Annual Conference Pre-Conference Session Abstracts

1031: No More Fear: How to Select Medications for use During Pregnancy and Lactation
Lyons Hardy, APRN

ABSTRACT
PROBLEM STATEMENT:
Many clinicians have a knowledge deficit related to prescribing psychotropic medications during pregnancy and lactation.  Increasing knowledge and comfort with prescribing to this population will reduce stigma and improve outcomes for patients. SUMMARY OF EVIDENCE: The safety profile of psychotropic medications during pregnancy and lactation has been researched, and understanding current guidelines in this area can effectively guide practice. DESCRIPTION OF PRACTICE OR PROTOCOL: Many clinicians abruptly discontinue medications or switch to inappropriate medications during pregnancy.  PMHNPs may defer to obstetrical colleagues who do not have expertise in treating psychiatric disorders.  Misconceptions exist about the safety of various medications during pregnancy.  PMHNPs may feel fearful and trepidatious when providing psychiatric care to patients who are pregnant and/or lactating. VALIDATION OF EVIDENCE: Current practice may be based on outdated and inaccurate beliefs about the safety of psychotropic medication during pregnancy and lactation.  Approximately 86% of pregnant patients with psychiatric illness never receive formal psychiatric care.  Patients who are treated may receive suboptimal treatment due to clinician knowledge gaps. RELEVANCE OF PMH NURSING: This topic is relevant to PMHNPs, because it involves prescribing practices for patient populations that PMHNPs will interact with in the course of daily practice.  PMHNPs should develop a working knowledge of an effective selection process for psychotropic medications during pregnancy and lactation.  Any PMHNP working with adults of reproductive potential may be faced with patients who become pregnant or wish to become pregnant during the course of treatment. FUTURE IMPLICATIONS: Enhanced outcomes for patients who are pregnant and/or lactating.  Increased comfort level of clinicians in treating this population.

 

1032: Group Leader Toolkit I: Overview of Group Theory and Principles, Planning a Group and Opening Strategies
Bethany J Phoenix, PhD, RN, CNS, FAAN; Frannie Pingitore, PhD, RN, PMHCNS-BC, CGP

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

 

1033: Psychotherapy Training Using Simulation
Michael Terry, DNP, FNP, PMHNP

ABSTRACT
PROBLEM STATEMENT:
Although simulation is a common feature in most PMHNP training programs, the simulated events are typically focused on performing physical exams and psychiatric assessments. The "4th P" in APRN-PMH curricula is supposed to be psychotherapy, yet the use of simulation to train students to perform effective psychotherapy is uncommon. SUMMARY OF EVIDENCE: 98% of APRN programs in the U.S employ simulation as a component of training according to a 2018 survey published in the journal, Clinical Simulation in Nursing. The use of clinical staff, faculty or actors to portray patients in the training of health care professionals has been in use since 1963. State and national accreditation agencies support the use of simulations and in some cases permit simulation hours to substitute for direct patient care hours. Training in psychotherapy, however, has been focused on feedback from supervisors and/or faculty employing two-way mirrors and recording of sessions; and this modality is typically limited to the training of therapists in programs for psychologists, MFTs and Social Workers but not PMHNPs. DESCRIPTION OF PRACTICE OR PROTOCOL: Using professional actors to portray patients in simulated sessions to provide the formative evaluation to PMHNP student therapists versus summative evaluations designed to determine competency in assessment alone. VALIDATION OF EVIDENCE: Our program evaluates students through direct observation by faculty, feedback from actors(patients) and grading of a submitted psychotherapy note with appropriate coding. RELEVANCE OF PMH NURSING: Student confidence and skills providing psychotherapy increased as a result of providing 3 simulated events per course for 3 courses. FUTURE IMPLICATIONS: PMHNPs entering the workforce after graduation are better prepared to provide psychotherapy.

