Annual Conference Thursday Abstracts

2035.1: Risk Perceptions and Reasons for Tobacco Use Among People with Mental Illness
Sarret Seng, RN, BSN, BA; Chizimuzo T.C. Okoli, PhD, MPH, MSN, RN, NCTTP

PROBLEM STATEMENT: There is disproportionate tobacco-use and associated morbidity and mortality among people with mental illness (PMI). Understanding the risk perceptions and reasons for tobacco-use among PMI is crucial to developing strategies for tobacco cessation. THEORETICAL FRAMEWORK: The Health Belief Model (Rosenstock, 1974) examines perceived risks that can influence health behaviors. Understanding patients’ perceived health risks can guide tobacco treatment efforts. METHODS AND DESIGN: We administered surveys to 137 patients from a state psychiatric hospital. Demographic, urban/rural status, medical illnesses, and tobacco-use and exposure variables were examined. Chi-square analyses stratified by MI categories (non-psychotic versus psychotic disorder) assessed differences in risk perceptions and reasons for tobacco-use. RESULTS: Participants were more likely to endorse that tobacco-use resulted in physical health consequences as compared to mental health problems. Participants were most likely to perceive that tobacco-use causes lung disease (83.2%), heart disease (79.6%), and cancer (77.4%). However, they were less likely to perceive that it causes addiction to other drugs (39.4%), or mental illness (23.4%). In addition, 71.5% of participants used tobacco to ameliorate psychiatric symptoms, among which 51.8% used tobacco to alleviate medication side effects. Among psychiatric symptoms ameliorated by tobacco-use, the primary symptoms were anxiety (87.8%) and depression (67.3%). Among medication side effects alleviated by tobacco-use, the primary symptoms were also anxiety (70.4%) and depression (63.4%). IMPLICATIONS (PRACTICE): Psychiatric nurses should assess and be willing to educate patients concerning their risk perceptions associated with tobacco-use in relation to addiction and mental illness. IMPLICATIONS (RESEARCH): Future studies may develop and test interventions that inform PMI about the relationship between tobacco-use, addictions, and MI.


2035.2: Thinking Outside the Bias: Ethical & Biological Implications of Tobacco Dependency and E-cigarette Use, Including Access to Care, Treatment Philosophies, & E-cigarettes as “Harm Reduction”
Carolyn Baird, DNP, MBA, RN-BC, CARN-AP, CCDPD, FIAAN; Carol Essenmacher, DNP, NCTTP

PROBLEM STATEMENT: Unconscious and conscious bias are part of human nature and frequently influence the treatment being offered. SUMMARY OF EVIDENCE: Bias in the treatment of tobacco dependency may stem from a lack of understanding of the biological changes in the brain resulting from tobacco use. Studies show that nurses do well in asking about tobacco use and advising cessation but bias may affect the efforts nurses expend when it comes to assessing readiness and linking to actual care. Personal bias about the use of e-cigarettes also affects access to care. Exploration of personal bias in translating evidence into nursing practice can improve care. DESCRIPTION OF PRACTICE OR PROTOCOL: Evidence based practice recommends an integrated screening for mental health and substance use, including tobacco, using a screening method such as SBIRT (screening, brief intervention, referral to treatment). VALIDATION OF EVIDENCE: Research shows personal bias is implicit in the types and energy of the nursing care nurses choose to provide. Confronting personal bias permits the nurse to be more objective in the delivery of care. RELEVANCE OF PMH NURSING: PMH nurses screen, assess, and refer each individual they come in contact with and this should include a tobacco use assessment. FUTURE IMPLICATIONS: Nurses will identify their personal bias and will provide integrated screening, intervention and referral for tobacco use.


2036.1: Just Culture: Time to Move the Needle
Linda Paradiso, DNP, RN, NPP, NEA-BC

