Poster #1: Collaboration Among Nurse Leaders to Ensure Ongoing Compliance With Psychiatric Mental Health Nurse Scope and Standards of Practice
Robin Conyers, MSOP, BAN, RN
Category: Administration
ABSTRACT
PROBLEM STATEMENT: Continuing work toward sustaining the third edition Psychiatric-Mental Health Nursing Scope and Standards of Practice to fulfill the goal of elevating the practice standards compliance. SUMMARY OF EVIDENCE: A current literature search was conducted related to nurse leadership competencies from the American Organization of Nurse Leaders (AONL). A comprehensive review of the Psychiatric-Mental Health Nurse Scope and Standards of Practice (Third Edition) was completed. A reevaluation of nurse leaders’ self-awareness as individual nurses, inpatient units and the organization’s strengths/weaknesses in practice were compared from 2023 to 2024. These competencies lead to improved patient outcomes, individual nurse performance and employee engagement to meet the high demands of today’s health care and workforce. DESCRIPTION OF PRACTICE OR PROTOCOL: Re-evaluated the 2023 lowest scores identified for the service line roll up; Implementation, Evidence Based Practice and Research, and Coordination of Care. We will continue to involve nurse leaders, unit nurses, and campuses within the behavioral health service line to determine growth in the above three areas and effectiveness of implemented action items. VALIDATION OF EVIDENCE: Continued use of the 2023 scoring algorithm (0–5) and methods for evaluation for standards compliance to provide a framework for action plan and implementation. RELEVANCE OF PMH NURSING: Individual nurse and campus scores were identified in 2023. The changes related to lowest scores from 2023 were implemented. Results from the upcoming 2024 re-survey will be identified within the presentation. FUTURE IMPLICATIONS: The use of the psychiatric and mental health (PMH) Scope and Standards of Practice will enhance competent nursing care resulting in positive patient outcomes, improved employee satisfaction, and pride in being a PMH Nurse!
Poster #2: Thriving Together: Best Strategies to Address Burnout Among Health Care Workers
Kimberly A. Delbo, DNP, RN-BC, CDP
Category: Administration
ABSTRACT
PROBLEM STATEMENT: Burnout among health care workers (HCWs) is a pervasive public mental health crisis and global occupational health problem. SUMMARY OF EVIDENCE: The prevalence of burnout is at an all-time high, thereby making it a high priority for health care organizations (HCOs) and academic institutions. There is a priority call to action for health care and academic leaders, and policy makers to promote health care workforce resilience and well-being through innovation, collaboration, and renewed focus. DESCRIPTION OF PRACTICE OR PROTOCOL: The overall purpose of this session will be to explore, review, critique, summarize, and analyze best practices and interventions to address burnout and promote engagement and well-being among HCWs. VALIDATION OF EVIDENCE: This presentation will provide a comprehensive summary and analysis of past empirical and theoretical literature related to the phenomenon of burnout while sharing a synthesis of literature aimed at identifying best strategies to address burnout and promote engagement and well-being among HCWs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines, Melnyk’s level of evidence pyramid hierarchy, and Whittemore and Knafl’s constant comparison method will be used when presenting this interactive review of literature. RELEVANCE OF PMH NURSING: A total of 16 studies (n = 16) published from 2017 to 2023 evaluating a wide range of interventions to reduce burnout will be highlighted. FUTURE IMPLICATIONS: Information gathered as a result of this presentation may be useful for health care and academic leaders, as well as executives and policy makers when seeking to implement and promote best practice strategies to address burnout among HCWs moving forward.
Poster #3: Elevating Suicide Prevention Through Realigning Safety Planning Intervention to Include Nursing Intervention at Admission and Discharge
Melissa L. Lehman, MSN, RN
Category: Administration
ABSTRACT
PROBLEM STATEMENT: The rate of suicide in the United States hit an all-time high in 2023. The overall suicide rate in Texas increased significantly between 2000 and 2022. Suicide prevention is a priority for all, including for hospital emergency departments frequented by suicidal patients. SUMMARY OF EVIDENCE: Brief Safety Planning Intervention is effective in decreasing future suicidal behavioral in hospitalized patients. DESCRIPTION OF PRACTICE OR PROTOCOL: Within a large safety net hospital, a suicide safety plan is currently implemented by the social worker when patients are assessed at risk for suicide. To improve the process and build interdisciplinary collaboration, nurses are trained on suicide safety planning interventions as trained Parkland nurses will introduce the suicide safety planning intervention to patients at admission. The social worker facilitates creation of a written safety plan. The nurse then reviews the implemented safety plan during discharge instructions. The outcome criteria of decreased sentinel events for suicide attempts and suicides post discharge will be measured. Nursing understanding of suicide safety planning and suicide prevention will be measured pre and post intervention. VALIDATION OF EVIDENCE: The outcome criteria of decreased sentinel events for suicide attempts and suicides post discharge will be measured. RELEVANCE OF PMH NURSING: Nursing understanding of suicide safety planning and suicide prevention will be measured pre and post intervention. FUTURE IMPLICATIONS: Future implications for nursing practice include creation of a post discharge follow-up call process to provide patient support and suicide prevention coaching surrounding the suicide safety plan and validating any needed updates to the patient plan. In addition, assisting patients to begin a “hope box” with reminders of reasons to live is an adjunct intervention for suicide prevention. Parkland nurses work to save lives during and after psychiatric services.
Poster #4: From Job Description to Practice: Developing the DNP QI Role
Emma Mangano, DNP, PMHNP-BC
Category: Administration
ABSTRACT
PROBLEM STATEMENT: Psychiatric facilities have several regulatory guidelines and metrics to meet for a variety of reasons, including reimbursement and accreditation. Often, providers are burdened by documentation and high volume to carry out quality improvement projects to meet these metrics. SUMMARY OF EVIDENCE: The Doctor of Nursing Practice (DNP) provider is well prepared to fill this essential role. Increasing patient complexities and health care needs give the DNP the unique position to improve outcomes and advance quality improvement (QI) initiatives. DESCRIPTION OF PRACTICE OR PROTOCOL: In a large, urban hospital, a reactive process was often utilized to improve outcomes or initiate practice change. The creation of a Psychiatric and Mental Health (PMH) DNP role focused on QI and performance improvement (PI) within the Department of Psychiatry provided an opportunity to proactively address quality care and safety. VALIDATION OF EVIDENCE: Increasing PMH-DNP presence in the health care system provides leadership with the opportunity to better understand the skills, value, and impact of the DNP. Participation in risk management, policy development, and patient-centered meetings provided the opportunity to address QI. RELEVANCE OF PMH NURSING: This new role will provide opportunities to address restraint and seclusion use on inpatient psychiatric units, distribution of naloxone kits on discharge, and trauma screening in medical patients. Ongoing data collection will be used to measure the successful implementation of this DNP position. FUTURE IMPLICATIONS: Health care organizations need to maximize the use of the DNP-prepared PMHNP. The education and training received allows us to practice at the top of our scope of practice, while improving patient and system outcomes.
Poster #5: The Effect of an Educational Intervention on Clinical RN Knowledge and Attitudes Toward a Shared Governance Program at Eastern State Hospital
Tanna McKinney, DNP, RN, NEA-BC
Category: Administration
ABSTRACT
PROBLEM STATEMENT: Shared governance (SG) programs are a popular way to improve Registered Nurse (RN) engagement and retention. These programs are notoriously difficult to garner and maintain participation. However, a successful SG program can improve patient outcomes, patient satisfaction, and RN engagement. SUMMARY OF EVIDENCE: This study was designed to gain knowledge of clinical nursing barriers to council participation. Eighty clinical registered nurses from a 168-bed state psychiatric hospital were invited to complete a survey to determine current attitudes about SG and intent to participate in SG. DESCRIPTION OF PRACTICE OR PROTOCOL: The study’s intervention was electronic education regarding the benefits of Shared Governance. A pre-post survey was provided to predict intent to participate using the Theory of Planned Behavior. We found that after the educational intervention, participants, on average, were more willing to make changes in their role because of practice participation. VALIDATION OF EVIDENCE: Analysis of data was performed using the SPSS software version 26. Descriptive statistics were used to analyze participant demographics. Paired sample t-tests were used to compare pre and post data to determine the effectiveness of the education. RELEVANCE OF PMH NURSING: The results of this study imply that clinical RNs are aware of the benefits of SG but may have different factors that hinder their participation. In addition, because intent to change practice based on participation was shown in this study, it is important for nurse managers to support RN participation, to ensure that patient care doesn’t suffer as a result of participation, and to ensure that RNs are paid for participation. FUTURE IMPLICATIONS: Additional studies could provide valuable information to increase SG participation.
Poster #6: Reducing Behavioral Health RN Turnover Through Effective Onboarding
Michelle Spurlock, DNP, MSN, MBA
Category: Administration
ABSTRACT
PROBLEM STATEMENT: It is not uncommon for turnover to be related to the nurses feeling inadequately prepared to care for their patients as they lack competence and confidence in their skills after graduation. SUMMARY OF EVIDENCE: According to the Nursing Solutions Inc. 2023 annual report, psychiatric mental health nurses’ annual turnover rate dropped from 2022 to 20.8% from 23.4% the prior year. One study in the United States found that 17.5% of new nurses entering the behavioral health field left within 1 year of graduation and 35% left within 2 years. With only 3% to 4% of nurses entering the psychiatric mental health nursing field each year and the increasing demand for services, this deserves much more attention. DESCRIPTION OF PRACTICE OR PROTOCOL: Based on research and validation from nursing-focus groups, an enhanced 4-day onboarding program focusing on the most current behavioral health content utilizing a multimedia approach was developed and implemented across the organization. As a result of this change, there has been improvement in the overall onboarding experience and reduction in turnover. VALIDATION OF EVIDENCE: Ninety-day turnover was used to measure the success of the program as well as feedback obtained via a post-orientation survey assigned to all new employees 3 weeks after their start date. RELEVANCE OF PMH NURSING: Since implementation, this organization is seeing some reduction in 90-day turnover and employees, per the post orientation survey, have improved clarity of role. FUTURE IMPLICATIONS: The organization is committed to meeting the needs of those new to the field with a focus on onboarding.
Poster #7: Increasing Structural Empowerment Through the Co-Creation of a Shared Governance Program of Nurse Leaders and Direct Care Nurses
Michelle S. Van Outer, RN
Category: Administration
ABSTRACT
PROBLEM STATEMENT: Shared governance is a model in health care systems where nurses are involved by participating in decisions that lead their practice. Participation in shared governance has been shown to improve nursing practice, employee satisfaction, nursing autonomy, and patient outcomes. SUMMARY OF EVIDENCE: The purpose of this study is to evaluate nursing feelings of empowerment when direct care nurses are involved with leaders in the design and structure of the hospital’s shared governance program. DESCRIPTION OF PRACTICE OR PROTOCOL: A total of 28 participants completed the pre-survey and 24 completed the post-survey. However, the mean score increased for all 12 questions of the Psychological Empowerment Instrument. VALIDATION OF EVIDENCE: This study utilizes a descriptive, quasi-experimental pre- and post-test design to examine the benefits of co-creating a professional governance model with nursing leaders and direct care nurses at Eastern State Hospital (ESH). The Psychological Empowerment Instrument was used to determine whether overall empowerment scores increased after participation in the design of the shared governance program. RELEVANCE OF PMH NURSING: Results of this study show that nurses at ESH show high levels of empowerment when discussing their competence and skill in their work and in finding meaning in their work. They show lower empowerment when discussing self-determination and impact of their work. FUTURE IMPLICATIONS: The increased mean from presurvey to postsurvey may show that when nurses have an opportunity to be heard, they feel more empowered in all four areas of empowerment: meaning, competence, self-determination, and impact.
Poster #8: Supporting the Development of Resilience Among Didactic and Clinical Faculty Through Mentoring Partnerships
Nadine Wodwaski, DNP, MSN-Ed, ACNS, RN; Elaine Webber, DNP, PPCNP-BC, IBCLC
Category: Administration
ABSTRACT
PROBLEM STATEMENT: A literature review indicates that stress among nursing faculty can affect productivity, job satisfaction, support of students, and personal mental well-being. Novice faculty, in particular, may struggle with role transition, adding to their stress level. Supporting the development of resilience through mentoring partnerships can mitigate these stressors. SUMMARY OF EVIDENCE: Clinicians often come to the faculty role with little knowledge for a role in academia. Academic life presents new challenges including teaching, advising, and scholarly productivity for which they may be unprepared. Competition in scholarly productivity can lead to incivility, a toxic work culture, and early burnout. However, many university settings do not provide formal mentoring structures. DESCRIPTION OF PRACTICE OR PROTOCOL: Developing formal mentoring programs has been shown to increase resilience and support the transition from a clinical to faculty role. A “three generation” mentoring program was initiated within a university nursing program, leading to increased support for novice faculty and scholarly support for novice and junior faculty—directed by senior/tenured faculty members. VALIDATION OF EVIDENCE: Faculty were surveyed about their needs and concerns prior to initiating the mentoring program. Surveys conducted after the first year indicated wide support of the program. RELEVANCE OF PMH NURSING: Formal mentoring led to increased confidence in novice faculty, improved classroom pedagogy, and increased student satisfaction. Informal scholarship partnerships grew from the formal teams, enabling novice and junior faculty to increase scholarly production, supporting their tenure journey—a significant source of stress. FUTURE IMPLICATIONS: Supporting the needs of novice and junior faculty can improve student satisfaction and reduce faculty stress leading to increased resilience, job satisfaction, and improved mental well-being.
