Friday, October 10 - APNA 27th Annual Conference Abstracts

3011: The Table-top Simulation as an Engaging and Inexpensive Approach to Teaching Psychiatric Nursing

Joan C. Masters, EdD, MBA, APRN, PMHNP-BC

The challenges with using simulation in teaching psychiatric nursing are well-known, for example, mannequins do not move and actors can be expensive. Table-top simulations, typically used in disaster scenarios, are an engaging and inexpensive alternative to standard simulations. However, no publications were found reporting their use in teaching psychiatric nursing. In this presentation the development of a psychiatric nursing table-top simulation will be discussed. At the start, students read a Joint Commission report on inpatient suicide risk and an article by a psychiatrist criticizing unreasonably punitive restrictions on patients. Working in pairs and following hospital policy, students log–in a “patient’s” belongings using faculty-prepared suitcases. Checking-in a patient is not something they are allowed to do in clinical and they enjoy this new activity as well as the challenge of finding more contraband than their classmates. Suitcases are packed with belongings patients would typically be allowed to have as well as more ambiguous items and contraband. In the debriefing, discussion centers on what are reasonable standards of safety in recovery-centered care, identifying risk factors for self-harm, and whether policies should be modified for different patients. Practical suggestions on assembling the suitcases as well as facilitating discussion will also be presented.


3011: Using Simulation Activities to Enhance Psychiatric Nursing Skills

Carole Bomba, MSN, RN, CNE

Therapeutic communication is a necessary skill for nursing students to learn early in the journey to becoming a registered nurse. Patient-actor scripted simulation scenarios with role-play are one method to provide beginning nursing students an opportunity to practice this skill in a non-threatening, safe environment while also assisting clinical faculty in the evaluation of skill acquisition. Students rotate through three different patient role-play situations with faculty observing the exchange between the beginning student and upper classman. One scenario utilizes a high fidelity mannequin that is programmed to have an alcohol withdrawal seizure. Students are required to interact with the patient as well as care for the patient during the seizure. The other two scenarios are role-play for a severely depressed client and a moderate to severely anxious client. A simple check list, completed by the observing instructor for each student regarding satisfactory or unsatisfactory (requires more practice), was developed to evaluate performance and determine areas for didactic enhancement. Student debriefing after each scenario provides qualitative information about the experience, which is also used to determine future revisions.


3012: CareIndicator, a Self-Management E-tool for Early Signaling and Intervention in Bipolar Disorder

Peter Goossens, PhD, MANP, RN, FEANS

IntroductionIn bipolar disorder, both patients, and caregivers experience the consequences of the illness and the burden is high. For patients, the risk of worsening of symptoms is increased when early warning signs for recurrence are not communicated effectively between patient, caregiver and professional. A lack of early intervention strategies increases the risk for recurrence to an episode of acute mania or depression. CareIndicator is an internet based tool that helps both patient and caregiver to monitor patient specific prodromes and symptoms.ObjectiveDeveloping and testing an E-tool for patients, caregivers and professionals that enables monitoring of early signals, based on an individual action plan composed by patient, caregiver and professional. MethodsDevelopment: focus group interviews with patients, caregivers, professionals and software engineers. After consensus in the focus group the software program was built and tested in an pilot.Pilot: 10 patients, 19 caregivers and 3 professionals have used the system over a period of 6 months. Evaluation pilot: a 24-item questionnaire on satisfaction, user friendliness and effects on self-management was administered.ResultsPilot: Preliminary results show that users find it easy to use and helpful to manage the illness symptoms. Full results will be presented during the APNA conference.


3012: Using a Web-based Patient-Provider Messaging System to Enhance Patient Satisfaction Among Active Duty Sailors and Marines Seen in the Psychiatric Outpatient Clinic: A Pilot Study


Problem: This paper will investigate the use of a web-based messaging system to increase patient satisfaction in a psychiatric outpatient clinic. Literature Review: Patient satisfaction is vital to the practice of psychiatry and remains as one of the key indicators of the quality of mental health care. One of the ways to measure the outcome of healthcare services is by determining the patient’s satisfaction with the care received. Patients and providers are embracing the use of online communication as a way to communicate about their health status and treatment strategies. Theoretical Framework: The Transactional Theory of Stress and Coping (TTSC) by Richard Lazarus posits that stress is not measured by a single element but instead is a culmination of the interactions between the person and the environment. Lazarus underscores the influence of the person’s self-appraisal or evaluation of the event in how the person will feel and respond to the situation. Implications: Maximizing technological advancements to improve patient satisfaction is imperative in the 21st century; and nurses are at the forefront of embracing this opportunity. However, to lead change and advance mental health, future efforts to integrate these innovations are needed in psychiatric mental health settings.


