Annual Conference Pre-Conference Session Abstracts

1011: Group Therapy for PMHRNs: Let's Get Started!
Leslie G. Oleck, MSN, PMHNP-BC, PMHCNS-BC, LMFT; Victoria G. Shull, BSN, RN

ABSTRACT
PROBLEM STATEMENT: Psychiatric/Mental Health Registered Nurses (PMHRNs) are often unprepared to conduct group counseling/therapy in settings with acutely ill patients. Since 2016 APNA Member Bridge posts have reflected the confusion about this and the desire of RNs to learn more about conducting groups. SUMMARY OF EVIDENCE: The majority of PMH-RNs work in hospitals, where: “From 2005 to 2014, the total number of hospital stays for mental health/substance use conditions rose 12.2% in the United States. This was the only category of hospitalization that increased in the time period.” (AHRQ, 2017)  The Scope and Standards of Psychiatric Mental Health Nursing (2014) describes PMHRNs as being able to use therapeutic relationships and counseling techniques in a group setting, utilizing the theories and concepts of group behavior to help consumers develop healthy behaviors and replace unhealthy, limiting ones. DESCRIPTION OF PRACTICE OR PROTOCOL: Group leadership trainings, orientations and inservice offerings vary immensely among facilities. Yet systems require that RNs lead groups or delegate that leadership to other staff, who may have even less preparation than the RNs. PMHRNs want to feel confident and knowledgeable in this realm.  VALIDATION OF EVIDENCE: Group therapy has produced positive outcomes for decades. Milieu therapy involves group therapies due to the nature of the setting and the efficacy of catalyzing behavioral change using this modality. RELEVANCE OF PMH NURSING: Since PMH-RNs are expected to be able to lead consumers in group settings, PMHRNs want to improve their skills and do evidence-based group therapy. FUTURE IMPLICATIONS: PMHRNs with evidence-based knowledge in group therapy and motivational interviewing will benefit consumers and will be role models for future PMHRNs.

 

1012: Nursing: Caring Science meets Psychedelic Assisted Psychotherapy for Depression and PTSD
Andrew Penn, RN, MS, NP, CNS; Bruce Poulter, RN, MPH

ABSTRACT
PROBLEM STATEMENT: PTSD and Depression impact millions of people worldwide. Psychotherapy can be effective, but change can be slow. Pharmacology can help symptoms, but does not address root causes or issues of meaning. Psychedelic assisted psychotherapy utilizes medication used in a controlled, psychotherapeutic setting to catalyze the therapeutic process. THEORETICAL FRAMEWORK: Stanislav Grof, MD's theories of holotropic/non-ordinary states of consciousness and self healing. Maria Sabina's indigenous use of psilocybin. Claudio Naranjo MD's's psychotherapy and spirituality integration models. Maria Mangini, RN, PhD's work with psychedelic medicines. Richard Schwartz PhD's Internal Family Systems Theory. The presenters will discuss a model informed by Jean Watson RN, PhD's Caritas Process. METHODS AND DESIGN: The presenters are part of an international, multisite double blind, placebo control trial of MDMA or placebo with psychotherapy for PTSD. RESULTS: Phase 2 studies indicate that 54.2% of MDMA/psychotherapy treated subjects no longer qualified for PTSD Dx (vs 22.6% of placebo/psychotherapy). A year later, 67% no longer met diagnostic criteria, indicating that healing continues after the treatment ends.  A meta-analysis of psylocybin-assisted psychotherapy also showed a large effect. IMPLICATIONS (PRACTICE): If Phase 3 trial are successful and FDA-approval follows, these medicines could be available for clinical use in 3-5 years. Nurses need to learn about how these medicines will be used in psychotherapy in the future. IMPLICATIONS (RESEARCH): The psychotherapy process in this model is clearly relational, enhanced by the medicine, but the exact components of the treatment remain unclear. Nursing, with an emphasis on understanding the care process, is well situated to study this question, utilizing Watson’s Theory of Caritas Processes.