Poster #9: Utilizing an Anti-Racist Approach to Teach Nurse Educators: A DEI Faculty Fellow Program
Paula Alexander-Delpech, PhD, PMHNP-BC, APRN; Tanya Belcheff, DNP, CNM
Category: Education
ABSTRACT
PROBLEM STATEMENT: Nursing faculty typically receive minimal academic training in Diversity, Equity, and Inclusion (DEI). Moreover, conventional methods of knowledge and skill acquisition, such as lectures and mandatory interactive modules, often oversimplify racism in nursing to mere cultural or communication disparities. This overlooks the profound influence of structural racism and neglects strategies for dismantling it within nursing education. SUMMARY OF EVIDENCE: To prepare a new generation of advanced practice nurses to provide culturally appropriate health care to diverse populations, nurse educators must develop knowledge and skills to teach about the effects of structural and systemic racism and how racism impacts health care. DESCRIPTION OF PRACTICE OR PROTOCOL: The Multicultural Awareness, Knowledge, and Skills Survey (MAKSS) was administered pre and post-program. The DEI self-assessment Anti-Racism tool was also administered to provide motivation and to help develop a range of personal and professional transferable DEI skills. VALIDATION OF EVIDENCE: A paired samples t-test was performed for each content area. RELEVANCE OF PMH NURSING: The difference between the pre- and post-assessment scores was statistically significant. FUTURE IMPLICATIONS: Nursing education is challenged to recruit and retain students of color to provide culturally congruent health care to communities. Effective faculty development programs focusing on anti-racism are needed to improve health equity and reduce health disparities.
Poster #10: Using a Legendary Project to Facilitate Conversations on Health Equity for PMHNP Students
Paula Alexander-Delpech, PhD, PMHNP-BC, APRN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Opportunity for PMH faculty to address structural racism in nursing education. SUMMARY OF EVIDENCE: Knowledge skills. DESCRIPTION OF PRACTICE OR PROTOCOL: A contemporary innovative approach utilizing the New York Times “1619 Project” was used as an anti-racist approach to facilitate dialogue on race and health in the United States in an Advanced Psychiatric Mental Health nursing course. VALIDATION OF EVIDENCE: For a course assignment conducted asynchronously, students were tasked with listening to a podcast from the “1619 Project” and responding to related questions. In a synchronous Zoom session, students participated in a discussion guided by the HEALS framework and pre-assigned questions. Following the discussion, students composed reflective papers on their experience and filled out a survey using Survey Monkey. RELEVANCE OF PMH NURSING: In the midst of a worldwide pandemic that has disproportionately affected marginalized communities and amid a national reckoning with racial and social disparities in the United States, it is imperative to highlight the effects of social injustice in health care, particularly within the realm of mental health. This awareness is crucial for upcoming health care providers. As structural racism is a core driver of health disparities, advanced practice psychiatric nurses hold a unique position to initiate discussions that can shape the care and outcomes of marginalized groups, thus promoting social justice. FUTURE IMPLICATIONS: The results suggest that utilizing contemporary topics in nursing education can increase students’ understanding of structural and systemic issues that lead to health disparities.
Poster #11: Decreasing Nurse Burnout With a Collaborative Learning Approach
Deborah J. Allen, BSN, RN; Zack D. Suttles, RN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Following the height of the COVID pandemic, nurses struggled with increased stress levels and burnout risk factors. Identifying a solution to support and refuel nurse well-being, with implications for patient care delivery and satisfaction, was a priority for the organization. SUMMARY OF EVIDENCE: The implications of nurse burnout are wide-reaching and affect both the retention and engagement of nurses, as well as the outcomes and satisfaction of patients. The proven success of a video-based, on-demand coaching platform was an opportunity to support staff by building targeted skills around wellness. DESCRIPTION OF PRACTICE OR PROTOCOL: Implementation involved weekly distribution of 5-min micro-learning video tips to all team members that included actionable techniques to improve well-being. The unit leader and educator incorporated the “tip of the week” into newsletters, huddles, and other staff communication driving meaningful conversation, engagement, and skill-building around the specific topic. VALIDATION OF EVIDENCE: Patient satisfaction outcomes saw significant improvement, with a department-specific Net Promoter Score increasing from 55% to 67.9% following implementation of the skill-building solution. In addition, a 9.5% relative reduction in nurse turnover was noted across the organization. RELEVANCE OF PMH NURSING: Nurses reported ease of use and relevance of topics as benefits of the solution. Developing communication skills around well-being is also applicable for Psychiatric Mental Health nurses to incorporate with their patient populations. FUTURE IMPLICATIONS: The measurable success and outcomes of this intervention validates an important opportunity to support and retain psychiatric mental health nurses. The potential to scale this initiative to a broader nursing audience could expand the successful outcomes seen on the Behavioral Health unit.
Poster #12: Cultivating Resilience: Self-Care for Long-Term Fulfillment in Mental Health
Tonjanika Ballard, DNP, PMHNP-C
Category: Education
ABSTRACT
PROBLEM STATEMENT: The emotional intensity of mental health care often compromises psychiatric and mental health (PMH) providers’ well-being, leading to compassion fatigue and limited long-term fulfillment. This presentation addresses this problem by advocating for resilience-building through self-care. By prioritizing self-care strategies, providers can protect their empathy, find sustainable joy in their work, and improve the quality of care they offer. SUMMARY OF EVIDENCE: Research, including a recent National Institutes of Health (NIH) study, highlights the damaging impact of compassion fatigue on mental health providers. This highlights the need to integrate self-care and self-compassion practices into mental health care. Such a practice change could protect well-being, enhance provider resilience, and ultimately improve patient care. DESCRIPTION OF PRACTICE OR PROTOCOL: In mental health care, the emphasis on patient care frequently neglects provider well-being, leading to burnout and diminished effectiveness. A shift toward proactive self-compassion and well-being strategies is essential for improving provider longevity and the quality of patient care. Proposed changes include integrating self-care practices supported by education, adjustments at the system level for designated self-care time, and ongoing evaluations of outcomes. VALIDATION OF EVIDENCE: The evidence highlights the link between compassion fatigue and provider well-being, suggesting that self-care practices focused on self-compassion can mitigate these effects. To measure the effectiveness of this practice change, I would use pre- and post-intervention surveys assessing resilience, compassion fatigue levels, and job satisfaction among providers. RELEVANCE OF PMH NURSING: PMH nurses directly experience the emotional toll of mental health care, making self-care and resilience-building essential for their well-being and ability to provide optimal patient care. FUTURE IMPLICATIONS: Prioritizing provider self-care could lead to a more sustainable mental health care system and improved patient outcomes.
Poster #13: Effects of Charge Nurse Leadership Development Program on Participants’ Confidence and Patient Satisfaction
Ugur Barut, EDD, MSN, RN, PMH-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: Factors such as the low confidence level of the charge nurses, not having a formal orientation process, and the absence of educational preparation for the role led us to develop the Charge Nurse Leadership Development Program. SUMMARY OF EVIDENCE: Evidence of participants’ low confidence levels and the need to improve patient satisfaction shows the need for leadership support, education, and training. DESCRIPTION OF PRACTICE OR PROTOCOL: Current practice is the implementation of a quarterly Charge Nurse Leadership Development Program based on Watsons model of caring, the professional practice model for nursing practice. The outcome of this activity was the development of this charge nurse Leadership program that resulted in participants’ confidence level and improved patient satisfaction. VALIDATION OF EVIDENCE: Evidence of increased confidence level of the charge nurses and patient satisfaction level validates the practice. Pre and post-assessment survey tools were utilized to measure outcomes of the program. RELEVANCE OF PMH NURSING: The knowledge, skill, and/or practice that may increase charge nurses’ confidence level is important to the functioning of a healthy unit and patient satisfaction in a psychiatric inpatient setting. All of the participants (100%) who completed the evaluation self-reported increased confidence in the roles and responsibilities of being a charge nurse. FUTURE IMPLICATIONS: As health care organizations continue to prioritize patient satisfaction and quality of care, the CNLA program offers a promising solution for improving these outcomes. By enhancing the nursing staff’s leadership skills, the CNLA program can contribute to improving charge nurses’ confidence level and improved patient satisfaction.
Poster #14: Community Mental Health Educational Videos
Thia Baugh, PMHNP-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: Nine out of 10 adults have difficulty understanding details regarding personal health information due to unfamiliar and complex terms and only one in 10 adults in the United States is health literate. Health literacy leads to improved health outcomes. Poor health literacy leads to higher rates of morbidity and mortality and disproportionately affects minorities, older adults, adolescents, and those with lower socioeconomic status. SUMMARY OF EVIDENCE: Over half of adult Philadelphians are functionally illiterate; and Philadelphia is the least healthy county in Pennsylvania. One in five Philadelphians has a serious mental illness (SMI) and treatment is often complex. Psychotropic medications have significant side effects and those with SMI have a greater risk of health care–associated trauma. DESCRIPTION OF PRACTICE OR PROTOCOL: The team partnered with Community Organization for Mental Health and Rehabilitation (COMHAR), a nonprofit mental health organization, to provide clients with relevant health education. Five key health topics were identified: Anxiety, Bipolar Disorder, Depression, Schizophrenia, and Metabolic Syndrome. Health information was translated into lay terms and 5-min videos were created about each topic. The videos will be used as teaching tools televised in COMHAR waiting rooms and available online. VALIDATION OF EVIDENCE: Feedback from COMHAR leadership was positive. Patient outcomes have not been measured at this time. RELEVANCE OF PMH NURSING: The videos will improve client education and enable clients to understand their health care needs, take better care of themselves, and reduce morbidity and mortality. FUTURE IMPLICATIONS: The videos are sustainable and may be used for many years to come.
Poster #15: Bridging Minds: Grand Rounds in Mental Health Simulated Experiences
Monica Boomgaarn, MSN, RN; Jacque Williams, MSN, RN, NC-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: While ground rounds typically take place in the hospital setting with other health care students, implementation into the educational setting offers a safe place for nursing students to actively take the lead on patient cases. This practice has been widely utilized in medical-based simulations; however, there is limited evidence of the use of nursing grand rounds in the psychiatric mental health specialty. SUMMARY OF EVIDENCE: The experiences students cultivate through clinical practice working with patients with mental health disorders are often more observational. Through this simulation, students can better understand the roles of the interdisciplinary care team and the importance of providing evidence-based care for the patient while allowing for professional growth and development. DESCRIPTION OF PRACTICE OR PROTOCOL: Health care organizations use grand rounds to promote interdisciplinary collaboration while increasing professional development among nurses. With early adaptation by nursing academia, nurses can recognize and learn from peers in a setting where critical thinking skills can be further explored. VALIDATION OF EVIDENCE: Student outcomes are measured through the presentation of their case scenario to peers and the creation of Next-gen NCLEX questions to quiz peers on the knowledge learned through these teachings. RELEVANCE OF PMH NURSING: Tailoring the nursing case scenarios to take place in units outside of the traditional mental health setting expands the application of the teaching platform across hospital departments. FUTURE IMPLICATIONS: Nursing grand rounds can promote interprofessional collaboration with nursing students and other disciplines while learning evidence-based practice.
Poster #16: How Are Recovery Principles Being Taught to Undergraduate Nursing Students? A Review of the Literature
Susan V. Brammer, PhD, RN, CNE, FAAN; Janet Passley-Clarke, PhD, DNP, MS, RN, CRNP, PHM-BC; Michael Thomas, DNP, APRN, PHMNP-BC, CNE
Category: Education
ABSTRACT
PROBLEM STATEMENT: Mental health recovery principles have existed for decades but have not been fully integrated into clinical practice or education. The APNA Recovery Council Steering Committee sought to identify how recovery principles were being taught in undergraduate nursing education. SUMMARY OF EVIDENCE: Recovery-oriented, person-centered care is widely endorsed as best practice. Despite this, students often report receiving more biomedically oriented education that does not include recovery principles or are unclear on their meaning and impact on patient care. DESCRIPTION OF PRACTICE OR PROTOCOL: Current practices in recovery-oriented education are primarily focused on contact with persons with lived experience, also called experts by experience (EBE), in clinical, the classroom, or in group discussions. EBE were reported by some to give input on course content. VALIDATION OF EVIDENCE: There were a total of 16 studies published on strategies for teaching recovery-oriented principals to undergraduate nursing students. Searches were performed in CINAHL Complete and PubMed with limiters of full-text and publication within the past 5 years. It was also noted whether studies were conducted in the United States. There were none. RELEVANCE OF PMH NURSING: According to the Psychiatric-Mental Health Nursing Scope and Standard of Practice, psychiatric and mental health (PMH) nurses play a “revolutionary role” in patient-centered care and promoting recovery. Unfortunately, except for studies on contact with EBE, there is limited information on teaching strategies for creating an educational foundation upon which nurses learn to promote recovery-oriented care. FUTURE IMPLICATIONS: More studies on recovery-oriented education are needed, particularly in the United States. A collaboration between the Recovery Council Steering Committee and Education Council could contribute to that body of knowledge.