PROBLEM STATEMENT: In 2017, The Joint Commission  identified that the response of leaders in an organization can contribute to adverse events.  When direct care staff speak up, they often find themselves as second victims from reporting the event. Non-punitive response to reporting is key to the development of organizational reliability. SUMMARY OF EVIDENCE: A review of the AHRQ Surveys on Patient Safety Culture™ (SOPS™)  results from 2008- 2018 indicates that staff perceptions of trust in leaders has decreased over the past ten years.  Leaders need to provide a trusting environment where all staff feel safe to speak up. DESCRIPTION OF PRACTICE OR PROTOCOL: Strategies for nurse leaders to improve trust include non-punitive response to error, eradicate uncivil and intimidating behaviors and model the desired behaviors, re-design systems that do not work, value and reward staff who report threats to patient safety, and address stressful work conditions and vicarious trauma which lead to professional burnout. VALIDATION OF EVIDENCE: A review of AHRQ Surveys on Patient Safety Culture™ (SOPS™)  results from 2008 through 2018 was conducted.  The data was analyzed, trended, and reported. RELEVANCE OF PMH NURSING: Psychiatric clients face negativity, discrimination, and stigma.  Nurses who trust will have psychological safety to bring to light prejudices and inequities. FUTURE IMPLICATIONS: Leaders can develop successful initiatives to improve trust in their organizations by reviewing survey results regularly to understand direct care staff perceptions of trust and concerns of punitive response to reporting.


2036.2: An Accountable Care Team Drives Results
Elizabeth Caine, MSHA, MBA; Lisa Mattox, DNP, MSN, RN-BC; Kimberly Ayers, RN-BC, BSN, MAEd; Wren Hand, PhD, RN

PROBLEM STATEMENT: Psychiatric length of stay and emergency department boarding are significant challenges that many healthcare organizations face. Furthermore, psychiatric hospitals are under increased scrutiny to foster improvements in the quality of care provided to patients with mental illness. UAB Hospital was facing increased demand for services for patients presenting with mental illness and increased length of stay as well as increased emergency department boarding for the psychiatric population. SUMMARY OF EVIDENCE: Kara et. al. tested an Accountable Care Team Model at Indiana University Health System on Medical/Surgical units in 2015 and found that "creating an environment and framework in which interprofessional collaboration is fostered, performance data are transparently available, and leadership is provided may improve value". DESCRIPTION OF PRACTICE OR PROTOCOL: To address the need to improve performance metrics around throughput, quality, patient safety, and patient engagement, UAB Hospital Center for Psychiatric Medicine developed an interprofessional ACT (Accountable Care Team) which provided a transparent collaborative framework. This ACT model allowed the team to receive timely feedback and enhance data driven decisions, drove accountability for all disciplines, and ultimately improved performance outcomes. VALIDATION OF EVIDENCE: The team measured outcomes and effectiveness via monthly review of performance metrics. RELEVANCE OF PMH NURSING: Following successful implementation of the interprofessional accountable care team, case mix adjusted(CMI) length of stay decreased, psychiatric boarding decreased, crisis calls decreased and our facility is ranked in the Top 5 hospitals in four Vizient Quality Indicators while exceeding our patient engagement scores. FUTURE IMPLICATIONS: An ACT creates changes in attitudes, knowledge, and culture and creates an environment where patient care, education and research can thrive.


2037.1: Cyberbullying: Determining the Prevalence and Impact of Bullying and Cyberbullying as a Contributing Factor in Patients Who Have Been Admitted Into an Inpatients Facility
Kelley Kardys, BSN RN-C; Rachel Pfafman, MPH; Connie Kerrigan, MSN; Lauren Reining, MS; Michelle Drouin, PhD; Tammy Toscos, PhD; Jessica Pater, MPH

PROBLEM STATEMENT: This study will examine the prevalence and impact of bullying/cyberbullying as a factor in youth admissions to an inpatient mental health facility. THEORETICAL FRAMEWORK: Brongenbrenner’s Ecological Systems Theory. METHODS AND DESIGN: To understand these impacts, the standard of care was modified to include a bullying/cyberbullying survey at intake and discharge with both youth patients and their parents. The survey assessed aspects of perceived safety, how the bullying took place, the impact on the patient, and if it contributed to their admission. The survey data is from between 06/2018 and 01/2019. RESULTS: A total of 733 patients had at least one survey in the dataset. Of these patients, 26.5% indicated bullying/cyberbullying contributed to admission. When compared to diagnoses of bullying, only 19.2% of those that had indicated bullying on the survey were captured by a diagnosis of bullying/cyberbullying. There was a slight relationship between gender and indication of bullying/cyberbullying as well as patient/parent disagreement about bullying/cyberbullying contributing to admission with parents being more likely to indicate this than the patient. IMPLICATIONS (PRACTICE): Based on our results, youth mental health inpatient programs would benefit from screening for bullying/cyberbullying. RNs will develop and/or provide education related to identifying and safely managing bullying/cyberbullying which is needed for both patients and their families. IMPLICATIONS (RESEARCH): Future research is needed to understand the disconnect between parental and patient perceptions of bullying/cyberbullying, educational needs at the individual, family, and community levels, and how this information can be best utilized for population health aims of identifying and addressing community-level patterns of bullying/cyberbullying.