 

1034: Psychotherapeutic Treatment of Male Survivors: A Gender-Cultural Competence Approach
Andrew M Walker, BSN, RN-BC

ABSTRACT
PROBLEM STATEMENT:
Sexual victimization of males is common and exponentially increases risk for negative mental health outcomes, especially suicidal ideation and attempts. Masculine gender norms exacerbate these outcomes and may unintentionally be reinforced by providers delivering psychotherapeutic treatment. THEORETICAL FRAMEWORK: With its emphasis on nurses' ethical obligation to prevent health inequities, "The Process of Cultural Competence in the Delivery of Healthcare Services" by Dr. Josephina Campinha-Bacote provided a social justice framework for this quality improvement project. METHODS AND DESIGN: Using a mixed methods pre-/post-intervention design, providers' gender-cultural competence (GCC) was measured before and after a 60-minute educational workshop about male gender role socialization and male sexual victimization. Change in GCC was evaluated via Wilcoxon Signed Ranks tests. Open-ended questions were coded and summarized via conventional content analysis. RESULTS: Providers’ (N=8) GCC increased significantly (Z=-2.52, p<.012) from pre- to post-test. Greater increases were seen in providers’ cultural knowledge (Z=-2.53, p<.012), cultural skills (Z=-2.52, p<.012), and cultural experience (Z=-2.46, p<.014) than in cultural humility (Z=-.71, p<.480) and cultural awareness (Z=-1.53, p<.127). Providers also reported increased comfort working with male clients and improved perceptions of the ability of therapeutic work with male clients to increase their respect and appreciation for gender differences. IMPLICATIONS (PRACTICE): Providers are eager to meet the treatment needs of males and male survivors, but a lack of organized, relevant, and evidence-based resources is a significant barrier to culturally-competent treatment. IMPLICATIONS (RESEARCH): Future research should further explore the concept of GCC and continue to develop, refine, and validate a GCC scale for use in measuring educational outcomes in GCC interventions.

 

1035: Assessment and Planning of Communication and Safety Needs Provide Optimal Outcomes for the Autism Spectrum Disorder (ASD) Patient in an Inpatient Setting
Wendy Dunn, RN, BSN; Sarah Aielli, MS, CCC-SLP; Robin Brewer, M.ED; Krista Keehn, MSN RN-BC

ABSTRACT
PROBLEM STATEMENT:
All psychiatric patients deserve to be provided with the safest care possible. Clinical staff working within a psychiatric and behavioral health division should be resourced with proper training, tools and equipment to properly serve patients with ASD when providing treatment on a non-specialized inpatient unit. SUMMARY OF EVIDENCE: The CCHMC Division of Psychiatry has ten inpatient units serving over 100 beds.  One unit is specialized to serve the needs of the ASD population. However, the demand to serve these patients is rapidly growing and the bed availability is limited. Patients are regularly admitted to non-specialized inpatient units and require individualized care to meet their treatment needs and keep patients and staff safe. DESCRIPTION OF PRACTICE OR PROTOCOL: An in-depth interdisciplinary assessment process is required to evaluate patient needs and create an appropriate treatment plan.  Implementation of an Initial Behavioral Assessment (IBA), communication tools and Personal Protective Equipment (PPE) will equip direct care staff to individualize care while maintaining safety. VALIDATION OF EVIDENCE: Proper training and implementation of treatment protocols decrease incidents of patient and staff injury. Measurable outcomes align with department strategic goals which include decrease in OSHA recordable events as well as a decreased use of seclusion and restraint. RELEVANCE OF PMH NURSING: Direct-care staff are provided with the tools necessary to maintain safety and achieve optimal patient outcomes. FUTURE IMPLICATIONS: All nurses can be more equipped to serve the ASD population when trained to assess the behavioral and communication needs along with need for proper PPE.  This will allow for individualized care and safety for all.

