weigh in on the need and relevance of SMS and to design specific exemplars for PMH nurses, with the support of unit management and policy makers, to integrate in their practice. VALIDATION OF EVIDENCE: An attempt was made to integrate SMS as part of one of the inpatient psychiatric unit’ guidelines. RELEVANCE OF PMH NURSING: This paper described the relevance of SMS as a promising framework with some practical examples to demonstrate how PMH nurses might integrate the SMS framework. FUTURE IMPLICATIONS: There is a need for nurses’ education on SMS, followed by research to test the effectiveness of SMS integration in working with patients at risk for suicide in an inpatient psychiatry.


3023.1: Access to Interprofessional Mental Health Education (AIME) for Youth: Creation of Interprofessional Workshops to Enhance Graduate Students' Knowledge on Management of Mental Health Diagnoses in Children & Adolescents
Kirstyn Kameg, DNP, PMHNP-BC; Judith Kaufmann, DrPh, FNP-BC; Luann Richardson, PhD, DNP, PMHNP, FNP; Janene Luther Szpak, DNP, PMHNP-BC; Neha Pandit, PhD; Tanya Fabian, PharmD, PhD; Christine Clark, PharmD; Brayden Kameg, DNP

PROBLEM STATEMENT: Substantial need exists to prepare healthcare professionals to manage the increasing prevalence of mental health conditions, specifically in the child and adolescent population. One in five children and adolescents in the United States experiences mental health problems with up to one-half of all mental health diagnoses emerging before the age of 14 (NIMH, 2015). SUMMARY OF EVIDENCE: The limited access to quality mental health care has become a national crisis with estimates that only 20-25% of affected children receive appropriate treatment (AACAP, 2008; CDC, 2013). DESCRIPTION OF PRACTICE OR PROTOCOL: Three workshops were developed focusing on treatment of ADHD, anxiety, and major depression in children and adolescents. All workshops involved delivery of didactic lectures and interaction with a standardized patient (SP) and his/her family member followed by a group debriefing. FNP, PMHNP, counseling, and pharmacy students participated in this interprofessional activity. VALIDATION OF EVIDENCE: Pre-workshop, participants completed a demographic questionnaire, the Student Perceptions of Interprofessional Clinical Education–Revised instrument, and a 10-item multiple choice knowledge test. Post-workshop, participants completed the same instruments in addition to a Debriefing Assessment for Simulation in Healthcare (DASH) Student version. RELEVANCE OF PMH NURSING: Data analysis from the workshops indicate that participants had statistically significant gains in knowledge of the content, enhanced perceptions of the interprofressional team, and valued the debriefing. FUTURE IMPLICATIONS: Child and adolescent workshops/simulations can be adopted by other schools of nursing to enhance future provider knowledge and confidence of caring for children with mental health diagnoses. Furthermore, there is a preceptor shortage and incorporation of child/adolescent simulations may be used as a method to educate students.


3023.2: Moving Beyond Provider Education to Implementation: An Innovative Field-Tested Model for Adolescent SBIRT
Aaron M. Williams, MA; Lindsi LoVerde, MPH, PMP; Pam Pietruszewski, MA

PROBLEM STATEMENT: Despite growing national interest in Screening, Brief Intervention and Referral to Treatment (SBIRT) and a focus on addressing adolescent substance use, widespread adoption of SBIRT is often hindered by a lack of uniform implementation guidance. Infusing adolescent SBIRT practices into routine RN/APRN services is a promising public health intervention to address risky substance use behavior in youth. SUMMARY OF EVIDENCE: Building upon the research on SBIRT adaptation for adolescents, the Facilitating Change for Excellence in SBIRT (FaCES) initiative developed an evidence-based guide, or ‘Change Package’ for adolescent SBIRT which comprises clinical and operational change levers that actuate SBIRT implementation. DESCRIPTION OF PRACTICE OR PROTOCOL: The Change Package was developed with guidance from esteemed national SBIRT experts and piloted by a geographically diverse group of Federally Qualified Health Centers. While developed particularly for primary and integrated care settings, there is promise in adapting the approaches to other settings, including mental health. VALIDATION OF EVIDENCE: Effectiveness of Change Package implementation was assessed through a comprehensive evaluation which included measurement of organizational and clinical outcomes and staff beliefs and attitudes. RELEVANCE OF PMH NURSING: Pilot sites increased rates of screening and delivery of brief interventions, and experienced advancements in penetration and adherence to the Change Package model. When compared to other roles, nurses saw the greatest increase in completion of SBIRT training, and greatest gains in positive attitudes towards screening and brief intervention, indicating they are critical stakeholders and champions for adolescent SBIRT. FUTURE IMPLICATIONS: The FaCES Change Package is recommended as an effective approach for adolescent SBIRT implementation in primary care, integrated care, and mental health settings.


