A Graduate Education Faculty Toolkit: Let’s Do It!
Beth M. King, PhD, APRN, PMHNP-BC; Sara Banzhaf, DNP, APRN-NP, PMHNP-BC; James F. Adams, PMHCNS-BC; Maureen Donohue-Smith, PhD, PMHNP-BC; Krystyna de Jacq, PhD, PMHNP-BC; Liz Hutson, PhD, APRN-CNP, PMHNP-BC; Latonia Chalmers, MSN, PMHNP-BC; Lyons Hardy, MS, RN, P-MHNP; Dorothy Jordon, DNP, APRN, PMHNP-BC, PMHCNS-BC, FAAN; Karen G. Pounds, PhD, PMHCNS, BC; Marian Farrell, PhD, PMH-CNS, BC, CRNP, CS
PROBLEM STATEMENT: The purpose of this workshop is to advance development of the Graduate Education Toolkit to support PMHNP faculty and programs in curriculum content, clinical best practices, and resources. SUMMARY OF EVIDENCE: A 2016 national survey of PMHNP programs offers insight into PMH NP educational challenges today: varying clinical hours by population (children, adult, older adult), degree types, varying psychotherapy approaches, preceptor capacity, and pressing need for increased mental health practitioners. Additionally, literature has brought forward the development of expertise in care of children with complex mental health issues and older adults as educational issues. DESCRIPTION OF PRACTICE OR PROTOCOL: APNA’s website currently hosts an Undergraduate Faculty Toolkit, which is nationally recognized by nurse educators. The Education Council Graduate Branch has identified a Graduate Faculty Toolkit as a priority goal and has initiated a national survey of APNA graduate educators which will serve as the grounding framework to build out the toolkit during this workshop. VALIDATION OF EVIDENCE: The National League for Nursing, American Nurses Association, and the American Association of Colleges of Nursing have toolkits, giving credence to the value of toolkits. Toolkits offer expertise in specialty areas, guidance in area of concern, and can facilitate adoption of best practices. RELEVANCE OF PMH NURSING: The outcome of this workshop is a PMHNP graduate faculty toolkit, developed by PMHNP colleagues, and focused on curriculum resources, clinical best practices, and regulatory guidelines. FUTURE IMPLICATIONS: A Graduate Faculty Toolkit can facilitate development of PMHNP programs with foundational similarities, lead to adoption of national best practices, and create a caring collegial community of graduate PMHNP faculty and programs.
A National Organization of Nurse Practitioner Faculty (NONPF) SIG Survey of How PMHNP Program Directors Facilitate Psychotherapeutic Skill Acquisition
Daniel Wesemann, DNP, MSW, APRN, PMHNP; Sean P. Convoy, DNP, PMHNP-BC; Kate Melino, MS, PMHNP-BC; Dawn M. Goldenstein, PhD, RN, PMHNP-BC
PROBLEM STATEMENT: PMHNP provision of psychotherapy varies in practice. It is unclear how many nursing programs revised curricula shifting PMHNP content from psychotherapy to other forms of treatment. This project aimed to survey PMHNP program directors/leads to identify how PMHNP program curricula facilitated psychotherapeutic skill acquisition for students. SUMMARY OF EVIDENCE: NONPF SIG invited all PMHNP programs listed on the APNA website to participate in a national RedCap by email (N = 150). The survey was internally piloted for reliability and usability prior to national dissemination with a response rate of 26%. DESCRIPTION OF PRACTICE OR PROTOCOL: Psychiatric-mental health nursing is grounded in psychotherapy informed by advanced practice nursing role (e.g., clinical nurse specialist). Influenced by numerous factors, the psychiatric mental health nurse practitioner role has come to dominate advanced practice psychiatric nursing, placing the profession’s psychotherapeutic skill set at risk for underutilization and devolution. VALIDATION OF EVIDENCE: Vanderhoef, D. M., & Delaney, K. R. (2017). NONPF: 2016 survey of psychiatric mental health nurse practitioner programs. Journal of the American Psychiatric Nurses Association, 23(2), 159-165. RELEVANCE OF PMH NURSING: PMHNP program delivery methods varied among hybrid, online only, and on-campus options. Cognitive behavioral therapy and motivational interviewing were the most common forms of psychotherapy taught. Most programs deliver psychotherapy content didactically through structured reading and lectures. PMHNP programs reported an average of 173.2 psychotherapy practicum hours (SD 132.9). Qualitative thematic analysis yielded varied educational strategies. FUTURE IMPLICATIONS: Psychotherapy education must be an intentional and consistent component of PMHNP education. The survey findings provide faculty leadership a reference point for change.
An Introduction of Lewy Body Dementia Using a Case Study (SPARK: Robin Williams and His Battle With Lewy Body Dementia)
Keri Greenfield, MSN, AGPCNP, NP-C
PROBLEM STATEMENT: Lewy body dementia (LBD) affects an estimated 1.4 million Americans and is often misdiagnosed as a mental disorder or another form of dementia. LBD is the costliest form of dementia to Medicare. SUMMARY OF EVIDENCE: LBD is characterized by dementia with accompanying parkinsonism, psychosis with prominent visual hallucinations, fluctuations in cognitive function and consciousness, autonomic dysfunction often presenting as constipation and orthostatic hypotension, and rapid-eye movement sleep behavior disorder. DESCRIPTION OF PRACTICE OR PROTOCOL: The clinical diagnosis of LBD requires a thorough history, neuropsychological assessment, and physical examination to determine the presence of dementia, parkinsonism, other supportive features, as well as the absence of other features that may point to an alternative diagnosis. LBD is often misdiagnosed or undiagnosed because the order of symptom appearance and the severity and a combination of features present varies among individuals. Our goal is to deliver an overview of LBD, generate awareness, and provide resources that could help health care professionals in the identification of, and caring for, patients diagnosed with LBD. VALIDATION OF EVIDENCE: A brief overview with references and resources can be found at https://www.lbda.org/wp-content/uploads/2011/02/3737-lbda-physicians-book-22dec17.pdf. If one can recognize LBD in a patient, the activity will be considered effective. Discussing Robin Williams’ journey and his lack of diagnosis may help learners recognize that this disease was a contributor to his untimely death. RELEVANCE OF PMH NURSING: The audience will become aware of the signs and symptoms of LBD to determine when to refer to a specialist. FUTURE IMPLICATIONS: Psychiatric mental health nurses will learn about how undiagnosed Lewy body dementia can affect a person and their family.