2037.2: Gardening on a Psychiatric Inpatient Unit: Cultivating Recovery

PROBLEM STATEMENT: Although the healing qualities of nature-related activities have been known and intuitively practiced for centuries, structured gardening for adults on an inpatient psychiatry unit has not been researched. The purpose of our multidisciplinary research team was to explore the experiences of gardening among adults in an acute psychiatric inpatient setting in the participants’ own words. THEORETICAL FRAMEWORK: The Recovery Model guided our conceptualization of the research. Personal interviews with 25 inpatients were done shortly after they had attended a gardening activity on an outdoor deck with a raised planter filled with non-toxic herbs, succulents, and flowers. METHODS AND DESIGN: A purposefully designed, semi-structured guide with neutral questions was used for data collection. Audio recordings were subsequently transcribed, de-identified, and checked for accuracy. Qualitative description inquiry was used by a three-person team to analyze the data. RESULTS: Resounding favorable descriptions of the overall experience was evident including metaphors for healing. Working with plants fostered a sense of belonging, a shared purpose, and allowed symbolic reflection upon healing. Four overarching themes were evident: motivations, experiences, reflections, and recommendations. IMPLICATIONS (PRACTICE): Based on our novel exploratory study, gardening offered a low-cost, low-risk therapeutic intervention for this sample. Psychiatric nurses and other health professionals working in inpatient and outpatient settings can incorporate gardening groups in their milieu programs. IMPLICATIONS (RESEARCH): Future quantitative research can focus on aspects such as the relationships between participation in a gardening activity and treatment outcomes, physiological measures, and measures of mood and aggression


2041: Pharmacogenomics and Psychiatry: Current Trends and Practical Experience
Jessica Whelan, FPMHNP-BC, RN, BSN, MSN, FMHNP; Jessica Whelan, DNPc, PMHNP-BC

PROBLEM STATEMENT: The purpose of this topic is to address the growing science and literature regarding pharmacogenomic testing and pharmacological approaches related to this testing in psychiatry. The problems that led to this intervention are poor psychiatric mental health outcomes, difficulty in utilizing pharmacogenomics in practice, and difficulty applying appropriate prescriptive strategies after the implementation of pharmacogenomic testing in practice. SUMMARY OF EVIDENCE: The background and evidence related to the topic generally consist of pre-clinical trials, randomized control trials, and scientific studies examining the relationship of specific genotype variants to specific phenotypes and the relationship of those to certain medications and treatment. In our specific practice, pharmacogenomics has been utilized to offer improved outcomes to patients who have demonstrated treatment resistance to an algorithm applied care utilizing traditional DSM methodology. DESCRIPTION OF PRACTICE OR PROTOCOL: Current practices do not support the use of pharmacogenomics as mainstream practice. Some literature questions the use of pharmacogenomics and asserts that the testing is not ready for application into practice. VALIDATION OF EVIDENCE: The current evidence is validated by randomized control trials that support improved outcomes against STAR D for depression and other mental health outcomes. RELEVANCE OF PMH NURSING: PMH nurses may work in facilities utilizing pharmacogenomic testing. In our practice testing is used successfully to improve patient outcomes. FUTURE IMPLICATIONS: PMH nurses will find that as the literature in genomic testing grows, so will its relationship to individualized treatment and pharmacological strategies.


2042: Making Mental Health Orientation Matter: Why It Is Critical
Tanner Stevens Funk, MSN, RN

PROBLEM STATEMENT: Related to an assessed deficiency in the orientation program for new mental health employees by organizational leadership, mental health leadership and the education department formed an interprofessional team to enhance the current orientation and onboarding program for all new employees in our three psychiatric and behavioral health areas. The primary goal of this program is to give all new employees who work and care for patients within this field a comprehensive education related to critical mental health topics so that safe patient care can be implemented. SUMMARY OF EVIDENCE: The organization's mental health leadership and the education department identified current mental health employees with deficient  levels of basic mental health knowledge. Occurrences of patients assaults and behavioral response teams have also been assessed as not meeting organizational goals related to ensuring staff and patient safety. DESCRIPTION OF PRACTICE OR PROTOCOL: The two-week program includes presentations by experts in nursing, case management, therapy, psychology, pharmacy, social work, facility police department, and the medical staff.  Interactive educational sessions, facility tours and events compliment the course presentations. New staff attend following their general onboarding education within the first month of hire. VALIDATION OF EVIDENCE: Program effectiveness is being assessed through employee program surveys, behavioral response team rates, staff assault rates, and employee retention rates. RELEVANCE OF PMH NURSING: Employee program surveys have had positive feedback. Participants rated suicide prevention, psychotropic medications, and determining when someone needs mental health treatment as the most influential and helpful presentations. FUTURE IMPLICATIONS: The Mental Health Training Program will be offered every month for new employees.