3024.1: Practicing What We Preach: Teaching Psychiatric-Mental Health Student Nurses To Care For Themselves And Their Patients
Briana L. Snyder, PhD, RN-BC, CNE, RYT 200

PROBLEM STATEMENT: Nurse burnout and nurse suicide are ongoing crises for psychiatric-mental health nurses.  Comprehensive, holistic preparation of undergraduate nursing students must include education about and first-hand exposure to self-care strategies. SUMMARY OF EVIDENCE: According to the American Nurses Association, registered nurses experience more stress, are more obese, and get less sleep than the average American, leading to poor outcomes. DESCRIPTION OF PRACTICE OR PROTOCOL: Using the ANA 2017 Year of the Healthy Nurse and 2018 Healthy Nurse, Healthy Nation initiatives as a guide, education about self-care was incorporated into an undergraduate psychiatric-mental health nursing course over the course of four semesters.  The last 5-10 minutes of each class period was reserved to learn about and practice a new self-care strategy.  Examples included guided meditation, yoga, journaling, gratitude lists, and progressive muscle relaxation. VALIDATION OF EVIDENCE: Thematic analysis of qualitative comments in the general free text section of the university's standard student course evaluation over four semesters revealed that students felt very positively about the self-care activities incorporated into each class and desired more of these activities in all of their nursing courses.  The students discussed the personal benefit of learning self-care strategies, as well as how they could apply these to the care of patients and families. RELEVANCE OF PMH NURSING: In order to effectively combat nurse burnout and nurse suicide, as well as improve patient outcomes, education about self-care strategies must start early in undergraduate nursing education. FUTURE IMPLICATIONS: Future research about incorporating self-care strategies in different levels of undergraduate, graduate, and doctoral nursing programs is warranted to improve the personal and professional well being of nursing.


3024.2: Improving Stress Management among RN-BSN students: Incorporating Mindfulness and Self-Care Principles
Nancy Wise, PhD, RN; Josh Baker, DNP, RN-BC

PROBLEM STATEMENT: Increasing demand for higher education has led many RNs to pursue Bachelor’s of Science in Nursing (BSN) degrees.  Due to time-commitments of academic programs and long work hours, nursing self-care practices are neglected. Sacrificing family and personal time leads to compassion fatigue, burnout, decreased patient satisfaction and poorer patient outcomes. Incorporating self-care and mindfulness education within the curriculum decreases nursing stress and facilitates nursing self-care practices. SUMMARY OF EVIDENCE: Self-care is the foundation of compassionate patient care and benefits nurses and patients. Nurses may be open to self-care strategies, but identify a lack of knowledge. Incorporating self-care into the curriculum improves RNs’ self-care strategies and provides long-standing therapeutic effects for decreasing compassion fatigue. Mindfulness improves safety in clinical practice. DESCRIPTION OF PRACTICE OR PROTOCOL: RNs in BSN programs and faculty who teach in RN-BSN programs. Mindfulness and self-care were incorporated into the curriculum and faculty were educated on self-care and mindfulness practices.  Continuing education courses are offered to nurses and members of the community at large. 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. RELEVANCE OF PMH NURSING: RN coping and self-care strategies in RN to BSN programs, as well as offering CE events to healthcare providers, can decrease the perceived stress. FUTURE IMPLICATIONS: Offer self-care and mindfulness education to RN-BS students and faculty who teach in the programs; increase the number of CE events related to nursing self-care.

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