Are You High? What Today’s Marijuana Laws Mean to Nursing Education
Cherie Rebar, PhD, MBA, RN, COI; Nicole M. Heimgartner, DNP, RN, COI
PROBLEM STATEMENT: Practice change: Legalization of medicinal and recreational marijuana in certain jurisdictions brings with it numerous questions about how the use of such is perceived, implemented, or banned. The National Council of State Boards of Nursing (NCSBN) has released Guidelines for (1) Nursing Care of the Patient Using Medical Marijuana, (2) Medical Marijuana Education in Pre-Licensure Nursing Programs, and (3) Medical Marijuana Education in APRN Nursing Programs. This session provides the learner with key knowledge about the Guidelines and how use (or banning) of medical and/or recreational marijuana impact policies that affect nursing education programs and the care that students and faculty provide to patients using marijuana. SUMMARY OF EVIDENCE: Evidence that has led to proposed change includes state law regarding marijuana use, and implementation of NCSBN Guidelines. DESCRIPTION OF PRACTICE OR PROTOCOL: Strategies for implementation include creation of policies at the nursing education program level regarding marijuana use by students or faculty, and educational policies regarding how teaching and evaluation occur to meet the NCSBN Guideline for Medical Marijuana Education in Pre-Licensure Nursing Programs. VALIDATION OF EVIDENCE: Efficacy is validated by whether nursing education programs have viable policies in place to address (1) use of marijuana by students or faculty and (2) education of students per the NCSBN Guidelines. RELEVANCE OF PMH NURSING: Policies enacted address current state law, NCSBN Guidelines, and nursing program needs. FUTURE IMPLICATIONS: All nursing education programs must continue watching state law, maintain and update policies accordingly, and observe ongoing Guidelines from NCSBN to ensure best practice in student education and patient care.
Decreasing Externalizing Behavior and Placement Disruption of Out-of-Home Children in Rural Southwest Arizona: A Quasi-Experimental Pretest-Posttest Design
Miriam Espinoza, DNP, RN, PMHNP-BC; Larry Hampton, BA; Lisa Hampton, BSN
PROBLEM STATEMENT: To promote the behavioral health outcomes of out-of-home (OOH) children with a history of maltreatment and explore the effect of enhancing the Arizona state mandated foster parent training (FPT) with verbal de-escalation training (VDT) on child externalizing behavior, caregiver stress, and placement disruption. SUMMARY OF EVIDENCE: FPT is necessary to manage externalizing behavior in OOH children; however, it often does not include skills training in trauma-informed verbal de-escalation (VDT). Parents often report they do not receive sufficient education/support to manage these behaviors despite receiving typical FPT. FPT has the ability to decrease externalizing behaviors of OOH children, which are predictive of caregiver stress and child placement disruption. Thus, providing VDT to foster parents has the potential to positively impact the family’s stress and limit child placement disruption, optimizing the foster child’s behavioral health outcomes across the lifespan. DESCRIPTION OF PRACTICE OR PROTOCOL: Enhancement of typical FPT with a 3-hour multifamily group multimodal trauma-informed VDT was provided to foster/kinship/adoptive parents by certified facilitators. VALIDATION OF EVIDENCE: Individual Parent Daily Report Checklists (PDR) were completed electronically at baseline, and 1- and 2-month post-intervention. Individual satisfaction and demographic surveys were completed at the conclusion of the intervention. RELEVANCE OF PMH NURSING: Participants were highly satisfied with the training and confirmed the need for enhanced training programs for parents of OOH children. Child externalizing behaviors yielded significant improvement in pretest/posttest scores in the high-risk groups (PDR score > 12). FUTURE IMPLICATIONS: Providing VDT for foster parents is minimally burdensome for the family and agency, efficient, cost-effective, and potentially efficacious intervention to decrease health disparities faced by this vulnerable population.
Documentation: Basics and Beyond
Gloria Umali, BSN, RN, MS, MPA, CPHRM; Allison Funicelli, MPA, CCLA, ARM, CPHRM, FASHRM
PROBLEM STATEMENT: Documentation reflects clinical decision making, serves as a means of communication among providers, and is the easiest risk reduction strategy to accomplish but is the most commonly missing piece. With the Cures Act, patients will have increased access to their medical record with intensified focus on what is written about them. SUMMARY OF EVIDENCE: Board complaints and claims often relate to missing or insufficient documentation, especially related to informed consent, and changing/altering a medical record. Knowing how to respond to patient requests to change their record is critical. DESCRIPTION OF PRACTICE OR PROTOCOL: APRNs and RNs will learn best practices for documentation in the medical record, whether paper or electronic, with the opportunity to practice their skills with real-life situations in outpatient settings. Participants will learn how to respond to requests to change records. VALIDATION OF EVIDENCE: Outcomes will be measured by attendees’ demonstration of best practices with documentation, increased confidence by the participants on how to effectively document complex and/or stressful situations, the process for responding to patient requests to change records, and by reducing the risk of a complaint or claim related to inadequate documentation or failure to allow access to their record. RELEVANCE OF PMH NURSING: Review of the basics of documentation, effective use of the electronic record, and the implications of the Cures Act are relevant and timely for PMH nursing. FUTURE IMPLICATIONS: Having the opportunity to practice and learn best practices for documentation will provide immediate and long-term benefit for APRNs and RNs, as documentation reflects on the professional credibility of the practitioner and is the best defense with a malpractice case.
Escaping Orientation and Competencies: Using Escape Rooms to Validate Knowledge
Lesley Worsley-Hynd, MSN, RN, CCRN-K
PROBLEM STATEMENT: New hires are often disengaged during orientation lectures, and current staff express frustration with annual competency requirements. Finding a creative way to engage new hires and validate knowledge of existing staff is imperative. SUMMARY OF EVIDENCE: Nursing professional development research has shown promise in concepts of flipping the classroom and utilizing gamification for increased retention and application of skills. DESCRIPTION OF PRACTICE OR PROTOCOL: I co-created an in-person escape room as a pilot program for orientation with the Nurse Residency Program. We established specific learning goals such as medication safety and infection prevention, and designed concrete skills to measure knowledge. Due to COVID-19, there was a need to adjust in-person learning to virtual. I created a virtual escape room experience and trained other Nurse Educators across VUMC on virtual escape room design. Virtual escape rooms are now being used for Nurse Resident orientation at Vanderbilt Adult & Children’s Hospital and annual competencies at Vanderbilt Psychiatric Hospital. VALIDATION OF EVIDENCE: Six different Nurse Resident groups have completed in-person or virtual experiences with very positive feedback. They express high levels of engagement and appreciate the opportunity to practice critical thinking. The virtual escape room for competencies is currently in process and I will have data by mid-June. RELEVANCE OF PMH NURSING: We live in an environment where it is very difficult to obtain specific patient experiences. Additionally, our learners need highly engaging educational offerings. Escape rooms offer a unique opportunity to create a specific learning environment and keep learners interested and critically thinking. FUTURE IMPLICATIONS: Escape rooms are a creative way to validate nursing skills across a wide spectrum.
