Annual Conference Saturday Abstracts

4011: Evaluation of an Adapted Dialectical Behavioral Group Therapy for Adults with Intellectual and Developmental Disabilities
Caroline M. Kraft, MSN, MA, PMHNP-BC; Grace Hubbard, DNP

PROBLEM STATEMENT: Many individuals with intellectual and developmental disabilities (IDD) who are dually diagnosed with mental health problems experience emotional, cognitive, and behavioral regulation difficulties (Brown, 2017). Adults with IDD are at greater risk for developing difficulties with emotional regulation and impulse control leading to challenging behaviors (Crossland, 2017). SUMMARY OF EVIDENCE: While there is no firm evidence about which therapies are most helpful in reducing challenging or problem behavior in adults with IDD, an adapted Dialectical Behavioral Therapy (DBT) can be used as an intervention to enhance emotional regulation skills which may result in decreased challenging behaviors (McNair, 2016).  There is evidence that adapted DBT for individuals with IDD demonstrate improvements on measures of well-being (symptoms of mental health, hospital admissions) and reduction of challenging behaviors (McNair, Woodrow, & Hare, 2017). DESCRIPTION OF PRACTICE OR PROTOCOL: In current practice, there are few evidenced based nonpharmacological methods for reducing challenging behavior (self-injurious behavior, aggressive-destructive behavior, stereotypy, sexually inappropriate behavior, stealing, bizarre rituals) in adults with IDD. Many people with IDD take several medications to reduce challenging behavior which increases their risk for potentially life threatening adverse events. VALIDATION OF EVIDENCE: An adapted Dialectical Behavioral Therapy (DBT) can be used as an intervention to enhance emotional regulation skills which may result in decreased challenging behaviors (McNair, 2016). RELEVANCE OF PMH NURSING: Individuals with IDD present with special challenges for psychiatric nurses.  They have higher rates of medical problems than the general population.  There are strategies to use when working with adults with IDD. FUTURE IMPLICATIONS: DBT may be a viable nonpharmacological method for reducing challenging behavior in IDD.


4012: Rolling Out the Interventions:  An Interdisciplinary Model of Care for Prevention and Management of Non-Suicidal Self-Injury
Jaime Lovelace, BSN, RN-BC; Darcey Philipp, BA, BS; Megan Rech, BA; Jennifer Velasquez, BSN

PROBLEM STATEMENT: The purpose of this project was to evaluate an interdisciplinary model of care developed by a quality workgroup aimed at decreasing non-suicidal self-injury (NSSI) frequency and severity in an inpatient psychiatric hospital. SUMMARY OF EVIDENCE: A literature review resulted in exploration of evidence-based interventions concentrating on nuanced themes.   Internal data showed the greatest NSSI frequency and severity on the young adult and adolescent programs. DESCRIPTION OF PRACTICE OR PROTOCOL: The project was operationalized on a restructured adolescent inpatient program. Strategies included: standardizing the definition and understanding the functions of NSSI, mitigating risks, providing education through grand rounds, safety planning via mobile apps, engaging unit champions to improve communication, and creating innovative interdisciplinary crisis-specific interventions like the mobile soothing cart and drumba. VALIDATION OF EVIDENCE: A chi-square test of independence was used to compare NSSI prevalence (measured by percentage of patients with incidents) between patients admitted the year before (N=122) versus after (N=156) workgroup interventions were implemented. NSSI severity was measured by comparing percentage of incidents requiring medical care send-out. RELEVANCE OF PMH NURSING: Compared to patients admitted pre-interventions, patients admitted post-interventions experienced a significantly lower NSSI prevalence [27.0% versus 15.4% of patients; X2 (1, N=278) = 5.7, p=0.017]. Likewise, 2/55 NSSI instances occurring pre-interventions required medical send-out, versus for 0/30 post-interventions, indicating decreased severity. Patients’ average length of stay decreased from 21.66 to 18.84 days; average daily census increased from 7.24 to 8.31 patients; admission criteria broadened to embrace higher acuity. FUTURE IMPLICATIONS: Future research should focus on a collaborative approach to developing innovative interdisciplinary models of care for reducing NSSI frequency & severity in inpatient settings.