3013: Feminist Theory: Exploration and Application to an 82 Year Old Anxious Female Therapy Patient

Beverly Reeves-Dudley, MSN, MA, RN, APRN, PMHNP-BC

Elderly female populations presenting for psychotherapy need exploration of a variety of useful theoretical approaches with respect to their developmental needs as well as with situational problems. The literature base for application of Feminist theory needs to be documented more extensively. Additionally, literature review shows some effects of ageism on elderly females as they interact with health care communities highlighting the need to explore how to normalize this population. Generativity set-point is reviewed in a longitudinal prospective study which found that it was achieved when combined with optimism even in declining health in that study of aging women. Feminist theory’s compatibility with the concept of generativity set-point as evidenced by improved self efficacy in elderly women is hypothesized. The basic tenets of Feminist theory are reviewed and applied to a therapy patient in an original case study of an elderly female with anxiety exacerbation after an interaction with a health care community. Results for this therapy patient using feminist therapy resulted in improvement in self efficacy. A scale quantifying psychological well-being is discussed as a possible measure of generativity set-point in future research.


3013: Need for Resourcefulness Training for Women Caregivers of Elders with Dementia

Jaclene A. Zauszniewski, PhD, RN-BC, FAAN

Nearly 10 million American women provide care to elders with dementia and may experience overwhelming stress that adversely affects their health. Interventions to teach them to be resourceful in managing their stress may promote their optimal health and facilitate continued caregiving. However, before examining the effectiveness of resourcefulness training (RT), the need for it must be established. Purpose: This pilot intervention trial examined the need for RT in women dementia caregivers. Theoretical Framework. Zauszniewski’s mid-range theory of resourcefulness identified the personal and social resourcefulness skills constituting RT. Methods. A convenience sample of 138 women caregivers supplied data on resourcefulness, stress, and depressive symptoms before and after RT. The analysis focused on baseline resourcefulness scores, correlations among resourcefulness, stress, and depressive symptoms, and caregiver post-RT evaluation of need for self and others. Findings: Only 4% of the baseline resourcefulness scores indicated a low need for RT. Lower resourcefulness was associated greater stress and depressive symptoms (r’s=-.37, -.53). After RT, 82% of the caregivers reported they needed RT; 93% believed other caregivers need RT. Implications: The results suggest a substantial need for RT in women dementia caregivers and support moving forward with testing RT effectiveness for reducing caregiver stress and depressive symptoms.


3014: Crisis Intervention Training with a Twist: National Staff Training to Develop Self-care Skills and Integrate Chaos Theory for Safer Work Environments

Angela C. Schmidt, BS, BSN, RN-C

Research has shown psychiatric nurse burnout is associated with violence, unsupportive management, lack of formal orientation programs or continuing education programs for staff, high risk and acutely ill patients, too much paperwork and inadequate numbers of staff and/or unsupportive staff communication. Organizational strategies must be developed to break through the silence around PTSD in nurses. Nursing leaders have a duty to inform nurses their work has the possibility for the development of PTSD. Administrative nursing leaders need to attend workshops on how to detect PTSD symptoms in nurses. Occupational stress for nurses can lead to compassion fatigue, burnout, and secondary traumatic stress syndrome. It is necessary for all nurses to be taught the applications of change and chaos theory to allow for daily transitions in the workplace. The ability of nurses to adjust to new evidence-based practice, new leadership models, the essentials of the Magnet hospitals along with nursing informatics have caused new levels of stress never experienced on this multitude of levels simultaneously. For nurses to survive and thrive in the 21st century healthcare model, the APNA must become a leading stakeholder in development and adoption of mandated staff development programs to create healthy work environments.


3014: Demographics, Clinical Characteristics, and Pharmacological Treatment of Aggressive Patients Admitted to an Acute Inpatient Behavioral Health Unit of a Community General Hospital

Cynthia Reade, MS, RN-BC, NE-BC

Introduction:The aggressive patient is a common presence upon the acute inpatient behavioral health units of general hospitals. Previous research has focused upon certain areas to examine regarding predictors or contributors to aggressive or violent behavior during patients' hospitalizations: demographics, clinical characteristics which includes diagnosis and symptoms, unit environment, and staff's interpersonal communication. These factors are all discussed in this research. Method: Forty behavioral health patients participated in this naturalistic observational study and met inclusion/exclusion criteria. Tools utilized were the CGI-S, MOAS with repeated measures statistical analysis and ANOVA. Demographics and clinical characteristics data were also obtained and medications utilized for stabilization at patient discharge. Results: Males of a younger age with a previous history of violence and psychotic symptoms with dominant interpersonal personality characteristics displayed more aggressive behavior. Detailed statistics will be presented at conference. Conclusion: Younger male patients who present with psychotic symptoms, agitation, paranoia, and have co-morbid substance use and a history of violence, particularly within 24-48 hours prior to admit are at risk for violent inpatient behavior during hospitalization with higher risk occurring during the first week of hospitalization.