 

1036: Antipsychotic Reduction in Nursing Homes: An Evidence Based Practice Protocol
Nancy M. Birtley, DNP, APRN, PMHCNS-BC, PMHNP-BC

ABSTRACT
PROBLEM STATEMENT:
Antipsychotic medications pose significant risk to elderly dementia patients and are frequently prescribed as first line treatment for behaviors associated with dementia in long term care (LTC) facilities.  LTC facilities are often cited by the Centers for Medicare and Medicaid for inappropriate antipsychotic use. SUMMARY OF EVIDENCE: A literature review of 17 rigorous research studies was conducted to determine psychotropic risk and efficacy in treating dementia behaviors. DESCRIPTION OF PRACTICE OR PROTOCOL: An evidence based practice clinical protocol establishing a hierarchy of psychotropic medications based on risk and efficacy was developed to guide clinicians practicing in LTC facilities away from the use of antipsychotic medications and toward the use of potentially safer and more efficacious psychotropic medications in dementia treatment while offering flexibility for clinical judgment. VALIDATION OF EVIDENCE: The rate of antipsychotic use in LTC facilities as reported by the Centers for Medicare and Medicaid Services was used to measure effectiveness of this protocol. RELEVANCE OF PMH NURSING: This protocol is associated with a reduction in antipsychotic use in the treatment of LTC residents suffering from dementia. Facilities where this protocol is used have lower rates of antipsychotic use than the state where this study occurred and than the federal rates. FUTURE IMPLICATIONS: This evidence based practice protocol has the potential to further reduce inappropriate use of antipsychotic medications in the treatment of dementia in LTC facilities.

 

1037: Behind the Curtain: Insights into the JAPNA Manuscript Review Process for Authors and Reviewers
Janice Goodman, PhD, PMHCNS-BC, PMHNP-BC; Geraldine Pearson, PhD, PMH-CNS, APRN, FAAN

ABSTRACT
PROBLEM STATEMENT:
Disseminating PMH nursing knowledge, expertise, and ideas is critical to the profession and is necessary for continuing advancements that promote optimal nursing care. This workshop will demystify the peer review/publishing process and provide aspiring authors and reviewers with practical tips and expert advice to facilitate writing, reviewing, and publishing success. SUMMARY OF EVIDENCE: Professional scholarly journals depend on practitioners and researchers in the field to write for publication and/or to provide peer-review to ensure quality manuscripts that meet the needs of the profession. DESCRIPTION OF PRACTICE OR PROTOCOL: Writing for publication and peer-reviewing are skills that can be developed through education, mentorship, and support.  JAPNA editors will offer pointers to help aspiring authors convert good ideas into published work.  Identifying and overcoming pitfalls, ethical issues, and effective use of resources also will be discussed. JAPNA editors and editorial board members will provide hands-on small group opportunities for questions and consultation. VALIDATION OF EVIDENCE: Outcomes will be determined via feedback about the workshop, by an increase in number of quality manuscripts submitted to JAPNA and by increase in volunteer peer-reviewers for JAPNA. RELEVANCE OF PMH NURSING: Writing for publication is essential for disseminating knowledge, sharing innovative practice ideas, and promoting best practice in PMH nursing. FUTURE IMPLICATIONS: PMH nursing will be strengthened as PMH nurses disseminate their unique knowledge and expertise through publication in JAPNA and other journals.

 

1041: "Not Just a Little Here and a Little There". Optimizing Best Practice Strategies For the Safe Cross-Titration and Tapering of Psychotropic Medications in Children and Adolescents
Nancy Noyes, PPCNP-BC, PMHCNS-BC; Meredith McCauley, PharmD, BCPS, BCPP