 

1013: Optimizing Wellness and Resilience; a Trauma Informed Playmakers Program for Clinical Mental Health Staff and Educators Working with Children & Families
Anka  Roberto, DNP, PMHNP-BC, APRN, MPH; Josalin Hunter-Jones, PhD, MSW, MPH; Cara Johnson, BSN Student; Haley Ormand, MSW student

ABSTRACT
PROBLEM STATEMENT: Mental health clinicians including nurses, educators, and staff who support children with behavioral concerns find themselves burned out, have higher levels of toxic stress, lower energy levels, disruptions in sleep patterns, partaking in high-risk behaviors and dissatisfied in their work environments. With the implementation of a trauma informed playmakers training, this project aimed to be part of the solution in a large community mental health agency and k-8 schools. THEORETICAL FRAMEWORK: Resilience theory and the resilience model was the frame used throughout this study. As one recognizes their own level of resilience allowing for an optimistic perspective, protective factors begin to develop breaking the cycle of trauma. METHODS AND DESIGN: Classroom observations, pre and post intervention data in a mixed methods study took place along with reflecting journaling of client observations by mental health clinicians. RESULTS: Increased levels of optimism among all study participants, an increase in resilience scores, decrease in burnout rates and positive changes in parent-child interactions within intensive in home care environments. IMPLICATIONS (PRACTICE): This training is unique in that the focus is on improving ones own resilience and optimism. With the high level of burnout among psychiatric mental health nurses, this program proves to be a positive implementation tool to prevent compassion fatigue and allow for psych nurses to engage in self care allowing for them to better help the children they serve. IMPLICATIONS (RESEARCH): The playmakers program could be utilized in many practice settings including in patient psychiatry and general pediatric units, allowing for positive connections between children and their clinicians while preventing compassion fatigue.

 

1014: Promoting Cultural Humility: LGBTQIA+ Safe Zone for the Psychiatric Nurse
Lauren Connelly Dorsey, RN-BC, BSN, MSNc; Lexi Robertson, BScN, RN-BC

ABSTRACT
PROBLEM STATEMENT: Discriminatory attitudes from healthcare professionals lead to many health disparities within the LGBTQIA+ population, including delay and avoidance of care.  Most often, these attitudes are not purposeful but occur due to a lack of education related to the LGBTQIA+ population. SUMMARY OF EVIDENCE: A literature review of 18 articles revealed a 2-hour training is successful in increasing providers' cultural humility.  Successful training sessions included role-play, terminology, concepts, and exploring barriers to healthcare that LGBTQIA+ individuals may face. DESCRIPTION OF PRACTICE OR PROTOCOL: Our 2-hour workshop covers terminology and concepts, role-play scenarios, specific healthcare barriers, and identifies ways healthcare professionals can become allies and create a welcoming and inclusive environment to LGBTQIA+ patients.  It is currently offered at our health system on a voluntary monthly basis.  Stakeholders include healthcare professionals, LGBTQIA+ patients and family, and hospital administration as programs like Safe Zone make a hospital more inclusive and welcoming to all. VALIDATION OF EVIDENCE: Outcomes were measured with a pre- and post-workshop survey consisting of a combination of modified versions of 4 evidence-based attitudes scales to survey behavioral, cognitive, and affective reactions to LGBTQIA+ individuals, and measure the overall effectiveness of the training. RELEVANCE OF PMH NURSING: 96% of participants "strongly agreed" the workshop was beneficial, 98% of participants "strongly agreed" their coworkers would benefit from participating in the workshop, and 100% of participants indicated increased comfort levels interacting with and advocating for LGBTQIA+ patients. FUTURE IMPLICATIONS: Expanding the workshop to provide this training across disciplines and health systems nationwide will create a welcoming, inclusive, and supportive environment for LGBTQIA+ patients in mental health crisis or seeking healthcare.

 

1015: An Overview of Safewards: an Exciting New Evidence-Based Psychiatric Nursing Model Designed to Reduce Conflict and Containment in Acute Care Settings
Suzie Marriott, MS, BSN, RN-BC; Jessica Marangio, MSN, RN-BC

ABSTRACT
PROBLEM STATEMENT:
To improve safety and the patient experience, the Stony Brook University Hospital Psychiatry Department decided to implement Safewards, an evidence-based psychiatric nursing model.   We received numerous requests for Safewards information, during the APNA 33rd Annual Conference, prompting this overview. SUMMARY OF EVIDENCE: Safewards resulted from 20 years of research led by Professor Len Bowers, including a comprehensive examination of international cross-topic literature on conflict and containment in inpatient settings, from 1960’s onward. Bowers states that patients who engage in one type of conflict behavior are more likely to participate in others, leading to containment events. DESCRIPTION OF PRACTICE OR PROTOCOL: Safewards has two components: a conceptual framework describing the relationship between conflict and containment, and staff interventions. The framework explains areas of imported vulnerability. The interventions aim to reduce the frequency of conflict and containment events. VALIDATION OF EVIDENCE: The Bowers RCT was the first to pull these items together to examine the efficacy of a complex intervention targeted at nursing staff, to reduce conflict and containment rates in acute psychiatric environments. The model was also implemented and evaluated in Canada, Australia and Germany. RELEVANCE OF PMH NURSING: Patients often engage in risky and unsafe behaviors, (conflict). In response, staff utilizes coercive approaches (containment). The model explains how staff and patients can contribute to a therapeutic environment and identifies interventions that reduce the likelihood of either. FUTURE IMPLICATIONS: Safewards is an easy-to-use model unifying all conflict and containment research. SBUH is one of the first US hospitals preparing to implement the model and evaluate its efficacy. The authors hope others will be inspired to do the same.