3015: African American Males Diagnosed with Schizophrenia: Strategies for Treatment

Lorraine B. Anderson, PhD, MPA, RN

AbstractOf the 2.4 million persons diagnosed annually with schizophrenia, African American males comprise a disproportionate cohort. Little, however, is published concerning how these men view themselves within the context of their recovery. This research explores and analyzes aspects of the recovery process that can inform treatment strategies applied by nurses. In the study, five men ranging in age from 21 to 57, living in an urban setting, described their lives in the context of existing with the diagnosis of schizophrenia. Their reports on how they see themselves and others in connection to their diagnosis of schizophrenia have distinct implications for treatment and further research. Based on the findings of this qualitative study, themes potentially impacting therapeutic relationships include ; a desire for authenticity and validation of how the men see themselves are important components of their sense of self; a determination to maintain the boundaries and integrity of their personhood fueled their dialog; by coming to terms with their diagnosis, the participants had achieved an intimate knowledge of themselves and they used this knowledge to improve themselves and advocate for others with schizophrenia. Specific recommendations for treatment planning are proposed in this presentation.


3015: Physical Violence, Emotional Support, Depression, and Suicidal Ideation Among Thai Women

Barbara L. Drew, PhD, PMHCNS-BC

Problem: Over one million people die by suicide worldwide annually. Suicidal ideation (SI) is a known risk factor for suicide and other negative sequelae of depression. Predictors of SI have not been thoroughly examined in women in Thailand. Purpose: To examine predictors (physical violence, emotional support, and depression) of SI among Thai women.Methodology & Analysis: Quantitative data pertinent to physical violence, emotional support, depression, and SI were retrieved from an embedded mixed methods study of 284 OB/GYN Thai patients. Well-established questionnaires (Severity of Violence Against Women Scale; Thai Depression Inventory; and Multidimensional Scale of Perceived Social Support) measured physical violence, emotional support, depression, and suicidality. Alphas of instruments ranged from .88 to .96. Amos Graphics version 21 was used to perform multiple regression analysis. Findings: Approximately 8% of participants had suicidal thoughts. Physical violence and depression were significant predictors of SI. The more the participants experienced physical violence (ß = .12) and depression (ß = .31), the more thoughts they had about committing suicide. Emotional support did not predict SI. The whole model yielded 11.4% of the explained variance in suicidal thoughts. Implications for nursing: Routine screening for physical violence, depression, and SI in Thai OB/GYN patients is warranted.


3016: Recovery Oriented Approach to Milieu Management in a Community Hospital

Jason Melegari, BSN; Brittany Chabak, LSW, MPH

The Tidal Model is a mental health recovery and reclamation model of nursing care specifically designed for acute inpatient psychiatric facilities. Rooted in existential phenomenological psychology and informed by chaos theory, this model provides a pragmatic approach to empowering patients by emphasizing the centrality of one’s lived experience, which is discovered and explored through an egalitarian patient-nurse relationship. The Tidal Model has been in use in over 100 facilities worldwide, but there has yet to be a documented implementation of this model in the US. A 32-bed inpatient adult psychiatric unit in Western Pennsylvania recently designated an interdisciplinary committee of 15 key employees to spearhead the creation of the first US inpatient program influenced by the Tidal Model. Utilizing Tidal Model components, this committee will develop a concrete recovery-oriented methodology to restructure the milieu on the inpatient unit and alter the staff’s philosophical approach to patient care. Based on research conducted at other institutions employing the Tidal Model, it is anticipated that successful implementation of the adapted Tidal Model at this inpatient adult psychiatric unit will result in fewer instances of patient aggression, a decreased need for restraint procedures, and improved patient satisfaction.


3016: Relationship Between Emotional Intelligence and Leadership Behaviors of Mental Health Nurses

Traci T. Sims, APRN-BC, MS

Emotional Intelligence (EI) is a growing field in both nursing practice and nursing education. Studies have shown that there is a positive relationship between EI and nursing performance. While there are gaps in the literature examining EI among mental health nurses, there is evidence to suggest that mental health nurses who use EI skills are more likely to promote high quality person centered care. Evidence also points toward a correlation between EI and leadership skills. Mental health nurses are agents of change, and research has shown that mental health nurses’ leadership and management skills are associated with patient outcomes and organizational effectiveness. The Mayer-Salovey-Caruso Emotional Intelligence model was used to guide this study. Two instruments were used to collect EI and Leadership scores: Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), and Leader Behavior Description Questionnaire - Self (LBDQ). The sample was drawn from mental health nurses at one facility in North Georgia. Results provide evidence of EI among mental health nurse participants and identify the relationship of EI scores to leadership skills. The study has implications for mental health nurse practice, nursing management, and nursing school curriculum.


