Annual Conference Friday Abstracts
3051: Benefits and Challenges of Preceptors and Students
Beth M King, PhD, APRN, PMHNP-BC; Dawn Vanderhoef, PhD, DNP, PMHNP-BC, FAANP; Lori Mooney, MS, RN, CRNP-PMH, PMHNP-BC, CRRN; Ruth Isediora, APRN, PMHNP-BC; Jo Anne Iennaco, PhD, APRN, PMHNP-BC
PROBLEM STATEMENT: ANCC requires 500 hours of precepted clinical experience for all advance practice nurses. The APNA Graduate Council and Practice Council will provide a discussion of the the benefits and challenges for preceptors and students. SUMMARY OF EVIDENCE: The availability of qualified PMHNP Preceptors is limited, yet the number of students needing preceptorship has increased dramatically over the last 5 years with the growth of new PMHNP programs. Advance practice nurses with limited clinical experiences are recruited as preceptors without the tools needed to serve in this role. DESCRIPTION OF PRACTICE OR PROTOCOL: The APNA Graduate Council and Practice Council will sponsor a panel discussion related to the benefits and challenges for preceptors and students. Panel members will include faculty and students from both live and online PMHNP programs. VALIDATION OF EVIDENCE: Participants will have an increased understanding of the roles and relationships between preceptors and students. RELEVANCE OF PMH NURSING: Information provided in this panel discussion will lead to improved communication and enhance the student/preceptor relationship. FUTURE IMPLICATIONS: Collaboration between education and practice in addressing relevant issues of today, can lead to improved student outcomes, ultimately leading to better patient care.
3052: Reducing Workplace Violence: A Hospital Wide Initiative to Increase Safety
Marlene Nadler-Moodie, MSN, APRN, PMHCNS-BC; Amy Roark, RN, MSN; Virtud P. Oloan, PH.D, PMHN-RN-BC; Melvin Aranzaso Lumagui, MSN, RN, PMHCNS-BC
PROBLEM STATEMENT: Workplace violence is unfortunately prevalent in the health care arena. A "Sentinel Event Alert" published by The Joint Commission, #59, April, 2018 reviewed "Physical and Verbal Violence Against Health Care Workers". In recent years the ANA, ENA and APNA have all had a focus on workplace violence. Administration and Clinical Leaders are looked to by their staff to ensure that they are working in a safe environment. SUMMARY OF EVIDENCE: "A Call to Action From the APNA Council for Safe Environments" (2019) cited the issue of aggression toward nurses, particularly in psychiatric hospitals, emergency departments and the general acute care settings. A wake up call by staff through satisfaction surveys as well as statistical outcomes which included significant rates of incidents provided the impetus to propose a multi-pronged approach for violence reduction. DESCRIPTION OF PRACTICE OR PROTOCOL: A "rapid improvement event" (RIE) was conducted including members from senior leadership, physicians, nursing leadership and front line nurses, human resources, employee assistance, and behavioral health clinicians. New practices were put in place while some were reviewed, revised and recommended for use. House wide education Risk Screening tool Visual Identifyers Code BURT (urgent behavioral rapid response team) Severe Agitation Order Set Go-Bags Post Event Checklist. VALIDATION OF EVIDENCE: Outcomes measurement of incidents ongoing monthly Committee meets weekly, reviews use of practice change items. RELEVANCE OF PMH NURSING: All practices are satisfactorily in progress at 6 months, results will be reported for 12 months. FUTURE IMPLICATIONS: Much of this practice change can be replicated in other facilities.
