Annual Conference Pre-Conference Session Abstracts

1012: The Central Autonomic Memory Network: A Theoretical Model for Understanding the Neurobiological Basis of Trauma and Suicidal Behaviors
William Nicholson, PhD, PMHNP-BC; Linda Moneyham, PhD, RN, FAAN; David Vance, PhD, MGS, MS

ABSTRACT
PROBLEM STATEMENT: Persons who have experienced trauma (e.g., childhood abuse, sexual abuse, post-traumatic stress) have higher rates of attempted and completed suicide. While many clinical factors are identified related to the trauma-suicide phenomenon, the neurobiological mechanisms underlying these associations remain poorly understood. SUMMARY OF EVIDENCE: Emerging evidence from neuroscience studies suggest converging dysfunction in central autonomic memory networks (CAMN) could provide a unique substrate for understanding the psychopathology of suicidality in traumatized persons. The CAMN model identifies impairment in two novel, parallel memory and behavioral systems that operate (regulatory or compensatory) during normal stress signaling (e.g., novelty). The CAMN suggests dysregulated stress-responses centers (e.g., inflammatory-driven learning, dysbiosis) disrupt systemic neural communication and co-opt this system for trauma-salient information by changing valence in reward and memory centers, thus perpetuating cognitive-behavioral disturbance and maintaining a “suicidal-loop.” DESCRIPTION OF PRACTICE OR PROTOCOL: Current treatments for trauma-suicidal behaviors include psychotherapy, psychopharmacology, and neuromodulation; however, specific treatment targeting trauma-suicidal behaviors remains a challenge for clinical providers.VALIDATION OF EVIDENCE: CAMN-based modalities provide innovative approaches to understanding (e.g., reward-aversion interactions) identifying (e.g., sleep-wake dysautonomia), and treating (e.g., GI-specific endozepine and vagal pathways, photobiomodulation, neurosteroids) suicidal-related behaviors from a neurointegrative standpoint. RELEVANCE OF PMH NURSING: The CAMN trauma-suicidal model provides a neurobiological basis for understanding suicide, which could increase the PMH nurse’s diagnostic precision and help identify lesser known predictors of trauma-suicidal behaviors; moreover, it offers novel treatment pathways that can be holistically targeted via multiple PMH-based interventions. FUTURE IMPLICATIONS: Given PMH nurses are inimitably positioned to interact with and affect outcomes in traumatized persons, understanding the mechanisms driving the trauma-suicidal behavioral axis is critically needed.  
 

1013: Implementation of a Trauma-Informed Care Program in Reduction of Crisis Interventions within the Child and Adolescent Inpatient Population
Renae Denise Hale, DNP

ABSTRACT
PROBLEM STATEMENT: The purpose of this project initiative is to implement a TIC program to decrease physical hold and seclusion rates thus decreasing a child’s risk of being re-traumatized. THEORETICAL FRAMEWORK: Implementation of a trauma-informed care program was constructed on the six primary prevention principles established by the National Association of Mental Health Program Directors (NAMHPD). The NAMHPD represents public health service delivery systems, and their goals are to promote wellness, resiliency, and recovery in the mental health community. METHODS AND DESIGN: Data collected for this project initiative used a quantitative design for the number of seclusion and physical holds that occurred prior to and after implementation of the TIC program.Data is broken down by patient, unit, time of day, and day of week. The data gathered was used to measure the number of crisis interventions for the six months prior to and six months after implementation of the TIC program. RESULTS: Data did show that implementing a TIC program decreased the use of physical holds and seclusions by 26% within six months of program implementation. After implementation of the TIC program there were 90 less seclusions and 91 less restraints. IMPLICATIONS (PRACTICE): Implementation of a Trauma-informed program will decrease use of crisis interventions, reduce risk of re-traumatization, improve patient outcomes and create a safer environment for both the patients and mental health staff. IMPLICATIONS (RESEARCH): Continued implication for future research include involvement of family dynamics with past trauma histories along with prevention and education in accordance with mental health awareness and treatments.  
 