2043: The Impact of Improved Resiliency on Education
Marion Donohoe, DNP APRN PPCNP; Allyson Matney Neal, DNP, APRN, CPNP, PPMHNP

PROBLEM STATEMENT: Children arrive in their classrooms with the impact of adversity caused by violence, media, home life, and neighborhood environment, which often leads to disruptive classroom behaviors. Resiliency skills in classrooms are necessary to decrease bullying, fighting, injury, and truancy that negatively affect the behavior and academic achievement of children exposed to trauma in underserved urban environments. SUMMARY OF EVIDENCE: Children are more affected by the socials determinants of health coupled with adverse childhood experiences (ACEs) than other populations (Ratclif, Crouch, & Strompolis, 2018). DESCRIPTION OF PRACTICE OR PROTOCOL: Tracking, Resourcing and Grounding taught by PNP faculty and PNP students to classroom teachers, staff and classroom students who responded by return demonstration.  Students and teachers will practice these three skills every day for 3 weeks, using CRM Felt Board to indicate feelings. VALIDATION OF EVIDENCE: This small test of change provides potential evidence to support how intervening with resiliency skills can mitigate the impact of ACEs on a child’s behavior. RELEVANCE OF PMH NURSING: Descriptive Findings: Child findings: Self-esteem – increased in 5-6 grades according to the surveys Compassion – in 3-4 graders  _100%_of students indicated they used the skills in school Teacher findings: _50% Used the skills daily _75% Saw change in the classroom behavior _50% Indicated they would continue to incorporate the skills in classroom curriculum. FUTURE IMPLICATIONS: Pediatric nurse practitioners who integrate Mental Health can positively impact the lives of children in a clinical setting and as a school consultant through the integration of CRM in daily elementary school curriculum


2044: Substance Use: Changing the Culture in Nursing Schools and Beyond
Brayden Kameg, BSN, RN, CARN; Ann Mitchell, PhD, RN, FAAN, FIAAN

PROBLEM STATEMENT: Substance use remains a public health crisis; nonetheless, barriers to treatment exist which further perpetuate the scope of the epidemic. SUMMARY OF EVIDENCE: Nurses and advanced practice registered nurses (APRNs) are key agents in mitigating barriers to substance use treatment, yet it has been well documented that schools of nursing fail to offer adequate substance use-related content.      DESCRIPTION OF PRACTICE OR PROTOCOL: A multi-modal approach was utilized to increase the quality and quantity of substance use content in undergraduate and graduate programs at a large school of nursing. Screening, brief intervention, and referral to treatment (SBIRT) content was implemented vertically and horizontally across programs. Information on medication assisted treatment (MAT) was included in the graduate pharmacology course; eventually, all APRN students were exposed to 24 hours of buprenorphine training needed to obtain the DATA waiver upon graduation, in addition to clinical experiential immersions in a substance use treatment setting. Marketing techniques were implemented to recruit and support faculty, student, executive, and community stakeholders and champions. VALIDATION OF EVIDENCE: Student progress was monitored throughout the various interventions implemented. Various knowledge and confidence measures were collected. Qualitative data was also collected and analyzed to assess the students' satisfaction with the content. RELEVANCE OF PMH NURSING: Psychiatric nurses and APRNs will treat patients with substance use disorders and must be proficient in doing so. Students responded positively to the content, felt it increased their knowledge regarding substance use treatment, and reportedly felt more confident to treat individuals with substance use disorders. FUTURE IMPLICATIONS: The success of this multi-modal program can be implemented in schools of nursing on a national scale.