4013: Improving Suicide Risk Assessment and Intervention in Baccalaureate Nursing Education
Claudia Denise Davis, MSN,RN

PROBLEM STATEMENT: This presentation will address  the implementation of concepts from the "Psychiatric-Mental Health Nurse Essential Competencies for Assessment and Management of Individuals at Risk for Suicide" into a baccalaureate nursing program psychiatric mental health nursing course. This instructor redesigned a psychiatric mental health nursing course to better prepare graduates to assess and intervene with individuals for suicide across the life span, and in diverse clinical settings, The presentation will discuss learning activities including classroom, clinical practicum activities and a suicide assessment. SUMMARY OF EVIDENCE: Suicide assessment and care of individuals at risk have been emphasized in The New Freedom Commission Report, Healthy People 2020 goals, and the American Psychiatric Nurses Association has developed "Psychiatric-Mental Health Nurse Essential Competencies for the Assessment and Management of Individuals at Risk for Suicide" with competency-based training programs. DESCRIPTION OF PRACTICE OR PROTOCOL: Baccalaureate programs generally incorporate concepts related to suicide in discussions of depression in psychiatric mental health course or in concept based curriculum's with mood or safety concepts. With increasing rates of suicidal risk in diverse clinical settings, graduates need to be prepared to assess and intervene in individuals with suicide risk across the life span and in diverse clinical environments. VALIDATION OF EVIDENCE: The method of evaluation the included successful completion of a simulation activity and exam questions. RELEVANCE OF PMH NURSING: The implementation of Competency Standards and Training Programs by the American Psychiatric Nursing Association is clear evidence of identification of the need for improved nursing education related to suicide risk assessment and intervention. FUTURE IMPLICATIONS: To prepare future nurses education needs to reflect emerging competencies in suicide assessment.


4014: Improve Communication using Improvisation Theater Techniques
Christianne Nesbitt, DNP, RN, GNP-BC, PMHNP-BC; Karen Higgins, DNP, FNP-BC

PROBLEM STATEMENT: Communication is the cornerstone of the therapeutic provider/client relationship. Psychiatric nurses in education programs benefit from novel techniques that enhance their ability to be in the moment and focus on what is being said without anticipation, resulting in increased trust. Improvisation theater techniques have been used to improve communication in a variety of settings including healthcare. SUMMARY OF EVIDENCE: Improvisation has been used with students in medicine, counseling, pharmacy, and dietetics. Studies have found that students who participated in improvisation training had improved empathy and confidence with communication.  It has also been found to improve skills for difficult conversations. DESCRIPTION OF PRACTICE OR PROTOCOL: The purpose of this presentation is to describe the use of improvisation techniques in communication training for nurse practitioner students.  Those who attend this presentation will learn how to add improvisation to their programs and will learn brief improvisation techniques that can be used with their students. VALIDATION OF EVIDENCE: The presentation will include an overview of using improvisation to improve healthcare communication.   It will also include a description of implementation and evaluation of improvisation in a nurse practitioner curriculum.   Improvisation techniques were threaded throughout the program to teach and reinforce skills for communication and collaborative practice. RELEVANCE OF PMH NURSING: Early results of the training showed a significant improvement in empathy scores for NP students compared to students without the training using the same standardized patient scenario. The training was well received by the students, and evaluations found that students used the skills successfully in their professional practice FUTURE IMPLICATIONS: Expanded use in nursing education. Faculty workshops. Using techniques with clients.


4015: Surviving and Thriving with Schizophrenia: a Perspective from Patient and Provider
Brooke Katz, DNP, ARNP, PMHNP

PROBLEM STATEMENT: The purpose of addressing the topic of recovery with schizophrenia is to fight stigma, promote acceptance and provide a viewpoint from an ARNP who is living with schizophrenia. SUMMARY OF EVIDENCE: Having been diagnosed with schizophrenia at age 16, my personal background is based on trying multiple medications until finally achieving success on clozapine.  I have also been hospitalized over 20 times and lived in 2 RTCs as a young adult.  I have worked with consumers, family members, teachers, and providers to help others understand how recovery is possible, even with severe psychosis. DESCRIPTION OF PRACTICE OR PROTOCOL: I believe that after hearing my story, nurses will grow and learn about maintain hope and believing in the people who they treat.  Everywhere that I have worked, the practice has been that people with schizophrenia are not expected to get advanced degrees and function as leaders in their community. VALIDATION OF EVIDENCE: I can measure the effectiveness of my presentation by previous talks that I have given. In the past I have lectured at Harvard Medical School, Brown University, Northeastern University, University of Washington, and many other medical and nursing schools in the United States. RELEVANCE OF PMH NURSING: Some PMH nurses may have never seen someone with schizophrenia succeed and thrive in life: I have a ARNP job, a wife, friends, a home, and I will soon have a baby. FUTURE IMPLICATIONS: The stigma of having schizophrenia can be shattered.  Nurses can learn how to promote hope in patients who are acutely and chronically suffering.  Everywhere that I have ever spoken, people have been moved.