3021: Intensive Outpatient Behavioral Health Program in a Military Facility

JoEllen Fielden, DNP, PMHNP-BC, ANP-BC

There is a great deal of evidence that psychosocial stressors may be etiological factors for depressive, anxiety, and adjustment disorders in the military. Difficulty coping with stressors was a contributing factor in 82% of active duty military suicidal deaths in the past few years. Behavioral health disorder costs are high, not only with lives lost to suicide; but with military readiness, poor work performance, social problems, and high rates of unhealthy behaviors. This presentation describes a three-week behavioral health intensive outpatient program design implemented at the San Antonio Military Medical Center. The program’s overarching philosophy was to develop and institute a holistic behavioral health fitness program for Service Members in order to decrease symptoms, enhance performance and build resistance. The program is specifically aimed at decreasing symptoms associated with depression, anxiety, and hyper-arousal while increasing the ability to self-regulate, and restoring a sense of self-efficacy through provision of coping skills. After completing the program, Service Members will have acquired knowledge and skills to assist them in their transition back to their units or into civilian life. Future implications include modeling readiness focused behavioral health treatment, utilizing alternative treatments, and improving continuity of care (between inpatient and outpatient services).


3022: Boy: TDTM Girl: CD9--Decoding the Dangers of Teen Sexting

Erin Ellington, DNP, RN, PMHNP-BC

Recently, a cultural phenomenon referred to as “sexting” has spurred media and parental attention. Sexting, a portmanteau of sex and texting, is the exchange of sexually explicit images between two people via cell phone or similar device. The prevalence among adolescents has been captured by popular press surveys and more recently by peer reviewed articles; involvement rates vary, but the numbers are alarming. Cell phone communication creates unique issues including development of digital artifacts, potential for widespread circulation, and permanency of the content. Teen vulnerabilities to sexting include volatility of teen relationships, normative increase in sexual energy, and neurodevelopmental influences. Sexual exploration without having sex and sexualization of youth are implicated in teen sexting; peer pressure and other social influences also play a role. Psychological, social, sexual, and legal consequences of sexting are unexpected to many teens during the impulsive act. Preexisting and subsequent mental health sequelae are of special concern. This presentation will equip mental health nurses with tools needed to improve their personal media literacy, incorporate media history taking into their assessments, support and educate teens and parents regarding sexting, and become involved in other activities to prevent or minimize the devastating effects of teen sexting.


3023: Lessons from the Front: Psychiatric Nurse Practitioners Providing Health Care Integration

Aaron M. Miller, RN, MS, PMHNP-BC; Sherri A. Borden, ANP-BC, CNS; Matt Tierney, MSN, CNS, ANP-BC, PMHNP-BC; Bethany Phoenix, PhD, RN, CNS

Despite well-documented high comorbidity of psychiatric and physical disorders and widespread recognition of the need for integrated behavioral health and primary care, stubborn barriers to integration persist. These include differing clinical cultures, a fragmented delivery system and varying reimbursement mechanisms. Psychiatric-mental health APRNs have a key role in bridging existing gaps in the health care delivery system and providing leadership to develop new systems to provide effective integrated care. This panel presentation will begin with an overview of integrated care initiatives and models for use of PMH-APRNs to provide integrated care. Panel members will provide exemplars of Psychiatric-Mental Health NP roles facilitating integrated care in three different settings: 1) a faculty practice offering on-site integrated health services in a community-based organization that delivers residential mental health treatment; 2) a federally qualified health center that provides on-site mental health services; and 3) an office-based buprenorphine induction clinic. Panelists will discuss 1) how health problems that otherwise “fall between the cracks” of our fragmented health care delivery system can be addressed using an integrated nursing model; 2) contradictions or areas of tension that must be resolved in order to provide comprehensive, coordinated, continuous and person-centered care.