Poster #17: Making Mental Health Matter in a Concept-Based Curriculum and Beyond
Skyler Brieanne Braswell, MSN, FNP-C
Category: Education
ABSTRACT
PROBLEM STATEMENT: With a growing mental health population and fewer providers, educating nursing students to provide holistic client care can help decrease the disparities experienced by this population. SUMMARY OF EVIDENCE: In 2021, one in five (57.8 million) U.S. adults have a mental illness with 17% of U.S. adults reporting comorbid mental and physical illness. In 2018, of the nearly 3 million licensed registered nurses (RNs) in the United States, only 4% were psychiatric mental health nurses. In 2014, there were less than one psychiatrist and 7.7 psychiatric nurses per 100,000 patients. As the number of mental illness diagnoses has grown and the shortage of all nurses has continued to rise, mental health disparities have worsened. Changing the face of psychiatric nursing from the beginning of nursing education has been hypothesized to lessen the shortage of psychiatric nurses. Improving nursing student knowledge about psychiatric disorders through didactic lectures and clinical experiences will improve mental health nursing competence. DESCRIPTION OF PRACTICE OR PROTOCOL: Mental health theory (didactic) has been woven into an ADN concept-based curriculum beginning with pre-nursing. Mental health clinical experiences have resumed at an inpatient psychiatric facility. In addition, beginning with semester 1, students are taught and use a holistic client assessment. VALIDATION OF EVIDENCE: Narrative documentation of mental health and physical health by senior students and improvement in standardized testing and mental health attitudes of students. RELEVANCE OF PMH NURSING: Holistic/Integrative/Comprehensive nursing care that will address all aspects of the client to improve overall well-being and client outcomes. FUTURE IMPLICATIONS: Nurses that are competent and confident in providing holistic care while considering SDOH.
Poster #18: Diversity, Equity, Inclusion, and Belonging: Addressing Health Disparities Through Inclusive Nursing Education
Donald Burdine, DNP, FNP-C, PMHNP-BC; Cyndi Faudree, DNP, FNP-BC, ACNP-BC; Catherine Godoy, DNP, ACNS-BC, PMHP-BC; Rodel Aguirre, DNP, AGACNP-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: Psychiatric nursing programs integrate diversity, equity, and inclusion (DEI) by enhancing educational experiences and creating opportunities to provide patient-centered care to diverse populations. Potential threats to DEI will likely have a significant impact on graduate nursing education, patients, and mental health care systems. SUMMARY OF EVIDENCE: A current trend to remove DEI from education and health care settings has been brought to light with at least one state banning DEI practices entirely. Banning will have negative consequences affecting further awareness and treatment of mental health at large and will directly affect educational institutions and psychiatric nursing programs. DESCRIPTION OF PRACTICE OR PROTOCOL: DEI is currently being used in educational institutions, psychiatric nursing programs, and health care systems to improve mental health outcomes, promote a culture of global wellness, and affirm inclusivity. VALIDATION OF EVIDENCE: Professional associations recognize the use of DEI to strengthen collaboration and enhance clinical excellence. In addition, accreditation bodies of graduate nursing education programs endorse the integration of DEI in advance nurse practitioner program curricula. RELEVANCE OF PMH NURSING: With mental health awareness in the forefront, and the next generation of psychiatric mental health nurse practitioners on the rise, commitment to fostering a diverse, equitable, and inclusive learning environment is paramount to psychiatric nursing education. FUTURE IMPLICATIONS: Reducing or banning DEI will adversely affect psychiatric nursing education and affect mental health care systems. Potential implications include challenges to nursing program accreditation, diminished clinical education experiences, and a reduction in quality psychiatric care. Further concerns involve legal risks and liability, potential perpetuation of existing inequalities, and an undermining of academic standards.
Poster #19: Assessing Side Effects and Adverse Events for Patients Prescribed Antipsychotic Medications
Luke Davies, MSN, PMHNP-BC; Jill Miller, MSN, PMHNP-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: Empowering floor nurses the confidence and knowledge to use nursing interventions to help common side effects that occur with patient’s taking antipsychotics but also being aware of what is an adverse event and knowing that a provider needs to be made aware right away so they can act accordingly. SUMMARY OF EVIDENCE: The practice gap lies with the communication between registered nurses and providers. The online module will provide clarity of what is within the registered nurses scope of practice and allowing providers a clearer understanding of what nurses can do to assist when assessing and treating patients who are prescribed antipsychotics. DESCRIPTION OF PRACTICE OR PROTOCOL: Provided a module that had a pre and post survey. It was available 24/7 and was interactive module based on multi-media scenarios. VALIDATION OF EVIDENCE: Pre and post survey on nursing knowledge and confidence with caring for patients on antipsychotic medications. RELEVANCE OF PMH NURSING: Bedside nurses should be empowered to intervene with side effects using nursing interventions but know when to notify provider regarding adverse events. FUTURE IMPLICATIONS: Spread this learning activity to all units where patients are prescribed antipsychotic medications. Use this educational methodology for other knowledge and confidence gaps.
Poster #20: Enhancing the Clinical Experience for Nursing Students at UofL Health Peace Hospital
Allison Deckel, MA, BSN, RN, PMH-BC, NPD-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: The goal of my quality improvement project is to improve the overall experience of the nursing clinical for nursing students at UofL Health Peace Hospital. This aligns with the vision and values of UofL Health Hospital. The vision reflects a commitment to collaborate with educational institutions to educate the next generation of health care professionals. In addition, our values include maintaining an inclusive environment where everyone is respected, and we act with sensitivity and empathy not only with our patients but with each other. First, a review of current literature on enhancing nursing clinical was completed. Next, specific interventions were created from the information obtained in the literature in a way that was applicable to the organization. Nursing evaluation scores were compared from the semester before the intervention to scores from the semester after the intervention was implemented. SUMMARY OF EVIDENCE: Aim: To improve the nursing clinical experience at UofL Health Peace Hospital as evidenced by nursing student evaluation scores. DESCRIPTION OF PRACTICE OR PROTOCOL: Intervention: Create an Inservice for Program Coordinators at UofL Peace Hospital on how they can assist students in their role on the unit. Share knowledge about how enhancing the student experience aligns with the vision and values of UofL Health and serves as a tool to recruit new nurses. Provide information on how creating a sense of welcoming and belonging enhances the nursing experience, while bullying and negatively impede learning and confidence. Encourage sharing or ideas and brainstorming of best practices for nursing student clinicals. In addition to the Inservice, provide purposeful rounding, information in the monthly newsletter, and positive reinforcement through the employee recognition program to also improve nursing student experience. VALIDATION OF EVIDENCE: Data Collection and Analysis: Nursing student evaluation scores were compared from Fall 2022 semester (before intervention) with Spring 2023 after intervention. The students rated each question on a 1 to 4 scale: 4 = strongly agree, 3 = agree, 2 = disagree, 1 = strongly disagree. The evaluation questions were: (1) Staff was welcoming; (2) Staff was knowledgeable; (3) You were treated as a professional; (4) Staff provided a positive role model for you; and (5) The staff worked as a team. Results: Modest gains were achieved in all five categories. RELEVANCE OF PMH NURSING: Discussion: The country is experiencing a significant nursing shortage, and this includes Kentucky. Registered Nurses are more likely to seek employment in practice areas that gave them a warm welcome and a feeling of belonging. In addition, students are more active and motivated, and gain self-confidence and investment in the clinical rotation. Finally, security and confidence are conducive to learning. Students who feel they do not fit in on their clinical placement experience increased anxiety, depression, and apprehension, making it more difficult to learn. Incivility, or negative interactions with staff members, damages the feeling of safety and satisfaction, which inhibit learning. Students may internalize negative interactions with staff, blame themselves, and question their right to be in the clinical setting. FUTURE IMPLICATIONS: It is important for Clinical Nurse Educators to take an active role in not only coordinating the nursing clinical but also actively engaging with employees to help improve the experience for the student.
Poster #21: Bridging the Gap: Mental Health Academy
Nicole Doerr, BSN, RN, PMH-BC; Ann Mautner, BSN, RN
Category: Education
ABSTRACT
PROBLEM STATEMENT: The World Health Organization (WHO) has found that many nurses are inadequately prepared to provide mental health care when exiting their education programs. SUMMARY OF EVIDENCE: Several studies have noted that nurses in the intensive care unit (ICU), emergency department (ED), and inpatient units believe that mental health care is important; however, they feel they need more training and education to care for patients with mental illnesses. Stereotypes and stigma also negatively affect the nurse–patient relationship. Providing nurses mental health education is essential to improving the recognition of mental health disorders, encouraging appropriate referrals, and preventing treatment delays. DESCRIPTION OF PRACTICE OR PROTOCOL: After noting this gap in mental health education, clinical nurse educators created a Mental Health Academy where new hire nurses and health techs receive a more in-depth education in common mental health topics and resources used at the facility. VALIDATION OF EVIDENCE: A pre and post class survey is provided to participants in which the participants rate their knowledge of mental health topics and resources using a Likert-type scale. Participants are also given the chance to provide comments for feedback and to suggest future topics. RELEVANCE OF PMH NURSING: Mental Health Academy has proven to produce new hire nurses and health techs who are able to communicate with mental health patients and other caregivers in a therapeutic and professional manner. They are more proficient in mental health illnesses, treatments, and resources available at the facility. FUTURE IMPLICATIONS: The course will continue to change and grow as needed following needs assessments and participant feedback.
Poster #22: Unveiling Bias: Exploring the Presence of Stigma Among Emergency Department Providers Toward Psychiatric and Substance Use Patients
Sydney Enlow, BSN, PMH-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: The potential existence and prevalence of bias among emergency department physicians toward patients diagnosed with psychiatric or substance use disorders. The research was prompted by the increased prevalence of diagnostic overshadowing experienced by psychiatric and substance use disorder patients transferred to an inpatient adult psychiatric unit. The research aims to investigate whether bias serves as a contributing factor in the observed instances of diagnostic overshadowing. SUMMARY OF EVIDENCE: Recent literature shows that bias toward psychiatric patients exists among health care workers, with psychiatrists having the lowest level of bias. Current evidence indicates psychiatric and substance use patients often do not receive the same level of medical care as non-psychiatric patients. The educational need is knowledge of bias. DESCRIPTION OF PRACTICE OR PROTOCOL: Outcomes to be measured is the reduction of bias after receiving education on bias toward psychiatric and substance use patients. VALIDATION OF EVIDENCE: Literature review showed that education was effective in decreasing health care provider bias. Outcomes are measured through pre-survey and post-survey at 3 and 6 months to study maintenance. RELEVANCE OF PMH NURSING: This topic is related to the quality of medical care received by psychiatric and mental health (PMH) patients and the interventions/resources being offered to them in the emergency department. Recent studies show that these patients are not receiving the same level of medical care as non-psychiatric patients with similar presentations. FUTURE IMPLICATIONS: Future implications include assessing for bias among other departments (neurology, internal medicine, etc.) and researching the impact of bias on patient outcomes such as length of stay and medical interventions offered.
Poster #23: Teaching Undergraduate PMH Nursing Students How to Run Psychoeducation Groups: An Opportunity for Connection With Patients and Staff
Katherine Evans, DNP, RN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Educators of psychiatric mental health (PMH) courses are experiencing challenges in the clinical setting since the recent pandemic in psychoeducation due to staff shortages and acuity nurses are not able to run psychoeducation groups. Nurse educators need to prepare students to teach a psychoeducation group. SUMMARY OF EVIDENCE: Psychoeducation groups are an essential for the success of managing mental illness. Nurses often facilitate psychoeducation groups which provide key concepts, knowledge, and insight to mental illness that assists patients in the successful management their mental illness, prevent relapse, and impact long-term outcomes. DESCRIPTION OF PRACTICE OR PROTOCOL: The goal of this learning module is to develop a lesson plan to teach nursing students how to facilitate a psychoeducation group. Student learning objectives encompass the opportunity to develop a psychoeducation lesson plan and props, conduct a psychoeducation group, and then evaluate the patient learning and outcomes. VALIDATION OF EVIDENCE: Evidence-based practices support psychoeducation as an effective tool to improve patient’s management of their mental health issue, prevent relapse, and improve long-term outcomes. Without psychoeducation, there is a decrease in the patient’s ability to manage their illness, and increased risk of relapse and poor long-term outcomes. RELEVANCE OF PMH NURSING: There is a gap in the literature regarding psychoeducation. Providing a lesson plan and template to run psychoeducation groups may be helpful to educators and undergraduate students as a future training program. Facilitating a psychoeducation group provides a rich learning experience for the nursing student within the behavioral health milieu and enhances connection with patients and staff. FUTURE IMPLICATIONS: Students will be better prepared to conduct psychoeducation groups.