ABSTRACT
PROBLEM STATEMENT:
There are no current specific guidelines regarding the safe titration and cross-tapering of psychotropic medications. This lecture will provide best practice treatment recommendations based upon general principles of pharmacokinetics . If cross-titration or tapering occurs too quickly, it can quickly destabilize the patient potentially prompting a psychiatric hospitalization, or increase the risk for suicidal ideation. SUMMARY OF EVIDENCE: This is limited clinical evidence guiding clinical practice with cross-titration and tapering of psychotropic medications in children and adolescents. NP's often learn this skill through experience in clinical practice. It is important to understand which neurotransmitters are targeted with specific medications,  implications of drug-drug interactions and and appropriate speed for cross-titration and tapering of psychotropic medications. DESCRIPTION OF PRACTICE OR PROTOCOL: Current practices depend on the clinical mentorship and training of the NP in addition to ongoing experience in clinical practice. This is often a challenging skill for the novice NP. Ongoing education and consultation by NP's with pharmacists and professional colleagues is essential to help guide safe clinical practice when tapering or cross-titrating psychotropic medications. VALIDATION OF EVIDENCE: Little evidence exists for effective strategies for cross-titration or tapering of psychotropic medications. This is often based on the practitioner's clinical experience. Decreased patient destabilization and inpatient psychiatric admissions are key measures of effectiveness. RELEVANCE OF PMH NURSING: With increased complexity of co-morbid psychiatric disorders, cross-titration or tapering of medications are common in practice. Decreased patient destabilization and inpatient admissions are desired outcomes. FUTURE IMPLICATIONS: NP educational programs should incorporate more psychopharmacology content to address best practice related to cross-titration and tapering of psychotropics. This will decrease symptoms destabilization.

 

1042: Group Leader Toolkit II:  The Working and Ending Phases of Group and Strategies to Manage Challenging Behaviors
Frannie Pingitore, PhD, RN, PMHCNS-BC, CGP; Bethany J Phoenix, PhD, RN, CNS, FAAN

ABSTRACT
PROBLEM STATEMENT:
Psychiatric nurses at all levels of practice lead groups for patients of all ages and in a variety of settings including inpatient, partial hospital programs and outpatient. Nurses lead a range of groups including process-oriented, supportive, skill-building and psycho-educational.  While many nurses lead groups, training of effective leadership and facilitation has been limited.  This session will offer nurses an opportunity to enhance skills of group facilitation with a focus on working and ending phases of groups.  In addition, strategies to manage challenging group dynamics will be addressed. SUMMARY OF EVIDENCE: Literature reviews demonstrate that group psychotherapy is as effective or more effective than individual therapy, and is more cost effective. Yalom's therapeutic factors in group psychotherapy bring about positive results for members where changes happen and healing takes place.  Nurse group leaders with an understanding of Yalom's therapeutic factors can enhance patients' group experiences. DESCRIPTION OF PRACTICE OR PROTOCOL: This presentation, which continues Group Toolkit I, will highlight the components of the working and ending phases of groups, including practical and theoretical components. Also, strategies to address challenging member behaviors and group processes will be presented. An experiential group simulation will be included. VALIDATION OF EVIDENCE: Participants will be asked to reflect on the knowledge gained in the workshop and how it can be applied to their practice. RELEVANCE OF PMH NURSING: Psychiatric nurses can positively impact a range of patients through group work. FUTURE IMPLICATIONS: Psychiatric nurses will become more confident and effective in leading a range of therapeutic groups.

 

1043: Yes, And! : How to Engage Patients in Therapeutic Groups through Improvisational Techniques!
Leilanie Ayala, MSN, PMHCNS-BC, PMHNP-BC; Stephanie Anderson, BA

ABSTRACT
PROBLEM STATEMENT:
Nurse-led groups are one of the main components of a therapeutic milieu environment in the inpatient psychiatric setting.  However, facilitating a therapeutic group can be challenging for nurses. The use of innovative approaches such as improvisational techniques in a group can help improve patient experiences and help lessen nurses’ anxiety in leading the groups. SUMMARY OF EVIDENCE: When implemented in a group experience, improv has been shown to serve as an alleviator of symptoms of anxiety. In addition to inspiring creativity, the act of improv has the ability to give patients a way to express their emotions without the fear of shame or doubt. DESCRIPTION OF PRACTICE OR PROTOCOL: The project consisted of four phases: 1. Finding the Evidence: Team of nurses reviewed the literature for best practice. 2. Obtaining Support: A project proposal was submitted to the nursing leadership for financial support and approval. 3. Staff Education- mandatory staff 4-hr education was implemented during the summer of 2019. An improv instructor with a background in mental health conducted the training.4. Application of Improv Techniques in Groups - At present, the use of improv strategies are incorporated in psychosocial group discussions VALIDATION OF EVIDENCE: Patients were surveyed to determine their level of satisfaction related to nurse-led groups. Staff provided feedback about the 4-hr improv class. RELEVANCE OF PMH NURSING: The use of improv techniques in a therapeutic group setting was well received by both patients and staff. There was a notable increase in group participation in groups where improve techniques were used. FUTURE IMPLICATIONS: The use of improvisational techniques is a safe and effective way of engaging patients in therapeutic groups. Through improv training, nursing staff can help identify and manage their anxiety when leading a group.