3024: Recovery Goals: Identifying a Patient's Passion

Chris Walker, MSN, RN, MHA

Problem: Historically patients on a locked mental health unit do not find their stay to be effective to help them cope with life issues in the real world. The patient’s plan of care typically involves the staff defining what goals the patient needs to accomplish in order to be discharged. Summary of findings from literature search: Reviewed 40 randomized controlled studies of illness management programs and identified five effective components of successful programs. Theoretical framework: Illness Management and Recovery (IM & R) is a step-by-step program that helps people set meaningful goals for themselves, acquire information and skills to develop more sense of mastery over their psychiatric illness, and make progress towards their own personal recovery. Effective components of IM & R programs include psychoeducation, behavioral tailoring for medication adherence, relapse prevention training, coping skills training and social skills training. Brief description of practice: Staff were taught how to connect everything to patient recovery goals, involving significant others, and tracking the patient’s progress towards goals. Staff uses motivational, educational, and cognitive behavioral techniques. Future implications: IM & R gives our patients the improved ability to manage their illness which helps to avoid relapses and hospitalizations.


3025: And the Oscar Goes to… Mental Health Therapeutic Communication Simulation: Enhancing Student Learning

Leslie Miles, DNP, PMHNP-BC; Linda Mabey, DNP, APRN-BC; Katie Stansfield, BSN Student; Sarah Leggett, BSN Student

Mental health nursing does not lend itself well for nursing faculty observation of student- patient therapeutic communication. There is limited literature about how to bridge the gap between didactic and clinical experiences that would guide students towards the highest levels of therapeutic communication competency. Brigham Young University faculty created an innovative simulation approach to enhance the learning of students in communication skills to promote change and growth in patients. First semester and senior nursing students participate in recorded patient interaction simulations. Standardized patients were developed to provide consistency. No expensive mannequins, paid actors or volunteer faculty are needed. Previous semester volunteer nursing students portray the standardized patient and provide immediate feedback about the therapeutic factors in the simulated interactions. To integrate the learning experience, students complete a written assignment where they identify the effective and non-effective communication skills and therapeutic techniques utilized, identify areas of personal strengths and weaknesses, and address the therapeutic factors of genuineness, empathy, and positive regard. A recording of each interaction provides the venue to assess essential verbal and nonverbal skills that faculty members were hoping to measure and provide formative feedback across the curriculum. Student evaluations have been positive about these unique learning activities.


3026: The Experiences and Needs of Family Members of Adolescents with Disruptive Behavior Disorders

Ukamaka M. Oruche, PhD, RN, PMHCNS-BC; Claire Draucker, PhD, RN, FAAN; Halima Al-Khattab, RN, PhD Student; Hillary Cravens, MSN, RN; Brittany Lowry, MSW; Laura Lindsey, RN

Purpose and Background: Adolescents with Disruptive Behavior Disorders (DBDs), which include Oppositional Defiant Disorder and Conduct Disorder, present unique challenges for their families. Most studies of these families have focused on the experiences of mothers, and little is known about the experiences of fathers, siblings, and other family members. To inform family-focused interventions, problems and perceived needs of all family members need to be better understood. This study aims to describe the functioning of families of adolescents with DBDs, levels of emotional distress of adult family members, and experiences and perceived needs for support and/or treatment of all family members. Methods: Multiple family members (e.g., parents/caretakers, siblings, and other significant family members) from 15 families of adolescents with DBDs are being recruited from a public mental health clinic. Data are gathered with self-report questionnaires and in-depth interviews. Survey data are being analysed with descriptive statistics and interview data are being analysed by standard content analytic procedures.Results: Preliminary results from eight families indicate difficult family functioning and above average levels of distress in adult family members. Content analyses of experiences and perceived needs for support and/or treatment are on-going.Conclusions: Implications for intervention development will be discussed.


3031: Moral Injury in Returning Veterans: Concept and Emerging Treatments

Doris C Vallone, PhD, PMHCNS, BC

Over two million service members have been deployed to Afghanistan and Iraq since 2001. Recent government reports have identified posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) as the signature mental illnesses among Veterans of these conflicts. Vast treatment resources have been marshaled in both the Veterans Health Administration and the Department of Defense. During the past few years, clinicians working with recently deployed service members observed that there were symptoms unique to those who witnessed or engaged in perceived unnecessary acts of violence. They identified the phenomenon as "moral injury". Moral injury results when there is an internal conflict resulting from a perceived transgression of a personal moral code. It is evidenced by shame, guilt, anxiety and self-condemnation. There is high risk for suicide. The treatment strategy combines education, elements of traditional exposure, self-forgiveness and restitution acts. The attitude and introspection of the therapist is also a key component. Nurse therapists will encounter returning Veterans in many treatment settings outside of the VA. Recognizing the manifestations of moral injury will enable them to offer these Veterans a compassionate connection.