4016: Being an Effective Patient Partner: Insights from Parents of Mental Health Consumers
Michael C Thomas, DNP, APRN, PMHNP-BC; Stacie Hunsaker, MSN, RN, CEN, CPEN, CNE, CNML

PROBLEM STATEMENT: The purpose of this presentation is to help PMH nurses learn to collaborate more effectively with patients and family members. SUMMARY OF EVIDENCE: Patient engagement has been shown to improve treatment satisfaction and outcomes, yet barriers to effective patient engagement remain. Healthcare professionals are sometimes reluctant to encourage patient involvement and patients can be hesitant to share their concerns. DESCRIPTION OF PRACTICE OR PROTOCOL: Patients and family members are supposed to be part of the treatment team, but often don't know how to effectively communicate with healthcare providers.  This can lead to miscommunication and mistrust between patients and healthcare providers. VALIDATION OF EVIDENCE: Patients and their family members are an important part of the healthcare team.  It is essential to develop an environment of mutual trust between them and healthcare providers but, the traditional power imbalance between the healthcare team and patients is a significant barrier to this.  Ineffective communication between these groups can lead to treatment non-adherence and adverse patient outcomes.  Basic assertive communication skills like CUS and the Two-Challenge Rule can help patients and family members more effectively communicate concerns and collaborate with healthcare providers. RELEVANCE OF PMH NURSING: Improving communication, collaboration, and trust between patients, families, and healthcare providers can greatly enhance the care provided to patients. PMH nurses can play a unique and important role in helping patients and their families become empowered health consumers. FUTURE IMPLICATIONS: Empowerment and hope are patient attributes that are positively correlated with improved outcomes among patients with mental illness.  Empowering patients and family members to be part of the treatment team can enhance treatment adherence and outcomes.


4017: Unlocking the Potential of Partnership: Psychiatric-Mental Health Nurses and Midwives Collaborating to Improve Perinatal Mental Health Care
Janelle Komorowski, DNP, CNM, CNE; Daisy Saulls, BS, BSN, RN

PROBLEM STATEMENT: Perinatal mood and anxiety disorders (PMAD) are the most common complication of childbearing, occurring at any time during the prenatal period, resulting in lifelong consequences for mother and child if not identified and treated. One in five pregnant women experiences a PMAD as a result of psychological and/or socioeconomic risk factors. SUMMARY OF EVIDENCE: Most pregnant women in need of mental health care will be forced to interact with siloed systems: a perinatal care system; a mental health care system; and for many, a substance use disorder system. Medicaid financed 43% of all US births in 2016, but only 41% of psychiatrists will accept Medicaid, creating a barrier to access for women with PMADs. DESCRIPTION OF PRACTICE OR PROTOCOL: Two-thirds of primary care providers report difficulty referring patients to mental health care. Many are uncomfortable performing mental health screening and treatment.  Women with PMAD are often untreated because providers cannot refer them, and are hesitant to prescribe medication and treatments outside their scope of practice. VALIDATION OF EVIDENCE: Current guidelines recommend regular mental health screening of pregnant and postpartum women. Growing evidence suggests screening and treatment during pregnancy leads to better perinatal outcomes. RELEVANCE OF PMH NURSING: The US has the highest maternal mortality rate of all developed nations. Seven percent of maternal deaths are related to underlying mental health disorders. PMHNPs and midwives, partnering together, can create care models integrating behavioral healthcare and perinatal care. FUTURE IMPLICATIONS: This presentation explores cutting-edge treatments and models of PMHNP/midwife collaboration with the potential to significantly improve outcomes for women with perinatal mood or anxiety disorders.


4021: It’s Not the Size that Matters, It’s How You Treat It: Updates in Trauma Treatment
JoEllen Schimmels, DNP, RN, PMHNP-BC, FAAN

PROBLEM STATEMENT: Trauma and adverse childhood events are common. SAMHSA refers to the "black box" of treatment as one of the main challenging aspects of behavioral health care today. "Big" vs. "little" traumas are not as crucial as the use of effective treatments. SUMMARY OF EVIDENCE: The human response to trauma is complex, and there are many theories that explain the mechanism of recovery. This presentations reviews trauma theory in the context of different types of evidence based trauma focused therapies by reviewing similarities and differences among different treatment modalities along with newer theories and approaches to trauma treatment. DESCRIPTION OF PRACTICE OR PROTOCOL: Evidence-based trauma-focused therapies such as EMDR, CPT, PE, IRT, WET, and ART utilize core concepts: Exposure to the traumatic memories, exposure to feared triggers, cognitive restructuring, and stress modulation. This presentation will review the similarities and differences between trauma focused psychotherapies for treatment and use of reconsolidation principles. Review prevention strategies, treatments, and outcomes. VALIDATION OF EVIDENCE: Outcomes are described with patient improvement subjectively on clinical rating scales and through objective observations with family, friends and other support systems. Evidence and clinician experiences will be reviewed. RELEVANCE OF PMH NURSING: Nurses should be incorporating reconsolidation theory and advocating for its use as it relates to trauma focused treatments. New research suggests the importance of mismatch in the treatment of traumatic memories to update memory, allowing for integration of new information and strengthening it on reactivation and re-stabilization; therefore opening a therapeutic window to further treatments. FUTURE IMPLICATIONS: This presentation will shed light into the multitude of trauma treatments and new theories behind the treatments.