1014: Nursing Faculty Training: Nuts and Bolts of Implementing an Integrated Nursing Curriculum on Screening, Brief Intervention and Referral to Treatment (SBIRT).
Martha "Molly" J Faulkner, PhD, APRN, LCSW

ABSTRACT
PROBLEM STATEMENT: Nursing students do not have an adequate education on substance use and how to screen for risky use and provide brief intervention and referral to treatment if necessary. SUMMARY OF EVIDENCE: Deborah S. Finnell's seminal article addressed the need for evidence based nurse-led screening, brief intervention and referral to treatment (SBIRT) (2012) to screen for risky substance use. One recommendation focused on intensive efforts to enhance the knowledge base of the current and future nursing workforce in substance abuse assessment, intervention and treatment. Mitchell, et. al (2015) reported that nurses are essential for integration and implementation of SBIRT into all health care settings and Broyles, et. al (2013) in her research on the development and implementation of nurse led inpatient SBIRT, found 95% patient acceptance of the nurse led intervention (Broyles, et. al., 2012). Finnell et. al. (2018) in her study regarding the development of curricular maps nursing students found that integrating content in the courses rather than putting all content in a stand-alone course resulted in new information without "crowding" the curriculum. DESCRIPTION OF PRACTICE OR PROTOCOL: Complete integrated nursing SBIRT curriculum for faculty to teach. VALIDATION OF EVIDENCE: Carlson et. al. (2017) researched students' perceptions of competence in delivering SBIRT and found that the structured SBIRT education intervention and curriculum improved students self-reported competence in implementing SBIRT. RELEVANCE OF PMH NURSING: Nursing faculty were able to implement integrated SBIRT curriculum in nursing program. FUTURE IMPLICATIONS: Nurses graduating will have be able to implement SBIRT in all clinical settings to screen for risky substance use, provide brief intervention and if appropriate referral to treatment.  
 

1015: Compassion Fatigue in a Forensic State Institution
Joan S Parker-Dias, MSN, APRN-CNS

ABSTRACT
PROBLEM STATEMENT:
When staff feel scared/stressed, they tend to react more to patient behaviors in a non-therapeutic manner which leads to increase patient escalations, seclusion/restraints & injuries for both patients & staff. SUMMARY OF EVIDENCE: Delaney, (2018) showed how an eight-week mindful self-compassion training intervention on Compassion Fatigue (CF) and resilience showed improved test scores related to compassion satisfaction, resilience and decrease in burnout and secondary trauma. Potter, Desheilds, Berger, Clarke, Olsen, & Chess (2013) in a Quasi experiment pilot study with oncology nurses showed decrease burnout and CF after resiliency training program. Potter, Deshields & Rodriguez, (2013) did a follow up Quasi experiment with all nurses in the same hospital which showed a correlation between education on CF leading to decrease burnout & CF. Flarity et. al. (2013), conducted a four hour training on CF to ER nurse which showed decrease burnout and CF. DESCRIPTION OF PRACTICE OR PROTOCOL: The stakeholders are the psychiatric nurses and aides at Hawaii State hospital who treat forensic mentally ill patients. The nurses will be given a pre/post tests to measure CF prior to and after a four-hour training on CF and interventions to deal with symptoms. VALIDATION OF EVIDENCE: The measurable outcomes will be the pre/post tests given before and after a 4-hour training on CF along with interventions on how to deal with CF symptoms. RELEVANCE OF PMH NURSING: The outcomes expected are improved CF scores, decrease patient crisis events, decrease seclusion/restraints, increase patient/staff satisfaction, & decrease injuries. FUTURE IMPLICATIONS: Continued improvement in seclusion/restraint events, ongoing improvement in patient/staff satisfaction, further decrease in injuries, & improved patient care.   
 