Identifying a Clinical Research Question in Your Workplace and Creating a Research Project: A Case Study
Janet Elrod, MSN, RN-BC
PROBLEM STATEMENT: The purpose of this workshop is to give nurses a framework for designing, implementing, and evaluating evidenced-based practice. SUMMARY OF EVIDENCE: How to conduct a literature review, develop a PICO question, the purpose of the institutional review board, and introductory practice change theory will be introduced to the participants. DESCRIPTION OF PRACTICE OR PROTOCOL: Attendees will be provided with a comprehensive reading list and links to the Johns Hopkins Evidenced Based Practice (JHEBP) Model so they can begin or continue their project independently. VALIDATION OF EVIDENCE: Permission has been granted to use the JHEBP Model in this presentation. This model has been designed for nurses and many exemplars of projects using this model are accessible for review online. RELEVANCE OF PMH NURSING: PMH nursing benefits from adoption of evidenced-based practice integrated with patient values and clinician expertise. FUTURE IMPLICATIONS: As a wider variety of data become more accessible through electronic health records, nurses are more able to identify and target health disparities by population. Nurses who develop an understanding of how to translate data into specific questions and resulting interventions will be vital to improving access and outcomes for the populations they currently serve and the populations that are underserved.
Identifying and Recognizing Nurses With a Substance Use Disorder: Implications for the Profession, Promoting Nurse Wellness, and Clinical Practice Policy Development
Donna White, RN, PhD, CNS, LADC-I; B. James, RN, MEd, CARN
PROBLEM STATEMENT: The profession of nursing is almost singularly the most respected profession in the United States. The opioid epidemic has ravaged the country but it is rare to see nurses with a substance use disorder (SUD) being discussed. So often, it is difficult for any professional to share their experience since stigma is pervasive when discussing addiction. SUMMARY OF EVIDENCE: For families of patients to consider a nurse could be an “addict” while caring for their loved one intensifies judgment and stigma. And nurses resist being open to addressing their addiction and may continue to divert and remain caught in the cycle of lying and hiding. DESCRIPTION OF PRACTICE OR PROTOCOL: Policies often are limited and specific to each agency/hospital. The profession would benefit from a unified approach to lessen stigma and punition. VALIDATION OF EVIDENCE: Various researchers have addressed the topic and provided valuable research. Finding willing nurse participants remains a concern since protection of identity remains at the forefront. RELEVANCE OF PMH NURSING: Promoting openness of the issue is not feasible since nurses fear reprisal with self-disclosure. Development of nursing-based recovery groups and safe discussion areas are utilized and offer the nurse a peer-based program of support. Psychiatric concerns are addressed and entry is voluntary and strongly encouraged but not mandated. FUTURE IMPLICATIONS: The admitting of a “problem” which is prevalent in the self-help movement is difficult to promote, since it may impact a nurse’s ability to earn a living. In addition, levels of depressive disorders and potential suicidality remain a constant concern when working with this population. The goal is to return valued professionals back to healthy practice.
Integrating Medications for Addiction Treatment (MAT) Into Whole-Person Care
MaryAnne Murray, DNP, EdD, MBA; Dave Cundiff, MD, MPH
PROBLEM STATEMENT: While federal policy has increasing options for prescribing buprenorphine to patients with opioid use disorder, continued federal restrictions and social/medical misconceptions have limited buprenorphine prescribing, especially among underserved populations, to a fraction of the need. SUMMARY OF EVIDENCE: Jones and McCance-Katz studied prescribers who were waivered in 2017 and found that 24.5% were not prescribing buprenorphine at all; only 13% were prescribing to their patient limit. Boston Medical Center newsletters advise that opioid overdose deaths are decreasing among White persons in the United States due to availability of buprenorphine, while overdose death rates are increasing among Black males and other persons of color. DESCRIPTION OF PRACTICE OR PROTOCOL: The presenters created a successful MAT program to treat persons with opioid use disorders in a rural remote location. The presenters address the practical aspects of creating an MAT program, including clinical and administrative preparation, roles of RNs/APRNs, and sample patient-facing forms. VALIDATION OF EVIDENCE: We have seen patients become stable, become employed and self-supporting, and families restored. RELEVANCE OF PMH NURSING: PMH nurses provide compassionate, nonjudgmental care so that patients feel respected. With this foundation, PMH nurses can facilitate successful MAT programs and perform skillful patient evaluations. Specialized professional development training is available. FUTURE IMPLICATIONS: The need for access to buprenorphine and other MAT continues to grow, especially in rural and impoverished areas. As the United States responds to unmet needs, PMH nurses are likely to see expanding opportunities for participation and leadership in this work. PMH nurses can guide patients and create successful programs which will save lives.
Integrating Psychotherapy Content in PMHNP Curriculum to Improve Person-Centered Care in Practice
Carol Campbell, DNP, APRN, PMHCNS-BC, PMHNP-BC, FNP-C; Sara Jones, PhD, APRN, PMHNP-BC, FAAN, FAANP
PROBLEM STATEMENT: Psychiatric mental health nurse practitioners (PMHNPs) are uniquely tasked with integrating psychotherapy into treatment to assure person-centered care. However, it is challenging for many PMHNP programs to promote competencies in psychotherapeutic modalities. This presentation will discuss the ongoing development and implementation of curriculum that promotes psychotherapeutic competencies among PMHNPs. SUMMARY OF EVIDENCE: The PMHNP Scope and Standards of Practice clearly indicates that PMHNPs conduct individual, couples, group, and family psychotherapy using evidence-based psychotherapeutic frameworks. DESCRIPTION OF PRACTICE OR PROTOCOL: In our hybrid (MNSc/DNP) PMHNP program of study, four didactic hours and 90 to 180 practicum hours are dedicated to psychotherapy. Our curriculum includes innovative strategies to teach competencies in cognitive behavioral therapy, motivational interviewing, group therapy, and trauma-informed care. Strategies include role play videos with peers, family, and friends; a social media forum for peer interaction and feedback; simulated telehealth sessions with faculty and virtual treatment team discussions with peers; and time for personal reflection through reading and workbook assignments. VALIDATION OF EVIDENCE: Using diverse teaching strategies, we facilitate learning for all types of learners—visual, auditory, reading/writing, and kinesthetic. Students recognize the importance of psychotherapy skills, not only in current practicum experiences, but also for future psychotherapy and pharmacotherapy treatment. They also report improved self-efficacy and self-reflection in their practices. RELEVANCE OF PMH NURSING: PMHNP students embrace learning strategies that are outside the box of traditional lectures. Innovative strategies can significantly improve practical learning and future application. FUTURE IMPLICATIONS: By implementing innovative teaching strategies into current PMHNP curriculum, future PMHNPs will be more comfortable and competent to integrate psychotherapy into practice.