 

1016: Supporting Growth of Psychiatric Mental Health Nurse Colleagues through APNA's "Mentor Connection" Journey & Beyond
Kathleen T McCoy, DNSc PMHNP-BC PMHCNS-BC FNP-BC FAANP

ABSTRACT
PROBLEM STATEMENT:
Nurses engage in highly complex and demanding endeavors that can take a toll. RNs and APRNs need to stand upon shoulders of leadership models who purposefully impart and develop skills to help increase learner armamentarium in both personal and professional journeys to ease the myriad demands promoting empowerment through an intended long and successful career trajectory. SUMMARY OF EVIDENCE: The APNA Mentor Connection provides opportunity for mentor-mentee relationships and provides examples of subsequent evidence of the work of successful mentor/mentee dyads.  Cases will be discussed, with varied career goal attainment through this venue. Growth/development of Mentors will also be discussed. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently, most professional nurses locate mentors, by happenstance, or may experience mentorship subsequent to Graduate school, as a pleasant byproduct. Many have serendipitous relationships with faculty, experiencing great growth and development as well as nurturing support. Mostly, mentoring is unplanned. Best practices incorporate mentoring into a fledgling's formational journey, this presentation focuses upon benefits of intended mentorship. VALIDATION OF EVIDENCE: With relational strength as core underpinning, why not establish mentoring as a norm in PMH Nursing? Measuring intended outcomes set forth in early mentoring dyads strengthens the case for mentors Incorporated into academic/professional trajectories. RELEVANCE OF PMH NURSING: Practice change is to encourage experienced nurses to mentor, and to empower inexperienced nurses, or those with determined needs to skillfully seek effective mentors, establish a mentoring relationship with clear plans for achieving intended outcome in early careers. FUTURE IMPLICATIONS: There will be increased meaningful working APNA Mentor-Mentee Connection dyads with an established means to measuring intended outcome successes within the next 5 years.

 

1017: Are You High? What Today’s Marijuana Laws Mean to Nursing Education
Cherie  Rebar, PhD, MBA, RN, COI; Nicole M. Heimgartner, DNP, RN, COI

ABSTRACT
PROBLEM STATEMENT:
Practice change: Legalization of medicinal and recreational marijuana in certain jurisdictions brings with it numerous questions about how the use of such is perceived, implemented, or banned. The National Council of State Boards of Nursing has released Guidelines for (1) Nursing Care of the Patient Using Medical Marijuana, (2) Medical Marijuana Education in Pre-Licensure Nursing Programs, and (3) Medical Marijuana Education in APRN Nursing Programs. This session provides the learner with key knowledge about the Guidelines and how use (or banning) of medical and/or recreational marijuana impact policies that affect nursing education programs and the care that students and faculty provide to patients using marijuana. SUMMARY OF EVIDENCE: Evidence that has led to proposed change includes state law regarding marijuana use, and implementation of NCSBN Guidelines. DESCRIPTION OF PRACTICE OR PROTOCOL: Strategies for implementation include creation of policies at the nursing education program level regarding marijuana use by students or faculty, and educational policies regarding how teaching and evaluation occur to meet the NCSBN Guideline for Medical Marijuana Education in Pre-Licensure Nursing Programs. VALIDATION OF EVIDENCE: Efficacy is validated by whether nursing education programs have viable policies in place to address (1) use of marijuana by students or faculty, and (2) education of students per the NCSBN Guidelines. RELEVANCE OF PMH NURSING: Policies enacted address current state law, NCSBN Guidelines, and nursing program needs. FUTURE IMPLICATIONS: All nursing education programs must continue watching state law, maintain and update policies accordingly, and observe ongoing Guidelines from NCSBN to ensure best practice in student education and patient care.