Poster #24: Impact of Leadership Presence for Enhanced Patient Care in the Inpatient Unit
Shanta Fells, MSN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Our mission was to strengthen leadership presence within the Inpatient Psychiatric Unit (17IP) to elevate the quality of patient care and promote effective teamwork. Recognizing the pivotal role leadership plays in shaping a therapeutic environment, our goal was to cultivate a robust leadership presence that enhances patient care and fosters a cohesive interdisciplinary team. SUMMARY OF EVIDENCE: Research suggests the potential positive impact of strong interprofessional leadership in psychiatric units on decreased restraint and seclusion when coupled with an evidence-based solution, such as debriefing, highlighting its influence on patient outcomes. Effective leadership presence involves more than just managing; it is about inspiring and guiding the team toward shared goals . The creation of a therapeutic milieu is essential in psychiatric settings, influencing patient well-being and recovery. DESCRIPTION OF PRACTICE OR PROTOCOL: To put our plan into action, we provided targeted leadership training for key staff members within 17IP. The focus was on developing leadership competencies, refining communication skills, and strengthening conflict resolution capabilities. We introduced a leadership presence framework, encouraging leaders to be visible, approachable, and actively engaged in daily activities. Regular team meetings and feedback sessions became a standard practice to encourage ongoing communication and collaborative problem-solving. VALIDATION OF EVIDENCE: Post-implementation, our team reported a stronger sense of cohesion and morale within the unit. Patient feedback reflected a noticeable improvement in the treatment environment. Importantly, the increased leadership presence was associated with a significant reduction in incidents, showcasing the team’s enhanced ability to proactively address challenges. Impact on Decreased Patient Restraint and Seclusion, and Safety. RELEVANCE OF PMH NURSING: In the context of 17IP, where patients are often in vulnerable states, cultivating a robust leadership presence is foundational to improving the overall treatment milieu. This initiative underscores the importance of fostering leadership skills among psychiatric nursing staff, creating a therapeutic environment that not only supports patient recovery but also prioritizes safety, leading to a reduction in the necessity for restrictive measures. FUTURE IMPLICATIONS: Furthermore, safety protocols, including regular safety drills, were reinforced through consistent leadership presence. Leaders actively participated in safety initiatives, ensuring the team’s preparedness to handle emergencies. This comprehensive approach resulted in a notable decrease in safety incidents, affirming the positive impact of a strong leadership presence on patient and staff safety within the Inpatient Psychiatric Unit.
Poster #25: Simulation Education to Build Cultural Humility in Behavioral Health Nurses Caring for Transgender and Gender-Diverse Patients
Nicole Figueroa, MSN, RN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Transgender and gender-diverse individuals face an increasing risk of poor health outcomes related to continued systemic bias resulting in health disparities, particularly in regard to mental health needs. Behavioral Health Nurses are well suited to support advocacy and system change to decrease health disparities; however, they lack the training and education around gender-affirming and inclusive care. SUMMARY OF EVIDENCE: Research highlights a significant deficiency in education for nurses concerning transgender and gender-diverse patients. A study by Carabez et al. found that discomfort was widespread among nurses when caring for transgender individuals, largely due to a lack of understanding and education regarding the stigma faced by this community. Moreover, emerging literature stresses the importance of fostering gender-affirming and inclusive health care cultures, as theorized by Rivera et al. Finally, the mode of education simulation has been shown to be one of the most effective ways to teach human factor skills, like creating gender-affirming spaces for transgender and gender-diverse patients. DESCRIPTION OF PRACTICE OR PROTOCOL: PICOT: For mental health nursing staff (P), does the use of scenario-based training focused on providing care to transgender and gender-diverse patient populations (I) increase knowledge, confidence, cultural humility in practicing gender affirming care (O) after one education session and at 1 month post training. (T) intervention still being implemented. VALIDATION OF EVIDENCE: Will be analyzing utilizing analysis of variance (ANOVA), to be completed by August 2024. RELEVANCE OF PMH NURSING: Results by August 2024. FUTURE IMPLICATIONS: Standardized trainings with matched outcomes for behavioral health nurses is a gap in the literature, this will help guide future education in this important topic.
Poster #26: Advanced Practice NuRses’ Opioid Use Disorder Education Through a Massive Open Online Course (APROUD-MOOC)
Karen J Foli, PhD, RN, ANEF, FAAN; Elizabeth (Libby) Kay Harris, RN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Recent changes made in the Consolidated Appropriations Act, 2023 resulted in practitioners no longer having to submit a waiver to prescribe medications, such as buprenorphine, for opioid use disorder (OUD). However, advanced practice registered nurses (APRNs) may lack knowledge and may hesitate to treat patients with substance use disorder (SUD)/OUD. SUMMARY OF EVIDENCE: In 2020, 40.3 million Americans, aged 12 or older, struggled with SUD. In 2021, 75% of the 107,000 overdose deaths involved opioids. In all specialty areas, APRNs interface with individuals who struggle with opioid and substance use. DESCRIPTION OF PRACTICE OR PROTOCOL: Supported by a SAMHSA grant, we created a massive, open, online course (MOOC) for APRNs focused on OUD/SUD. The APROUD-MOOC, with seven modules, is housed on the CANVAS learning portal and contains lectures, unfolding case study videos, quizzes, and more. This open-access education is designed to decrease hesitancy and increase knowledge in APRN assessment and management of individuals with SUD/OUD. VALIDATION OF EVIDENCE: Industry APRNs as well as faculty teaching APRNs can download sections or the entire curriculum. We collect post-module evaluations that indicate the usefulness of the APROUD-MOOC contents, as well as what could be improved upon. RELEVANCE OF PMH NURSING: Faculty with PMH graduate students can download components of this MOOC to supplement and/or replace their SUD curriculum content. The desired outcome is delivery of education in the assessment, management, and referrals of those with SUD/OUD. FUTURE IMPLICATIONS: The APROUD-MOOC addresses major barriers to the diffusion and implementation of OUD/SUD education. Faculty can access expertly crafted advanced nursing SUD education modules that employ cutting-edge virtual instructional design thinking.
Poster #27: Individual Delivery Model in Individuals With Autism and Intellectual and Developmental Disabilities
Sally A. French, PMHAPN BC, MSN; Jeninfer E. Konek, AGPCNP-BC, MSN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Developed a comprehensive program for autism spectrum disorder (ASD). SUMMARY OF EVIDENCE: Education, Process changed, Provider to patient. DESCRIPTION OF PRACTICE OR PROTOCOL: Developed a governance committee inclusive of families. Developed an educational CLN program as well as lunch and learns to educate all 2,500 employees. Put on conferences to teach staff from experts in the field in the management of behaviors. Built five sensory rooms in and out of hospitals and put sensory carts and sensory toys. Informatics system integrated into EPIC Care Coordination Team Mobile Unit to community Complex patient program started. VALIDATION OF EVIDENCE: As we are new, we follow up on every ones care for feedback and outcomes of care: collaborating with Bancroft to lessen medical problems; information sharing and initiation of special data base; Educate, Informatics, Clinical Resource, rooms sensory specific; identified specialist to assist in care for very complex combative patients; and collaboration with community. RELEVANCE OF PMH NURSING: Most ASD patients are complex with comorbid issues. Taper medications and go to root cause with correct diagnosis. They come to us with multi meds at high doses and no direct improvement. FUTURE IMPLICATIONS: Treat ASD-IDD differently. Reduction of meds. Success of treatment with process change. Team approach with DCS, BA’s, and psychologist.
Poster #28: Psychiatric Mental Health Nursing Academy
Aimee Gabuya, DNP, RN, CEN, PMH-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: With the expansion of the current behavioral health unit, the organization has been hiring nurses even those who are new graduates to fill in the positions and the staffing needs of the unit. SUMMARY OF EVIDENCE: It has been identified that there is gap in knowledge, skills, and attitudes among the new hires in caring for patients with mental and behavioral health issues. The need to establish the psychiatric mental health nursing academy is crucial to prepare the new RNs with the complex role of a psychiatric mental health nurse. DESCRIPTION OF PRACTICE OR PROTOCOL: A robust 4-day didactic session with a case study presentation to culminate the academy. The first 3 days comprise comprehensive lectures with various speakers who are experts of the topic of discussion. VALIDATION OF EVIDENCE: Since the establishment of the academy in June 2023 and to present, we already have conducted three cohorts with the fourth cohorts coming this April 2024. The participants of the academy gave positive feedback on the importance and significance of the academy. RELEVANCE OF PMH NURSING: A feedback from a nurse extern—the academy was very helpful and insightful program that adds to the continued learning and professional education to work in behavioral health. FUTURE IMPLICATIONS: A comprehensive education program tailored to the needs of the psych nurses is crucial in setting them for success. Providing them with the educational resources is pivotal for the safety and success of the staff, the organization, and ultimately the recipients of care.
Poster #29: InjectaBuddy
Jennifer Gonzales, BSN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Opportunity for improvement: In my role as the CL Psych RN and Behavior Emergency Response Nurse at Parkland Hospital in Dallas, TX, I identified a crucial need for enhancing education and training among our nursing staff. The focus was on ensuring safe administration, particularly when using the same syringe for pairing medications. By addressing this need, we aimed to enhance patient care, safety, adverse reactions, and response times within our hospital environment. SUMMARY OF EVIDENCE: Patients in the acute phase of agitation can require the administration of multiple drugs by intramuscular injection in order to temporarily stabilize their condition. Administration of multiple psychotropic medications in a single syringe can be beneficial to both the patient and health care professionals.. DESCRIPTION OF PRACTICE OR PROTOCOL: A Badge Buddy is a double-sided, badge-sized reference card or cheat sheet that can help clinical staff to find appropriate resources and actions to take. This badge buddy is equipped with common intramuscular psychotropic and non-psychotropic same syringe compatibility, how to administer linked medication orders, medications to med committed patients, and adverse reactions. VALIDATION OF EVIDENCE: Creating and implementing this badge buddy allowed for nursing to have a quick and easy reference. RELEVANCE OF PMH NURSING: In the event of an acute behavioral emergency and the need for medication administration specifically, aimed to improve the nurse’s knowledge and skills related to the administration of Intramuscular Psychotropic and non-psychotropic medications in the context of acute hospitalization and Psychiatry settings. FUTURE IMPLICATIONS: Enhanced response times to behavior emergencies that warrant meds, same syringe administration knowledge, and adverse reactions.
Poster #30: What to Expect Your First Year in Practice
Amanda Guarnere, MSN, APN, PMHNP-BC; Courtney Seidenberg, MSN, APN, PMHNP-BC, FN-CSA
Category: Education
ABSTRACT
PROBLEM STATEMENT: Practice change: Educational preparation for the novice Nurse Practitioner. SUMMARY OF EVIDENCE: Underlying educational need: navigate through clinical decision making, address early burn out, discuss contracts, collaboration, and mentorship. DESCRIPTION OF PRACTICE OR PROTOCOL: Clinical topics: “Fake it until you make it and sink or swim” mindset. We plan to challenge previous mindsets and encourage professional growth and development. VALIDATION OF EVIDENCE: A successful NP mentoring experience benefits the mentee, the mentor, and the organization by easing the period of transition. This in turn results in job satisfaction and retention. RELEVANCE OF PMH NURSING: Clinical topics: Every nurse can relate personally to their own experience during their first year in practice. Sometimes, it is challenging to know who and when to ask for help. It is important we continue to support each other and grow as a field. FUTURE IMPLICATIONS: Organized education, guidance, and support for new graduate APNs.
Poster #31: Unlocking Knowledge: Connecting Students With Open Access Resources
Patricia M. Guenther, MS, RN-BC; Jenna Rupert, DNP, RN, PMHNP-BC, FNP
Category: Education
ABSTRACT
PROBLEM STATEMENT: High cost of student textbooks/student financial struggles in undergraduate nursing education. Traditional and Accelerated BSN programs. Current textbook with online resources cost $260 per student. Student complaints high cost, minimal gain. Students not purchasing book/not reading book. SUMMARY OF EVIDENCE: Rising costs of nursing education (textbooks, fees, supplies) are overwhelming for students, and many have exhausted financial aid. Evidence shows OER textbooks are as effective as traditional texts with significant cost savings. DESCRIPTION OF PRACTICE OR PROTOCOL: Traditional textbooks with online resources used in mental health nursing course (Fall 2021–Fall 2023). OER textbook implemented Spring 2024. Undergraduate nurse educators and undergraduate nursing students benefited from this change. VALIDATION OF EVIDENCE: Student survey, course evaluations (pre and post intervention), student discussion. Faculty survey. RELEVANCE OF PMH NURSING: Outcomes: Saved more than $17,000 in student textbook fees in one semester; Improved student completion of assigned readings in course text; Increased student satisfaction; Increased faculty satisfaction; and Decreased waste. FUTURE IMPLICATIONS: OER text possibilities: High sustainability/environmentally friendly; Lower student costs; Improve student completion of reading assignments; Expand use to other nursing courses; and Potential to grow OER repository.
