Annual Conference Saturday Abstracts

4011: Addressing Psychiatric Boarding in the Emergency Department: An APRN's role in Decreasing Length of Stay
Karen Cheeseman, DNP, PMHCNS, APRN, BC; Susan Painter, DNP, PMHNP, BC, PMHCNS, BC

PROBLEM STATEMENT: Psychiatric boarding is a national problem. Psychiatric patients are frequently boarded for significant lengths of time in the emergency department (ED) with minimal or no treatment. Studies have indicated that the length of stay (LOS) for the psychiatric ED patient can be decreased with appropriate intervention by a psychiatric APRN. SUMMARY OF EVIDENCE: Most EDs are limited in their provision of and access to psychiatric services, and most do not have access to a readily available psychiatrist to initiate treatment.   Early intervention improves the quality of care by addressing the presenting psychiatric crisis when the patient presents to the ED. DESCRIPTION OF PRACTICE OR PROTOCOL: There are not enough psychiatrists to meet these needs, but the psychiatric APRN is able to provide care, either independently or through a collaborative agreement with a psychiatrist depending on the practice state. The psychiatric APRN can provide psychiatric evaluation and treatment, therefore, decreasing psychiatric boarding and financial cost to the facility. VALIDATION OF EVIDENCE: This practice change has the potential to improve care for patients and decrease psychiatric boarding times. The desired outcome was to show a reduction in boarding times, meaning psychiatric patients receive treatment that can potentially stabilize their presenting problem. LOS was used as the outcome measure to evaluate the effectiveness of the intervention. RELEVANCE OF PMH NURSING: A 32.59% decrease in LOS was noted based on a pre-LOS of 40.5 hours and a post LOS of 27.3 hours. FUTURE IMPLICATIONS: Utilization of psychiatric APRN's in the ED can decrease psychiatric boarding of patients, therefore, decreasing patient stress and the financial burdens to patients, staff, and healthcare organizations.


4012: Creating a Holistic Environment for the Inpatient Setting
Donna Linette, DNP, NEA-BC, HN-BC

PROBLEM STATEMENT: As nurses, we are always seeking alternative interventions that can be nurse-facilitated/organized for our patients. This small hospital has an umbrella focus of holistic nursing and the mental unit was eager to try new and different groups/exercises/interventions to support the patient in some way other than pharmacology. SUMMARY OF EVIDENCE: Using the Core Values of Holistic Nursing and the concepts of Recovery, new groups and a new culture was added to the unit; the patients reported positive feedback on the groups. The staff found that they also enjoyed facilitating the groups, that participation increased and that we were able to reach patients in a way that we had previously thought about. DESCRIPTION OF PRACTICE OR PROTOCOL: RNs at times struggle for group topics - the use of complementary and interdisciplinary groups provided comfortable environment for the staff RN to gain experience an, use non-pharmacological interventions; holistic and psychiatric mental health nursing overlaps nicely. VALIDATION OF EVIDENCE: There is literature support for drumming (one new group) and aromatherapy/meditation (second new group) - in addition to the other groups that fall under the holistic mental health umbrella (spirituality, pet therapy, art, music). These new groups showed promise as self-perception was measured by the patients (aromatherapy) using the DASS-21. Patients perceived a decrease in depression, anxiety and stress. RELEVANCE OF PMH NURSING: There is significant need for finding non-pharmacological interventions - for the health of our patients. FUTURE IMPLICATIONS: Recommended research to correlate participation in drumming and aromatherapy in the outpatient setting (difficult to do in the inpatient setting) with symptom relief; replicate study with DASS-21 to include biomarkers.


4013: The Imagine Project: Helping Kids Overcome Stress and Trauma through Expressive Writing
Dianne Maroney, RN, MSN

PROBLEM STATEMENT: Research shows that stress and trauma is escalating across the globe. The Imagine Project supports healing for children in a simple and free format. SUMMARY OF EVIDENCE: The Imagine Project writing activity is based on years of research on expressive writing. Data shows that expressive writing increase GPA, lessens anxiety, depression, some PTSD symptoms, and teaches participants how to manage stress. DESCRIPTION OF PRACTICE OR PROTOCOL: The Imagine Project writing activity can be used with individuals, small groups, even larger group settings. The simple writing activity that uses a 7-step journal (downloaded for free from to guide the writer to tell their story using the word Imagine. Once their difficult story is written, they are prompted to write a new Imagine story in its place. The use of the word Imagine gives a safety net that is unusual for journal writing. It also brings in the creative side of the brain to help with healing. VALIDATION OF EVIDENCE: There are numerous studies on expressive writing that are both qualitative and quantitative. Our quantitative study measured 5 constructs before and after writing. Our current study is focusing on deeper mental health constructs. RELEVANCE OF PMH NURSING: Current data showed improvement in middle schoolers attitudes towards school by 11.6%, their ability to manage stress by 9.8%, and their perceptions of support by 8.0%. PMH nurses can use this process with individuals and groups to improve stress management. FUTURE IMPLICATIONS: The Imagine Project can positively impact the mental health of communities world wide by giving kids a voice for positive change in their lives and those around them.