 

1044: Use of Mindfulness Practices to Enhance Mental Health and Physical Well-being
Nasrin Falsafi, PhD, RN, PMHCNS-BC, AHN-BC

ABSTRACT
PROBLEM STATEMENT:
In private practice, I worked with clients with depression and/or anxiety. Some clients complained about the side effects of medications and the costs associated with them. I used both regular psychotherapy techniques and holistic interventions including mindfulness with my patients. I received positive feedback. SUMMARY OF EVIDENCE: In a research study, I used mindfulness, self-compassion, and yoga with depressed and/or anxious patients from two clinics. Findings indicated that interventions were effective in helping patients reduce depression and/or anxiety. In another study, I randomized 90 students who were depressed and/or anxious into three groups (mindfulness, yoga, and control).  The results indicated that both interventions were effective in helping students cope with depression and/or anxiety and stress. DESCRIPTION OF PRACTICE OR PROTOCOL: I conducted a study on the use of mindfulness with patients in cardiac rehabilitation. At the end of training, some of the participants indicated that anyone who attends cardiac rehab should take the training. In a few months, I received an invitation to offer the training to cardiac patients on a regular basis. VALIDATION OF EVIDENCE: At the end of training sessions, the participants completed an evaluation form. 100% of participants recommended the training to other cardiac rehab patients. RELEVANCE OF PMH NURSING: Mindfulness practices have relevance to clinicians in inpatient and outpatient mental health settings. Psychiatric settings already use group treatment modalities; therefore, it is easy to add group mindfulness practices in patient activities. FUTURE IMPLICATIONS: These practices have implications for cost-effective treatment for patients with depression, anxiety, and stress. Mindfulness-based practices don’t have side effects, and once learned, patients can apply them without medical costs.

 

1045: Addressing the Needs of Individuals with Autism Spectrum Disorders and Intellectual and/or Developmental Disabilities on Inpatient Psychiatric Units
Kristen Kichefski, MSN, MBA, NC-BC

ABSTRACT
PROBLEM STATEMENT:
Addressing the clinical needs of individuals with mild to moderate presentations of Autism Spectrum Disorders (ASD) or other intellectual and/or Developmental disabilities (ID/DD) presents a challenge for nurses on inpatient psychiatric units.   When acute psychiatric hospitalizations are required, these individuals have specific sensory supports, de-escalation needs, and medical needs that do not fit the model of care in milieus that focus on group therapy, community, and routines. SUMMARY OF EVIDENCE: It is reported that individuals with ASD/ID/DD have prevalence rates of bipolar disorder, depression, psychosis, and Schizophrenia that are higher than the general population.  Impairments in skills needed for daily living, sensory processing, communication, and adaptability can make the milieu a frightening place.  Nurses need tools to differentiate between behaviors associated with ASD/ID/DD and those associated with symptoms of psychiatric disorders. DESCRIPTION OF PRACTICE OR PROTOCOL: Education on communication strategies, environmental supports, and sensory processing (including sensory seeking and avoiding behaviors) help staff understand and develop an environment that is comforting to the patient. VALIDATION OF EVIDENCE: Increased communication with community providers minimizes the difficulty in the transitions to and from inpatient care. Having supports in place upon admission is critical to preventing escalations due to individuals not understanding their surroundings or because staff do not understand the patient’s needs/language. RELEVANCE OF PMH NURSING: Understanding how to recognize the needs of individuals with ASD/ID/DD improves care, minimizes escalation events, and avoids prolonged inpatient stays. FUTURE IMPLICATIONS: More research is needed in this area of inpatient psychiatric care however education can open the dialog and provide nurses with the tools and confidence to care for challenging cases.