Poster #32: Incorporating the 4Ms Framework of Age-Friendly Health Systems Into an Undergraduate Mental Health Nursing Simulation
April Haberyan, PhD, MS, RN, CNE
Category: Education
ABSTRACT
PROBLEM STATEMENT: The older adult population is projected to continue growing around the world. There is a need for more nurses to be trained in geriatric psychiatric nursing. To help address this practice gap, incorporating the 4Ms (Matters, Mentation, Mobility, and Medication) Framework of Age-Friendly Health System into an undergraduate nursing curriculum can help to increase student comfort in working with this patient population. SUMMARY OF EVIDENCE: According to McGrath, mental illness can affect many aspects of an individual’s life, such as finances, independence, and dependence on caregivers, and can lead to frequent hospitalizations. Nurses need to be able to assess what Matters, Mentation, Mobility, and Medication (4Ms). DESCRIPTION OF PRACTICE OR PROTOCOL: Undergraduate nursing students participated in a geriatric mental health simulation that required a patient assessment using the 4Ms Framework. VALIDATION OF EVIDENCE: Students were measured using a pre- and post-anonymous electronic survey. RELEVANCE OF PMH NURSING: Potential benefits from this project include enhanced knowledge, comfort, and skill in caring for older adult clients experiencing a mental health condition. It may increase student nurses’ interest in working as a geriatric psychiatric nurse. FUTURE IMPLICATIONS: Future studies could include 4Ms simulations that address other types of mental health disorders such as depression, substance use, or anxiety disorders.
Poster #33: On Call: A Simulation for Advanced PMHNP Students With a Focus on Conflict Resolution Skills
Lyons Hardy, EdD, MSN, PMHNP
Category: Education
ABSTRACT
PROBLEM STATEMENT: Faculty identified that conflict resolution skills were not being adequately addressed in the PMHNP curriculum. In addition, all of the previously used simulations focused on outpatient psychiatric settings. We developed this simulation to touch on both of these skills for PMHNP students. SUMMARY OF EVIDENCE: We identified that there was an educational need for PMHNP students regarding their skills in conflict resolution with other colleagues. We also found that there were limited opportunities for students to practice being the on-call clinician for an inpatient psychiatric unit. DESCRIPTION OF PRACTICE OR PROTOCOL: PMHNP faculty and the standardized patient educator developed and implemented a new simulation experience using an on-call scenario for an inpatient psychiatric unit. The standardized patient educator trained standardized patients to act in the role of an inpatient psychiatric RN in a phone interaction with the PMHNP student. VALIDATION OF EVIDENCE: We reviewed feedback provided to students by trained standardized patients and student evaluations of the simulation experience. Of 24 students who completed the evaluation, nearly all of them agreed or strongly agreed that the simulation and debriefing enhanced their confidence and knowledge. Standardized patient feedback indicated that the majority of students’ skills were developing or highly developed. RELEVANCE OF PMH NURSING: The simulation was successfully conducted with a cohort of PMHNP students. We found that students reported a positive learning experience that improved their confidence and knowledge. We received qualitative feedback that the experience was valuable for their learning. FUTURE IMPLICATIONS: Psychiatric nursing faculty can implement similar simulations to help students develop skills in conflict resolution and serving in an on-call role.
Poster #34: Connections to Support Life and Safety: The Impact of Mental Health Supports on Campus
Todd B. Hastings, PhD, RN, CNE
Category: Education
ABSTRACT
PROBLEM STATEMENT: Despite the mental health crisis on college campuses, programs and processes to support mental health awareness, challenge stigma, and impact suicide prevention remain limited on college campuses. SUMMARY OF EVIDENCE: Evidence suggests mental health supports can have positive impact on campus safety and decrease mental health stigma in higher education settings. Broader campus awareness of student-centered initiatives such as the Green Bandana Project (https://www.thebandanaproj.org/) facilitate the formation of a more just campus culture. DESCRIPTION OF PRACTICE OR PROTOCOL: Psychiatric and mental health (PMH) nursing faculty at a small university collaborated with the campus offices of student affairs and counseling, student government, and a local NAMI affiliate to implement the Green Bandana Project (GBP) during ’22–’23 and ’24–’25 academic years. A strong positive effect is observed in student members expressing their greater comfort and proficiency to engage peers and share mental help information. VALIDATION OF EVIDENCE: Surveys addressing GBP outcomes were provided to volunteer student members near the time they join the project and approximately 6 months later. RELEVANCE OF PMH NURSING: The results display GBP member (nursing and other majors) confidence for engaging college peers struggling with psychosocial distress and for their ability to promote these peers to seek mental health help. Furthermore, a significant benefit of the GBP is demonstrated in expanded discussions on campus about mental health and pushing back on mental health stigma. FUTURE IMPLICATIONS: Although counseling centers are the cornerstone of places for college students to receive therapeutic mental health help, college campuses will benefit from expanded mental health supports to better meet the challenge of the current mental health crisis on campus.
Poster #35: Suicide Prevention Education for College Faculty
Michelle Hext, DNP, APRN, CPNP-PC, FNP-C, ENP-C, PMHNP-BC; JT Seaman, DNP, APRN, PMHNP-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: As there is currently a suicide crisis in college-aged students, it is imperative that we improve the knowledge and ability of college faculty to recognize and offer help and resources to college students who may be suffering from suicidal ideation to ultimately reduce suicide completion in this population. Our research revealed most college faculty do not feel comfortable or lacked the knowledge and skills to recognize or intervene for a college student with suicidal ideation. Furthermore, few of them recognized the signs or were aware of local and national resources that could help. SUMMARY OF EVIDENCE: Suicide is the second leading cause of death in persons aged 20 to 34, and the third leading cause of death in persons aged 10 to 19. One in four college students are mentally ill, and one in five college students consider suicide. There is a significant need within the higher education community for increased awareness, knowledge, and a toolset that will allow faculty and staff to act swiftly to protect human life. DESCRIPTION OF PRACTICE OR PROTOCOL: Research demonstrates college educators do not have many resources for education related to the identification of mental illness leading to risk of suicidal ideation in college students. In addition, few faculty feel comfortable identifying what to do or say to prevent suicide. In addition, most higher educators are not familiar with community mental health resources. VALIDATION OF EVIDENCE: Pre- and post-presentation surveys. RELEVANCE OF PMH NURSING: Increased knowledge and willingness to help. FUTURE IMPLICATIONS: College educators equipped with knowledge on suicide prevention can save lives.
Poster #36: Onboarding With Intention: The Effects of a Comprehensive New Hire Orientation Process
Liam Hix, MSN, RN, PMH-BC; Lacy Hager, MSN, RN, R.T. (R) (MR)
Category: Education
ABSTRACT
PROBLEM STATEMENT: Due to the lack of consistent training pathways specific to pediatric, psychiatric nursing, there is often a gap between newly hired nursing staffs’ (NHNS) existing and desired practice levels required to care for this unique population. This can lead to negative patient outcomes, decreased safety, lower staff satisfaction, and high turnover. SUMMARY OF EVIDENCE: There is a need for onboarding programs designed to adequately prepare NHNS for their specific practice areas. DESCRIPTION OF PRACTICE OR PROTOCOL: A comprehensive onboarding process was designed and implemented for psychiatric, pediatric NHNS in addition to existing hospital orientation. This process included a series of individualized “check-ins” with an educator beginning 2 weeks before a new hire’s start date; a 2-day “Welcome Week” experience to introduce core psychiatric-mental health nursing concepts; behavioral health-specific medical trainings; a 5-day de-escalation course; and computer-based training modules. VALIDATION OF EVIDENCE: Surveyed NHNS report feeling prepared, confident, and supported in their practice areas. Interviews of multidisciplinary stakeholders highlight a perception of better-prepared NHNS with readiness for further learning. More data collection is needed to review impact on tenure and retention, though initial impressions are positive. RELEVANCE OF PMH NURSING: Through an intentional, relationship-based approach to onboarding and orientation, our Behavioral Health Nursing Education team was able to better support NHNS in providing high-quality psychiatric nursing care. By establishing strong, authentic rapport with staff, educators overcame individual barriers to create more inclusive learning experiences. FUTURE IMPLICATIONS: Now that a foundational knowledge level has been established during onboarding, educational offerings can now be expanded upon to further support growth of our NHNS.
Poster #37: Addressing Social Health Disparities Through Community Partnerships: Mental Health First Aid Training for Clergy Members Who Work at Predominantly Black Churches
Quetina Howell, PhD, RN; Stephanie Belim, PhD, RN, CNE
Category: Education
ABSTRACT
PROBLEM STATEMENT: The problem is that Black Americans who suffer from mental illness or emotional distress are more likely to seek treatment through their church, verses attempting to receive mental health treatment from a trained mental health professional. Reasons for not seeking professional treatment may include (1) mistrust of the health care system, (2) fear of discrimination, and (3) fear of being misdiagnosed. Therefore, African Americans are much more likely to rely on their faith and church clergy than they are to seek treatment from a mental health professional. SUMMARY OF EVIDENCE: Only one in three Black adults with mental illness receive treatment. However, they may be inclined to meet with church clergy who may have little to no training screening or treating mental illness. DESCRIPTION OF PRACTICE OR PROTOCOL: The change to be implemented is an 8-hr mental health first aid course for church clergy who work at predominantly Black churches. VALIDATION OF EVIDENCE: The expected outcome is that after clergy members complete the mental health first aid training course, they will have the fundamental skills to recognize a mental health or substance abuse crisis and know where to turn for help. RELEVANCE OF PMH NURSING: This is an opportunity to reduce mental health disparities in the African American community. FUTURE IMPLICATIONS: Continued research in improving mental wellness in African Americans, the creation of community partnerships in black communities, and mental health first aid training for clergy members outside of Black churches.
Poster #38: Human Caring Theory and Psychedelic-Assisted Therapy: Planning a Prelicensure Nursing Course
Anita Iyengar, DNP, RN, PMHCNS-BC, CNE
Category: Education
ABSTRACT
PROBLEM STATEMENT: The development of a course about safe and therapeutic psychedelic treatment, within a nursing framework, was identified as a quality improvement opportunity at a university’s nursing school. SUMMARY OF EVIDENCE: The first Food and Drug Administration (FDA) approval of a psychedelic substance (3,4-Methylenedioxymethamphetamine [MDMA] for Posttraumatic Stress Disorder [PTSD]) is anticipated within the next few years. Other psychedelics, including psilocybin, are anticipated to also receive FDA review in the near future. DESCRIPTION OF PRACTICE OR PROTOCOL: The practice change was to plan a course focused on psychedelic-assisted therapy (PAT) using Human Caring Theory as a framework. Implementation strategies included intensive instructor training. Current stakeholders are students and instructors. Ultimately, people who acquire psychedelic services in health care settings, assuming national regulatory and legal changes, will benefit from nurses that are knowledgeable about the safety, therapeutics, and equity implications. VALIDATION OF EVIDENCE: Psychedelic nursing experts advise nurses to be active in learning about psychedelics and advocating for their roles within the field. Evidence of these expert recommendations will be included in the poster. Initial effectiveness of the practice change was measured by obtaining the required SON approvals for the course and eliciting enrollment. RELEVANCE OF PMH NURSING: Psychedelics have the potential to largely impact PMH nursing. The initial FDA approvals are anticipated for medications to treat PTSD and major depressive disorder. The outcomes of the project to date include increased psychedelics visibility within the SON, and planning a course within a rapidly evolving, and stigmatized, field. FUTURE IMPLICATIONS: Future implications include course revisions according to legal, regulatory, and clinical developments, and nursing’s response.
Poster #39: Collaboration and Integration: Strengthening Psychiatric Care Through a Psychiatric Mental Health Nurse Practitioner Consortium
Jennifer Jimenez, DNP, FNP-BC, PMHNP-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: Many psychiatric nurse practitioners feel isolated and work independently without much support. Psychiatry lacks the ability to provide algorithms which are applicable across patient populations—it is much more complex and a perfect blend of science and art compared to our primary care colleagues. There is no “5 minute consult for psychiatry.” SUMMARY OF EVIDENCE: Many NPs graduate and enter into positions where they have little or no supervision, support, or collaboration. This is an increased burden in rural areas. Some novice PMHNPs feel unprepared and unsettled in practice and seek peer support. Novice NPs seek guidance and reassurance from expert NPs. DESCRIPTION OF PRACTICE OR PROTOCOL: Our mission is to develop a strong group of PMHNPs in Northwest Indiana by providing an atmosphere for engagement, communication, continual learning, and growth. VALIDATION OF EVIDENCE: Consortium started in February 2023. Started list of 18 NPs in the area. We met monthly for the last 12 months and have averaged 14 to 17 NPs or PMHNP students per month. The list is now 52 people. RELEVANCE OF PMH NURSING: Consortium members feel empowered to precept NP students; teach others; and mentor one another. They are eager to participate in collecting treatment outcome data to contribute to a database from which we will generate evidence. FUTURE IMPLICATIONS: Hosting an inaugural NWI Psych Summit in May, CME/CEU conference. Initiating membership and CME/CEU offerings for not only PMHNPs but primary care NPs as well in the area. Capacity to collect evidence and disseminate findings to peers to improve practice guidelines.