4014: Promoting Civility in Psychiatric Mental Health Undergraduate Nursing Education
Traci Sims, DNS, RN, CNS/PMH-BC; Jill Steinke, MS RN; Linda Ewald, MS BSN RN PMHCNS-BC; David Sharp, RN, PhD

PROBLEM STATEMENT: Concerns of student and faculty safety has increased in recent years on college campuses. The Pre-Licensure Branch of the Education Council wants to present the survey results of what are currently the practices to promote safety and civility on college campuses. SUMMARY OF EVIDENCE: The American Nursing Association [ANA] (2015) and the American Psychiatric Nurses Association [APNA] (2008) have addressed concerns about workplace violence as an occupational concern for nurses. APNA (2016) has also addressed violence prevention strategies and encouraged educators (APNA, 2008) to address workplace violence prevention and conflict resolution in nursing education.  The importance of healthy work environment education has also been recommended for undergraduate nursing education including education about communication and conflict resolution techniques by the American Association of Critical-Care Nurses [AACN] (2017).  In order to promote a culture of respect, safety, and effective interprofessional communication, incivility concerns need to be addressed (ANA, 2015). DESCRIPTION OF PRACTICE OR PROTOCOL: Survey results of PMH undergraduate educators will be presented to encourage a dialog to assimilate civility promotion practices in undergraduate nursing programs. VALIDATION OF EVIDENCE: Clark, Olender, Kenski and Cardoni (2013) advocate for higher education to raise awareness, build collegial relationships, and foster organizational collegiality while serving as exemplars of civility. RELEVANCE OF PMH NURSING: Discussion will include ways to enrich PMH nurse educator's content on communication with the addition of civility content. FUTURE IMPLICATIONS: The result will provide deliverables to include the development of civility resources for nurse educators and added as an update to the Undergraduate Education Toolkit.


4015: SMART Recovery: REBT and Motivational Interviewing Tools for Persons with Addictive Behavior
Diane Vines, RN, PhD

PROBLEM STATEMENT: To introduce SMART Recovery as a whole health approach for addictive behavior  Persons with addictive behavior need tools and strategies to achieve a healthy, positive and balanced lifestyle. SUMMARY OF EVIDENCE: SMART Recovery utilizes scientifically proven methods for addiction recovery such as cognitive behavior therapy and motivational interviewing.  There are 2500 face-to-face meetings around the world and 28 online meetings.  The corrections program has proven to decrease recidividism and anecdotal evidence from participants demonstrates successful recovery from addictive behaviors.  As a facilitator for SMART Recovery meetings, I have seen the transformation in the lives of participants by promoting self empowerment, unconditional self acceptance, and self management. DESCRIPTION OF PRACTICE OR PROTOCOL: SMART Recovery focuses on a four point program: building and maintaining motivation; coping with urges; managing thoughts, feelings, and behaviors; and living a balanced life.  Tools include: word exchange for words such as "awfulizing" and "musting"; rational thinking versus irrational thinking strategies; cost/benefit analysis; ABCs of REBT; destructive imagery and self-talk awareness and refusal method; brainstorming; role-playing/rehearsing; urge log; and a change plan worksheet.  Stakeholders are persons with any addictive behavior. VALIDATION OF EVIDENCE: The effectiveness of SMART Recovery is measured by decrease in the number of relapses, subjective recovery from addictive behavior, and lowered recidivism in prisoners. RELEVANCE OF PMH NURSING: Psychiatric nurses and advanced practice nurses can refer persons with addictive behavior to SMART Recovery meetings as an alternative or adjunct to twelve step programs.  They can also choose to train to be a meeting facilitator or host through online education programs. FUTURE IMPLICATIONS: SMART Recovery can change lives and help friends and families.