4022: Managing Staff Fear and Anxiety with Agitated Patients
Lesli Reeves, MSN, RN; Caroline Baker, RN-C, MSN

PROBLEM STATEMENT: The purpose of this quality improvement project explored how a multilevel approach addressed staff fear and anxiety related to managing agitated patients. Psychiatric nurses come in contact with agitated patients.  Negative outcomes have resulted from these types of situations such as patient or staff injury. SUMMARY OF EVIDENCE: Mental health workers often express feelings of fear and anxiety when working with agitated patients.  Adverse outcomes such as physical injury, time off, and job termination have resulted from working with agitated patients.  Ridenour et al. (2015) study showed that “20% of psychiatric nurses have been physically assaulted, 43% were threatened with physical assault, and 55% were verbally assaulted at least once during the equivalent of a single work week.” DESCRIPTION OF PRACTICE OR PROTOCOL: Four strategies were implemented to address staff fear and anxiety:  psychiatric simulation, psychiatric emergency crisis support, enhanced crisis prevention intervention, and self-care education.  Key stakeholders included patient care technicians, registered nurses, and managers. VALIDATION OF EVIDENCE: Outcomes were measured by summarizing raw data from surveys, staff comments, medical record reviews, and crisis debriefings. RELEVANCE OF PMH NURSING: With the psychiatric simulation, staff reported improved role clarity, confidence, and team communication. Support during psychiatric emergency crisis revealed additional support needed with team response, communication, teamwork, and leadership. With enhanced crisis prevention intervention training, staff expressed improvement in physical hold techniques.  Following self-care education, staff knowledge of self-care and prevention of compassion fatigue increased. FUTURE IMPLICATIONS: There is limited research on how managing fear and anxiety impacts staff engagement with agitated patients.  A multilevel approach, leadership support, and follow up has potential to improve these factors.


4023: Bringing Innovative and Creative Evidence-Based Learning Activities to the Undergraduate Psychiatric Nursing Post-Clinical Conference: Integrating Clinical Experiences and Theory
Berry Anderson, PhD, RN; Kerry Young, BSN, RN

PROBLEM STATEMENT: Adjunct clinical faculty often lack resources and contact with undergraduate psychiatric mental health didactic faculty. Aligning post-clinical conference activities to enhance active learning classroom environments is challenging. SUMMARY OF EVIDENCE: The literature lacks evidence to guide best practices for post-clinical conference of a pre-licensure mental health course. DESCRIPTION OF PRACTICE OR PROTOCOL: The didactic faculty furnished the clinical instructors with weekly resources relating to the upcoming topic of discussion in the didactic portion of the course. The material included case studies, debriefing exercises, assessment videos, and journal articles focused on the specific population of the week.  At the beginning of the semester, students attend communication simulation, complete a detailed self-care plan, and attend Motivation Interviewing training. A reflective model guides the students though their experiences. VALIDATION OF EVIDENCE: Student course outcomes and satisfaction scores will measure effectiveness. RELEVANCE OF PMH NURSING: The full results will be presented during the conference. FUTURE IMPLICATIONS: Bridging the gap between didactic and clinical instruction with these activities will help enhance the learner’s experience, reinforce the didactic teaching, and provide opportunities for students to develop clinical skills.


4024: Modeling Course Work to Reflect Practice:  Using Narrative Pedagogy for DNP-PMHNP Education
Ruth Staten, PhD, APRN, PMHNP-BC, PMHCS-BC; Mary-Beth R Coty, PhD, APRN, PMHNP-BC, PMHCS-BC; Catherine R Batscha, DNP, APRN, PMHNP-BC, PMHNP-CS; Gayle Mink, DNP, APRN, PMHNP-BC

PROBLEM STATEMENT:  This presentation examines a doctorate of nursing practice (DNP) psychiatric-mental health nurse practitioner (PMHNP) curriculum based on narrative pedagogy. SUMMARY OF EVIDENCE: Narrative pedagogy is built on case-based, simulation, and team-based learning. The Narrative pedagogy places students at the center of learning, actively guiding their own learning as they meet educational and personal goals. The narrative pedagogy keeps student engaged and excited about their learning and provides a collaborative, co-learning, consulting approach for faculty.  DESCRIPTION OF PRACTICE OR PROTOCOL: Learning activities were created to model the actual practice of PMHNPs and the leadership expectations of doctorally prepared advanced practice nurses. Students facilitated case studies, and applied clinical interventions in simulation and video recordings. All assignments focused on the DNP-PMHNP as clinical expert, leader, innovator and problem solver included writing about stigma in op eds, developing briefing papers for a proposed prevention program for college student at-risk for mental health problems, and development of a staff education programs. Students explored the evidence, facilitated online and in-class discussions. An emphasis was placed on developing their own voice, creating a professional presence and building confidence as leaders. VALIDATION OF EVIDENCE: Formative and summative evaluations were used to assess the outcomes. Completion of the program, clinical preceptor evaluations and certification pass rates were included in the evaluation. RELEVANCE OF PMH NURSING: Narrative pedagogy prepares the graduate for the ever changing health care system that needs their transformative leadership. FUTURE IMPLICATIONS: Assuring that graduates have the knowledge, skills and attitude for providing high quality care and transformational leadership requires our educational programs to be creative and shift learning and expertise to students. The Intensive has been offered for a year with positive results in terms of student engagement and self-report of reduced stigma and readiness for entering PMHN. FUTURE IMPLICATIONS: While clinical hours vary across curricula nationally, nurse educators are encouraged to incorporate an Intensive into the undergraduate course.