3053: Crisis? Escalation or Innovation, It is Your Choice. The Use of Innovative DBT-Informed Nursing Care Techniques and their Impact on Crisis Management in a Child and Adolescent Psychiatric Inpatient Setting
Dawnelle Romero Baca, BSN, RN-BC
PROBLEM STATEMENT: Advancements in treatment and understanding of mental health issues have led to better care for psychiatric patients in a drastically shorter amount of time. However, as result of shorter inpatient stays, patient acuity has intensified making patient healing and crisis management more challenging. Applying an evidenced based model of nursing care such as DBT-informed care, is one such way to bridge the gap. SUMMARY OF EVIDENCE: Frontline mental health workers recognize specific training as a means to increase knowledge, build therapeutic relationships and manage crisis. Staff training in Dialectical Behavioral Therapy (DBT) can assist in addressing these training needs. DESCRIPTION OF PRACTICE OR PROTOCOL: The use of DBT-informed nursing care has shown promising results in those struggling with emotional dysregulation and the reduction of seclusion and restraint events in this inpatient child and adolescent psychiatric setting. VALIDATION OF EVIDENCE: The implementation of a DBT-informed model was monitored on an ongoing basis at a 36-bed hospital. The development of a fidelity index along with extractions of event data was reviewed and evidence supports the use of the model. RELEVANCE OF PMH NURSING: Mental health organizations are in drastic need of quality improvement initiatives in the area of seclusion and restraints as it is stringently monitored and poses a challenge to the psychiatric mental health nurse. Collected data from a 36-bed inpatient psychiatric hospital revealed a drastic reduction in both seclusion and restraint trends and event minutes since the initiation of the DBT-informed care model. FUTURE IMPLICATIONS: Findings supports continued use of a strengths-based model in the psychiatric setting to address educational needs and increase patient and staff safety.
PROBLEM STATEMENT: To examine the contributing factors, manifestations and consequences of moral distress experienced by PMH nursing students and clinical faculty. SUMMARY OF EVIDENCE: Students and faculty sometimes witness events in clinical settings that conflict with their values, professional code of ethics and established standards of practice. When personal or institutional constraints prevent them from acting in the best interest of a patient, they may experience moral distress. DESCRIPTION OF PRACTICE OR PROTOCOL: Students and faculty can often identify the right thing to do in situations that produce moral distress, but fail to act because of a variety of personal factors (perceived lack of power, fear of consequences, etc.) and institutional constraints (unclear chain of command, lack of leadership, etc.) VALIDATION OF EVIDENCE: Several authors have published papers examining moral distress in nursing students and faculty. They've identified contributing factors, manifestations, consequences and implications for nurse educators and clinical institutions. RELEVANCE OF PMH NURSING: Leaders in PMH nursing are working to improve quality of care in clinical settings, but this is a work in progress. Students and faculty regularly witness clinical practices that do not appear to be consistent with standards of care. When students and faculty do not feel equipped or empowered to impact these situations, poor patient care persists and learning opportunities for students are wasted. Students may become disengaged and disinterested in pursuing careers in PMH nursing. FUTURE IMPLICATIONS: Personal and institutional constraints that contribute to moral distress need to be examined, addressed and eliminated. This will require better collaborations between clinical facilities and schools of nursing, better faculty role modeling and modifications in nursing curriculum.
3055: Explore How an Acute Care Medical Facility Defied the Traditional Practices of Standardized Healthcare by Creating a Patient Centered Unit to Meet the Physical and Emotional Needs of More Complex Medical Patients
Stephanie Murray, MSN, RN; Carly Kruszewski, RN-BC
PROBLEM STATEMENT: There is a growing prevalence of complex patients with concurrent medical and psychiatric needs in the acute care hospital setting. These patients lead to longer lengths of stay, increased 1:1 care hours, higher readmission rates, improperly managed care, and have a lack of access to appropriate care. SUMMARY OF EVIDENCE: Underserved poverty level metropolis Above average readmission rates, LOS, care hours and costs for complex patients Number of psychiatric consultations per day Fragmented care between medicine and psychiatry Inconsistent care of patients from community based psychiatric facilities High incidence of compassion fatigue and burnout in nursing. DESCRIPTION OF PRACTICE OR PROTOCOL: Stakeholders: Departments of Psychiatry, Nursing, Medicine Hospital Administration Patients Strategy: Identify unit leadership, roles and responsibilities Created admission criteria Educate nursing, provider groups Partner with facilities management to safeguard clinical environment within licensed medical guidelines Staffing requirements, budgeting, care model, unit processes for care delivery, safety, visitors, and holistic initiatives that differentiate unit from other medical units. VALIDATION OF EVIDENCE: 1st Year average LOS = 5.41 compared to national average of 15 days Decreased organizational 1:1 SI hours ADC Budgeted versus actual Readmission rates Patient satisfaction with unit initiatives Productivity rates. RELEVANCE OF PMH NURSING: Improved access to psychiatric resources Patient compliance with dual diagnoses Enhanced Interdisciplinary collaboration and communication to provide patient centered holistic care Enhanced nursing education to identify and mitigate potential areas of risk without stigmatizing or jeopardizing quality care. FUTURE IMPLICATIONS: A comanaged unit could change the historical definition of care delivery by maximizing the effectiveness of limited and costly resources to meet the complex patient's needs before a crisis manifests.