1016: Using Simulation to Enhance Advanced Practice Psychiatric Nursing Education
Lori Mooney, MS, PMHNP-BC; Beth King, PhD, PMHCNS-BC; James Adams, MSN, PMHCNS-BC; Ruth Ifediora, MSed, RN; Elizabeth Hutson, MS, PMHNP-BC

ABSTRACT
PROBLEM STATEMENT:
Preparing graduate nursing students for clinical practice is a complex process. Simulation is an important tool for development of clinical skills, yet under-utilized in the education of advanced practice mental health nurses. There is an unmet need to train facilitators to provide simulation that will assist in preparing students for practice, evaluate their level of clinical performance, and provide feedback on areas for improvement. SUMMARY OF EVIDENCE: Advance practice psychiatric/mental health nursing students receive education in pathology, neurophysiology, diagnosis, psychotherapy, and medication management. However, most students have limited opportunities to utilize the full breath of this education in a clinical setting prior to starting their career as an advanced practice nurse. DESCRIPTION OF PRACTICE OR PROTOCOL: Utilizing simulation in graduate nursing education provides an opportunity for students to practice skills in a safe and supportive environment. Simulation also provides faculty the ability to assess students' clinical skills, and provide feedback for further growth. VALIDATION OF EVIDENCE: Participants in this presentation will verbalize strategies to promote, develop, and present clinical simulation for advance practice psychiatric/mental health nursing students. Students participating in simulation will evaluate the program, providing positive feedback of the benefit for their education and preparation for practice. RELEVANCE OF PMH NURSING: Initiation and/or expansion of clinical simulation for psychiatric/mental health graduate students will better prepare them to enter the workforce as advance practice nurses. FUTURE IMPLICATIONS: The presenters seek to promote the use of simulation in graduate nursing programs, to preparing students for practice, evaluate their level of clinical performance, and provide feedback on areas for improvement.   
 

1017: Still Up the Behavior Change River without any OARS?: Advancing Your Motivational Interviewing Skills for Challenging Clinical Problems (Part I of II)
Carol Essenmacher, DNP, C-TTS; Susan W Blaakman, PhD, RN, PMHNP-BC

ABSTRACT
PROBLEM STATEMENT:
This session provides MI training that builds on previous APNA MI Task Force and conference sessions from 2017 and 2018. The purpose of this session is to provide participants with dynamic “real-play” opportunities that improve listening and interaction skills and demonstrate understanding of MI core principles. SUMMARY OF EVIDENCE: The study of MI has been widely undertaken by various disciplines in a plethora of clinical settings. MI is used in facilitating health behavior change, i.e., treatment compliance, lifestyle habit improvements, medication and diagnoses education, etc., having direct treatment implications when MI is practiced according to treatment fidelity. DESCRIPTION OF PRACTICE OR PROTOCOL: Best practice in achieving fidelity to MI is founded on variability in teaching. MI is best learned in small group real-play, practicing assessment of importance, confidence, and readiness to change, and listening skill exercises. This session is Part I of II; provides participants with foundational MI knowledge and initial practice activities. VALIDATION OF EVIDENCE: Learning is validated in supervised peer real-plays, ongoing session participant feedback of presenter lecture, power points, and activities. MI research has been widely published, and empirically validated fidelity tools are used as standard in training, with helpful outcomes directed towards what does and does not work. RELEVANCE OF PMH NURSING: PMH Nurses address many worrisome patient-related dilemmas, often related to the need for health behavior change. Nursing practice that is MI-adherent has been demonstrated to improve patient quality of life and outcomes and enrich the nurse-patient relationship. FUTURE IMPLICATIONS: MI is person-centered, enhances nurse-patient connection, facilitates behavior change, improves quality of patient life and nursing practice, creates a supportive change environment.   
 