4025: Supporting Families through the Crisis of First Episode Psychosis
Susan Fitzgerald, MSN, RN, NE-BC

PROBLEM STATEMENT: The  diagnosis of First Episode Psychosis(FEP) and  stress of caring for a loved one with the disease places significant stress on caregivers. Without adequate support, caregivers are unable to effectively cope with the demands of caregiving, often impacting the outcomes of the individual with FEP. SUMMARY OF EVIDENCE: Families experiencing First Episode Psychosis are particularly at risk for burden at the early stages of a psychotic illness when changes in the patient are most visible (Birchwood & Macmillian, 1993). McCann, Lubman, and Clark (2011) assert that caregivers need sufficient knowledge and ongoing support, such as a family support group, to help them with grieving, and accept their situation. DESCRIPTION OF PRACTICE OR PROTOCOL: Four separate  series of psychoeducational groups were conducted over a nine month period at Zucker Hillside Hospital and South Oaks Hospital. Recruitment was from multiple FEP specialty sites within Northwell Health. Stakeholders included patients, families, FEP treatment teams ,and hospital leadership. VALIDATION OF EVIDENCE: Participants completed the General Health Questionnaire 12 (GHQ- 12), to measure stress and The Self -Efficacy Scale for People with Mentally Ill Relatives to measure self- efficacy,pre and post intervention.Qualitative information was gathered  to further explore individual caregiver experiences and specific needs in caring for a family member with FEP. RELEVANCE OF PMH NURSING: A comparison of the GHQ-12 scores pre and post intervention showed a signifiant decrease in overall stress as well a decrease in the domain of anxiety. Qualitative themes included helplessness, and lack of understanding and resources. FUTURE IMPLICATIONS: The group format is an en exemplar for educational support groups for  caregivers facing other serious illnesses.


4026: Survivors of Torture: Providing Psychiatric Services to Asylees and Refugees
Molly Willis, MSN, RN; Connie Quach, RN

PROBLEM STATEMENT: With an estimated 1.3 million torture survivors living in the United States, approximately 35,000 of whom reside in San Diego County, the demand for specialized psychiatric care for international trauma survivors cannot be understated. SUMMARY OF EVIDENCE: This population is at a significantly greater risk for PTSD, depression, anxiety and psychosis and requires culturally specific, specialized psychiatric care. DESCRIPTION OF PRACTICE OR PROTOCOL: UCSD partners with this organization for providing psychiatric medication management services, utilizing psychiatric nurse practitioner trainees in the care delivery. VALIDATION OF EVIDENCE: References: Risk of Psychosis Among Refugees A Systematic Review and Meta-analysis Lasse Brandt, MD; Jonathan Henssler, MD; Martin Müller, MD; Stephanie Wall, MS; David Gabel, BS; Andreas Heinz, MD, PhD Mental Disorders in Asylum Seekers: The Role of the Refugee Determination Process and Employment. Debbie Hocking;Gerard Kennedy;Suresh Sundram RELEVANCE OF PMH NURSING: This model provides a unique opportunity to serve this ever growing subset of psychiatric patients with an evidence-based approach that improves both quality and access. FUTURE IMPLICATIONS: Through a series of vignettes, the presenter will illustrate how this training model addresses cultural, language and gender barriers that historically have limited access to high quality mental health care. With a more comprehensive approach to their psychiatric care and mental health more generally, patients experience quantifiable improvement in symptom presentation and level of functioning.