Nursing Competency-Based Tobacco Treatment: Seeing Through the Smoke to Translate Evidence Into Effective Tobacco Treatment for Every Patient, at Every Visit, in Every Setting (Part 1 of Four Sessions)
Carol Essenmacher, PMHCNS-BC, DNP; Sara B. Adams, PhD, RN, CNE; Carolyn Baird, DNP, MBA, RN-BC, CARN-AP, CAADC, FIAAN; Julia Houfek, PhD, APRN-CNS; M. Rene Spielmann, DNP, ARNP, FNP-BC, PMHNP-BC
PROBLEM STATEMENT: Tobacco use and dependence (TUD) poses significant population health risks, especially among persons with mental illnesses. Nurses lack consistent standardized tobacco use treatment education. Studies show nurses lacking confidence in TUD intervention skills provide fewer and less effective interventions. The APNA Board of Directors (BOD) commissioned a member task force (TF) to study and address these issues. SUMMARY OF EVIDENCE: Part 1 of a four-part series founded on 300+ peer-reviewed publications, literature by subject matter experts, treatment protocols, practice standards, key stakeholder organizational mission/policy statements, report of Surgeon General, and CPGs. Literature made available through APNA Resources page. DESCRIPTION OF PRACTICE OR PROTOCOL: This is the first of a four-part, train-the-trainer series. This session begins roll out of curriculum for newly constructed Nursing Competencies for Treating TUD. This session includes activities to discover one’s own implicit biases, small group communication improvement activities, validated screening and assessment tools, case study discussions, PowerPoints, and Q&A. VALIDATION OF EVIDENCE: Pre- and posttests will measure changes in knowledge, confidence, and intent to change practice. RELEVANCE OF PMH NURSING: Project outcomes: 300+ sources of information are available on APNA Resources page, serving as foundational knowledge for competencies, conference abstracts, and publications. Nursing Competencies for Treating TUD were created, peer reviewed, approved by APNA BOD, and are on APNA Resources page. FUTURE IMPLICATIONS: Population health and mental health issues are adversely affected by chronic health problems such as metabolic, respiratory, and heart diseases. Decreasing tobacco use can reduce chronic diseases. As one of the largest health care disciplines, nurses educated in effective TUD treatment have an opportunity to improve population health.
Nursing Competency-Based Tobacco Treatment: Seeing Through the Smoke to Translate Evidence Into Effective Tobacco Treatment for Every Patient, at Every Visit, in Every Setting (Part 2 of Four Sessions)
Julia F. Houfek, PhD, APRN-NS; Carol A. Essenmacher, PMHCNS-BC, DNP, NCTTP; M. Rene Spielmann, DNP, ARNP, FNP-BC, PMHNP-BC; Carolyn A. Baird, DNP, MBA, RN-BC, CARN-AP, CAADC; Sara B. Adams, PhD, RN, CE
PROBLEM STATEMENT: Tobacco use and dependence (TUD) pharmacotherapies remain underutilized. Inconsistent evidence adoption hinders use of effective TUD medications. Results: Increased adverse population outcomes, especially in vulnerable cohorts (mentally ill). Covers correct use of pharmacotherapies and innovative applications of TUD medications. SUMMARY OF EVIDENCE: Part 2 of a four-part series founded on 300+ peer-reviewed publications, literature by subject matter experts, treatment protocols, practice standards, key stakeholder organizational mission/policy statements, Report of Surgeon General, and CPGs. Literature made available through APNA Resources page. DESCRIPTION OF PRACTICE OR PROTOCOL: SBIRT benefits and limits are examined. Participants will identify key stakeholders and develop pragmatic, financially sound nursing TUD treatment strategies. Participants learn an array of effective interventions applicable in various clinical settings for a variety of patient populations. Additional skills learned include recognizing teachable moments, creating reachable moments, and maximizing both to improve patient and population health outcomes. Train-the-trainer level of education creates a network of TUD treatment champions who can create a variety of educational sessions for individuals, facilities, and systems. VALIDATION OF EVIDENCE: Posttest data are gathered of knowledge changes, confidence levels, and intent to change practice. Strategies for quality improvement projects measuring long-term patient outcomes provides participants with direct, take to work applications. RELEVANCE OF PMH NURSING: Nurses, the largest health care disciplines, have only modestly engaged in TUD treatment activities and are inconsistently taught competency-based interventions. Nurses need access to scientific education to efficiently deliver innovative care. Participant knowledge and confidence change shapes future TUD treatment education. FUTURE IMPLICATIONS: Knowledgeable, confident nurses are more likely to deliver effective TUD interventions. Widespread nursing TUD treatment improvements enhances population health, improving outcomes for vulnerable populations.