Poster #40: Significant Improvement of Somatic Symptom Disorder With Brief Educational Intervention by the PMHNP in Primary Care
Kim K. Johnson, DNP, PMHNP-BC, FNP-C, RN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Somatization disorders are prevalent in primary care offices, urgent care centers, and emergency rooms. They are associated with significant functional impairment, reduced quality of life, increased rates of disability, and increased suicidality. The frequency of Somatic Symptom Disorder in the general population is 5% to 7%; however, in primary care settings, incidence is estimated to be between 5% and 35%. SUMMARY OF EVIDENCE: Somatic Symptom Disorder is underdiagnosed and underreported due to provider time constraints, intensity of complications, and confusing symptom presentation. Providers are often flummoxed because assessment and diagnostic findings do not match symptom intensity. DESCRIPTION OF PRACTICE OR PROTOCOL: Providers often dismiss somatic complaints or only treat symptoms. Testing can be costly. Health care practitioners must embrace comprehensive evaluation and consider the neuronal response and physiological role of the hypothalamic–pituitary–adrenal (HPA) axis. VALIDATION OF EVIDENCE: The study used a pre- and post-teaching Visual Analog Scale in a primary care setting and a self-reported Patient Health Questionnaire-15 before and after 3 weeks following a 30-min educational intervention. Results showed significant somatic symptom improvement immediately after and sustained 3 weeks post-intervention using the PHQ-15 somatic symptom measurement tool. RELEVANCE OF PMH NURSING: Both Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) can employ this educational intervention to alleviate somatic symptoms in their patients. This component facilitates patient comprehension regarding the correlation between anxiety, depression, and stress response and their symptoms. FUTURE IMPLICATIONS: Offering targeted education on the role of the HPA axis has the potential to mitigate the suffering associated with Somatic Symptom Disorder and reduce the overall demand for health care resources.
Poster #41: Results of a Two-Year, Multicohort Implementation of a Transition to Professional Practice Program for New Graduate Nurses in an Inpatient Psychiatric Setting
Paula Knotts, DNP, RN, PMH-BC, NEA-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: In the aftermath of the pandemic, 22 New Graduate Nurses (NGNs) were hired into a 24-bed medical psychiatric unit at a large academic medical center over a 12-month period. SUMMARY OF EVIDENCE: NGNs need additional support when transitioning to professional practice. There is scant literature describing characteristics, implementation, and efficacy of transition to professional practice (TPP) programs for NGNs in inpatient psychiatric settings. DESCRIPTION OF PRACTICE OR PROTOCOL: This presentation describes the conceptualization, design, implementation, and evaluation of a novel TPP educational program for three cohorts of NGNs in an inpatient psychiatric setting. VALIDATION OF EVIDENCE: This presentation describes the educational program, methodology and sample of participants, and results of pre-employment and post-orientation survey data. Discussion will describe similarities and differences between three cohorts samples, lessons learned, and suggestions for similar programs. RELEVANCE OF PMH NURSING: The outcome of the project allowed for the identification of major themes and most helpful elements of the program that were important to NGNs before and after participation in a psychiatric nursing–based transition to professional practice program. Twenty of 22 NGNs are still employed on the unit 6 to 18 months after the completion of orientation, which supports the unit operational goals of adequate staffing with progressive competency and development. FUTURE IMPLICATIONS: The identification of themes important to NGNs can help inform future program development. Further research is needed to examine the efficacy of transition to professional practice programs in inpatient psychiatry and the characteristics of such programs. Additional research is needed to determine the appropriate components of psychiatric TPPs, including didactic learning, skilled preceptorship, and clinical coaching.
Poster #42: Shaping Tomorrow: Nursing Students’ Role in Hospital Audit Innovation
Tiffany Lofgren, RN, MSN, MBA; Jacque Williams, MSN, RN, NC-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: When nursing students enter the workforce, there is a professional gap in charting detailed and accurate information. Giving students opportunities to learn this early in their career and before working bedside ensures nurses will pay attention to more detail. SUMMARY OF EVIDENCE: There must be more understanding of the rationale of audit charting among students and health care professionals. To help close this gap, partnering with the hospital system educators and management team stresses the importance of charting while assisting with reviewing documentation for accuracy within the health institution. DESCRIPTION OF PRACTICE OR PROTOCOL: Undergraduate nursing students utilize data collected in the hospital to present evidence-based practice to peers, completing a fishbone assignment and reviewing interventions’ rationale. This assists in gaining knowledge about the importance of audits and how they can improve patient outcomes in the health care systems. VALIDATION OF EVIDENCE: The health care system measures the student audits for accuracy and provides direction on areas to further review. Academia measures the outcome through assignments in a Professional Concepts course, assessing learning through project development. RELEVANCE OF PMH NURSING: While many nursing students do not seek employment in a mental health setting, gaining insight into the importance of accurate restraint charting, safety concerns, and pain charting can strengthen their understanding of how to approach mental health needs in other settings best. FUTURE IMPLICATIONS: Giving students early access to audits allows a safe environment for them to learn the importance and accuracy of charting. This can further strengthen their knowledge as they transition into professional practice and chart auditing becomes an expectation.
Poster #43: The Development and Evaluation of a Toolkit for Registered Nurses on the Prevention and Management of Patient Aggression and Violence in the Hospital
Alison Malpass, MSN, RN-BC, CPPS
Category: Education
ABSTRACT
PROBLEM STATEMENT: Most interventions for the prevention and management of aggression and violence have been designed for the psychiatric and emergency room setting. Identifying strategies that acute care nurses can use to prevent and manage violence and aggression is important to their physical and emotional well-being as well as to the quality of care that is provided. SUMMARY OF EVIDENCE: Successful interventions for preventing workplace violence use multicomponent interventions and are based on a strong collaboration between health care providers and hospital management. Toolkits can be used to identify evidence-based strategies and facilitate practice change. DESCRIPTION OF PRACTICE OR PROTOCOL: Most interventions for the prevention and management of aggression and violence have been designed for the psychiatric and emergency room setting and focuses on education. Neuman Systems Theory was used as a framework to develop a toolkit on violence prevention. In using this theory, the nurse considers the physiological, psychological, sociocultural, developmental, and spiritual variables of each person and plans interventions to strengthen their ability to cope with environmental stressors. Interventions in the toolkit are organized into primary, secondary, and tertiary interventions. The toolkit can be used by providers and management to identify multicomponent strategies to prevent and manage patient aggression and violence. VALIDATION OF EVIDENCE: This study was successful in providing a toolkit to 344 nurses on the prevention and management of patient aggression and violence. RELEVANCE OF PMH NURSING: Five participants evaluated the toolkit as focused and useful. FUTURE IMPLICATIONS: The toolkit can be used by clinical nurses, managers, and educators as part of a multifaceted approach to violence prevention.
Poster #44: Self-Care and Preventing Burnout for the Inpatient Psychiatric Nurse
Kyle Markle, BSN, RN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Burnout and compassion fatigue are a consistent problem for inpatient psychiatric nurses around the country. One main factor affecting burnout is lack of self-care. SUMMARY OF EVIDENCE: There is significant evidence demonstrating burnout, compassion fatigue, depression, and more with inpatient psychiatric nurses. There is evidence showing that practices like self-care help with this problem. Unfortunately, a lot of nurses are not educated on how to properly do self-care and stress management practices, which would be the focus of my presentation. DESCRIPTION OF PRACTICE OR PROTOCOL: This past year our hospital implemented a supporting you program (I am a team member) that educates staff on this topic. As a result, we have seen better care from our staff and less burnout. Hospitals should implement some form of education and support services to inpatient psych nursing staff. VALIDATION OF EVIDENCE: We have seen an increase in staff utilizing the service, showing its effectiveness and benefit. Staff have also self-reported improvements in those areas. RELEVANCE OF PMH NURSING: The outcomes were that the supporting you sessions/education have helped staff burnout, compassion fatigue, and taught them better self-care. FUTURE IMPLICATIONS: If nurses around the country put an emphasis on learning self-care practices, they will be able to help prevent burnout/compassion fatigue.
Poster #45: Mitigating Workplace Violence: A Systematic Review of Behavioral Response Team in Health Care Settings Across United States
Adam D. Mayfield, BSN, RN, PMH-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: As workplace violence initiated by behavioral health patients constantly poses threats of physical and psychological harm to health care workers, there has been an urgent need to address the workplace violence in health care settings. To mitigate the workplace violence and to promote a safe work environment, variations of Behavioral Response Team (BRT) have been developed in different health care institutions across the United States. SUMMARY OF EVIDENCE: The development of BRT started since the early 2010 as a strategy to address the increasing patient-initiated workplace violence in health care settings. The main purpose of the team is to proactively provide support to health care workers and to assess and de-escalate the behaviors of patients of different ages who have diagnoses of neurodevelopmental disorders and/or psychiatric disorders. The study is the first systematic literature review study that provides a detailed description and analysis of the capacity and the efficiency of extant BRTs in different health care settings across the United States. Increasing the awareness among health care workers of what BRT is and how to utilize it to decrease behavioral health patient-initiated workplace violence. DESCRIPTION OF PRACTICE OR PROTOCOL: Including a Board-Certified Behavior Analyst and Registered Behavioral Technicians to provide more behavior-focused preventions and interventions. VALIDATION OF EVIDENCE: The number of restraints, seclusions, PRNs, and social validity/staff satisfactions. RELEVANCE OF PMH NURSING: Promoting the mental health of health care workers by making a safe and healthy work environment. FUTURE IMPLICATIONS: Recommendations were made on how to optimize the function of BRT to improve the lives of behavioral health patients as well as to promote the mental health of health care workers.
Poster #46: Anxiety in Nursing Students in a Southern California Simulation: A Descriptive Study
Cynthia McClain, EdD, MHA, PHN, RN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Simulation class continue to report episodes of nursing student anxiety in the simulated class. The students gave accounts of their experiences, difficulties learning, and performing nursing skills. The purpose of the qualitative descriptive study was to explore how nursing students describe the influence of anxiety on their skill performance and skill transfer in the simulation class in Southern California nursing programs. SUMMARY OF EVIDENCE: While many students reported enjoying their time spent in the simulation and how they wish they could have more practice in the simulated environment. There were also statements of students saying they were scared, had blocked thinking, and disliked their peers watching and judging them while they struggled to remember nursing skills. DESCRIPTION OF PRACTICE OR PROTOCOL: For the past 20 years, there have been off and on studies of anxiety in the simulation. There have been no successful changes to the simulated class that I found during my literature review. VALIDATION OF EVIDENCE: This study had 10 individual nursing students and four focus groups. They were asked questions which supported two research questions. This descriptive study used thematic coding to analyze data. RELEVANCE OF PMH NURSING: Student anxiety during the learning process inhibits learning new skills. FUTURE IMPLICATIONS: Use standardized terms and practices. Continue to research for solutions to eliminate anxiety in nursing students.
Poster #47: Connecting Distance and On-Site Learners With PMH Competency-Based, Community, and Interprofessional Simulation
Melissa Neathery, PhD, RN, CNE
Category: Education
ABSTRACT
PROBLEM STATEMENT: Minimal research and resources address how to provide competency-based psychiatric mental health (PMH) community simulations that engage online and onsite BSN and APRN students. SUMMARY OF EVIDENCE: National health care recommendations call for redirecting care from institutional to community-based settings where interprofessional health care providers address physical and PMH needs emphasizing disease management, prevention, and health promotion. Therefore, nursing education must “incorporate innovative pedagogical methods that enhance instruction and improve student preparation through clinical simulation” (p. 11). DESCRIPTION OF PRACTICE OR PROTOCOL: Based on Community/Public Health Nursing Competencies and Core Competencies for Interprofessional Collaborative Practice (IPEC), a multi-scene community-based simulation of an adolescent patient was created with HRSA funding. Standardized patients, telepresence robots, audio-visual modalities, and a simulation management system enabled active online student participation. Key stakeholders include nursing students receiving state-of-the-art experiential learning; faculty; employers; and patients of these future nurses. VALIDATION OF EVIDENCE: Faculty and peers provided students with formative feedback regarding physical and mental status assessment, data interpretation, provision of culturally responsive care, documentation, patient education, counseling, referrals, and interaction with other professionals. Debriefing, self-reflections, Readiness for Interprofessional Learning Scale, Readiness for Interprofessional Learning Scale, and C/PHN Competency Evaluation Tool measured learning objectives attainment. RELEVANCE OF PMH NURSING: Results indicated favorable student perceptions of the simulation that increased knowledge, insights, and competency resulting from the engaging level of realism. Data continue to be collected through Spring, 2024. FUTURE IMPLICATIONS: Integrating innovative technologies into realistic and relevant community-based simulations like this will better prepare future nurses to address PMH needs across the lifespan and continuum of care.
Poster #48: The Mental Health Specialist (MHS) Educator Role: Driving an Innovative Approach to Nursing Staff Development
Andy Otten, MA, BA; Hanah Ball, BA; Tammy Aleshire, STNA
Category: Education
ABSTRACT
PROBLEM STATEMENT: Nursing workforce shortages have impacted all aspects of the profession, including unlicensed assistive personnel (UAP). The number of novice nursing staff, combined with difficulties in recruiting, training, and retaining staff, has challenged organizations to think critically and resourcefully in how they approach nursing education and professional development for all roles. SUMMARY OF EVIDENCE: Following the COVID-19 Pandemic, Nationwide Children’s Hospital needed to rebuild their critically depleted workforce within the Big Lots Behavioral Health Pavilion (BHP). Although UAP staff accounted for more than 70% of the nursing staff in the BHP, they received recognizably lower resources. High patient acuity, minimal support, and few development opportunities resulted in dissatisfaction, decreased staff safety, and high turnover rates. Nursing leaders recognized the need for additional representation and resources to expand the Mental Health Specialist (MHS) role. DESCRIPTION OF PRACTICE OR PROTOCOL: The Behavioral Health Nursing Education Team was supplemented with the creation of the MHS Educator role to spur foundational change in the way UAP staff are represented in onboarding, retention, and development. VALIDATION OF EVIDENCE: Outcomes of the intervention were evaluated through surveys and interviews with nursing staff and leadership. RELEVANCE OF PMH NURSING: The intervention revealed unrecognized needs for a position historically viewed as entry level, including development opportunities, insight from leadership, and lack of representation. FUTURE IMPLICATIONS: The priority intervention identified was the creation of an MHS Development program, which includes trainings, certifications, and career pathways. In addition, two more MHS Educator FTEs were added to the BH Nursing Education team to address the identified needs.
