IV. APNA Recovery to Practice Program

Year 05: October 1, 2013-September 30, 2014

The American Psychiatric Nurses Association (APNA) is one of six awardees to receive a Recovery to Practice (RTP) subcontract to develop and implement a training curriculum that promotes greater awareness, acceptance, and adoption of mental health recovery principles and practices among psychiatric-mental health nurses.

Year 01: A systematic assessment was conducted to determine the status of recovery principles and practices within the discipline of psychiatric mental health (PMH) nursing. Educational gaps were identified and recommendations made for program development.

Year 02: A Recovery to Practice workgroup was formed to begin development of the nursing curriculum and training manual. Persons with mental health lived experience participated in development of the curriculum and as faculty with nurse experts in recovery. The target audience for the pilot programs was identified as nurses who work in psychiatric mental health acute care settings and are recovery naive.

Year 03:  Year 03 included finalizing the RTP curriculum, Acute Care Psychiatric-Mental Health Nurses: Preparing for Recovery Oriented Practice and piloting the content through live facilitated programs. A participant manual was also developed. The first half of the year was spent refining content for the pilot programs and identifying and securing appropriate pilot sites to deliver the curriculum content. The curriculum was piloted in Texas, North Carolina and California. Feedback from the pilot programs was used to evaluate the effectiveness of the nursing curriculum and manual content.

Year 04: A fourth pilot program was delivered as a preconference during the APNA Annual Conference on November 7, 2012 in Pittsburgh, PA. The program was audio/video recorded for development of the final program to be disseminated in Year 05. Feedback from program participants and SAMHSA reviewers was incorporated into the final curriculum. Six modules were developed to address knowledge, skills and attitudes related to recovery nursing practice.  Year 04 changes to the program included the following:

  • Individual program focus was transitioned to facilitated discussion format.
  • Facilitator training was developed to include video content and live exercises for group training.
  • Facilitator manual was developed and participant manual was revised.
  • Modules were shortened to allow more time for discussion of the consumer perspective.
  • Content for modules 3 & 4 was redeveloped to include nursing self-assessment of attitudes, verbal and nonverbal communication and recovery language.

Program faculty: Four recovery leaders delivered the content for the APNA RTP pilot programs. Program faculty included: Eric Arauz, MA, MLER; Jeanne A. Clement, EdD, PMHCNS-BC, FAAN; Kris McLoughlin, DNP, APRN, PMH-CNS, BC, CADC-II, FAAN; Mary D Moller, DNP, APRN, PMHCNS-BC, CPRP, FAAN. Eric Arauz provided perspective throughout the program from both professional and personal experience. Faculty met in person and through conference calls to prepare, debrief and revise content and/or process for each pilot program. Support for faculty and all phases of the RTP program was provided by APNA staff members. Program materials were developed by APNA staff

Program content: Program objectives were developed from the learning needs that were identified in the Year 01 analysis. Program content was developed to include foundational knowledge of recovery with experiential learning related to nursing attitudes and recovery-oriented nursing care. Trauma, language, person-centered care and culture were included in the curriculum. Content was organized by knowledge, skills and attitudes. Content was revised in year 04 to incorporate feedback from pilot programs and content expert reviews. Learning objectives for the program included the following:

  1. Identify at least three areas of the recovery movement that will have an impact on nursing.
  2. Identify at least three aspects of nursing care that can be modified to become recovery-oriented.
  3. Identify three ways in which nurses can use their life experiences and those of persons with mental health and/or substance use conditions to promote recovery in inpatient settings
  4. Describe at least two ways in which the attitudes of nurses impact the implementation of recovery-oriented nursing intervention
  5. Name 2 Standards of the PMH-Scope and Standards of Practice and identify a key part of the Standard
  6. List at least 3 psychiatric-mental health nursing interventions and connect them to recovery-oriented outcomes

Pilot sites: 23 hospitals volunteered to pilot the APNA RTP nursing curriculum. Sites were screened for location (geographic distribution), type of hospital, size of facility, number of nursing staff, types of units, and commitment of administrative support. Sites that had no previous experience with recovery were contacted for more information and to confirm availability and commitment. APNA requested that hospitals recruit a minimum of 25 nurses for each pilot program.

Participant Pilot programs: Round 1- Four full-day programs (ranged 6 – 8 hours) were conducted to pilot the RTP nursing curriculum, Acute Care Psychiatric-Mental Health Nurses: Preparing for Recovery Oriented Practice.  Nurses who attended the entire program and completed an evaluation were awarded continuing nursing education contact hours. Nurses who participated in the pilot programs confirmed the need to deliver the RTP nursing curriculum in a discussion format using trained facilitators.

Facilitator Pilot programs: Round 2 - Nurses reviewed and evaluated video content prior to attending a live pilot training to learn to facilitate RTP programs. Nurses earned contact hours when they completed the entire program and an evaluation.
 