Nursing Competency-Based Tobacco Treatment: Seeing Through the Smoke to Translate Evidence Into Effective Tobacco Treatment for Every Patient, at Every Visit, in Every Setting (Part 3 of Four Sessions)
M. Rene Spielmann, DNP, ARNP, FNP-BC, PMHNP-BC; Carol A. Essenmacher, PMHCNS-BC, DNP, NCTTP; Carlolyn A. Baird, DNP, MBA, RN-BC, CARN-AP, CAADC, FIAAN; Julia F. Houfek, PhD, APRN-CNS; Sara B. Adams, PhD, RN, CNE
PROBLEM STATEMENT: Treating tobacco use dependency (TUD) is often seen by clinicians as a secondary health and mental health issue, resulting in adverse outcomes. Nurses knowledgeable about effects of TUD can advocate for patients to receive effective pharmacotherapy and counseling. Patients and colleagues need scientific, objective information about integrative TUD therapies and ENDS use. SUMMARY OF EVIDENCE: Part 3 of a four-part series founded on 300+ peer-reviewed publications, literature by subject matter experts, treatment protocols, practice standards, key stakeholder organizational mission/policy statements, Report of Surgeon General, and CPGs. Literature made available through APNA Resources page. Evidence shows nurses ask and advise about TUD, yet inconsistently engage beyond treatment referral to other multidisciplinary members. Nurses have opportunities for a greater impact on population TUD health outcomes. DESCRIPTION OF PRACTICE OR PROTOCOL: Participants will be assisted to construct strategies to engage key health care stakeholders in efficacious TUD treatment that lower health care costs and maximizes precious nursing resources. VALIDATION OF EVIDENCE: Series posttest data about knowledge changes, confidence levels, and intent to change practice is captured. Strategies for QI projects measuring long-term patient outcomes will be prepared for participants to engage key stakeholders indirect, cost-effective, evidence-based application. RELEVANCE OF PMH NURSING: PMH nurses are ideally suited to engage others in behavior change, whether it be patient’s behaviors, assisting colleagues to update skills, or facilitating key stakeholder support for systems-level change in TUD treatment. Participants can initiate and engage multidisciplinary colleagues, key stakeholders, and individual patients with TUD treatment. FUTURE IMPLICATIONS: Knowledgeable, confident nurses delivering efficient TUD treatment are more likely to intervene. Widespread nursing TUD treatment improvements improve population health outcomes.
Nursing Competency-Based Tobacco Treatment: Seeing Through the Smoke to Translate Evidence Into Effective Tobacco Treatment for Every Patient, at Every Visit, in Every Setting (Part 4 of Four Sessions)
Carolyn Baird, DNP, MBA, RN-BC, CARN-AP, CAADC, FIAAN; Julia F. Houfek, PhD, APRN-CNS; M. Rene Spielmann, DNP, ARNP, FNP-BC, PMHNP-BC; Carol A. Essenmacher, PMHCNS-BC, DNP, NCTTP; Sara B. Adams, PhD, RN, CNE
PROBLEM STATEMENT: Final of four-session series focuses on local, state, and national tobacco use and dependency (TUD) policy development. Attention is given to constructing scientific inquiries (i.e., PICOT, PDSA) through quality improvement (QI) projects, randomized control trials, and literature review synthesis. Strategies are explored in small group activities. SUMMARY OF EVIDENCE: Part 4 of a four-part series founded on 300+ peer-reviewed publications, literature by subject matter experts, treatment protocols, practice standards, key stakeholder organizational mission/policy statements, Report of Surgeon General, and CPGs. Literature made available through APNA Resources page. DESCRIPTION OF PRACTICE OR PROTOCOL: Attendees will examine and discuss current facility, state, local, and national TUD policies for the purpose of understanding work involved in creating and updating policies. Series attendees are encouraged to regularly network, notifying members of opportunities to engage in policymaking and scientific inquiry. Sample policy writing strategies will prepare attendees to engage in facility and/or local TUD policymaking. VALIDATION OF EVIDENCE: Series posttest data about policy knowledge changes, confidence levels, and intent to change practice is captured. Strategies for QI projects measuring long-term patient outcomes will be constructed to engage key stakeholders in direct, cost-effective, evidence-based application. RELEVANCE OF PMH NURSING: PMH nurses are ideally suited to engage others in examining and negotiating construction of TUD policies, given their effective communication and negotiation skills. PMH nurses can serve as advocacy role models, treatment champions, and resources for competency-based TUD policy and research. FUTURE IMPLICATIONS: Nurses who are knowledgeable and confident in delivering TUD treatment are more likely intervene. Widespread nursing TUD treatment improvement enhances general population health, improving vulnerable population health outcomes.
Pharmacologic Treatment of Bipolar Depression: Moving Beyond the Standard Paradigm
Lyons Hardy, PMHNP; Brian McCarthy, MSN
PROBLEM STATEMENT: Pharmacologic treatment of bipolar depression can be challenging for many clinicians. If patients do not respond to standard treatments or have intolerable side effects, clinicians need to have creative options for treatment that they can draw upon. This presentation will provide a review of standard pharmacologic treatment options for bipolar depression and will also expand participants’ knowledge of less commonly used treatments that are supported by evidence. SUMMARY OF EVIDENCE: Literature related to pharmacologic treatment of bipolar depression has now expanded beyond standard treatment paradigms. Many clinicians are not aware of other treatment options. In addition, pharmaceutical company marketing has impacted practice trends, and clinicians may not be as aware of evidence-based generic drug options. DESCRIPTION OF PRACTICE OR PROTOCOL: Most clinicians are aware of standard treatment options for bipolar depression. Clinicians may be reluctant to use lithium and less commonly prescribed medications. In addition, many clinicians are still using antidepressants to treat bipolar depression, despite the fact that this practice is not supported by evidence. VALIDATION OF EVIDENCE: Literature supports the use of a number of pharmacologic agents for bipolar depression. There is evidence that less commonly known agents such as pramipexole, T3 hormone, amantadine, and others can be effective. RELEVANCE OF PMH NURSING: PMHNPs engage in medication treatment for patients with bipolar depression. This presentation will update participants’ knowledge on this topic. FUTURE IMPLICATIONS: This presentation will enable attendees to provide effective and evidence-based pharmacologic treatment for bipolar depression. Implications include improved quality of life and better symptom control for patients.
Reducing and Eliminating Psychotropic Medications Using the “Ds” of Deprescribing: Practical Application and Case Studies
Erica S. Ramey, DNP, PMHNP
PROBLEM STATEMENT: There is little evidence to support the long-term use of psychotropic medications. Polypharmacy is a growing concern among mental health providers. The need to decrease and eliminate psychotic medications has been identified but prescribers need guidance on where and how to start this process. SUMMARY OF EVIDENCE: There is an increase in prescribing practices that are not evidenced base or safe. These include off label prescribing, polypharmacy, duplication of therapeutic indications, and failure to follow a treatment strategy. The structured approach provides prescribers with a starting point to reduce and eliminate medications to improve patient outcomes and provide more person-centered care. DESCRIPTION OF PRACTICE OR PROTOCOL: There are no current deprescribing practices recognized as standard of care. This presenter will review the structured process for identifying where/how to start deprescribing and build on this information with time for practical application through case examples. VALIDATION OF EVIDENCE: This presenter is engaged in ongoing practice and research applying the deprescribing process on a state level through medication reviews and active practice. Outcomes are measured through continual evaluation of patient outcomes (biometrics, hospitalization, and quality of life). RELEVANCE OF PMH NURSING: PMHNPs have recognized the need to be safer and more judicious in prescribing practices but often do not know where or how to start. The purpose of this presentation is to provide the knowledge and personalized application skills for the PMHNP to start deprescribing safely in their own practice. FUTURE IMPLICATIONS: Safe, person-centered, high-quality care is important for improved patient outcomes in mental health. Rethinking how we prescribe, and how to deprescribe when indicated is imperative.