3032: Turning the Tides of Trauma and Addiction Through Group Therapy

Joan Parker-Dias, RN-BC, MSN, PMHCNS; Tina M. Truncellito, RN, BS, CNIV

Turning the Tides of Trauma and Addiction through Group TherapyPurpose/Description of ProblemUp to 59% of adolescents with post-traumatic stress disorder (PTSD) subsequently develop substance abuse. These co-morbid conditions are associated with increased symptom severity and worse treatment outcomes. Youth in the inpatient setting face a lack of integrated services. This project seeks to identify an effective evidenced-based group therapy for treating trauma and substance abuse within the adolescent population. Model/PlanThe Iowa model of Evidenced-based Practice guided this clinical innovation project.Background/MethodsThe trigger for this project was a lack of standardized therapeutic approaches for treating trauma and substance abuse disorders in a residential behavioral health unit. A team met monthly to critique and synthesizes twenty-one articles. Expert opinion was solicited from substance abuse treatment centers. Outcomes/ResultsBy March 2013 it is anticipated that a group therapy program will be implemented. Expected evaluation measures include: trends in incidence of adverse events (seclusion/restraints, self-injurious behaviors, PRN medications); prevalence of PTSD symptoms (via patient self-report tool); recidivism rates; patient adherence with substance abuse relapse prevention plans.Recommendations/Implications for NursingAnticipated implications for psychiatric nursing include the delivery of safe, quality patient care as evidenced by positive improvement in patient outcomes.


3033: Integrating Behavioral Health in a Primary Care Clinic

Kathy E. Brotzge, MSN, PMHNP-BC

Psychiatric treatment is not available to everyone. Many seek treatment thru primary care. Advanced practice psychiatric nurses can help by working as prescribing/treating psychiatric consultants in the primary care setting. Integrating care can improve quality of life and health. A review of literature provided studies on the increase in quality of life for persons receiving care in an integrative system. Research supported improvement in medical and mental illnesses in co-located primary care and mental healthcare clinics. Eight hours a week I work in a community health primary care clinic as a psychiatric nurse practitioner. I am a consultant to the primary care prescribers. This position is supported by an LCSW, behavioral health support associates and a case manager. I evaluate persons who have failed on multiple treatments, gotten lost in the mental health system and provide education to prescribers.The primary care clinic provides a great opportunity for behavioral health care. It can also help persons with severe comorbid medical conditions maintain better health. This model is one that improves quality of life. The advanced practice psychiatric nurse can improve care and collaboration with primary care.


3034: Promoting Recovery with Trauma Informed Practice

Diane H. Esposito, ARNP, MSN, PMHCNS-BC

The incorporation of a recovery model in the treatment of mental health disorders has been cited as one of the most important goals for the mental health care delivery system. Another key focus in transforming the mental health care system is the concept of ‘trauma-informed care’. These concepts go hand in hand, and research has already identified that incorporation of trauma specific interventions has enhanced the recovery and decreased relapse rates when used in chemical dependency treatment programs (McHugo et al, 2005). This presentation will review the fundamental components of ‘recovery’ and ‘trauma informed care’ as they relate to behavioral health care. This presentation will also review several theoretical frameworks regarding trauma, and discuss the standardized assessment tools available to screen for the experience of trauma, and present several treatment strategies for trauma related behavioral health conditions.


3035: Creating and Evaluating “The Mental Health Ward”: An International Collaborative Evidence Based Simulation

Jeanette Rossetti, EdD, MS, RN; Trish J. Bendel, MS, RN

There is a need for significant enhancement of psychiatric mental health nursing education that incorporates recovery principles into the undergraduate curriculum. Educational models and innovative teaching strategies that are evidence-based are needed to better prepare nursing graduates entering the specialty of psychiatric mental health nursing. This presentation will discuss the development and evaluation of a new curriculum “The Mental Health Ward” offered at a Midwestern University. This innovative, simulated hospital environment (situated at a collaborating behavioral health hospital) includes the use of standardized patients and scenarios resulting in a full mission simulation. The collaborative effort between faculty, students, nurses, service users, and international colleagues in the development and success of the Mental Health Ward will be highlighted. In this simulated hospital environment, students learn a variety of psychiatric diagnoses and practice a variety of skills while incorporating recovery principles in their care. The developed infrastructure of the Mental Health Ward and results of research utilizing the CAE© Simulation Effectiveness Scale will be reviewed. Learning Outcomes related to self-efficacy and communication techniques utilized by nursing students in the simulated experience will be highlighted.


3036: The Effects of Aroma Therapy on Falls in a Geropsychiatric Population.