2045: Disrupting the Culture of Nursing:  Educating Psychiatric Nurses in the Whole Health and Entrepreneurship Connections to Address Health Disparities in the 21st Century
Eugenia Millender, PhD, RN, PMHNP-BC, CDE; Marilyn McGhee, PhD; Alicia Craig-Rodriguez, DNP, MBA, APRN, FNP-BC; Kathleen Valentine, PhD, MS, RN

PROBLEM STATEMENT: Although psychiatric mental health nurses (PMHN) are well prepared to address clinical needs, they are not as prepared to manage an independent practice. PMHNs lack training in business models of care, thus bringing uncertainty and a dampening of the entrepreneurial spirit. THEORETICAL FRAMEWORK: Innovation, entrepreneurship, and leadership are essential components of any nurse-driven model of care, yet nursing programs focused exclusively on mastery of clinical competencies, excluding such fundamental business concepts as finance, economics, and risk-taking.  As a result, nurses enter practice unprepared to adopt entrepreneurial approaches to healthcare to change the status quo and improve health disparities. DESCRIPTION OF PRACTICE OR PROTOCOL: With the leadership of experienced entrepreneurs, nurses and nursing students will strengthen fundamental knowledge of entrepreneurship and innovation, including healthcare finance, practice economics, business planning, risk-taking, and negotiation strategies. This preparation would necessitate evidence-based approaches using authentic real-life scenarios and interprofessional collaboration across a variety of disciplines including law, business, and finance. VALIDATION OF EVIDENCE: Increase in knowledge and competencies will be evaluated using validated pre and post-tests and qualitative questions. In addition, participants’ innovation and entrepreneurship endeavors will be tracked over time. RELEVANCE OF PMH NURSING: Nurses are not perceived as financially savvy leaders; thus, a culture shift is urgently needed. PMHN play a major role in transforming clinical mental health services and now is the time to become entrepreneurs to improve mental health equity and economic influence. FUTURE IMPLICATIONS: Entrepreneurship poses a unique opportunity for PHMNs to become confident and financially savvy change agents who can design, own, and lead profitable models of mental health practices.


2046: Countertransference in Geriatric Psychiatry: What is Beneath the Stigma and How to Address It
Andree de Lisser, DNP, APRN

PROBLEM STATEMENT: The “silver tsunami” has arrived on healthcare’s shores and we lack geripsychiatric providers to address the needs of its “victims”.  All will be pressed into service as the world’s population ages. Psych nursing  is uniquely positioned to respond to this need but addressing curricula and competencies is not enough.  We must lift the veil from the stigma and ageism and examine what lies beneath if we hope to provide empathic care for this complex group of patients. SUMMARY OF EVIDENCE: The literature suggests that little value is placed on geropsychiatry curricula in both nursing and medical education. Lack of geripsych experts to champion and be role models for quality clinical care and lack of mental health content woven into and valued by other specialties perpetuates geriatric psychiatry as unattractive and unappreciated. Ageism and stigma are identified as barriers but provider discomfort with highly charged topics such as loss and grief, dependency and QOL are rarely addressed. DESCRIPTION OF PRACTICE OR PROTOCOL: Reflective exercises encourage students' self-exploration and faculty can address countertransference and other responses to geriatric clients. Providers need to negotiate for psychotherapeutic modalities as an integral aspect of the role and be encouraged to become involved in policy and program design and implementation. VALIDATION OF EVIDENCE: Stigma and ageism is reported but not examined in the literature. Little addresses the deeper concerns voiced by students. RELEVANCE OF PMH NURSING: APRNs have the ideal provider profile to address the complex needs of the aging population.      FUTURE IMPLICATIONS: Psychiatric providers must address their own responses to patient care challenges in order to provide truly empathic care to elders.


2047: Towards Better Sleep: CBT-I strategies for the Patient with Insomnia
Virginia Sinclair Gardner, MSN, PMHNP-BC

PROBLEM STATEMENT: Sleep is integral to overall health. Disordered sleep accompanies many mental health conditions and may be treatment resistant in some individuals.  Untreated insomnia increases health care utilization and costs (Wickwire, et. al, 2019).  Additionally, untreated insomnia has been shown to increase cardiovascular and neurocognitive morbidity (Fernandez-Mendoza & Vgontzas, 2013).  Medications for sleep, such as benzodiazepines and non-benzodiazepines may be effective for short-term use, but less is known about long-term risks. Additionally, long-term efficacy has not been demonstrated for many of these drugs. SUMMARY OF EVIDENCE: Cognitive-behavioral therapy for insomnia is emerging as a treatment of choice for individuals who suffer from insomnia. CBT-I is now recommended as a first-line treatment for insomnia by the NIH Consensus Statement and the British Association of Psychopharmacology. DESCRIPTION OF PRACTICE OR PROTOCOL: CBT-I consists of behavioral and cognitive components.  The PMH nurse may be equipped to implement these strategies in the clinical setting.  This talk will elaborate the key necessary elements. VALIDATION OF EVIDENCE: Data is emerging that demonstrates that, compared with medications such as benzodiazepines and non-benzodiazepines, CBT-I is just as effective for treating insomnia and its beneficial effects may be more enduring than those of medications (Mitchell, 2012)      RELEVANCE OF PMH NURSING: PMH nurse clinicians and educators are well positioned to equip their patients with strategies from CBT-I which may enable them to break the cycle of insomnia. FUTURE IMPLICATIONS: As clinicians keenly aware of the importance of a multidimensional approach, PMH nurses can be a part of expanding this evidence-based treatment to help patients with insomnia in our various practice areas.