Revolutionizing Our Teaching Practice: Nursing Education During the Pandemic
Todd B. Hastings, PhD, RN, CNE; Mary Justice, PhD, RN, CNE; Rebecca Kalinoski, DNP, PMHNP-BC; Katherine Lucatorto, DNP, RN; Melissa Neathery, PhD, RN, CNE; Linda Ewald, MS, BSN, RN, PMHCNS-BC; Traci T. Simms, DNS, RN, CNS/PMH-BC
PROBLEM STATEMENT: Nurse educators were challenged to modify classroom and clinical educational pedagogies in response to the COVID-19 pandemic. SUMMARY OF EVIDENCE: The literature indicates a dramatic shift in educational processes and pedagogies required to support nursing education during the pandemic. Nurse educators have responded as change agents in support of new and evolving practices aligned with student-centered learning during this challenging time. DESCRIPTION OF PRACTICE OR PROTOCOL: The challenge of COVID-19 on campuses included social distancing and the need for virtual teaching capabilities prompting a creative response by nurse educators. Nurse educators have developed and modified a range of virtual and hybrid learning activities over the past year and a half in response to nursing program needs. The nurse educator consensus suggests a very effective adaptation to the difficult circumstances associated with remote teaching/learning environments. VALIDATION OF EVIDENCE: Nurse educators associated with the APNA Education Council have come together in collaboration to share novel teaching approaches. This presentation will articulate how educators have coped with distancing and safety protocols to create remarkable and effective clinical and classroom experiences for students. RELEVANCE OF PMH NURSING: Nurse educators in forums such as the APNA Member Bridge have shared and provided relevant feedback about unique and creative strategies for teaching during the COVID-19 crisis. FUTURE IMPLICATIONS: Nursing education is adapting to the recent public health crisis in changing processes and practices. The landscape of nursing education has been modified in creative and effective ways. The new pedagogies will require further validation and research in pursuit of novel best practice.
Simulation Creation: An Innovative Teaching Strategy
Andrea Alexander, FNP-BC, MSN
PROBLEM STATEMENT: Challenges in obtaining clinical placements have necessitated creative ways to assist students to meet clinical learning outcomes. Additionally, students must improve their clinical judgment ability in today’s complex medical environment. SUMMARY OF EVIDENCE: Research shows that new graduate nurses lack critical clinical judgment ability. Innovative strategies are needed to help bridge this gap. DESCRIPTION OF PRACTICE OR PROTOCOL: Student clinical groups collaborated to develop an unfolding case study of a patient with a dual diagnosis. Requirements included medications, orders, laboratory results, and standardized patient direction. VALIDATION OF EVIDENCE: Quality of simulation, student comments, student survey results. RELEVANCE OF PMH NURSING: Student survey results after the experience exhibited that students found creating a simulation to be a challenging, unique, and rewarding experience. The majority of students stated that they found the experience to be equal to or more preferable to a day of on-site clinical. FUTURE IMPLICATIONS: This experience can be replicated in future cohorts and subjects for nursing students.
Successes and Challenges: How to Make Your Research Innovative and Significant
Karen Jennings Mathis, PhD, APRN-CNP, PMHNP-BC, FAED
PROBLEM STATEMENT: Person-centered care is predicated on strong evidence-based (EB) psychiatric nursing research. Informal surveys of APNA members and a random sample of U.S. nurses identified challenges to engaging in research. SUMMARY OF EVIDENCE: Evidence indicates that providing knowledge and mentorship can assist psychiatric nurses to be innovative and successful in research. DESCRIPTION OF PRACTICE OR PROTOCOL: Research Council Steering Committee members will provide a unique opportunity for reflection and discussion of research issues that are critical to psychiatric nurse researchers. This interactive session will provide knowledge and strategies about how to make one’s research innovative and significant. VALIDATION OF EVIDENCE: Two moderators will pose questions to five panelists (Research Council Steering Committee members) at different stages in their research trajectories about key research concepts (idea conception, framing, significance, and innovation). Panelists will provide examples from their own research, highlighting the successes and challenges of how to be innovative and significant while simultaneously promoting person-centered care and mental health through their research projects. Attendees will be encouraged to participate in the discussion through electronic polling and Q&A. RELEVANCE OF PMH NURSING: As psychiatric nurses, person-centered care should be grounded in evidence derived from psychiatric nursing research. Focusing on rigor, innovation and significance in psychiatric nursing research advances psychiatric nursing research and highlights the importance of research practice integration. FUTURE IMPLICATIONS: Reflecting on and discussing both successes and challenges in being innovative and significant in one’s research proposals and program of research will add to psychiatric nurse researchers’ toolkits as they seek funding and conduct research that promotes person-centered care in mental health.
The Design of Outpatient Detoxification
David N. Ampong, DNP, APRN, PMHNP-BC; Michele Burdette-Taylor, PhD, MSN, RN, NPD-BC
PROBLEM STATEMENT: The project provides a pragmatic biopsychosocial model for outpatient detoxification. SUMMARY OF EVIDENCE: The literature findings revealed that outpatient detoxification is feasible, safe, affordable, and effective as the initial principal stage of substance treatment and an alternative for inpatient backlog. DESCRIPTION OF PRACTICE OR PROTOCOL: A biopsychosocial model of detoxification was designed to evaluate, identify, and provide appropriate detoxification for patients seeking alcohol and substance treatment at Alaska Treatment Center (ATC). VALIDATION OF EVIDENCE: ATC’s inclusion and exclusion criteria to identify and provide detoxification were consistent with the ASAM level I and level II ambulatory settings criteria and other clinical studies done in an outpatient setting. The outcomes of the model were measured using the Generic Short Patient Experience Questionnaire (GS-PEQ). Descriptive statistics of demographic and survey responses were presented using counts and percentages for categorical and ordinal variables. Of the 50 participants of the study, 42 responded to the questionnaire. RELEVANCE OF PMH NURSING: The findings revealed 100% successful completion rate of detoxification, significant correlation of the before detoxification (rho = 0.1414, p = .007) and after detoxification (rho = −0.439, p = .769). The findings provide a modified biopsychosocial model of detoxification that PMH can adapt and adopt into their practice. FUTURE IMPLICATIONS: Future projects need to focus on designing a metric or modification of the GS-PEQ instrument that evaluates larger samples to increase variety in the outcomes.