Poster #49: Is Anybody Out There? Creating Connection and Presence in Online Learning Environments
Katherine Pfeiffer, DNP, APRN, PMHCNS, PMHNP
Category: Education
ABSTRACT
PROBLEM STATEMENT: Whether a new or seasoned online educator, creating meaningful and engaged active learning experiences in online classroom is a common challenge. The natural distance of an online classroom can undermine learner self-motivation and engagement required for active learning unless presence is intentionally curated. Furthermore, student success and perceived course satisfaction can be linked to feeling as if the educator is “really there.” SUMMARY OF EVIDENCE: We will discuss types of online classroom presence (social, cognitive, and teaching presence) and the evidence for each that develop an asynchronous or synchronous active learning community that is student-centered and engaged. DESCRIPTION OF PRACTICE OR PROTOCOL: We will define standard elements of online course design that promote connection and presence between educators and students. Specific opportunities for interaction and cultivating presence for active learning and engagement will be discussed with emphasis on particular activities, communication strategies, and technologies (i.e., student response systems) that promote active learning. VALIDATION OF EVIDENCE: We will share results, learner and educator responses to the course design, successes, barriers, and other lessons learned from implementation that can shape knowledge, skills, and attitudes toward competency attainment. RELEVANCE OF PMH NURSING: The educator’s presence in the online environment is critical to increase engagement, decrease isolation, provide a sense of community, and may even decrease attrition. Understanding how to cultivate an online presence can provide a robust online learning experience and sense of camaraderie in the classroom. FUTURE IMPLICATIONS: Understanding how to establish and maintain presence and engagement for active learning in the online classroom is a necessary skill for nurse educators teaching outside of traditional classroom spaces.
Poster #50: Mental Health Nursing Clinical: Perfecting Student Skills Utilizing Clinical and Simulation Environments
Kathryn Phillips, PhD, APRN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Prelicensure mental health nursing students need to learn clinical skills for practice. Clinical environments may not provide the unique learning opportunities necessary for skill development. In addition, students often express anxiety about mental health clinical experiences. Therefore, offering students simulated learning activities can enhance their skill development. SUMMARY OF EVIDENCE: A large study by the National Council of State Board of Nursing (NCSBN) indicated that up to 50% of clinical time could be exchanged with simulation without changing NCLEX pass rates or clinical supervisor ratings of new nurse skills. DESCRIPTION OF PRACTICE OR PROTOCOL: We provide psychiatric mental health nursing students a combined experience in both the clinical environment and the simulation lab. VALIDATION OF EVIDENCE: Clinical assignments, preceptor ratings, and student feedback indicate that students are learning the clinical skills necessary for mental health nursing. RELEVANCE OF PMH NURSING: Nursing faculty are seeking ways of clinically training students in the simulation environment due to the challenges of finding relevant clinical experiences. This presentation will provide one model for nursing schools to consider. FUTURE IMPLICATIONS: Nursing educators need novel ways to train students in the skills necessary for mental health nursing clinical practice. This presentation will provide one example of a clinical course with simulation and clinical components for skill development.
Poster #51: Learning Group by Doing: Integrating Theory With Low-Fidelity Simulations to Train Nurses to Lead Therapeutic Groups
Bethany J. Phoenix, PhD, RN, FAAN, CNS
Category: Education
ABSTRACT
PROBLEM STATEMENT: Psychiatric mental health nurses at all levels of practice lead therapeutic groups across health care settings, but the knowledge and skills needed for successful group facilitation may receive scant attention in educational programs. Lack of knowledge, skills, and confidence in group leadership hinders optimal use of nurse-led. SUMMARY OF EVIDENCE: A well-established body of literature demonstrates that group psychotherapy and other types of therapeutic groups improve access to care, are cost-effective, and produce a broad range of therapeutic benefits. However, a recent survey of PMH-APRN practice patterns indicates that almost 80% of PMH-APRNs do not include group therapy as part of their practice. DESCRIPTION OF PRACTICE OR PROTOCOL: Presentation provides an overview of a graduate nursing course on facilitating therapeutic groups, with a focus on how didactic and experiential learning are integrated in four group simulations. Presentation content includes key concepts of group process and structure; skills developed in the simulations; and simulation scenarios, participant roles, and processes for preparation and debriefing. VALIDATION OF EVIDENCE: Data from student evaluations will be presented, as well as vignettes illustrating student “aha” moments experienced during simulations. RELEVANCE OF PMH NURSING: Given the wide variability in clinical opportunities to receive supervised training in group facilitation, low-fidelity simulation provides opportunities for nurses and nursing trainees to integrate theory and practice and increases interest and confidence in leading groups in their practice. FUTURE IMPLICATIONS: Given the increasing need for behavioral health services and proven benefits of group treatment, PMH nurses must be prepared to make optimal use of group modalities. Well-designed clinical simulations increase nurses’ confidence and skills in group facilitation.
Poster #52: Leveraging Student Peer Storytelling to Combat Stigma and Foster Connection: A Psychiatric Nursing Perspective
Rebecca Puchkors, MSN, RN, PMH-BC, CA-CP SANE
Category: Education
ABSTRACT
PROBLEM STATEMENT: In the realm of psychiatric nursing, addressing stigma surrounding mental health is a critical endeavor. The negative stereotypes and discrimination associated with mental illness often serve as significant barriers to effective treatment and recovery. Moreover, fostering a sense of connection and understanding among individuals grappling with mental health challenges is essential for holistic care. SUMMARY OF EVIDENCE: Peer support is shown to improve experiences and decrease stigma. This innovative approach of utilizing student peer storytelling in the classroom and clinical supports the evidence. By harnessing the authentic narratives and lived experiences of peers, students are provided with invaluable insights into the realities of mental health conditions, dispelling misconceptions and fostering empathy. DESCRIPTION OF PRACTICE OR PROTOCOL: Drawing on empirical evidence and case studies, the student’s personalized concept map and storytelling cultivated a supportive learning environment, encouraging open dialogue, enhancing therapeutic relationships between student nurses and patients, addressing implicit bias and stigma, and encouraging student mental health awareness and support. VALIDATION OF EVIDENCE: Peer support and storytelling improved empathy and self-advocacy of undergraduate nursing students. RELEVANCE OF PMH NURSING: This presentation will delve into practical strategies for implementing student peer storytelling initiatives within academic curricula, including ethical considerations, faculty support, and student engagement. Attendees will leave equipped with actionable insights and resources to integrate this innovative approach into their own educational settings. FUTURE IMPLICATIONS: By embracing student peer storytelling as a means to decrease stigma and increase connection, psychiatric nursing educators can empower the next generation of nurses to provide compassionate, person-centered care in the field of mental health.
Poster #53: Interdisciplinary Collaboration: Educating Inpatient Psychiatric Staff on Medical Concerns
Natalie Ramirez, BSN, RN; Amanda Meffert, RN, BSN; Emily Sperberg, MSN, RN; Amy Weaver, MHA, BSN, RN, CEN, PMH-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: Due to being out of practice with medical needs, psychiatric nurses are out of practice with the latest evidence-based practice on certain procedures and may affect their ability to deliver the highest quality care. SUMMARY OF EVIDENCE: Event report data and nurse survey. DESCRIPTION OF PRACTICE OR PROTOCOL: Because of their lack of recent practice, psychiatric nurses may miss signs indicating a patient’s worsening condition or fail to implement the latest evidence-based practices. VALIDATION OF EVIDENCE: Based on event report data and nurse survey, there is a gap in knowledge. RELEVANCE OF PMH NURSING: This is data based on an inpatient psychiatric unit. FUTURE IMPLICATIONS: Psychiatric nurses will enhance their confidence in making informed decisions and effectively apply the latest evidence-based practices to care for medically complex patients. Collaborating with educators from more medically focused units, they will optimize the education of psychiatric nurses on current evidence-based information. These education sessions will be recorded for later review, with additional resources and tip sheets to support ongoing learning.
Poster #54: Empowering Psychiatric Nurses: Understanding Psychiatric Laws With Social Work Insight
Natalie Ramirez, PMHN-BC, BSN, RN; Karina Rosales, LCSW; Sarah Sperberg, BSN, RN, PMHRN-BC; Amanda Meffert, RN, BSN; Kateleen Collins, BSN, RN; Emily Smith, MSN, RN
Category: Education
ABSTRACT
PROBLEM STATEMENT: To help nurses have better understanding of psychiatric laws and how it applies to their practice so they can make confident choices related to their patient care and promote compliance. SUMMARY OF EVIDENCE: Based on a survey conducted on our inpatient psychiatry unit, nurses voiced concerns about the gap in knowledge regarding laws and their understanding of patient rights. DESCRIPTION OF PRACTICE OR PROTOCOL: At this time, our social worker who also works as a Mental Illness Court Liaison for our psychiatric unit handles all our involuntary patient cases. She coordinates with the courts, public defenders, and DAs and then relays information to staff members about the commitment status. We have learned that our staff nurses have minimal knowledge about the legal terms that are used during these cases. VALIDATION OF EVIDENCE: As a teaching hospital, we also hire on several newly graduated and certified nurse residents who do not receive dedicated training on this information. With more and more new nurses coming into psychiatry every year, this is not an isolated finding. RELEVANCE OF PMH NURSING: By understanding the laws, nurses can help patients advocate for themselves because there will be a better understanding of the patient’s own rights. We can do a survey for staff confidence, more collaboration within the treatment team, and reduce safety events. FUTURE IMPLICATIONS: By having a better understanding of standards and laws, nurses will be able to provide a safer and more recovery-oriented environment for their patients, who will also be benefiting from a more consistency from their care providers.
Poster #55: Empowering Nurses: Integrating Self-Care Into Pre-Licensure Curriculum
Lisa Reyes-Walsh, DNP, APRN, FNP-BC, PMHNP-BC, CARN-AP; Ashley Barber, DNP, CPNP-PC, PMHS
Category: Education
ABSTRACT
PROBLEM STATEMENT: The purpose of this poster presentation is to underscore the necessity of integrating self-care strategies into the nursing curriculum, fostering future nurses’ well-being and enhancing patient care. SUMMARY OF EVIDENCE: Research indicates that increased stress negatively affects learning in pre-licensure nursing students. Nursing education often overlooks stress reduction techniques, yet evidence suggests integrating self-care strategies into curricula using a student-centered approach is vital for enhancing student and patient outcomes amid the nursing shortage. DESCRIPTION OF PRACTICE OR PROTOCOL: We are inviting students to sign up weekly to share self-care activities during the first 10 min of our mental health nursing course. By integrating education and research into our lectures, we emphasize the importance of these strategies. Each week, we focus on different self-care methods to empower students with a variety of resources. In addition, students are introduced to a college-created definition of self-care to underscore its significance in education. VALIDATION OF EVIDENCE: The literature validates the evidence by consistently highlighting the importance of holistic health concerning mind, body, and soul in self-care practices for pre-licensure nursing students through pilot studies, qualitative research, and integrative review. RELEVANCE OF PMH NURSING: Nurses, regardless of experience, can face psychological strain. Novice nurses often lack coping skills. Teaching self-care strategies to pre-licensure students may help prevent nursing shortages. FUTURE IMPLICATIONS: As nurse educators, we are ethically bound to prioritize the well-being and resilience of the future nursing workforce. Given the declining mental health among nursing students and nurses, mental health nursing presents an ideal platform to underscore self-care concepts and teach strategies for improving student mental health.
Poster #56: Implementing a Structured Psychiatric and Mental Health Nurse Practitioner Student Clinical Training Program: One Approach
Beverly W. Rich, DNP, APRN BC; Morgan Goncalo, BSN, RN
Category: Education
ABSTRACT
PROBLEM STATEMENT: Address the shortage of and develop a high-quality structured clinical nurse practitioner (NP) training program within an academic mental health setting. SUMMARY OF EVIDENCE: NP students must struggle to secure clinical training sites which can vary significantly in clinical experience and mentor investment. Many academic institutions task their students to seek out preceptors and find their own clinical placements. There is a shortage of mentors. DESCRIPTION OF PRACTICE OR PROTOCOL: We developed criteria for training NP/advanced practice registered nurse (APRN) candidates. We provided high-quality focused learning and direct teaching/supervision for the NP/APRN student through in-person and hybrid patient care clinical hours and focused didactic experiences, featured speakers who are content experts, and engaged in a process component which included mindfulness. We afforded graduate nursing students an opportunity to gain proficiency with public speaking and “give back” by educating our nursing staff and Behavioral Health Specialists. VALIDATION OF EVIDENCE: We provided frequent check-ins and support to assure that the dyad of preceptor/student remained a positive and a rewarding experience. Students reported on areas they had mastered, were achieving proficiency in, or needed more exposure to. At the end of the program, the student provided a self-assessment and completed a formal qualitative and brief quantitative feedback tool evaluating all aspects of the program. RELEVANCE OF PMH NURSING: More than 20 NP students have participated in this formal training program. Students expressed appreciation for the customization of their learning, and report feeling seen and valued as members of the health care team. FUTURE IMPLICATIONS: Through sound and accountable clinical training, NP students will reach the fullest extent of their education with readiness for practice.