4016: Trauma has a Frequency: A RESET of the Emotional Aspects of Trauma
Susan Parcell Bindewald, PMHCNS-BC

PROBLEM STATEMENT: Human beings are not geared to live in chronic stress and trauma.  Talk therapy nor psychopharmacology have succeeded in providing the relief of emotional symptoms secondary to post-trauma and other related mental health disorders.  Acoustical neuromodulation to modify memory reconsolidation has shown to be highly effective in reducing the emotional symptoms of PTSD. SUMMARY OF EVIDENCE: Theoretically, because of trauma, neurons are no longer in growth mode, but protective mode.  RESET therapy, using the bio-acoustical utilization device (BAUD), allows for reconsolidation enhancement by the stimulation of emotional triggers (RESET) so there is a return to growth mode. DESCRIPTION OF PRACTICE OR PROTOCOL: The clinician uses the BAUD to allow a sound frequency to resonate with the target neuronal circuit.  Two frequency adjustable sound tones interact to generate a third binaural sound and the intense negative emotion "drops out" of the memory. VALIDATION OF EVIDENCE: Advances in neuroscience and brain imaging have allowed understanding of the interweaving of PTSD symptoms with memory circuits in the limbic system.  QEEG brain mapping provides objectification of the evidence of neuronal change.  The research protocol involves a brain map before and after a twenty-minute BAUD session, with the client remembering the same traumatic event during the brain mapping and the BAUD intervention.  Post-RESET brain maps have shown significant normalization of the QEEG in regions of the brain related to PTSD.  Life satisfaction, depression, and anxiety self-reports support evidence of symptom reduction and elimination. RELEVANCE OF PMH NURSING: Psychiatric nurses use this transformative intervention.  The proof is in the pudding.  Permanent symptom reversal. FUTURE IMPLICATIONS: Can use of the BAUD prevent PTSD?


4017: ACE Hardware: A Tool for Measuring Adverse Childhood Experiences
Kenneth Longbrake, RN, MSN; Lisa C. Farmer, BSN, RN-BC, LMSW

PROBLEM STATEMENT: Psychometrically-established tool does not exist to measure adverse childhood experiences (ACEs) from child’s perspective. Study purpose: evaluate reliability and validity of ACEs questionnaire when administered twice to caregivers and their children admitted to inpatient psychiatry unit or partial hospitalization program. THEORETICAL FRAMEWORK: Original ACEs study demonstrated: (1) childhood maltreatment and stressors are common, and (2) risk factors lead to poor adult quality of life. Neurosequential Model of Therapeutics is a neuro-bio-developmental approach to working with at-risk children. METHODS AND DESIGN: Comparative design evaluated if caregivers and their children (5–17 years), within psychiatric setting, reliably and validly identified similar trauma histories about their child or themselves, respectively. Ten-item ACE questionnaire was administered to caregivers and electronically to children at admission and discharge to assess test-retest reliability. For convergent validity, ACEs item and total scores were correlated for between-group agreement. RESULTS: Eighty-six participants enrolled (43 caregivers [88% female; 39yrs]; 43 children [61% male; 10yrs]). Reliability between caregiver ACEs #1 and #2: significantly strong correlations for 9 items and total score (exception: weaker correlation on question related to slapping child). Reliability between child ACEs #1 and #2 produced significantly strong correlations on sexual abuse. Convergent validity between caregiver and child responses was not established (exception: 3 questions related to divorce, ability to care, or sexual abuse). IMPLICATIONS (PRACTICE): Caregivers of children with psychiatric diagnoses were reliable historians about child’s trauma history. Children were less reliable but disclosed sexual abuse electronically. IMPLICATIONS (RESEARCH): Next steps: engage content experts to compare child ACEs with caregiver ACEs, obtain content validity index, and re-evaluate convergent validity.


4021: Healing in the Eye of the Hurricane:  Innovative Programs for Workplace Self-care and Mental Health

PROBLEM STATEMENT: One million people miss work everyday due to stress, costing $225.8 billion annually. While not specific to the stress and psychological impact on nurses. Only recently we have begun to examine such serious results nurse suicide, we have long known that floating nurses to unfamiliar units, mandatory overtime, lack of respect/civility, and working in environments where their skills are not fully utilized leads to staff turnover and increased injuries. SUMMARY OF EVIDENCE: Increased complexity of care, increased natural disasters in our region, increased aging with cognitive loss among our veterans, and increased violence in our society including the shooting of one of our own staff members, led us to recognize addressing only safety concerns were not sufficient and we involved staff members in developing a more comprehensive approach. DESCRIPTION OF PRACTICE OR PROTOCOL: Utilizing direct input from front line staff members, we developed a aggressive program including: shared-governance, focus on staff engagement in all decision making and developed ways to improve staff member and manager relationships, such as instead of "Exit Interviews" we implemented "Why do you Stay" Interviews as often at exit it is too late to help and care our nursing staff members. We utilize consult services for nurses such as customer service  and mental health support teams to support nurses with challenging patients at the bedside, and more. VALIDATION OF EVIDENCE: RN satisfaction improved 22% and turnover decreased by nearly 4% in eight months.  Staff injuries decreased by half. RELEVANCE OF PMH NURSING: PMH nurses were central champions, helping other nurses change, and improving physical and psychological safety for all. FUTURE IMPLICATIONS: Continued improvement.