2051: The Art of Polypharmacy: There’s a Pill for That
Melissa Whitesell, MS, CPNP-AC, FNP-BC, PMHS-BC

PROBLEM STATEMENT: Rationale for polypharmacy is unclear better standardized assessment & practices of polypharmacy need to be established, What is polypharmacy inluding psychiatric polypharmacy?Do the benefits outweigh the risks? SUMMARY OF EVIDENCE: The presence of polypharmacy has the potential for many drug to drug interactions and noncompliance,both of which can have unfavorable outcomes including increased mortality.Those clients with mental illness are at increased risk of serious adverse effects from polypharmacy including death & have been estimated to die 15-20 years earlier than the general population.Between 2004-2013 polypharmacy in adults increased from 1.5 million to 3.68 million including psychiatric polypharmacy & in children ranging 2.9-27% worldwide. DESCRIPTION OF PRACTICE OR PROTOCOL: In a community study, 9% of psychiatric patients received polypharmacy & in the general population increased 13% & again 90% in psychiatric settings.Studies show polypharmacy practices are observational vs interventional & rely mostly on prescriber's autonomy,response rate of client,& have significant comorbid risks associated with it.Recommendations to aid in EBP,improve client outcomes,& limit adverse events are needed. VALIDATION OF EVIDENCE: Literature search included randomized control trials,evidence summaries,reports of medical treatment, comparative studies,safety and efficacy studies conducted from 2005-2017. RELEVANCE OF PMH NURSING: Increased risk of drug to drug interactions & multiple other medications being prescribed the risks can outweigh the benefits. There have been two protocols developed to aid in the management of polypharmacy.Lee’s SAIL protocol and Werder and Preskorn’s TIDE protocol are a few. FUTURE IMPLICATIONS: Improved guidelines & recommendations needed to provide best care to clients, especially those with mental illness.Education of clinical staff and the client need to occur simultaneously to prevent adverse outcomes; including death.


2052: Live Actor Simulation to Improve Therapeutic Communication in Novice Nurses
Nikki Graham, RN-BC, MSN

PROBLEM STATEMENT: The nursing shortage has created an imbalance of novice nurses to experienced nurses, reducing the depth in role-modeling and mentoring therapeutic communication on the unit.  An enhanced method was needed to increase the competence and confidence of the novice nurse when experiencing challenging communication situations. SUMMARY OF EVIDENCE: Simulation is widely used in undergraduate and graduate programs, increasing confidence and competence for novice and learning practitioners.  Studies show communication skills are gained in standardized-patient simulated exchanges, especially when coupled with didactic content and reflective debriefing. DESCRIPTION OF PRACTICE OR PROTOCOL: Leadership, experienced staff, research bodies and simulation experts were consulted to assist with development of a live simulation for psychiatric nursing residents.  Expert nurses were enlisted as actors and debriefing coaches. VALIDATION OF EVIDENCE: Nursing residents were observed by educators and coaches and evaluated on communication skills during the simulation, consisting of 5 classes over a 6 week period.  Residents were also given evaluations, ranking the simulation on a Likert scale for value and skill acquisition. RELEVANCE OF PMH NURSING: Resident nurses consistently ranked the live simulation at the highest rating and offered supportive comments on the effectiveness and value of the experience.  Increased competence and confidence was observed over the course of simulation.  Expert nurses gained confidence in the novice nurses by watching their increase in therapeutic effectiveness,  fostering an unintended but enriching bond between the novice nurses and their coaches. FUTURE IMPLICATIONS: Live simulation is useful in improving communication skills in novice nurses and should be considered in all transition to practice programs.  Engaging current staff in the process can create relationships and build trust.