The Interrelationship Between Writing Scholarly Publications and Reviewing Scholarly Manuscripts
Geraldine S. Pearson, PhD, APRN, FAAN; Janice Goodman, PhD, PMHNP-BC, PMHCNS-BC
PROBLEM STATEMENT: JAPNA has enjoyed significant success in submissions, rising Impact factor, and scholarly focus. This workshop recruits and supports reviewers so that the positive direction of JAPNA growth can be supported. The presentation also reflects the views of the presenters: reviewing for publication and submitting written scholarly work are interrelated. SUMMARY OF EVIDENCE: One key to quality in a scholarly journal involves the skill and professionalism of reviewers who choose to support the journal by conducting excellent and honest manuscript review. At the same time, quality is dependent on the excellence of submitted manuscripts for publication. This is the standard of practice in interdisciplinary journals, including nursing. The skill and professionalism involved in both practices are enhanced by planning, writing, and submitting manuscripts. Conducting reviews allows authors to critically review the information submitted to a journal and ascertaining how this will enhance and inform their writing. These relationships will be discussed in this presentation. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently, many nurses are willing to conduct reviews but they are reluctant to write about their work and submit it for publication. This workshop is aimed at encouraging those individuals to write while, at the same time, offering guidance to newer authors who have not been reviewers and might not understand the links between writing and reviewing. VALIDATION OF EVIDENCE: The nursing literature supports the process of manuscript review and writing for publication. RELEVANCE OF PMH NURSING: Writing for publication is essential to dissemination of psychiatric nursing knowledge. FUTURE IMPLICATIONS: Implications will be increased numbers of manuscript reviewers who are also authors and link these activities.
The Person at the Center of the Storm: Integrating Cultural Humility and Trauma-Informed Approaches Into a Behavioral Escalation Support Team
Jessica Vetter, MSN, RN, CNS, PMHNP-BC; Sharon Demeter, MSN, MA, RN, NP, CNM; Marcus Christian, CSPHA; Johnny Vera; Antoine Simmons
PROBLEM STATEMENT: Without a designated psychiatric unit in our hospital, patient behavioral escalations have invoked a response from security. This reactive response is limited by a lack of psychiatric and medical assessment, lack of diagnostic understanding of initiating triggers, historically stigmatizing beliefs, and culturally discriminatory interventions. SUMMARY OF EVIDENCE: Patients with psychiatric issues are at increased risk of harm in medical hospitals. Concurrently, behavioral health crises are implicated in the majority of patient-initiated assaults on nurses. BEST teams have potential to improve outcomes for both patients and staff (e.g., decrease injury, avoid restraints, increase staff skill and comfort) in a cost-neutral way. DESCRIPTION OF PRACTICE OR PROTOCOL: People of color are disproportionately harmed by structural discrimination and security responses. This is also true for people with psychiatric issues. A culturally diverse team reflecting our community was gathered. Issues of discrimination were highlighted during training, and a nonhierarchical, trauma-informed culture was facilitated. Supportive stakeholders include Pharmacy, MDs, Nursing Administration, Campus Police. VALIDATION OF EVIDENCE: Published data on behavioral rapid response teams is primary limited to postintervention descriptive statistics and the use of ad hoc surveys. We sought to extend the existing literature by emphasizing cultural humility and trauma-informed approaches, not having a security member on the team, comparing pre- and post-trial data on trial and control units, using validated tools, examining previously undocumented outcomes, and examining outcomes for statistical significance. RELEVANCE OF PMH NURSING: Analysis pending. To date: 70 calls, 100% de-escalation, no injuries, no security back-up required. FUTURE IMPLICATIONS: These PMHNP-led teams deserve rapid, nation-wide implementation to provide person-centered care with significantly improved outcomes for patients and health care staff.
The Power of Self-Compassion
Nasrin Falsafi, PhD, RN, PMHCNS-BC, AHN-BC
PROBLEM STATEMENT: Nursing is a stressful profession, especially in a COVID-19 environment. Self-compassion practices can be beneficial to nurses in all specialties, particularly mental health nursing. It is also helpful for other health care professionals. It is greatly beneficial to individuals who are working to improve their mental health. SUMMARY OF EVIDENCE: Research indicates that about 31% of nurses experience emotional exhaustion. Self-compassion is a great tool for nurses to help themselves and others. DESCRIPTION OF PRACTICE OR PROTOCOL: Therapists have added self-compassion therapy to their practices. They also realize that practicing self-compassion for themselves improves their own mental health and makes them better practitioners. Self-compassion practices are also being used for difficult medical situations such as post-cardiac rehabilitation. Equally, it can be a beneficial practice for long-term caregivers. VALIDATION OF EVIDENCE: Research indicates that practicing self-compassion improves mental health, increases optimistic thoughts, increases resilience, and overall greater social and emotional skills. RELEVANCE OF PMH NURSING: Depression and anxiety are two of the most common mental health issues in the United States. The benefits of self-compassion training can be helpful with both of those mental health conditions and other mental health challenges. FUTURE IMPLICATIONS: Self-compassion training should be a part of mental health curriculum for nurses, medical doctors, and other health care professionals. They should be encouraged to use it for the patients and for themselves.
TMS 101: A Review of the Evidence and Practice of Transcranial Magnetic Stimulation
Michael Thomas, DNP, APRN, PMHNP-BC
PROBLEM STATEMENT: Repetitive transcranial magnetic stimulation (rTMS) has been a Food and Drug Administration (FDA)–approved treatment for depression since 2008. Psychiatric nurse practitioner programs do not typically prepare their students to provide rTMS treatment, and psychiatric RNs often have a limited understanding of this treatment modality. SUMMARY OF EVIDENCE: Multiple states allow APRNs to provide TMS treatment independently, but APRNs remain underrepresented as TMS providers. Insurances will cover rTMS treatment for individuals with severe treatment resistant depression if they fit certain criteria. DESCRIPTION OF PRACTICE OR PROTOCOL: rTMS for depression is typically provided 5 days per week for between 4 and 7 weeks. There are two FDA-approved depression treatment protocols for rTMS provided over the left dorsolateral prefrontal cortex. Non-FDA-approved treatments for other psychiatric disorders are provided over other areas of the frontal lobe. VALIDATION OF EVIDENCE: There is an estimated 58% treatment response to rTMS for depression, with 37% experiencing full remission. rTMS is better tolerated than electroconvulsive therapy. The effectiveness of rTMS in treating schizophrenia, anxiety disorders, posttraumatic stress disorder, obsessive-compulsive disorder, addictions, attention-deficit hyperactivity disorder, and autism spectrum disorders has also been studied with varying results. RELEVANCE OF PMH NURSING: Psychiatric nurse practitioners trained in rTMS treatment and psychiatric RNs with an understanding of rTMS can help educate and improve access to rTMS treatment for patients with treatment-resistant depression and other psychiatric disorders. FUTURE IMPLICATIONS: An estimated 17.3 million individuals in the United States experienced a major depressive episode in 2017. Up to 60% of individuals with depression do not experience full remission from psychotherapy and antidepressant treatment. It is imperative for PMH nurses to provide and understand other evidence-based treatment modalities for depression.