 

1021: Complicated Grief Group Therapy for Community-residing Persons with Serious Mental Illness
Katherine Supiano, PhD, LCSW, F-GSA, FT, APHSW-C; Riley Colin, RN; Ann Hutton, PhD, APRN

ABSTRACT
PROBLEM STATEMENT:
The death of a significant person, particularly in traumatic death is an under-appreciated adverse life event. Unresolved grief from traumatic death is highly associated with complicated grief in adulthood and both contributes to and sustains serious mental illness in adulthood. THEORETICAL FRAMEWORK: Persons with serious mental illness experiencing Complicated Grief (CG) represent a vulnerable population of persons for whom traditional care is therapeutically insufficient, when the trauma features of underlying grief are unaddressed. METHODS AND DESIGN: We examined treatment efficacy, feasibility and impact of community implementation of our Complicated Grief Group Therapy for persons with serious mental illness who had experienced a traumatic death and met criteria for CG in an outpatient psychiatric clinic for uninsured persons with untreated persistent mental illness. We conducted two 12-week CGGT groups, incorporating psychiatric Doctorate of Nursing Practice trainees. Participants were examined for changes in several key behavioral questionnaires prior to the intervention (N=16) and at the end of the study (N=10). RESULTS: Paired Wilcoxon signed rank tests were utilized to examine changes in scores on the Brief Grief Questionnaire, Inventory of Complicated Grief, PHQ-2, GAD-2, Integration of Stressful Life Experiences Scale, and Interpersonal Needs Questionnaire. All  measures showed improvement with statistically significant results at p<0.05 for the BQG, ICG, and INQ questionnaires. IMPLICATIONS (PRACTICE): Treatment was demanding, yet acceptable for all completers. Critical challenges of retention and adherence required concentrated team engagement and have stimulated programmatic redesign. IMPLICATIONS (RESEARCH): CGGT holds promise for therapeutic restoration of healthy grief, cost savings, resource efficiency, and improved treatment access.

 

1022: Group Leader Toolkit I: Overview of Group Theory and Principles, Planning a Group and Opening StrategiesCombining CBT and Medication Management in Brief Visits: An Evidence- Based Collaborative Approach to Promote Best Outcomes
Bethany J Phoenix, PhD, RN, CNS, FAAN; Frannie Pingitore, PhD, RN, PMHCNS-BC, CGP

ABSTRACT
PROBLEM STATEMENT:
Psychiatric mental health nurses at all levels of practice lead groups across the continuum of care. These include inpatient, outpatient, psychoeducation, medication, support and interpersonal process groups. However, many nurses receive little training in effective group leadership. Without basic knowledge of group facilitation skills, therapeutic benefits of group participation are not fully realized and PMH nurses may find leading groups frustrating or unfulfilling. SUMMARY OF EVIDENCE: Literature reviews have established that group mental health treatment is as effective or more effective than individual treatment, and is more cost-effective. Yalom's (2005) research on the benefits of therapy groups identified 11 therapeutic factors that are responsible for the positive results achieved with group treatment. Nurse group leaders who understand these factors can foster their emergence across different types of therapeutic groups. DESCRIPTION OF PRACTICE OR PROTOCOL: Workshop and its companion session will review literature on benefits of participation in therapeutic groups, phases of group development, establishing group norms, leader strategies and therapeutic group processes. This workshop will include an experiential group simulation focused on the opening phase of a group in which participants experience group dynamics from the perspective of group members and observe how leaders structure the group process. VALIDATION OF EVIDENCE: Participants will reflect on what they learned in the workshop and how they will apply it in their clinical practice. RELEVANCE OF PMH NURSING: Groups are a powerful and effective way to meet the needs of multiple patient populations with which PMH nurses work. FUTURE IMPLICATIONS: Greater understanding of group structure and therapeutic processes helps PMHNs become more effective in leading therapeutic groups.