4022: Setting the Standard: The Impact of Nursing-led Groups on an Inpatient Psychiatric Unit
Stephanie Verdeflor, MSN, RN-BC

PROBLEM STATEMENT: -Patients report a lack of activities on the unit -Inconsistent Press Ganey scores in response to: Amount of time spent in groups and activities SUMMARY OF EVIDENCE: -Patients report feeling "bored" on inpatient units -Patients in mental health wards feel deprived of human interaction -Lack of staff interaction can have a significant impact on patient satisfaction DESCRIPTION OF PRACTICE OR PROTOCOL: Strategies for implementation include providing an educational in-service to the 4 North Team about the importance of patient engagement through nursing-led groups and obtaining resources for nurses to create engagement in areas that are of personal interest as well as foster patient recovery.  Stakeholders include: patients, nurses, support staff (MHWs & Psych Techs), and other members of the interdisciplinary team VALIDATION OF EVIDENCE: Press Ganey Survey results for: 1- Helpfulness of nursing staff 2- Amount of time spent in groups and activities RELEVANCE OF PMH NURSING: Pending results from practice change FUTURE IMPLICATIONS: More research needs to be done on quality improvement in mental health care. Make time to spend with patients - increased patient engagement has a positive impact on staff morale


4023: ADHD or Bipolar Mania? Using Neuroscience to Inform Diagnosis and Treatment in Children and Adolescents
Marci Zsamboky, DNP, PMHNP/CNS-BC, CNE; Matt E Schroer, DNP, PMHNP-BC

PROBLEM STATEMENT: Due to overlapping symptoms, diagnosing and effectively treating ADHD and bipolar mania in children and adolescents can be difficult for APRNs. It further complicates matters that ADHD is often comorbid with bipolar disorder. It is essential that APRNs correctly differentiate between ADHD and bipolar mania, as treatment strategies differ. SUMMARY OF EVIDENCE: Both ADHD and bipolar disorder are highly heritable illnesses which can lead to poor outcomes if untreated or incorrectly treated. Both disorders also have distinct neural mechanisms and neurobiological differences. Irritability is an example of an overlapping symptom that has different treatment implications depending on the identified disorder. Understanding the neuroscience associated with each disorder can help facilitate differential diagnosing and inform effective treatments. DESCRIPTION OF PRACTICE OR PROTOCOL: Early detection and targeted drug treatments promise substantial benefits.Currently, stimulants are first line treatments in youth with ADHD, while atypical antipsychotics are first line treatments for youth with bipolar mania. Clinical strategies for management of comorbid disorders, however, become more difficult to determine. VALIDATION OF EVIDENCE: Evidence of target validation in ADHD and bipolar disorder in youth include neurotransmission dysregulation (norepinephrine and dopamine in ADHD; norepinephrine, dopamine, and serotonin in bipolar disorder); neural mechanisms; intracellular signaling; and sleep/circadian regulation (bipolar disorder). RELEVANCE OF PMH NURSING: APRNs working with children and adolescents can effectively diagnose and treat ADHD and bipolar mania through a clear understanding of the neuroscience underpinnings. Furthermore, APRNs can consult with primary care providers to assist them in correctly diagnosing and treating these disorders. FUTURE IMPLICATIONS: APRNs should continue to refine their diagnostic skills with youth, leading to enhanced treatment outcomes.


4024: An Undergraduate Intensive Orientation for Mental Health Nursing Students:  Breaking Down Stigma and Fostering Compassion
Pamela J. Worrell Carlisle, RN, MA, PhD