2053: Novel Approaches to Strengthening the PMHNP Workforce: Establishing the Nationwide Children's Hospital PMHNP Fellowship and the Children's of Alabama/UAB Child & Adolescent PMHNP Residency
Simone Durand, PMHNP-BC; Nancy Noyes, PMHNP-BC, PMHCNS-BC; Shelley Lauterbach, PMHNP-BC; Michelle Mulroy, PMHNP-BC; Steffanie Schweitzer, PMHNP-BC; Lianne Grice, PMHNP-BC; Ashley Hollingsworth, PMHNP-BC

PROBLEM STATEMENT: One in five children will develop a serious and debilitating mental health disorder in their lifetime.  Access to mental health care is limited for many children and adolescents, especially in rural areas.  This hinders recovery and increases utilization of inpatient and emergency services. SUMMARY OF EVIDENCE: Currently only 2.4% of the 234,000 U.S. nurse practitioners work in psychiatry.  Of those, even fewer care for children and adolescents.  New graduate PMHNP’s report that they do not feel prepared to provide care to children with complex mental health needs and comorbidities. DESCRIPTION OF PRACTICE OR PROTOCOL: The Nationwide Children’s Hospital and the Children’s of Alabama/ UAB PMHNP post-graduate programs are among the first of their kind to bridge this gap.  Prior to their establishment, there were no other avenues for obtaining additional formal nursing education and training in child and adolescent psychiatry. VALIDATION OF EVIDENCE: Program evaluation is done by faculty, clinicians, and organizational stakeholders. The five core elements and eight clinical competencies of the post-graduate residency/fellowship programs drive ongoing development and evaluation.  Additional quality outcome measures include resident/fellow-lead quality improvement projects, educational offerings for nursing and medical staff, and scholarly writing. RELEVANCE OF PMH NURSING: Psychiatric RN’s and PMHNP’s can contribute to ongoing professional role development through the pursuit of advanced training, improving evidence-based practice and patient outcomes, and ongoing interdisciplinary collaboration. FUTURE IMPLICATIONS: PMHNPs are poised to be leaders in the field of mental health care.  A PMHNP fellowship/residency specific to children and adolescents will increase access to high-quality mental health services, and develop practitioners capable of excelling in an interdisciplinary workforce.


2054: Peer Recovery Specialist Impact on Improving Nursing Care for People with a Substance Use Disorder
Michael Valenti, Ph.D., RN; Kelly Allred, Ph.D., RN-BC, CNE; Shannon Robinson, MSN, RN-BC

PROBLEM STATEMENT: People with mental health disorders are more likely to have a co-occurring substance use disorder.  Since 2010, the number of people in Central Florida with self-reported poor mental health has doubled while overdose deaths increased significantly.  Current educational practices need to be revised and enhanced to address this public health concern. SUMMARY OF EVIDENCE: This is the first project to include a peer support specialist in the development of an empirical, multicomponent integrated learning experience (MILE) for undergraduate nursing students.  This project is based on data provided by community clinical partners, U.S. Surgeon General recommendation, quantitative (DDPPQ) and qualitative data collected from undergraduate nursing students, curricular evaluation, and recommendations from a community advisory board (CAB). DESCRIPTION OF PRACTICE OR PROTOCOL: The MILE consisted of four components, 1) enhanced curricular content, 2) in-class Peer Recovery Impact Project (PRIP), 3) simulation with a standardized patient, and 4) structured debrief.  This proposed presentation is on the objectives of the PRIP, challenges in facilitating the project, and the impact of the PRIP on nursing care in simulation. VALIDATION OF EVIDENCE: A mixed-method, nonequivalent control group post-test only design was conducted to assess the PRIP.  Following the PRIP, students completed the DDPPQ and described their experience of the PRIP.  Subjective and objective clinical measures/simulation outcomes, developed with national experts, were collected and analyzed. RELEVANCE OF PMH NURSING: Students' role security, therapeutic commitment, and intent to practice with people with co-occurring disorders increased.  Several qualitative themes emerged.  Simulation data reflected increased role security and therapeutic commitment. FUTURE IMPLICATIONS: Include Peer Recovery Specialists in nursing curriculum. Incorporate content from PRIP in education and practice


2055: Social Determinants of Health: A Missing Piece of the Puzzle in Mental Health and Whole Health Care
Susan V. Brammer, PhD, RN, CNE; Saundra Regan, PhD; Chris White, MD, JD, MHA