1021: Integrating Brief Cognitive Behavioral Therapy (CBT) into Medication Management Visits : Advanced Practice PMH Nurses Leveraging their Psychotherapy Skills as well as their Knowledge of Pharmacology in 20 - 30 Minute Visits to Optimize Outcomes

Pamela Lusk, RN, DNP, PMHNP-BC, FAANP; Bernadette Mazurek Melnyk, PhD, RN, PMHNP-BC, CPNP, FAAN, FAANP

ABSTRACT
PROBLEM STATEMENT:
Increasingly advanced practice psychiatric nurses are employed by organizations to provide medication management for patients/ clients across the lifespan. Psychiatric APRNs are one of the few mental health professions that have the knowledge/ and clinical skills to prescribe and manage psychotropic medications. Psychiatric APRNs are also skilled and knowledgeable in psychotherapy but believe they aren't able to use those skills in day to day busy practice. SUMMARY OF EVIDENCE: Numerous systematic reviews/ meta analysis (Level 1 evidence) strongly support Cognitive Behavioral Therapy as a well established, effective psycho-social intervention / treatment for common psychiatric disorders. DESCRIPTION OF PRACTICE OR PROTOCOL: We will demonstrate how CBT interventions can be integrated into brief medication management visits, in order that patients 1) experience better recovery from symptoms 2) increase active participation in their treatment and 3) learn coping strategies for a better quality of life. We also propose the APRN will experience increased satisfaction with their combined therapist / medication provider role. VALIDATION OF EVIDENCE: Text often used in graduate education: " High Yield CBT for Brief Sessions", Wright, Sudak, Turkington & Thase. ( 2010) .Presenters published pilot study on this practice. RELEVANCE OF PMH NURSING: Advanced practice PMH nurses are well positioned in healthcare to develop and promote models of care that emphasize the importance of therapeutic interactions/ interventions as a vital component of all visits including brief medication management visits. FUTURE IMPLICATIONS: APRNs can lead initiatives to integrate evidence-based psychotherapy/ interventions into brief med management visits.and demonstrate improved patient outcomes, cost effectiveness, increased patient satisfaction. and APRN role satisfaction (when the APRN can use all of their skills).  
 

1022: A 3rd Nervous System? Lions and Tigers and Bears, Oh My!
Mary D Moller, DNP, ARNP, APRN, PMHCNS-BC, CPRP, FAAN; Kathleen Wheeler, PhD, APRN, PMHNP-BC, FAAN

ABSTRACT
PROBLEM STATEMENT:
Very few nurses learned about the dorsal and ventral polyvagal components of the parasympathetic nervous system (PNS) in either their prelicensure or graduate education because it was only discovered in the late 1990s. Learn the art and science of nursing care of both the hyperaroused and ‘shut down’ patient by understanding the polyvagal nerve functions and polyvagal theory (PVT) to promote safety by strengthening the social engagement system. SUMMARY OF EVIDENCE: The vagus nerve located in the brain stem has two divisions (dorsal/ventral ) that regulate the PNS through neural circuits that distinguish whether situations or people are safe, dangerous, or life threatening (neuroception). The unmyelinated dorsal vagal regulates visceral organs below the diaphragm with connections to the heart and lungs and is responsible for the freeze/dissociation response similar to reptiles and mammals that can 'play dead' in the face of danger. DESCRIPTION OF PRACTICE OR PROTOCOL: Nurses employ interventions such as mindfulness, deep breathing, Yoga, therapeutic touch, and active listening that are now known to dampen the dorsal vagal and activate the ventral helping patients stimulate the social engagement system by promoting and eliciting an internal sense of safety. VALIDATION OF EVIDENCE: Steven Porges (1996) developed PVT. Hundreds of studies have since replicated the findings. RELEVANCE OF PMH NURSING: By teaching PVT, nurses will purposively use classic interventions to modulate anxiety and fear because they will activate the myelinated ventral vagal innervating above the diaphragm to promote the human social interaction system. FUTURE IMPLICATIONS: If every nurse applied PVT interventions to self and patients the symptoms of anxiety from panic to dissociation would be better modulated.  
 