Acute Care Psychiatric-Mental Health Nurses: Preparing for Recovery Oriented Practice
Pilot programs - Round 1
Pilot
Date
Location
Format
Participants
1
May 2012
Los Angeles, CA
Live
24
2
June 2012
Dallas, TX
Live
41
3
July 2012
Greensboro, NC
Live
21
4
November 2012
Pittsburgh, PA
Live
25
Pilot Programs - Round 2
1
September 2013
 
Online
62
2
October 2013
San Antonio, TX
Live
89


Year 05: Year 05 began with the delivery of a live facilitator training in October, 2013 at the APNA Annual Conference. Attendees previewed online video content prior to the live training and evaluated:

  • Technical aspects of the program (access, usability)
  • What they liked most/least about the program
  • How they intended to use the program (orientation, lunch & learn, educate students)
  • Additional tools needed to implement training in their facility

Participants of the online program indicated that the video content was easy to access but depended on individual technology available through facilities. APNA made revisions to program materials based on feedback from the facilitator training. In December, 2013, APNA invested in an updated platform for program delivery. APNA also provided trained facilitators with video content in DVD format so that the RTP program could be delivered in any setting regardless of internet capabilities.

APNA support for facilitators was sustained during Year 05 through an APNA online community, a recovery mailbox (recovery@apna.org) and through bimonthly conference calls to facilitate ongoing education, assist with problem solving and CE support.  The online site was used to share resources for nurses who were planning RTP trainings. New facilitators were given access to this site so that they could access RTP training materials and participate in facilitator discussion.

In February, 2014, APNA initiated virtual facilitator trainings using web based and teleconference resources. APNA successfully conducted 5 facilitator trainings between February and May, 2014 and trained 34 new RTP facilitators.

To date, 1230 individuals have completed the APNA’s Recovery to Practice educational program through 4 pilot and 46 facilitated accredited programs; and 123 nurses have completed the APNA facilitator training. Additional programs may have been delivered by facilitators but were not accredited or reported to APNA.
 

Dissemination – Facilitated RTP Education January – September 2014
Date
Location
Participants
Disciplines
January
Texas
21
RNs, Case manager, CNA
February
Texas
Nebraska
55
RN leadership; RNs; NP; Army nurses; LVN
March
 
California
7
RNs Therapist
April
Tennessee
Colorado
California
195
RNs; LVN; BH Techs. Social Workers;
MH Specialist; OT; PT
May
California
North Carolina
Colorado
239
RNs, BH Techs; Social Workers; LMFT; Case Managers; Rec Therapist; Psychologists; CNA; PT/OT
June
California
Tennessee
New Mexico
New York
104
RNs; BH Techs; Therapist; ER/ Med-Surg & ICU nurses
 
July
 
Nebraska
New Mexico
Massachusetts
Oklahoma
103
RNs; CNAs; Psychologist
 
August
North Carolina
New Mexico
Nebraska
New York
245
RNs
September
Virginia
Nebraska
150
RNs


Participant Comments:
Participant comments supported the nurses’ appreciation for bringing recovery into nursing practice and they reported that they would change their practice to include recovery.

  • Several nurses commented that the program was inspiring.
  • Most helpful "psychiatric" specialized nursing training I've had since orientation. This is an awesome model.
  • Renewed hope for PMH nursing practice.  “Gave us practical tips on how to make the change to recovery practices.”
  • “I look forward to on-going updates and to implementing methods as a central part in our culture change efforts.”
  • Nurses repeatedly commented on how helpful it was to have Eric Arauz provide his personal experience and guidance throughout the knowledge, attitudes and skills content. “Eric’s input was invaluable!”

Participants also requested additional education in recovery oriented nursing practice that would focus on additional content in trauma informed care, overcoming challenges to implementing recovery practices with limited community support, and effective engagement in the recovery process with persons and families who have been using services in the mental health system for many years.

Facilitator feedback included the following:

  • Facilitators confirmed that the RTP content should be delivered as an interactive  discussion based program in order to facilitate change in nursing practice.
  • The program facilitator guide, presentation slides, participant handouts and video   content were usable and easily adaptable from one full day live training to live training delivered in 3 parts/components
  • Facilitators reported that the recovery content presented was appropriate for a multidisciplinary audience.

Some challenges experienced with training facilitators and delivering content included:

  • Internet access for streaming video content was inconsistent
  • Individuals attended facilitator training without adequate preparation or with varied recovery knowledge and the scheduled training time did not allow for leveled participation
  • RTP training could not be delivered at one state hospital due to the inflexibility of the hospital’s processes and procedures.
  • Difficulty scheduling facilitator training that could accommodate individual’s availability across the country
  • Reporting of programs delivered did not always happen in a timely manner

APNA will continue to disseminate and sustain the Recovery to Practice program after September, 2014. APNA will maintain the APNA recovery webpage, recovery mailbox, online facilitator community and facilitator trainings for APNA members and nonmembers. APNA will continue to promote the RTP content as a facilitated program and will offer continuing nursing education contact hours for a small fee. Two modules of video content will be available for viewing free to the public via the APNA website. Organizations that wish to offer the complete facilitated program will pay a small fee for training, use of materials, video content and online support from APNA. Additional information can be obtained through recovery@apna.org.

 

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

AMERICAN PSYCHIATRIC NURSES ASSOCIATION and APNA-Logoare registered in the U.S. Patent and Trademark Office as trademarks of the American Psychiatric Nurses Association.
The American Psychiatric Nurses Association is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.