4027: Improving Whole Health Outcomes: A Novel Approach to Nursing Education through an Integrated Behavioral Health/Medical Surgical RN Residency and Fellowship Program
Amanda Young, BSN, RN-C; Elizabeth Rubin, MSW, LICSW, SUDP; Melinda Furrer, MN, RN; Zachary Brochu, BSN, RN-BC

PROBLEM STATEMENT: Psychiatric mental health nurse residency programs are an emerging approach to address the shortage of mental health nurses. However, there are not enough of these programs and few address rising medical acuity on inpatient behavioral health units. To fill this gap, we developed an integrated behavioral health/medical surgical specialty track (MedPsych) of our RN Residency and Fellowship program. SUMMARY OF EVIDENCE: While many organizations offer residency and fellowship programs in medical surgical areas, critical care, emergency services, newborn-intensive care, family-childbirth, and antepartum areas, few offer behavioral health focused programs. No other known nurse residency program has an integrated behavioral health/medical surgical specialty. DESCRIPTION OF PRACTICE OR PROTOCOL: The medpsych track is designed for fully licensed, new graduate and new-to-specialty nurses. Interdisciplinary in design and facilitation, the program includes: cohort hiring and training; didactic and e-learning education in behavioral health and medical specialty areas; high fidelity simulation in a range of stressful medical and behavioral health situations; and strong mentoring using experienced nurse preceptors and professional development specialists. VALIDATION OF EVIDENCE: Primary outcomes measured include: nursing retention (program completion, length of employment with the organization), and hospital wide patient safety indicators (falls, rapid response vs. code blue, hand hygiene, restraints). RELEVANCE OF PMH NURSING: Outcomes from the first three years indicate promising results for nursing retention and patient safety, meeting and/or exceeding organizational and/or national benchmarks. FUTURE IMPLICATIONS: Future implications of this work include adaptation of core program elements into education and training for experienced as well as student nurses, expansion of interdisciplinary collaboration in nursing clinical education, and expanded evaluation of behavioral health focused quality indicators.


4031: Psychotherapy, an essential Competency for the APPN, is a Complex and Multifaceted Endeavor to Teach
Candice Knight, PhD, EdD, APN, PMHNP-BC, PMHCNS-BC; Danielle Conklin, DNP, NP-P, PMHNP-BC; Michelle Knapp, DNP, NP-P, PMHNP-BC

PROBLEM STATEMENT: Many APPN faculty are not well versed in teaching psychotherapy, especially the contemporary, short-term approaches such as Interpersonal Psychotherapy (IPT). A case study approach is a unique way of teaching psychotherapy that bridges the gap between theory and practice. Using didactics and experiential learning, excerpts from an actual psychotherapy sessions are enacted from the initial session to termination in segments of dialogue from session transcripts, providing faculty with a rich and unique methodology. SUMMARY OF EVIDENCE: Recent evidence reveals that the case study method of teaching psychotherapy provides students with a robust learning experience that directly translates to clinical competency. Case studies allow students to view psychotherapy over time through segments of verbatim session transcripts that bring the psychotherapeutic process to life and allow a glimpse of the dialogue that occurs within sessions. DESCRIPTION OF PRACTICE OR PROTOCOL: Case studies are often used in teaching psychiatric diagnoses and psychopharmacology, but have not been used in teaching psychotherapy to APPNs. A new text to be published in September, 2020, and written by the primary presenter with chapters by the additional authors is the first case study approach to psychotherapy for APPNs. VALIDATION OF EVIDENCE: Literature is plentiful in other mental health disciplines, such as psychology and social work, and shows that the case study approach is an efficacious method of teaching psychotherapy. RELEVANCE OF PMH NURSING: Teaching psychotherapy to APPN students through the case study approach will enrich the current available methodologies. FUTURE IMPLICATIONS: Participants will take home a new and innovative approach to teaching psychotherapy.  Ideas for further case studies will be generated as well.


4032: Managing Behavioral Health Patients in Acute Care and Emergency Departments with Remote Safety Monitoring: a Marriage of Technology and Caring
Lisbeth Votruba, MSN, RN; Janet Cipkala-Gaffin, DrPH, PMHCNS-BC

PROBLEM STATEMENT: Hospitals and EDs are the last line of defense in a crisis and faced with caring for patients with behavioral health needs in environments that aren’t designed to keep them safe.  These patients are often at risk of harming themselves and/or staff. SUMMARY OF EVIDENCE: 3 recent peer reviewed articles demonstrate feasibility of remote patient safety monitoring (RPSM) for low/moderate suicide risk and violent patients. DESCRIPTION OF PRACTICE OR PROTOCOL: RPSM is interactive video monitoring where one trained staff member interacts with multiple patients via verbal redirection and with ability to summon bedside staff as needed. Monitoring staff can provide brief descriptions of adverse events witnessed on camera.  Patient types, interactions and adverse events are captured in software to a national database. VALIDATION OF EVIDENCE: RPSM software captures data from multiple subscribing hospitals. All of which have an executed agreement allowing for analysis and publication of aggregated data. The data contains no PHI according to Safe Harbor Method. This database currently contains data from 14,380 suicide-risk patients and 5,004 risk-for-violence patients. RELEVANCE OF PMH NURSING: For suicide risk patients from 249 different hospitals, there were no documented suicides.  There are 9 documented suicide attempts.  Methods of these attempts will be described.  In the database there are 320 documented violent incidents against staff.  Categories of verbal and physical abuse incidents will be described. FUTURE IMPLICATIONS: Qualitative descriptions of suicide attempts and workplace violence incidents provide insights for future safety improvements.  Future study is needed on risk for aggression scales for patient selection criteria as well as deescalation training for monitoring staff.