1023: The Impact of Adverse Childhood Experiences and Forgiveness on Nurses' Capacity for Compassion Satisfaction
Anne D Troy, PhD, APRN, FNP-BC

ABSTRACT
PROBLEM STATEMENT:
There is limited research to date that has identified or measured the ramifications of the personal traumas that were experienced by nurses in their childhood. There is also a paucity of research on the role of nurses’ present personal forgiveness ability on their compassion satisfaction ability, after the inevitably diverse childhood experiences of abuse(ACEs) they may have experienced. THEORETICAL FRAMEWORK: The framework was the work of Jean Watson. Nursing is identified as a humanistic science with the concept of caring being the central unifying domain. METHODS AND DESIGN: A descriptive, correlational research study was used to establish the relationship of ACEs to nurses forgiveness ability and compassion satisfaction. RESULTS: Statistically significant correlations were found between the demographic variables of age, gender, and educational status with adverse childhood experiences. One-half (51%) of the N=255 nurses who answered the survey, were in the moderate or high categories for ACEs, which was defined as two or higher adverse experiences before eighteen years of age. Past adverse childhood experiences correlated with forgiveness of self and situation and total forgiveness but not with forgiveness of others. The demographic variable of race, with African American nurses as the predictor, explained 11.5% of the variation in self-forgiveness. Mental Health/ Forensics participants scored lowest for nurses responses in the area of self forgiveness. IMPLICATIONS (PRACTICE): Nursing must take the lead in caring for our own, with the same enthusiasm and determination with which our profession has approached historical challenge for others. IMPLICATIONS (RESEARCH): ACEs require that healing processes be initiated to mitigate the long-term outcomes.  
 

1024: Cannabis and Cannabis Use Disorder: What Nurses Need to Know
Bari K Platter, MS, RN, MHCNS-BC, FIAAN

ABSTRACT
PROBLEM STATEMENT:
Many nurses are not aware that there is actually a dearth of data that supports the use of cannabis for any medical condition. Furthermore, cannabis use can cause significant medical and psychological complications. The cannabis plant has been manipulated to produce higher percentages of THC, the psychoactive component of cannabis. Some preparations, such as "dabs" and "wax" contain as much as 98% THC. Treatment centers have seen an increase in admission for patients with cannabis use disorder (CUD), particularly with young men. SUMMARY OF EVIDENCE: Because cannabis is poorly studied and the content of the drug is rapidly changing, nurses must be educated about medical and psychological complications associated with cannabis use. Knowing more about the substance, how to assess use and how to refer patients to appropriate treatment is essential. DESCRIPTION OF PRACTICE OR PROTOCOL: Nurses receive varied messages about the consequences of cannabis use. NIDA reports that states with legalized recreational cannabis have the lowest level of concern about the use of cannabis. Nurses support alcohol assessment through SBIRT; cannabis assessment should also be prioritized. VALIDATION OF EVIDENCE: SBIRT research demonstrates that nurses who are able to provide assessment and early intervention significantly decrease progression of the disease of addiction for those patients. RELEVANCE OF PMH NURSING: It is essential that PMH nurses understand the significant risks associated with cannabis use. FUTURE IMPLICATIONS: Over the past several years, many states have legalized cannabis for medical and/or recreational use. The current trend points towards eventual legalization of cannabis throughout the US.  
 

SESSION CANCELLED
1025: Rediscovery: Burnout, Compassion Fatigue, and Building Resiliency in the Workplace