 

1023: Pediatric Bipolar Disorder: Where Are They and How We Care for Them
Daniel Wesemann, DNP, PMHNP-BC, ARNP

ABSTRACT
PROBLEM STATEMENT:
Pediatric bipolar disorder (PBD) continues to be a controversial disorder and is poorly understood longitudinally. This has led providers to either assume PBD is everywhere or nowhere. SUMMARY OF EVIDENCE: Currently PBD is estimated to have a prevalence rate of 1-3%.  This has been established by professional organizations.  The DSM5 lists diagnostic criteria for bipolar disorder down to the age of 12.  Yet providers continue to make the diagnosis of PBD under the age of 12. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently PBD is a clinical diagnosis which makes accurate diagnosis challenging.  Utilization of screening tools can offer validation of a suspected diagnosis of PBD but is rarely utilized in practice.  It is unclear why providers do not utilize open access screening tools that are available to ensure accurate diagnosis. VALIDATION OF EVIDENCE: Wesemann, D. (2016). Decreasing Rates of Pediatric Bipolar Within an Outpatient Practice. Journal of Child and Adolescent Psychiatric Nursing, 29(4). 188-195. DOI: 10.1111/jcap.12162  Wesemann, D., Saeidzadeh, S. & Wimmel, C. Use of Multiple Screeners in a Pediatric Psychiatric Clinic to Improve Diagnostic Accuracy of Pediatric Bipolar Disorder. Archives of Psychiatric Nursing.  Manuscript submitted for publication. RELEVANCE OF PMH NURSING: PMHNPs are board certified to care for people across the lifespan.  Therefore PMHNPs can be trained to identify and care of those with PBD and remain their provider throughout their lives.  Participants will understand the qualitative and quantitative data on how to identify this at risk population. FUTURE IMPLICATIONS: Accurately identifying PBD will result in more accurate treatment and change trajectory of lives for those with PBD and the families that care for them.

 

1024: Queers and Christians Sharing the Closet:  Exploring Nursing's Role in Spirituality as the Access Point to Healing Marginalized Communities
Lindsey Schweiger, DNP, PMHNP, RN; Tori Kelly, RN

ABSTRACT
PROBLEM STATEMENT:
Both Christians and LGBTQ+ people have been closeted due to their fear of publicly embracing these identities - to the outside world and to each other. SUMMARY OF EVIDENCE: Based on a nationwide survey conducted in 2016 by Andrew Marin, 86% of LGBTQ+ patients were raised in a home which regularly attended a church. Though over half leave their religious community prior to the age of 18, the majority are open to returning, or practice faith independently despite being exiled from their church. DESCRIPTION OF PRACTICE OR PROTOCOL: Nursing assumptions about queers and Christians may lead to language in practice that disillusions clients, reinforces stigma/shame, and effectively keeps the closet door closed. VALIDATION OF EVIDENCE: Eighty percent of LGBTQ+ people pray on a regular basis compared to 60% of the general American population. One third of LGBTQ+ people continue to practice their faith in exile. RELEVANCE OF PMH NURSING: The presentation will assist the nurse in: Fostering self-awareness about bias related to Christianity and sexuality. Recognizing the compatibility and potential strength of a dual Christian/queer identity.   Promoting spirituality as a source of healing and self-actualization in the client. FUTURE IMPLICATIONS: This presentation invites conversation about the role of the psychiatric nurse in connecting patients to healing and recovery through spiritual practices.

 

1025: Patient Safety 2.0: Using Technology to Enhance Patient Safety Practices
Tina Aown, MSN, RN-BC, CNML; Robyn Welch, MSN; Amy Rushton, DNP, APRN; Jennifer Bush, RN; Deborah Parker, MSN, RN-BC

ABSTRACT
PROBLEM STATEMENT:
Patient safety is a priority in inpatient psychiatric units and across the hospital.  Assessment, observation and rounding practices were not standardized and manual processes were time consuming, taxing staff resources and causing delays in care. SUMMARY OF EVIDENCE: Technology enhances existing safety practices. Evidence supports a structured response to behavioral crises, reducing restraint use and injuries.  The use of evidence based assessments facilitates appropriate care based on identified needs. DESCRIPTION OF PRACTICE OR PROTOCOL: Evidence based assessments such as the Broset, PHQ-9 and C-SSRS have been built into our EMR across BH and non-BH units.  We have developed guidance for staff to implement appropriate interventions based on assessment findings.   Behavioral Emergency Response Teams (BERT) have been implemented across hospitals, including those without behavioral health services.  BERT calls and evaluations may be completed via iMobile on iPhones. Use of virtual safety attendants to supplement staffing needs for 1:1 or continuous line of sight We are piloting two different platforms for electronic safety rounding which ensures safety rounds are being conducted in a more timely and accurate manner. VALIDATION OF EVIDENCE: Patient safety metrics are tracked and reported to hospital leaders, with action taken when benchmarks are not met.  A clinical dashboard allows us to evaluate patient outcomes. RELEVANCE OF PMH NURSING: These measures support nursing practice, by improving workflow and optimizing nurses’ ability to assess and intervene appropriately. FUTURE IMPLICATIONS: Based on our pilots, we plan to implement electronic rounding in all BH units and expand use of the Broset on non-BH units.  We also continue to explore how iMobile can be used to enhance patient care.