PROBLEM STATEMENT: Purpose: 1) To raise awareness of the impact of social determinants of health (SDH) on mental health and whole health care; 2) To introduce audience members to virtual reality (VR) simulation as a strategy for connecting with patients' experiences of health disparities. SUMMARY OF EVIDENCE: Despite driving health outcomes, SDH curricula are often lacking in healthcare provider training.  VR is an effective, validated way of providing experiential learning. DESCRIPTION OF PRACTICE OR PROTOCOL: A multidisciplinary team from the University of Cincinnati received a Medicaid Equity Simulation Project grant from the Ohio Department of Medicaid.  To better understand how SDH impact the Medicaid patients they serve, the grant is to create VR simulations to improve providers' cultural competency and reduce implicit bias.  The patient featured in one simulation has comorbid schizophrenia and asthma.  The simulation offers providers a chance to experience the daily challenges beyond disease symptoms and to see how those challenges impact health and health care.  Providers encounter effects of poverty and discrimination, such as lack of access to health care and social isolation. VALIDATION OF EVIDENCE: Content experts, including advanced nurse practitioners and physicians, are providing feedback on the validity of the simulations during the development process.  Participants in the simulations will complete pre/post tests to assess self-efficacy in managing SDH. RELEVANCE OF PMH NURSING: Because patients with mental health disorders are more likely to experience SDH, such as poverty and discrimination, PMH nurses must recognize and address them when planning and implementing care. FUTURE IMPLICATIONS: Recognizing SDH can provide the impetus for utilizing a multidisciplinary approach to improving whole health outcomes for vulnerable populations.


2056: Palliative Psychiatry:  The Role of the Psychiatric Nurse Practitioner in Palliative Care
Kristyn Pellecchia, RN, MSN, PMHNP-BC

PROBLEM STATEMENT: With the advent of modern medicine in the 20th century, we have seen a doubling of life expectancy.  Now, the majority of people live with and die from chronic illness such as dementia, cancer, and cardiovascular disease, living often ten or more years with disability that affects their physical and mental health and reduces quality of life. SUMMARY OF EVIDENCE: To meet the complex needs of patients with chronic and serious medical illness, palliative care has become the standard of care.  Palliative care is comprehensive, patient-centered care performed in an interdisciplinary team with the goal of reducing suffering and improving quality of life for patients with serious illness.  While this care model is being taught to many primary care providers, education is lacking for psychiatric providers. DESCRIPTION OF PRACTICE OR PROTOCOL: Palliative psychiatry requires ability to identify and manage psychiatric issues at end-of-life (EOL) and distinguish them from other sources of distress.  Often strategies used at EOL are off-label, which requires education about these treatments.  Palliative psychiatric providers must be able to navigate complex communication and decision-making and be versed in ethical issues such as physician-assisted suicide and withholding or removal of treatment. VALIDATION OF EVIDENCE: Palliative psychiatry research topics include fast and effective treatment for depression at EOL and better delirium detection and treatment. RELEVANCE OF PMH NURSING: PMHNPs are philosophically aligned with goals of palliative care but require additional education in palliative psychiatry topics in order to comprehensively care for and improve quality of life for patients. FUTURE IMPLICATIONS: With this knowledge, PMHNPs are better prepared to meet demands of our aging population.


2057: TMS for OCD: New Hope for Suffering
Cecelia Rush, BSN, RN; Paula Bolton, MS, CNP, ANP-BC

PROBLEM STATEMENT: Transcranial magnetic stimulation (TMS) is the newest treatment option for patients with treatment resistant OCD and involves both provocation and magnetic stimulation. Nurses play a vital role in assessment and management of patients undergoing TMS for OCD. SUMMARY OF EVIDENCE: TMS has recently been approved as a treatment for OCD.  Utilizing brief magnetic pulses with a newly designed deep TMS coil, TMS stimulates areas (CSTC) of the brain to aid cellular function and enhance neural pathways. DESCRIPTION OF PRACTICE OR PROTOCOL: TMS for OCD is a daily treatment lasting approximately 20 minutes for 6-8 weeks.  Prior to treatment, the patient engages in a provocation exercise to raise anxiety levels.  Nurses are involved in the development of treatment programs providing guidance for assessment and monitoring of patients. VALIDATION OF EVIDENCE: Utilizing experience gained for many years providing TMS for treatment resistant depression and collaborating with OCD exposure therapy specialists, nurses are refining screening protocols, identifying risks and developing of nursing care plans to enhance the patient experience and help patients manage rising anxiety levels during treatment. RELEVANCE OF PMH NURSING: TMS nurses can in assist in the careful monitoring of patients with challenging presentations.   Providing patient education, monitoring progress and encouraging patient input, TMS nurses help with patients manage anxiety related to treatment. FUTURE IMPLICATIONS: As TMS is used to target various parts of the brain involved in mental illness, experience with this treatment modality assures nurses can assist patients as they participate in new treatments for resistant mental illness.

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