Cheryl M. Miller, MSN RN-BC CCFP

ABSTRACT
PROBLEM STATEMENT:
Several attempts have been made to examine and treat burnout and compassion fatigue in healthcare workers, yet it remains a growing concern in all healthcare environments. Turnover of all healthcare professionals is noticeable. Suicide in healthcare providers is the end result in the silencing of this epidemic. Compassion fatigue is not new, it emerged in 1995, by Charles Figley. The idea of a caregiver being negatively impacted by his or her work can be traced to Carl Jung in 1928 in Time Magazine. SUMMARY OF EVIDENCE: With the development of Accelerated Recovery Program in 1996, there have been thousands of healthcare professionals assisted by this method. The evidence is very well related to this topic. DESCRIPTION OF PRACTICE OR PROTOCOL: Strategies: *Participants will learn about and apply the 4 step Accelerated Recovery Program (ARP) by: -assessing their risk using multiple assessment tools (Pro-QOL, silent witness, silencing response, and trauma recovery scale, gratitude journals), -design a self-directed recovery program (gratitude journaling, self-recovery plan), -developing a mission statement and implementation plan -implementing their support and recovery plans -evaluating their progress towards becoming more resilient healthcare professionals. VALIDATION OF EVIDENCE: Evidence is validated in the literature as far back as Carl Jung in 1928, Charles Figley in 1996. RELEVANCE OF PMH NURSING: Increased issues with burnout and leaving nursing practice, increased practitioner suicides. FUTURE IMPLICATIONS: Future implications if this issue is not addressed, continued burnout, suicides, and employee and patient safety issues.   

 

1026: A Deep Dive Into the Process of Reviewing Manuscripts for Publication
Geraldine Pearson, PhD, APRN, FAAN; Janice Goodman, PHD, PMHCNS-BC, PMHNP-BC

ABSTRACT
PROBLEM STATEMENT:
JAPNA depends heavily on the skills and ability of reviewers to critically look at a manuscript and judge it appropriateness for publication in the journal. This workshop will address this knowledge need. SUMMARY OF EVIDENCE: The editors of a peer reviewed journal rely on high quality manuscript reviews when making editorial decisions about publication. This workshop will further educate participants building on workshops in prior years. DESCRIPTION OF PRACTICE OR PROTOCOL: Peer review is a systematic process requiring knowledge, critical thinking skills, and the ability to assimilate lots of information into a gestalt. This will be described in this workshop. VALIDATION OF EVIDENCE: Heavily validated in the scholarly nursing literature. RELEVANCE OF PMH NURSING: Related to knowledge development in PMH nursing and validation of nursing care practices. FUTURE IMPLICATIONS: The more competent peer reviewers JAPNA can recruit and develop, the better for maintaining and increasing the quality of the journal.  
 

1027: Still Up the Behavior Change River without any OARS?: Advancing Your Motivational Interviewing Skills for Challenging Clinical Problems (Part II)
Susan W. Blaakman, PhD, RN, PMHNP-BC; Carol A. Essenmacher, PMHCNS-BC, DNP, CTTS

ABSTRACT
PROBLEM STATEMENT:
Building on previous work of the APNA Motivational Interviewing (MI) task force, the purpose of this session is to provide participants with opportunities to role-play interactions that incorporate the theoretical basis and spirit of MI and MI-consistent communication skills. Part I of this series centers on engaging, which informs the processes of focusing, evoking, and planning presented in this session, Part II. SUMMARY OF EVIDENCE: MI has been tested in hundreds of randomized trials across numerous settings and services oriented toward health behavior change that has direct implications for virtually all aspects of psychiatric mental health nursing. DESCRIPTION OF PRACTICE OR PROTOCOL: The process of learning MI varies widely. Best evidence indicates that engaging participants in guided practice activities, such as small group role-play, with supportive feedback, reinforces both confidence and skill, leading to more effective adoption in clinical practice. VALIDATION OF EVIDENCE: Learning will be validated by supervised peer role-plays and constructive presenter and peer feedback throughout the session. This session is designed for nurses across all skill levels and practice settings. RELEVANCE OF PMH NURSING: PMH nurses address complex patient-related dilemmas in a variety of clinical settings. These are often related to challenging health-related behaviors, ineffective medication adherence, and sub-optimal treatment engagement. Utilizing the spirit of MI and actively employing MI-consistent communication techniques enriches the nurse-patient relationship and creates a fertile environment for the seeds of behavior change to grow. FUTURE IMPLICATIONS: MI is a person-centered approach that can improve the nurse-patient connection, facilitate behavior change, enhance patient quality of life, decrease provider burnout, and support recovery and independence for consumers of mental health services.   

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