PROBLEM STATEMENT: Although existing trauma-focused treatments are clearly effective, challenges remain in overall effectiveness, service delivery, and clinical resources needed to support them. For these and other reasons, there is a need for further research of promising novel treatments that might offer additional options for providers delivering trauma-focused care. SUMMARY OF EVIDENCE: Although the most recent and up and coming research on ART to date is promising, further research is clearly needed. Case reports and case series have shown that ART is associated with clinically significant pre- to post-treatment reductions in anxiety and PTSD symptoms in both civilian and military populations. DESCRIPTION OF PRACTICE OR PROTOCOL: ART is an eye movement based therapy that has been successfully delivered in 2-5 treatment sessions and involves no homework assignments by patients. It is used to treat a variety of behavioral health disorders. VALIDATION OF EVIDENCE: ART has been tested in randomized controlled clinical trials compared to attention control condition (similar to wait-list) in approximately 60 combat veterans with PTSD, including many with refractory symptoms. The trial showed 94% treatment completion, significant reductions in PTSD checklist scores (17-20 point average PCL reductions), and a high effect size after an average of only 3-4 sessions that persisted for 3 months, as well as significant improvements in other outcomes (depression, anxiety, anger/aggression, guilt). RELEVANCE OF PMH NURSING: This is a promising treatment modality that can be used safely and quickly by APRNs. There is also a version for RNs that teaches stress reduction techniques. FUTURE IMPLICATIONS: There needs to be more ART and other novel therapy providers and more research on such promising therapies.
3057: Piloting the Children's Program Kit: Supportive Education for Children of Addicted Parents: Addressing the Needs of and Promoting Resiliency for Youth Experiencing a Parent with Opioid Use Disorder
Brandy Mechling, PhD, RN, PMHCNS-BC; Ruthanne Palumbo, DNP, RN, CNE; Nancy Ahern, PhD, RN; Angelena Vandenberg, LCSW
PROBLEM STATEMENT: Opioid use disorder (OUD) is extensive in the U.S. Interventions aim to assist individuals with OUD achieve recovery. However, children of parents with OUD are impacted; garnering high risk for mental illnesses and substance use disorders, with few interventions to assist them to cope. THEORETICAL FRAMEWORK: The purpose of this intervention pilot study was to assess the impact of SAMHSA’s Children’s Program Kit: Supportive Education for Children of Addicted Parents. METHODS AND DESIGN: Participants (N=9, ages 12-17) completed a knowledge pre-/post-test and the Behavioral and Emotional Rating Scale (BERS) (measures interpersonal strength, family involvement, intrapersonal strength, school functioning, affective strength, overall strength index and career strength). Foster parents/social workers completed the BERS parent version. Paired-samples t-tests were used to compare youth OUD knowledge and youth and parent BERS scores. RESULTS: Findings showed a significant difference in youth OUD knowledge pre (M= 11.55, SD= 1.92) to post (M= 14.33, SD= 1.92); t(8)= 4.34, p= <.05, affective strength pre (M= 11.44, SD= 3.77) to post (M= 12.66, SD= 3.77); t(8)= 2.65, p= <.05, and strength index pre (M= 103.44, SD= 11.26) to post (M= 112.55, SD= 11.26); t(8)= 2.43, p= <.05. Career strength index showed a significant difference for youth pre (M= 7.33, SD= 2.78) to post (M= 10.33, SD= 2.78); t(8), 3.23 p= <.05 and parent pre (M= 9.11, SD= 3.04) to post (M= 13.11, SD= 3.04); t(8), 3.95 p= <.05. IMPLICATIONS (PRACTICE): Findings could facilitate focused interventions for children of parents with OUD. Such interventions are needed to promote coping and better outcomes for this population. IMPLICATIONS (RESEARCH): Above.