 

1046: Private Practice 101: A Risk Management Perspective
Anne Huben-Kearney, RN, BSN, MPA, CPHQ, CPHRM, DFASHRM; Allison Funicelli, MPA, CCLA, ARM, CPHRM

ABSTRACT
PROBLEM STATEMENT:
Patients in these increasingly stressful and polarizing times are presenting with more stress, expressing intolerance and disrespect toward their mental health providers, and verbalizing threats of complaints to the licensing and regulatory boards and/or threats of litigation, especially if the RN APRN is unwilling or unable to meet their demands. SUMMARY OF EVIDENCE: Based on analysis of closed medical malpractice claims, use of risk management best practices reduces the potential for litigation. The educational session is geared to RNs APRNs to proactively mitigate risk in private/office practice. DESCRIPTION OF PRACTICE OR PROTOCOL: Whether as independent practitioners or working under collaborative practice agreements, RNs APRNs need to know how to terminate the relationship with patients and reduce the potential for an allegation of abandonment, how and when to release records, including in response to subpoenas, best practices to obtain truly informed consent and how to objectively, concisely and factually document these and other difficult scenarios. VALIDATION OF EVIDENCE: Outcomes are measured by effective implementation of the risk management best practices by the RNs APRNs as evidenced by fewer complaints to the licensing boards and by decreased litigation involving psychiatric nurse practitioners. RELEVANCE OF PMH NURSING: Based on studies of closed claims, behavioral health nurse practitioners who employ strong risk management strategies have fewer claims and lawsuits and fewer complaints to licensing boards. FUTURE IMPLICATIONS: Knowledge truly is power: the knowledge of risk management strategies will help the RNs APRNs gain the power to better manage their private practice while reducing patient complaints, licensing board investigations, and lawsuits.

 

1047: Formulating Diagnostic Impressions and The Pitfalls of Self-Report
Catherine Carlson, Psy.D. LP

ABSTRACT
PROBLEM STATEMENT:
Detecting a major psychiatric disorder can be very difficult especially when the examinees' self-report is unreliable. A diagnosis based on unreliable self-report will be erroneous. Clinicians need to recognize that subjective data (e.g. self-report) is less reliable than objective data (e.g. behavioral functioning) and patients with mood and thought disordered symptoms often have limited, distorted or no insight into their true psychiatric condition. Detectives do not expect criminals to admit to the crime, they look at the objective evidence and determine whether the self-report is reliable or not. Psychiatric clinicians must do the same to arrive at a valid diagnosis. SUMMARY OF EVIDENCE: I provide several citations that ground the content in state of the art research. Studies detail the interpersonal functioning of manic patients. There is a focus on differentiating personality disorders from Bipolar Disorder and the high comorbidity rates of substance use and anxiety disorders in Bipolar Spectrum. Cited studies address both child and adult populations and the early onset of Bipolar Disorder in the United States. DESCRIPTION OF PRACTICE OR PROTOCOL: Psychological testing, checklists, and/or structured clinical instruments are commonly used in psychiatric assessments but many do not assess 'response set.' Did the examinees' approach to the instrument show underreporting or over-reporting (guarded or exaggerating)? Tests are only tools and the clinician determines the validity of all data. VALIDATION OF EVIDENCE: My presentation shows clinicians how the empirical evidence should be brought to bear on individual evaluations. RELEVANCE OF PMH NURSING: Designed to greatly enhance the diagnostic skills of psychiatric providers. FUTURE IMPLICATIONS: To reduce erroneous diagnoses based on unreliable self-report.

 

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