4033: Transforming Rn Roles In Primary Care (TRIP): Interprofessional Partnerships for Holistic Care
Lora Humphrey Beebe, PhD, PMHNP-BC, FAAN; Sandra Mixer, PhD, RN, CTN-A

PROBLEM STATEMENT: An unprecedented need for holistic care is forecast for the next decade SUMMARY OF EVIDENCE: An interprofessional group of faculty and clinical partners developed an innovative curriculum and academic partnership to prepare RNs to lead interprofessional teams providing community based, holistic care. DESCRIPTION OF PRACTICE OR PROTOCOL: The first TRIP cohort began fall 2018. Didactic content included recovery based mental health promotion, substance abuse treatment, multiple chronic condition prevention/control, social determinants of health, cultural diversity and vulnerable populations. TRIP nursing, pharmacy and nutrition students (all undergraduate) participated in two simulation scenarios developed by our clinical partners- the first focused on recovery based mental health/substance abuse, and the second on interprofessional team-based care incorporating cultural diversity and multiple chronic conditions.   Clinical activities included service learning and interprofessional team conferences in all four semesters, with a total of 300 hours of clinical immersion. VALIDATION OF EVIDENCE: Students participated in online and in person evaluation and debriefing (conducted by our independent evaluation team) at multiple points of the TRIP curriculum. RELEVANCE OF PMH NURSING: The first cohort will complete the TRIP program spring 2020. TRIP has enrolled 38 students so far (22  nursing, 8 pharmacy, and 8 nutrition).  We will present: 1) an overview of TRIP activities, including the planning and partnership development phases 2) details of recovery based didactic and simulation content, and 3) preliminary results from cohort one evaluations (collected spring 2020). FUTURE IMPLICATIONS: TRIP has funding support through 2022.  We look forward to sharing our experiences with the first cohort, and hearing from our colleagues about their experiences using interprofessional education to foster holistic care. Results will be used to improve and expand the program to a permanent service line in the healthcare organization.


4034: Creating A Clinical Learning Environment Supporting Interprofessional Practice Using a Synchronous On-Line Strategy
Sara E. Banzhaf, DNP, MSN, APRN-NP, PMHNP-BC; Rhonda Coffman, DNP, ARNP, ACNP-BC, FNP-C; Paul L. Price, Pharm D, BCPP; Lindsay Iverson, DNP, APRN, ACNP-BC

PROBLEM STATEMENT: Creating learning environments that offer students the opportunity to gain experience in interprofessional practice has been identified as a priority (NCICLE). This creates a challenge for on-line graduate programs ensuring flexible clinical activities supporting consistent student learning outcomes and preparing students for this future role. SUMMARY OF EVIDENCE: Opportunity for interprofessional learning experiences to support integration into future practice to promote quality outcomes  NCICLE,  IHI,  University of Washington AIMS Center DESCRIPTION OF PRACTICE OR PROTOCOL: To meet the challenge for students enrolled in an on-line Psychiatric-Mental Health Nurse Practitioner (PMHNP) program, a synchronous on-line simulation was created in partnership with faculty from the Pharmacy and the Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) Programs to provide an interactive simulation of an interprofessional treatment team of an older adult patient experiencing both psychiatric and medical comorbidities during an acute care hospitalization. Students were assigned to groups and provided a scenario in advance of simulation to prepare and contribute to the development of a comprehensive evidence-based treatment plan. The PMHNP students were additionally assigned as team facilitators offering experiences in communications, conflict resolution and negotiation skill VALIDATION OF EVIDENCE: Direct Observation, Debrief, Student Reflection RELEVANCE OF PMH NURSING: Effective in assessment of student performance skills, knowledge.  Students report effectiveness in understanding roles of other professionals, managing initial feelings of discomfort when asked to share clinical expertise, conflict management skills, experience interacting in an environment similar to telehealth, observing faculty role model interprofessional practice, importance of interprofessional relationships and network building, and growth in confidence and knowledge. FUTURE IMPLICATIONS: Expand health professions involvement, broaden specialty populations and create additional clinical scenarios


4035: Using Digital Stories to Understand Recovery and Reduce Stigma in Future Healthcare Providers
Sheila Linz, PhD, PMHNP-BC, RN; Mary Wunnenberg, Ed.D, MSN, RN, CNE; Robert Emmons, D. Litt; Jacqueline Durham, MSW, LCSW; Phyllis Solomon, PhD