Trauma in Children and Adolescents: A Roadmap for Assessment, Diagnosis, and Treatment
Marci Zsamboky, DNP, PMHNP-BC, PMHCNS-BC, CNE; Matt Schroer, DNP, PMHNP-BC; Molly Butler, PMHNP-BC
PROBLEM STATEMENT: Since the initial research linking negative health outcomes with adverse childhood experiences (ACEs), myriad studies have provided additional data supporting the cumulative impact of childhood trauma. Recent research indicates that 57.8% of individuals surveyed experienced at least one adverse childhood event, with certain groups of individuals appearing to be more vulnerable to ACEs. Nurses and nurse practitioners are uniquely positioned to assess and treat trauma in youth. SUMMARY OF EVIDENCE: Youth exposed to trauma are more likely to have changes in brain structure and connectivity. These changes can lead to deficits in executive function, as well as emotional, behavioral, and relational dysfunction. Knowledge of the neuroscience and related developmental considerations behind youth trauma provides direction for evidence-based treatments. DESCRIPTION OF PRACTICE OR PROTOCOL: Attachment theory provides context for neuroscience as a model for evidence-based care. Such care includes validated screening tools, assessment strategies anchored in case formulations, and pharmacological and nonpharmacological interventions. VALIDATION OF EVIDENCE: Research on ACEs has flourished over the decades, and the use of trauma-informed care is becoming standard practice across disciplines. RELEVANCE OF PMH NURSING: Nurses are at the forefront of care and are frequently the first health care providers to engage with traumatized youth. This presentation will equip nurses and nurse practitioners with knowledge and skills to optimize health outcomes in traumatized youth. FUTURE IMPLICATIONS: Opportunities for nurses and nurse practitioners include identifying and treating ACEs in vulnerable ethnic and cultural groups, where prevalence of ACEs is greater than in the general population. The intergenerational exposure to adverse events is also significant.
Understanding Loneliness as a Unique and Complex Biopsychosocial Stressor That Requires Intervention to Prevent Its Known Sequelae of Poor Behavioral, Physical, Social, and Functional Health Outcomes
Laurie Ann Theeke, PhD, FNP-BC, GCNS-BC, FAAN
PROBLEM STATEMENT: Loneliness is a prevalent problem reported by up to 35% of mid-life and older adults. The purpose of addressing this topic with the intended RN APRN audience is to increase awareness of the prevalence of loneliness, help nurses to understand risks for loneliness, examine loneliness as a predictor for psychological and physical illness including functional decline, and learn about interventions that have demonstrated effectiveness for diminishing loneliness. SUMMARY OF EVIDENCE: Loneliness elicits a neuroendocrine stress response that is linked to depressive symptoms, cognitive decline, multiple chronic physical health conditions, functional decline, and mortality in mid-life and older adults. Identifying loneliness and providing interventions can diminish loneliness and its sequelae. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently, there is an ICD-9 code and nursing diagnosis for loneliness. Many electronic health record (EHR) systems incorporate measures of loneliness and social isolation but there is a gap in nursing education when seeking to implement interventions for loneliness. VALIDATION OF EVIDENCE: Since 1955, loneliness has been reported to be a health practice and there are thousands of descriptive studies including more recent reviews and meta-analyses that evaluate the effectiveness of intervention on loneliness and its subsequent outcomes. RELEVANCE OF PMH NURSING: Since loneliness is reported as an independent predictor of depression, it should be a priority for psychiatric and mental health nurses. Understanding interventions that can diminish loneliness will be relevant to psych nurse practice. FUTURE IMPLICATIONS: Future work is needed to continue to develop novel interventions for loneliness that can be implemented in health care and community settings. Building evidence on these interventions will influence future practice with lonely people.
We Don’t Have Time! Revisiting the Interpersonal Process and Building Recovery, Resiliency, and Empowerment Into the Nursing Relationship Using Recovery-Oriented Cognitive Therapy (CT-R)
Joseph Keifer, PsyD, BSN, RN; Ellen Inverso, PsyD; Paul Grant, PhD
PROBLEM STATEMENT: Nurses often report that a significant portion of their workday is taken up by tasks other than client contact (e.g., paperwork, administrative tasks). Such demands create challenges to quality person-centered care. SUMMARY OF EVIDENCE: D’Antonio and colleagues observed that Hildegard Peplau called upon nurses to use their relationships with patients. Yet, more than half a century after the publication of Interpersonal Relations in Nursing, a literature review found that at best psychiatric nurses spend 50% of their worktime in contact with patients, and as little as 4% of their time “providing specific therapeutic interventions.” DESCRIPTION OF PRACTICE OR PROTOCOL: Recovery-oriented cognitive therapy (CT-R) operationalizes the relationship turning every nursing contact into a therapeutic one. CT-R capitalizes on defining aspects of the nursing relationship (empathy, care, trust, and hope) to discover, with the individual, meaning, purpose, and a desired life, creating a collaborative relationship to tackle psychiatric problems. VALIDATION OF EVIDENCE: A vast literature supports the importance of connection as basic human need that fosters better physical and mental health outcomes. CT-R has demonstrated efficacy to improve quality of life and reduce psychiatric symptoms. Program evaluation studies show reduced loneliness, increases hope, and promotes flourishing. RELEVANCE OF PMH NURSING: CT-R provides a framework through which nurses can maximize the impact of the time they have to collaborate with individuals. They can accomplish this through strategic and targeted points of connection, which can fall naturally into their existing workflow. FUTURE IMPLICATIONS: Nurses will become more effective in providing person-centered care, developing practical interventions, empowering individuals, building recovery and resilience, and producing better outcomes.