PROBLEM STATEMENT:  This session provides details of a Mental Health Clinical Orientation Intensive designed to reduce stigma and increase student readiness.  The presenter will review the rationale and outline the essential content and teaching/learning strategies used. SUMMARY OF EVIDENCE: Undergraduate student nurses entering the mental health course wear a cloak of skepticism that the course has anything to do with being a “real nurse” as well as misconceptions about mental health disorders and the consumers served. DESCRIPTION OF PRACTICE OR PROTOCOL: One of the pedagogical strategies implemented at Georgia Southern University to confront these challenges is the Intensive.  Labeling the three day, on-campus experience an intensive was purposeful to set up an expectation for students that we are embarking on an intellectual and emotional journey worthy of their attention.  Using the literature and prior student feedback, the Intensive was designed to address student knowledge deficits, challenge negative stereotypes/stigma, introduce basic skills for safety and communication; benefit from former student suggestions about how to succeed; and provide orientation to agency expectations and assignments. VALIDATION OF EVIDENCE: The presenter will review the results of students’ reflection papers assigned at the end of the Intensive Clinical Orientation.  A qualitative analysis of the narrative reflections reinforce that the Intensive is of value. RELEVANCE OF PMH NURSING: 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: HIV, Mental Health, and Substance Use: An Integrated Trauma Informed Behavioral Health Approach
Rosalind De Lisser, MS, FNP-BC, PMHNP-BC; Genesis D Vasconez, RN; Katerina Melino, MS, PMHNP-BC

PROBLEM STATEMENT: Women with HIV are not dying from HIV but rather they are dying from the effects of untreated trauma and substance use. In an effort to address this we have designed a model of trauma informed integrated behavioral health and substance use care in the primary care setting. This presentation will present the model and the unique opportunity for PMHNP practice innovation. SUMMARY OF EVIDENCE: Nationally, women accounted for 1 in 5 individuals diagnosed with HIV in the US in 2016. Rates of infection in women of color are rising disproportionately faster than white women (61% newly infected in 2016 were African American). While 87% infected were due to heterosexual contact more than 12% were due to injection drug use. Our clinic is 49% African American and 20% white with 65% prescribed opiates and over 41% illicit drug use in last 3 months. 73% of our women have a positive trauma screen. We have found that trust is key. DESCRIPTION OF PRACTICE OR PROTOCOL: We have built a model of care which seeks to build trust, foster relationships, and empower women to engage in healing. The trauma informed model of care includes the domains of inquiry, education, response, environment, and foundation.      VALIDATION OF EVIDENCE: The model will be presented  and discussed. Domains will be illustrated using 4 cases highlighting the care of individuals with opiate, stimulant, and alcohol use disorders. RELEVANCE OF PMH NURSING: This integrated trauma informed model of behavioral heath care aligns with the humanistic philosophy of PMH. FUTURE IMPLICATIONS: Research is needed to better understand the long term outcomes of this innovative practice model.


4026: Complicating the Nature of the Individual in Trauma-Informed Care (TIC)
Jason F Earle, PhD, APNP, CFPNP

PROBLEM STATEMENT: The psychiatric literature on trauma has typically not questioned the nature of the individual (Segal, 2018). However, recent scholarship has started to problematize this view with the recognition that trauma is entangled with a complicated array of factors resulting in more individual variability than previously realized (Maercker et al., 2013; 2016). This presentation introduces recent research on neurobiological and social factors that influence individual trauma variability. SUMMARY OF EVIDENCE: fMRI research finds that common impairments linked to trauma such as attention to threat, memory, self, and interpersonal processing can vary neurobiologically if a person has an independent self (found in individualistic cultures) versus an interdependent self (found in collectivist cultures) (Liddell et al., 2016). New research on individual interoceptive dysfunction, a neurobiological emotion processing issue linked to trauma, finds multidomain, multidimensional impairment variability (Murphy et al., 2018) in contrast to the single dimension impairment found in popular neurobiological models of trauma (van der Kolk, 2014). Psychological and anthropological trauma research finds that interpersonal  and wider societal contexts create individual variability (Maercker et al., 2013; 2016; Segal, 2018) not reflected in the TIC literature (Reeves, 2015). DESCRIPTION OF PRACTICE OR PROTOCOL: This presentation focuses on recent neurobiological and social factors that influence individual trauma variability to help improve the trauma-informed care implemented by psychiatric nurses. VALIDATION OF EVIDENCE: The evidence discussed in the presentation has been validated through the following research methodologies: fMRI, interoception tasks, surveys, questionnaires, ethnography, observation, and interviewing. RELEVANCE OF PMH NURSING: Improve TIC education in psychiatric nursing programs. FUTURE IMPLICATIONS: Prepare psychiatric nurses to grapple with the complexity of individual variability in TIC.