 

1026: PartnerSHIPs:  Collaborating with Recovery-Oriented Services and Supports
Michael Valenti, PhD, RN; Shannon Robinson, RN, MSN

ABSTRACT
PROBLEM STATEMENT:
While many recovery-oriented services and supports exist, nurses, especially PMH-RN/APRNs, have not taken full advantage of reciprocal partnership opportunities. These include seeking out and building new, non-traditional, relationships/collaborations and enhancing existing partnerships. SUMMARY OF EVIDENCE: Partnerships were guided by Florida State Health Improvement Plan’s (SHIP) priorities a) decreasing opioid deaths, b) increasing access to care, c) decreasing death by suicide, d) reducing and preventing infectious diseases, and e) promoting coordination and collaboration between health care and affiliated industries. DESCRIPTION OF PRACTICE OR PROTOCOL: Through a community taskforce, stakeholders came together to a) collaboratively examine the strengths, b) identify needs, and c) determine benefits from partnerships. VALIDATION OF EVIDENCE: Based on a hybrid integrated care model, outcomes were determined based on each of the stakeholder’s identified needs.    Academic - qualitative data - describe experience of a) peer led educational program, and b) assigned clinical/community sites.  Quantitative data - DDPPQ.    Clinical - externship requests, progress on QI projects, training evaluations, recruitment of nurses, and continuity of care.    Community - individual services and supports accessed including referrals and prevention strategies for infectious diseases. RELEVANCE OF PMH NURSING: Academic – increased understanding of current state of practice, accessed guest lecturers, resources, clinical practice sites, externships/preceptorships, and research partners.   Clinical - received in-service training, a connection to new nurses, support with QI initiatives, and to maintain continuity of care.  Community - benefited though education, advocacy, and practice. FUTURE IMPLICATIONS: Practice – Determine ongoing needs, encourage students to experience the scope of recovery services through externships.  Research – Evaluate patient outcomes such as perceived stigma, self-stigma, engagement in recovery services, and retention in services.

 

1027: What you Measure, Motivates: Advancements in a Vulnerable Population's Care, Using Evidence-Based Practice to Improve Outcomes in Alcohol Withdrawal Syndrome, A.W.S-related Psychosis, and A.W.S.-related Delirium
Carrie A Hartung, BSN, BS, RN

ABSTRACT
PROBLEM STATEMENT:
Nurses, physicians and patient outcomes indicate Alcohol Withdrawal Syndrome (AWS) is poorly understood. More objective, precise and accurate assessments are needed to identify severe AWS, Delirium and/or Delirium Tremens. Outcomes for patients with severe AWS, Delirium/Delirium Tremens could be vastly improved with education and precise assessment. Patient outcomes and literature indicate that psychosis during alcohol withdrawal may be mis-identified as DTs, which result in elevation of patients' level of care. Clinical specialty and patient data indicate delirium may be related to the use of a commonly-used treatment for AWS. SUMMARY OF EVIDENCE: Nursing requested AWS education. Evidence-based" assessment tools flawed design. Significant numbers of "higher levels of care transfers", delirium cases, and behaviors indicate identification of possible specific effects related to common AWS interventions. Assessment identifying specific, objective AWS & delirium-related behaviors is proposed. DESCRIPTION OF PRACTICE OR PROTOCOL: No standard nursing education and/or competencies for AWS, Delirium, Delirium Tremens (D.T.s), or psychosis related to AWS exists. No measures of performance or outcome standards for these clinical issues exists. Refinement of inpatient nurses' assessment skills and education provide ample opportunities for improved patient outcomes. VALIDATION OF EVIDENCE: Assessment included nurses' level of knowledge pre-and post-education, and perceptions of effectiveness of education. Patient data included delirium rates, "higher levels of care transfers", and chart audit data regarding specific behaviors associated with various interventions. RELEVANCE OF PMH NURSING: Significant differences in nursing knowledge after education. Perceptions of education's effectiveness indicates need. Patient data inspired audit tool development. Objective assessment refinement distinguished opportunities for intervention changes, reducing patient harm, including "higher levels of care transfers". FUTURE IMPLICATIONS: Research is indicated.

 

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