PROBLEM STATEMENT: The Process of recovery from mental illness is not fully understood. Digital stories can elucidate the experience; they are 3-5 minute stories using music, visuals, and voiceover to tell a compelling story. People with serious mental illness (SMI) experience stigma from healthcare providers. Nursing students can reduce stigma prior to practice by working with consumers to create digital stories about recovery. THEORETICAL FRAMEWORK: Gordon Allport's Contact theory postulates that discrimination is reduced when the discriminated against and the discriminator work together on an approved project with equal status and a  mutual goal. METHODS AND DESIGN: Four individuals with SMI and eight nursing students formed teams to create a digital story of recovery together at an all-day digital storytelling workshop. The students functioned as assistants to individuals with mental illness,  helped them tell their stories,  and assisted with technical matters. The digital stories were mined for themes through narrative analysis. The students qualitatively answered a written question about their experience. Their answers were thematically analyzed. RESULTS: The digital storytelling themes were rich with the process of recovery: The themes included: How you once were, Revisiting pain and trauma, Infatuation with aspects of the illness, Loss, Scars, Relapse, Hitting bottom,  Spiritual experience, Support, Come full circle, Back to how you were, Hope and renewal Students themes were: Everyone has a story, Never judge a person, Mental illness does not define them IMPLICATIONS (PRACTICE): Clinical experience can include working in a digital storytelling group to support individuals with recovery and reduce stigmatized attitudes. IMPLICATIONS (RESEARCH): A larger sample size needs to be used.


4036: Behind Bars: Providing Advance Practice Psychiatric Nursing in Correctional Facilities

PROBLEM STATEMENT: Our nation has the highest incarceration rate of any other country in the world. As incarceration rates increase, so does the number of incarcerated persons with mental illness. People with mental illness are landing in the criminal justice system at alarming rates. Jails and prisons are not equipped to meet the unique needs of incarcerated persons with mental illness. Psychiatric Mental Health Nurse Practitioners (PMHNP) are well equipped to meet these needs. The purpose of this presentation is to discuss the role of the PMHNP in correctional facilities and the challenges they may face in these facilities. Demographics of incarcerated persons with a mental illness and strategies to enhance buy-in from correctional facilities to provide psychiatric nursing to incarcerated persons will be explored. SUMMARY OF EVIDENCE: Many experts agree that the criminal justice system has become the de facto mental health facilities for the seriously mentally ill. Instead of providing people with mental illness the treatment and support they need, our society criminalizes them and puts them behind bars. DESCRIPTION OF PRACTICE OR PROTOCOL: Evidence-supported guidelines for the provision of advance practice psychiatric nursing in correctional facilities will be explored during this presentation. VALIDATION OF EVIDENCE: Both evidence from the literature and current practice will guide the discussion of the role of the PMHNP in correctional facilities. RELEVANCE OF PMH NURSING: It is expected that the PMHNP will gain knowledge about providing advance practice psychiatric nursing in correctional facilities. FUTURE IMPLICATIONS: Criminalizing persons with a mental illness can lead to grave circumstances. Increased utilization of PMHNPs can improve the quality of life incarcerated persons with mental illness.


4037: Nurse Led Interdisciplinary Treatment Planning: A Proactive and Holistic Model for Behavioral Emergency Response Teams
Adam Kozikowski, MS, PMHNP-BC; Nathan Jones, RN-BC

PROBLEM STATEMENT: We aim to reduce negative outcomes associated with acute behavioral emergencies during medical admissions. It was recognized that treatment planning relating to behavioral emergencies was not consistently incorporated into overall treatment plans after the activation of the Behavioral Emergency Response Team (BERT). SUMMARY OF EVIDENCE: Behavioral emergencies have been shown to increase length of stay and morbidity. Patients with repeat behavioral emergencies demonstrated increased length of stay, disrupted medical treatment, and higher readmission rates, as well as staff injury and burnout. DESCRIPTION OF PRACTICE OR PROTOCOL: Current practice includes BERT nurse-led interdisciplinary behavioral health safety huddles and proactive rounding by the Psychiatric RN Liaison (PRNL), utilizing real-time education. The PRNL facilitates relationships across key disciplines- implementing collaboration between psychiatry, medicine, nursing, social work, nutrition, security, and others. VALIDATION OF EVIDENCE: Since implementation of these initiatives, there is an increase in utilization of the BERT service, while reducing the number of repeat activations for unique patients. There is an increase in consultation of the BERT/PRNL RN. We trend overall activations of the behavioral emergency response team, reapeat activations for unique patients, highest utilizing units, and psychiatric comorbidities. RELEVANCE OF PMH NURSING: The PMH nurse is key in implimenting the strategies utilized by the BERT service. They anchor treatment planning with a holistic approach. We've shown an increase in staff satisfaction and competency and reduction in repeat acute behavioral emergencies FUTURE IMPLICATIONS: The BERT/PRNL RN's will continue to facilitate daily safety huddles on high risk patients. We are standardizing the huddles for reliability, and units are using them to lead HRO huddles.

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