4027: Intervening in Childhood Bullying Using Cognitive Behavioral Skills Building
Elizabeth Hutson, MS, RN, PMHNP-BC; Bradley Thompson, RN; Bernadette Melnyk, PhD, RN, APRN-CNP, FAANP, FNAP, FAAN

PROBLEM STATEMENT: 1 in 5 youth report experiencing bullying. Both short-and long-term consequences of bullying victimization exist, including decreased self-esteem, depression, and suicidal ideation and behaviors. Despite these adverse mental health outcomes, no interventions have been studied in the mental health setting, where many youth present. Therefore, the application of cognitive behavioral skills building (CBSB) as a framework to approach bullying victimization in adolescents will be discussed. THEORETICAL FRAMEWORK: The intervention was guided by Cognitive Theory and uses evidence-based CBSB components. The intervention, Mind Strong, is an adapted version of the 7-session manualized Creating Opportunities for Personal Empowerment (COPE) Program for depression and anxiety. METHODS AND DESIGN: Adaptation of the intervention for a feasibility/acceptability pilot study with adolescents was conducted by including bullying education and tailoring case examples in the COPE Program to bullying and how to respond using CBT skills. RESULTS: Adolescents responded favorably to the intervention using concepts from CBT to deal with bullying. CBSB appears to be an effective theoretical framework to guide intervention research for youth who have experienced bullying and have adverse mental health concerns. IMPLICATIONS (PRACTICE): As CBT strategies are familiar to many PMH Nurses, this intervention can easily be implemented by both PMH RNs and APRNs for patients who present with mental health concerns related to bullying. IMPLICATIONS (RESEARCH): Few studies evaluate interventions for individuals who have experienced bullying and adverse mental health outcomes. Though the results of this study are promising, future research should include a larger population and a control group to be able to generalize the results.


4031: Caring for the Caregivers After the Storm
Diane Esposito, PhD, ARNP, PMHCNS-BC; Jessica Gordon, PhD, ARNP, CPNP-PC; Susan Gatzert-Snyder, APRN, PMHCNS-BC

PROBLEM STATEMENT: Catastrophic hurricane Michael struck the Florida Panhandle on October 10th, 2018. The public infrastructure is severely damaged from unimaginable destruction. Thousands of people including families with small children have been affected by losing their homes, jobs and living in distress. SUMMARY OF EVIDENCE: According to Neria & Shultz (2012) early proactive efforts directed towards more vulnerable populations can play a significant role in disaster mental health recovery.  Kessler et al. (2008) reports the prevalence for mental health problems such as PTSD, Severe Mental Illness and Suicidal Ideation  increased over time after a storm.  The After the Storm guide is based upon principles of stress and coping, developed in response to previous storms in Florida.  (LaGreca, Sevin & Sevin, 2018). DESCRIPTION OF PRACTICE OR PROTOCOL: The practice protocol included instruction on disaster recovery and review of the After the Storm materials.  The participants shared their experiences during the storm, and then were led in the practice of relaxation exercises including mindfulness meditation, guided imagery as well as aromatherapy.  A review of storm preparedness was also discussed to promote self-efficacy. VALIDATION OF EVIDENCE: The participants completed evaluations of the Training Program and After the Storm Materials. RELEVANCE OF PMH NURSING: PMH Nursing is an integral component of disaster recovery.  Caregivers need support during stressful experiences as well, to enable them to care for others. FUTURE IMPLICATIONS: It is critical to have a workforce prepared to provide disaster mental health relief services to those impacted by disasters.  Trauma focused interventions, to allow a client to share their story and focus on positive coping skills are an essential component of recovery.


4032: The Care Journey Map: Mapping family centered care and education for a Supportive Inpatient Admission and Successful Discharge Home
Wendy Susan Dunn, RN-BC, BSN; Theresa Marie Oghojafor, RN-BC, MSN; Krista Keehn, RN-BC, MSN

PROBLEM STATEMENT: At the largest pediatric Psychiatric/Behavioral Health Division in the nation, with ten inpatient units,clinical staff believes all families should have consistent education and treatment planning. SUMMARY OF EVIDENCE: There was a strong desire to enhance the education process through engagement and collaboration with families from admission through discharge to improve the family’s comfort level in managing their child’s condition after discharge. DESCRIPTION OF PRACTICE OR PROTOCOL: The shared governance structure and Patient/Family Experience Committee collaborated to reach all points of care and to leverage unique skills and resources of various groups and individuals throughout the hospital.  Using Human Centered Design practices, team members shadowed families from admission through discharge to gain an empathetic perspective and deeper understanding of their unique experiences. Clinicians participated in health literacy training and review of best practices. VALIDATION OF EVIDENCE: The result was a Care Journey process focusing on five key components.  1.Standardization of the care experience across all points of care  2. Utilization of the Care Journey Map- a teach back tool  3. Interdisciplinary documentation which is purposeful, collaborative, non-repetitive, and efficient  4. Continuity of care for re-hospitalized children and their families  5. Staff training, coaching and accountability  Process and outcome measures were aligned with the hospital strategic goal to improve patient and family experience. RELEVANCE OF PMH NURSING: An educational tool tailored to the family centered care model for child and adolescent psychiatry. Outcomes included increased patient and family satisfaction and knowledge, improved relationship between family and treatment team. FUTURE IMPLICATIONS: The Care Journey Map currently allows for opportunities for further expansion to medical or residential units, though requiring modifications.