Suzanne Lee, BSN, RN; Erin Ritter, MSN, RN, CNL

Background: Geriatric populations are at risks for falls. Purpose: Use aroma therapy to decrease agitation and decrease the use of sedating medication in geriatric patients in the hospital. Theory: there is some evidence that essential oils have an effect on GABA pathways and have anxiolytic effect on patients. Method: each month director collects fall information and adds the number of falls to the matrix. Data has been collected for the past year on the geriatric unit and compared to previous year falls. Findings: Falls have reduced 50% over previous year since the introduction of aroma therapy. The number of medications given for agitation has also decreased over the past year. As an unintended consequence, staff report feeling calmer and more relaxed during aroma therapy use. Implications: Agitation in geriatric patients can be relieved by the use of aromatherapy. Aromatherapy has been proven to relieve agitation, reduce sensory stimulation, enhance memory, and improve sleep. In addition, it provides an alternative to sedating medications which can pose a risk for falls in geriatric patients.


3041: Roadmap to Recovery along the VA Way : A Guide to Applying the Recovery Model to Nursing Practice Across the Continuum of Care

Joan Strenio, MSN,PMHCNS-BC

During the 26th Annual APNA conference, the Recovery Council confessed that psychiatric nurses as a discipline were behind their professional peers in incorporating recovery principles into their practice. Despite research findings which support the belief that many individuals with serious mental illness can achieve high levels of social, educational, and occupational functioning despite experiencing relatively severe symptoms, traditional paternalistic models of psychiatric care persist in many settings. This session will describe how the Cleveland VA's Psychosocial Rehabilitation and Recovery Center (PRRC) achieved award winning recovery model fidelity status by offering evidence-based programming and processes,community integration activities, and individualized goal planning and coaching to help participants achieve greater life satisfaction. In particular,classes in CBT, Social Skills Training, WRAP, Illness Management and Recovery, Health and Wellness and Dual Diagnosis are offered to address learning and rehabilitation needs. Collaboration with intensive case management, supportive employment, primary care and other VA and community based services are used to provide holistic,integrated care. The model supports the concepts of mutual respect, strengths focus, trauma informed and choice driven care. Case study examples will be provided during the discussion to illustrate success stories.Implications for nursing practice across the continuum of care will be provided.


3042: Promoting the Therapeutic Alliance by Defining Effective Engagement Between Adolescents and Their Mental Health Clinicians

Jennifer S. Schneider, RN, MA

Client engagement in mental healthcare is critically important to facilitate effective therapeutic change and is vital to the psychiatric nurse-patient relationship. Engagement is especially critical with adolescents, as this is a time period of enormous identity development. Adolescent engagement is a common construct in both the research and clinical literature although definitions are inconsistent. In the research literature, engagement is often defined in terms of behavioral measures such as attrition rates, while the clinical literature focuses on the therapeutic alliance between client and clinician. Using Morse’s Pragmatic Utility Method of concept analysis, the depth and breadth of “adolescent engagement” will be explored across literature contexts and mental health practice disciplines. A definition of adolescent engagement in mental health services will be presented using cognitive behavioral change theory to organize components of engagement into three discreet and exemplar categories: behavioral, affective, and cognitive. Having a richer definition of engagement will allow for better measurement of this concept and can improve understanding of its role in the therapeutic relationship and in mental health outcomes for adolescents. Presentation participants will be introduced to new strategies of engaging with their adolescent clients based on this emerging theoretical model.


3043: Development of a Behavioral Health Medical Home: Nurses Filling the Gap

Paula Bolton, MS, APRN-BC; Margaret Knight, PhD, PMHCNS-BC

Obesity, metabolic syndrome and cardiovascular disease are major health issues. Persons with serious mental illness are at higher risk for these conditions than the general population. Psychiatric nurses encounter patients with these conditions as well as risks for developing severe complications.Addressing the medical needs of the acutely ill psychiatric patient is challenging and complicated. As patients move toward self-care, chronic medical issues may not be fully addressed by the psychiatric team, yet patients have difficulty negotiating the complexities of the health care system to get medical needs met. This presentation will highlight risks and discuss evidence-based nursing measures to integrate psychiatric, medical, lifestyle and behavioral issues across inpatient, residential, and outpatient settings.The concept of the behavioral health medical home will be explored along with the integral role nursing must play to develop these ventures. This presentation will include a description of a pilot study underway to implement a behavioral health-medical home within a psychotic disorders program at a major free-standing psychiatric institution.


3044: Advancing Mental Health Recovery: Lessons Learned from the Transformation of an Inpatient Unit

MaryBeth Cassidy, MSN, APRN-BC; Sandra Jensen, BSN, RN

The 2011-2014 SAMHSA initiatives of recovery support and health reform along with increasing recidivism in the psychiatric population provided the vision for the transformation of a 20-bed inpatient psychiatric unit. This presentation will explore the catalysts for change, planning, implementation and evaluation processes associated with the collaborative, interdisciplinary initiative to launch a recovery based treatment program on a psychiatric unit where the previous treatment delivery model was inconsistent with recovery oriented principles. Participants will learn about the critical psychiatric nursing roles required in transforming the delivery of inpatient care. This will include discussion about the leadership role of the nurse manager in gaining staff buy-in, instilling motivation, providing education, and ensuring nursing accountability in the implementation of a recovery paradigm. It will also focus on the refinement of the nurse practitioner’s role as hospitalist in managing all aspects of patient care and providing clinical leadership to target outcomes for this redesigned inpatient program.