4033: Pediatric Telepsychiatry in Collaborative Care: Lessons Learned during a Pilot Program
Amanda L Schuh, PhD, APRN, PMHNP-BC

PROBLEM STATEMENT: Pediatric psychiatry providers are limited and can result in clients traveling long distances to receive mental health care. Clients being referred out of the clinic organization to receive specialty care can lead to fragmented care between the primary care pediatrician and psychiatry provider. Timely access to care is another barrier for clients and families. SUMMARY OF EVIDENCE: Telepsychiatry is an emerging evidence- based clinical practice to provide psychiatry and mental health services to clients via telecommunication technology. There are some pilot programs to measure feasibility, satisfaction, and effectiveness of this type of practice delivery. However, few focus on providing this service as part of a collaborative practice model with a PMHNP in a large non-profit health system. DESCRIPTION OF PRACTICE OR PROTOCOL: Clients, clinicians, families, administrators, clinical staff, and Information Technology specialists were included in program planning, implementation, and evaluation. VALIDATION OF EVIDENCE: Effectiveness of the program was measured via surveys delivered to all families of clients who participated in the pilot. Surveys were distributed by medical assistants immediately after each visit with the telepsychiatry provider. The primary care pediatricians provided narrative feedback and completed surveys about their experiences of the pilot program. All project team members collaborated to provide formative and summative feedback regarding technical and operational processes. RELEVANCE OF PMH NURSING: Clients, their families, and primary care pediatricians were highly satisfied with the care they received. Opportunities for improvement were identified for expansion of telepsychiatry services. FUTURE IMPLICATIONS: Results will be used to improve and expand the program to a permanent service line in the healthcare organization.


4034: Nurse Educator on a Mission: Supporting Mental Health Awareness on Campus
Todd Hastings, PhD, MS, RN

PROBLEM STATEMENT: Mental health issues on campus have escalated and are a huge concern relative to undergraduate student health and well-being. SUMMARY OF EVIDENCE: Current evidence suggests behavioral health problems among college students continue to rise. Student services and campus resources targeting mental health promotion are limited. However, studies show expanded faculty initiatives beyond expected roles can better promote mental and whole health in college and university settings. DESCRIPTION OF PRACTICE OR PROTOCOL: A nurse educator demonstrates enhanced positioning to facilitate mental health awareness and suicide prevention by: 1. Teaching psychiatric nursing topics in the nursing major but also by providing instruction in first year experience, honors, and liberal arts foundation classes across campus.  Themes associated with behavioral health, substance use problems, and mental health stigma are addressed to support a just campus culture.  2. Engaging in service roles beyond committee which includes conducting mental health and suicide prevention bystander trainings (MHFA and QPR), acting as an advisor to the student club "Active Minds", and facilitating mindfulness/relaxation sessions across campus; and  3.  Conducting research studying student feelings about mental illness. VALIDATION OF EVIDENCE: Surveys and class evaluations were used to solicit student responses relative to knowledge and feelings about mental illness.  Descriptive survey responses and reports by participants provided feedback about service activities supporting mental health and suicide prevention themes.  Research about mental health attitudes was obtained through psychometric rating tools and focus groups. RELEVANCE OF PMH NURSING: Enhanced nursing faculty roles resulted in improved knowledge and attitudes about mental illness on campus. FUTURE IMPLICATIONS: Nurse educators can facilitate improved mental and whole health awareness on campus.


4035: Nurses in Recovery: A Healthcare Provider Treatment Program
Bari K Platter, MS, RN, MHCNS-BC, FIAAN

PROBLEM STATEMENT: Nurses develop substance use disorder at a rate somewhat higher than the general public. Risk factors include role strain, enabling by peers and managers, lack of education regarding addiction, lack of controls and prescribing practices of peer providers. The presentation of "nurse as patient" creates a unique opportunity to provide tailored treatment interventions that meet the needs of this population. The Healthcare Provider Treatment Program provides nurses with the opportunity to explore how professional thoughts and behaviors become distorted in active addiction. The result is the development of common unhealthy coping strategies that reinforce the use of substances. SUMMARY OF EVIDENCE: Common themes of burnout, work stress, stigma and return-to-work issues can more easily be addressed in a specialized track of a residential addiction treatment center that includes a cohort of healthcare providers. DESCRIPTION OF PRACTICE OR PROTOCOL: In addition to focusing group therapy on common themes related to nurses, this program provides return to work evaluations, communication and coordination with Alternative to Discipline programs and a 6 month-1 year aftercare VALIDATION OF EVIDENCE: The majority of addiction treatment programs that offer specialty healthcare tracks focus on treatment of physicians. Issues specific to nurses are not addressed and return to work issues specific to nurses, such as access to medication, are not addressed. RELEVANCE OF PMH NURSING: Nurses are more likely than the general public to develop the disease of addiction. PMH nurses must be prepared to effectively work with this population. FUTURE IMPLICATIONS: Being aware of common nursing themes, how they are distorted in active addiction and how to support recovery of fellow nurses.


4036: Do you See What I See? Recognizing Human Trafficking
Deborah Salani, DNP, PMHNP-BC, APRN, NE-BC; Beatriz Valdes, PhD, MBA, RN, CHSE

PROBLEM STATEMENT: Human trafficking is one of the fastest growing criminal enterprises worldwide and a global health concern, involving the exploitation of people for labor, services, or commercial sex. This program will discuss human trafficking including: types, prevalence, risk factors, symptomology, healthcare issues, nurses’ role, and referrals. SUMMARY OF EVIDENCE: Human trafficking is an estimated 150 billion dollar global industry.  Exploiting vulnerable populations, human trafficking affects an estimated 40.3 million people globally, with 29.4 million reported to be children (25%), females (75%), and forced labor (81%) (International Labor Organization, 2017). DESCRIPTION OF PRACTICE OR PROTOCOL: Despite this growing epidemic, only a few states in the United States require continuing education regarding human trafficking.  Nurses are in a unique position to identify human trafficking victims. If more nurses are educated on this important issue, more lives may be saved. VALIDATION OF EVIDENCE: Along with training and education, it is essential that nurses play a role in addressing human trafficking by forming relationships with the community, such as police departments, schools, shelters, etc. RELEVANCE OF PMH NURSING: Nurses play a pivotal role in the identification and management of human trafficking victims because they are often the only professionals able to interact with trafficking victims in captivity.  Research has shown a high prevalence of mental health disorders among trafficking victims, such as PTSD, depression and anxiety (Ottisova, Hemmings, Howard, Zimmerman & Oram, 2016). FUTURE IMPLICATIONS: Developing guidelines/protocols using evidence-based research and education can impact early recognition and care of trafficking victims. Future research to develop effective prevention strategies to becoming a tracking victim and help mitigate this crime against humanity is needed.


4037: Social Media & Adolescent Suicide: Risks, Benefits, & a Novel Monitoring Intervention
Jamie Zelazny, PhD, MPH, RN; Candice Biernesser, MSW, PhD(c); Craig Sewall, MSW, LCSW

PROBLEM STATEMENT: Suicide is the 2nd leading cause of death among youth ages 10-24. An upward trend in adolescent suicide coincides with a rise in social media usage, which is alarming because heavy use of social networking sites places youth at 6 times greater risk of suicidal thoughts. THEORETICAL FRAMEWORK: Berkmans Social Network Theory was applied to conceptualize emerging themes surrounding adolescents' experiences of connectedness within online social networks.  Theory of Parental Mediation was used to offer context to themes regarding parental monitoring. METHODS AND DESIGN: A mixed-methods approach was used to explore the context of suicidal adolescents' online experiences and their perceptions toward an automated social media monitoring system.  Fifteen acutely suicidal teens and 12 parents completed surveys regarding digital medal use.  Teens participated in focus groups and parents underwent qualitative interviews. RESULTS: 93% of adolescents reported internet use several times per day or almost constantly.  Over 2/3 of adolescents reported social media use for 2+ hours per day. Teens reported both supportive and harmful experiences on social media.  Parents perceived a heavy emotional toll with monitoring  and  feelings of powerlessness with failed attempts at monitoring.  Adolescents and parents described barriers and facilitators to automated monitoring of social media to protect youth against suicidal risk. IMPLICATIONS (PRACTICE): Teens reported willingness to discuss social media experiences in treatment, but were hesitant to initiate conversation.  Social media and online experiences should routinely be incorporated into assessment and treatment. IMPLICATIONS (RESEARCH): We are now collecting retrospective social media data from suicidal teens to identify risk phrases and to inform a future prospective monitoring system.

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