3045: Hearing Voices: Evaluation of a Six Second Simulation

Brenda Marshall, EdD, PMHNP-BC; Julie Bliss, EdD, RN

Background: Simulation teaches nurses about urgent situations without posing any threat to the patient during the learning session. Psychiatric hi tech simulations provide opportunities to interview a bipolar patient or “see”, using special eyeglasses, visual hallucinations. Evaluating the educational worthiness of these experiences on educational impact have not been well documented in the literature. Purpose: This study evaluates the educational impact of a six second in-class simulation of “hearing voices”. Theoretical Framework: Meizirow’s (1981) transformational learning focusing on experience, critical reflection and rational discussion in education. Method: Over a three year period (2010-2013) over 200 undergraduate nursing students engaged in the six second “hearing voices” simulation during a mental health class. Sixty randomly chosen, anonymous self-reflective papers were analyzed using ATLAS ti7 software to identify common recurring themes. Findings: Preliminary results demonstrate that students report increased empathy for the schizophrenic patient, a deeper understanding of the stress and anxiety a schizophrenic patient experiences and a professional determination to engage in therapeutic communication techniques to support the clients road to recovery. Future Implications: Developing short, effective experiential learning simulations for psychiatric mental health education would transformational learning experiences that can increase understanding of the importance of developing strategies for therapeutic communication.


What You Really Need to Know About Menopause, Prescribing & Depression for Advanced

Margit B. Gerardi, PhD, RN, WHNP

It is well established that rates of depression for women peak from 45 to 64 years of age. What remains more elusive is the role of estradiol in the aging brain as the many activities of estradiol in the human brain have only recently been explored. It has been suggested that estrogen has a role as a trimonoamine modulator for depression and vasomotor symptoms especially in the beginning of menopause. Estradiol influences regionally specific apoptosis, synaptogenesis, and the form of neurons and astrocytes with additional non-estrogen receptor effects influencing ion channels and G protein-coupled receptors. These and other factors need to be considered when prescribing antidepressants for women experiencing peri-menopause and menopause. With regard to prescribing, estrogen has been found to decrease oxidation of some tricyclic antidepressants such as imipramine. Concurrent use of medications and regimens known to induce cytochrome P450 enzymes may increase the metabolism of estrogens and progestogens. Researchers have suggested that certain antidepressant classifications work better in the presence of hormone replacement therapy than other classes (SSRI versus SNRI). APRN’s need to use this information to individualize pharmacotherapy and address important health concerns and related nursing interventions for care of the peri-menopausal and menopausal woman experiencing depression.


3051: APNA's Institute for Mental Health Advocacy: What's New on the Advocacy Scene for 2013

Margaret Halter, PhD, APRN; Christine Tebaldi, MSN, PMHNP-BC

The Institute for Mental Health Advocacy Interactive Panel focuses on advocacy initiatives for the past year. We will describe the initiatives that APNA signed onto and exciting events where APNA took its place at the table. APNA members will share health policy issues happening in their states and solicit feedback. Attendees will be encouraged to interact and share their ideas for APNA's advocacy work.


3052: Child and Adolescent Council Interactive Panel

Sue Odegarden, MA, MS, BSN; Vanessa Genung, PhD, RN, PMHNP-BC, LCSW-ACP, LMFT, LCDC

This panel meeting is an opportunity to address advances in mental health recovery for child/adolescent practice. Share your success stories, recovery principles, and methods to minimize mental health problems for children/adolescents/ families. Go to the APNA website discussion board-post a topic for discussion-describe care that was successful.


3053: Tobacco Dependence Interactive Panel

Daryl Sharp, PhD, PMHCNS-BC, NPP; Susan Blaakman, PhD, PMHNP-BC

The interactive panel will update participants on our progress in implementing APNA's national strategic plan for addressing tobacco dependence with a particular focus on nursing education.


3054: Forensic Psychiatric Nurses Council Interactive Panel

Carrie M. Carretta, PhD, APN, AHN-BC, FPMHNP

Violence and crime are major issues facing practicing psychiatric nurses. Forensic psychiatric nurses are poised to deal with these issues in a variety of settings. The purpose of the Interactive panel is to focus on key issues through interactive case studies involving homicide, suicide, and combined homicide/suicide.



The American Psychiatric Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.