Poster #57: Enhancing Early Pre-Licensure Nursing Student Clinical Education Through Academic Practice Community Health Partnerships
Kathleen Sarzyenski, MS, DNP, APRN, PMHNP-BC, CNL; Erin Miller, DNP, APRN, PMHNP-BC, CNL
Category: Education
ABSTRACT
PROBLEM STATEMENT: Community-based placements for nursing students could provide a multifaceted opportunity to expand placement capacity, serve as a recruitment tool to alleviate workforce shortages, and encourage shifts in career focus. By leveraging Academic Practice (APs) Partnerships based within the community, students may gain invaluable exposure to care transitions and a deeper comprehension of the disparities experienced by marginalized populations. SUMMARY OF EVIDENCE: Community-based placements for nursing students offer opportunities to expand placement capacity, recruit amid workforce shortages, and shape career focus. Despite student preference for inpatient experiences, Academic Practice Partnerships (APs) in communities provide invaluable exposure to care transitions and disparities among marginalized populations. This study examines nursing students’ capacity to meet learning competencies and develop therapeutic engagement skills within APs health clinics for justice-impacted individuals. DESCRIPTION OF PRACTICE OR PROTOCOL: Justice-impacted individuals face challenges including limited access to care and fragmented health care connections. APs offer unique learning environments for nursing students, fostering an understanding of health care disparities and fulfilling AACN competencies. VALIDATION OF EVIDENCE: Student learning was evaluated utilizing Clinical Performance Appraisals (CPAs) derived from the AACN Essential competencies. The highly validated and reliable Attitudes Toward Prisoners (ATP) scale was used in this retrospective pre-test methodology to assess student perspectives. Qualitative data was collected from students, faculty, and program staff with themes identified. RELEVANCE OF PMH NURSING: Exposing nursing students to marginalized populations fosters advocacy and collaboration, driving them toward community-focused practice. FUTURE IMPLICATIONS: Engaging APs in initial clinical experiences not only develops core competencies but also increases access to quality care for vulnerable populations while enhancing clinical placement capacity.
Poster #58: Applying a Spiritual Care Framework to Direct Reflection and Understanding in the Study of Psychiatric Mental Health (PMH) Nursing
Kimberly J. Sharp, RN, PhD
Category: Education
ABSTRACT
PROBLEM STATEMENT: The practice change in education was to use spiritual health assessment to assist nursing students to understand clients in psychiatric mental health (PMH) setting and to plan their care. SUMMARY OF EVIDENCE: There is a lack of spiritual health assessment in the classroom, and most undergraduate students are inexperienced in using spiritual concepts to assess and understand client behavior. The spiritual care focus of “self-control” within the context of working with mental health clients was used to understand clients and reflect on interactions in the clinical setting. The underlying educational need was for students to make their learning more relevant to the clients they will encounter. DESCRIPTION OF PRACTICE OR PROTOCOL: Students were not used to spiritual health assessment, and the use of spiritual concepts such as “self-control” to organize their reflection of clinical experiences in PHN settings. The practice change was the introduction of a model based on spiritual care to provide deeper insight into the understanding of clients, providing a framework within which the reflective experiences of the students could be organized. VALIDATION OF EVIDENCE: The effectiveness of the learning approach was validated via the reflective journals completed by students and through increased involvement of students in class via discussion on issues pertaining to spiritual health assessment. RELEVANCE OF PMH NURSING: Students developed an interest in spiritual issues, such as “self-control” within PMH care and the outcome of the intervention is that this spiritually focused approach will be utilized in future PMH classes. FUTURE IMPLICATIONS: Teaching that includes spiritual health assessment for planning teaching and reflective exercises across the curriculum will be explored.
Poster #59: Exploring Mental Health Issues With Psychiatric Mental Health (PMH) Nursing Students Through the Use of Contemporary Music
David Sharp, RN, PhD
Category: Education
ABSTRACT
PROBLEM STATEMENT: The practice change in education was to involve and engage undergraduate students in a more direct manner in the understanding of clients and planning care. SUMMARY OF EVIDENCE: There is a lack of student involvement in the classroom, in addition, most undergraduate student have a lack of interest in psychiatric mental health (PMH) nursing as they do not intent to work in that field. The practice change was in moving from a didactic approach to PMH teaching to a more student centered, andragogical approach as first suggested by Knowles. The underlying educational need is for students to develop an interest in mental health topics in order to make their learning more effective and relevant to the clients they will encounter. DESCRIPTION OF PRACTICE OR PROTOCOL: Students viewed PMH nursing as having a lack of relevance. The practice change was a project where students were awarded credit for finding a contemporary song that had content related to a mental health issue. Students were surprised by how many songs they were familiar with that fit into this category. They then had to write about the issue relating to their mental health textbook and discuss it in class. VALIDATION OF EVIDENCE: The effectiveness of the learning approach was validated via a survey completed by students and through increased involvement of students in class via discussion. RELEVANCE OF PMH NURSING: Students developed an interest in PMH issues and the outcome of the intervention is that this student-centered project will be utilized in future PMH classes. FUTURE IMPLICATIONS: Teaching that relates to the learning styles and personal culture of students will be explored.
Poster #60: Nurses Navigating Psychedelic Medicalization
Evelyn Shoop, BSN, BS Psychology
Category: Education
ABSTRACT
PROBLEM STATEMENT: The Food and Drug Administration (FDA) will likely approve 3,4-methylenedioxymethamphetamine (MDMA) therapy for posttraumatic stress disorder (PTSD) in 2024, a potential psychiatric revolution. Psychiatric nurses will play an important role in psychedelic-assisted therapy (PAT). Advances in nursing education are vital to prepare nurses for this breakthrough therapy in the United States. SUMMARY OF EVIDENCE: Within profitable Western PAT practices, findings indicate ethical concerns, limited diversity, and high costs, impacting accessibility post-legalization. Nurses must embrace their role in this imminent field, otherwise knowledge deficits and involvement gaps will persist, limiting the potential of this specialized intervention. DESCRIPTION OF PRACTICE OR PROTOCOL: My practice change aims to convince professors to include key topics relating to psychedelic medicalization in BSN-level curriculum. I persuaded a professor at Penn to incorporate PAT into their Clinical Modalities course. To support this goal, I will create an infographic summarizing recent PAT advancements and nursing’s pivotal role. VALIDATION OF EVIDENCE: Time and resource-intensive demands will produce access barriers upon legalization, and more than 80% of research participants are Non-Hispanic White. Outcomes may also be hindered by the competitive nature of health care or exaggerated efficacy claims. The evidence validates the need for change, and nurses are poised to confront these challenges through education and awareness. RELEVANCE OF PMH NURSING: Psychiatric nurses are exceptionally well suited to care for PAT patients due to their unique roles and clinical duties. Undergraduate education is vital to prepare nurses for this responsibility, equipping them to effectively address potential problems upon legalization. FUTURE IMPLICATIONS: Future implications involve integrating psychedelic programs within community and educational settings. Expanding nurse opportunities within curriculums and health systems amplifies knowledge and involvement, enabling collective risk mitigation.
Poster #61: Using Trauma-Informed Teaching Practices With PMHNP Students to Foster Resilience in the Workforce
Megan Simmons, DNP, PMHNP-BC; Rose Vick, PhD, PMHNP-BC; Jessica Walker, DNP, PMHNP-BC; Christian Ketel, DNP, FNAP
Category: Education
ABSTRACT
PROBLEM STATEMENT: Nursing burnout has reached a new level of prevalence among professionals, with 80% of registered nurses and 64% of advanced practice registered nurses (APRNs) reporting burnout. Among APRNs, psychiatric-mental health nurse practitioners (PMHNPs) have the least favorable combination of low compassion satisfaction and high secondary traumatic stress, placing them at even greater risk for burnout compared with other specialties. New graduate nurses are especially at risk, with higher burnout and compassion fatigue scores, and 35% to 60% leave their first job within 12 months. SUMMARY OF EVIDENCE: Trauma-informed teaching and learning principles can serve to prevent burnout. Through these teaching methods, nurse educators have the opportunity to prepare students for the professional stressors that contribute to burnout. DESCRIPTION OF PRACTICE OR PROTOCOL: This quality improvement project involved implementation and evaluation of a grant-funded program to train PMHNP students interested in working in rural and underserved areas. VALIDATION OF EVIDENCE: The program integrates trauma-informed principles and provides specialized resilience training to better equip PMHNP students to serve vulnerable populations and handle their own emotional and psychological well-being when they enter practice. RELEVANCE OF PMH NURSING: Qualitative program outcomes indicated that trainees were implementing trauma-informed principles and skills with patients and for self-care during their nursing training and at 1-year follow-up, suggesting a long-term impact of the program. The 1-year follow-up data with new PMHNP graduates will be discussed. FUTURE IMPLICATIONS: The use of trauma-informed teaching interventions in this program may offer practical upstream solutions for nurse educators. Future studies should explore concepts more formally to develop best-practice approaches.
Poster #62: Preparing Prelicensure Students to Provide Care for Aggressive, Psychotic Patients Through the Use of Standardized Patients
Jody Smith, DNP, APRN, FNP-C, CNE
Category: Education
ABSTRACT
PROBLEM STATEMENT: A rise of violence in the workplace by aggressive patients has had a negative impact on nursing. Nursing education has historically relied upon observation of escalated during clinical rotations to learn how nurses de-escalate a patient to maintain safety. With a rise in aggressive patients, limited clinical time, and a call by the stakeholders to prepare new nurses for the reality of nursing practice, nurse educators need to find innovative ways to teach de-escalation and violence prevention to pre-licensure nurses. SUMMARY OF EVIDENCE: Brusie cited a Press Gainey Survey that identified two nurses are assaulted every hour in the workplace. Ozkara identifies budget cuts, a rise in mental health problems, reduced availability of clinical sites, and student anxiety as cl barriers to effective mental health clinical experiences. DESCRIPTION OF PRACTICE OR PROTOCOL: The use of a simulated patient will prepare nurses for safe practice by enhancing their ability to complete a mental health assessment and communicate while increasing their self-confidence. Alexander identified the benefit of the use of simulation in that focuses on therapeutic communication and interpersonal skills as a safe innovative way to decrease student anxiety, reduce stigma, and sharpen nursing skills. VALIDATION OF EVIDENCE: In response, the faculty provided a simulation of an aggressive patient to senior-level undergraduate students. Their qualitative feedback provides insight to the value and need for this type of simulation. RELEVANCE OF PMH NURSING: Mental health (MH) nurses are at increased risk for violence in the workplace. FUTURE IMPLICATIONS: This innovative teaching method may help undergraduate nursing programs prepare students to practice safely upon graduation with increased self-confidence
Poster #63: Mitigating Medication Errors in the Inpatient Psychiatric Setting: A Synthesis of the Evidence
Tiara K. Stepp, BA, BSN, RN, PMH-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: Through audits of patients’ medication administration records and event reports, discrepancies were identified among over half of psychiatric nurse residents during their first year of practice. Medication administration errors can have unanticipated, adverse effects on patients, ranging from extended length of stay to psychological or physical harm. SUMMARY OF EVIDENCE: A literature review was conducted to support the writer’s PICOT question. Recurring themes and contributing factors to medication errors among novice nurses, and opportunities for training were identified. DESCRIPTION OF PRACTICE OR PROTOCOL: Within the current nurse residency program in the writer’s workplace, formal education regarding medication administration is not provided. The presentation proposes a solution to reduce rates of errors through simulation training for nurses within their first 2 years of practice. Strategies to implement change through simulations on the inpatient psychiatric setting are discussed. Stakeholders include nurse residents, patients, hospital administration, and nurse residency coordinators. VALIDATION OF EVIDENCE: The current rate of medication errors for the inpatient psychiatric unit will be established and compared to errors among nurses with two or less years of experience. Random audits of medication administration error rates will be completed and methods of teaching adjusted based on areas of error. RELEVANCE OF PMH NURSING: Continued educational support is needed during the transitional period of nurse graduates entering independent practice. Knowledge on commonly prescribed psychotropic medications and their unique effects on patient outcomes is essential to understanding and supporting the patient through their recovery. FUTURE IMPLICATIONS: Continued training on medication administration practices may serve to benefit patients while sharpening novice nurses’ critical thinking skills in their formative professional years.
Poster #64: Educate, Enhance, Enlighten: Teaching Staff About Psychiatric Medication
Lincoln Teal, MSN, RN, PMH-BC; Madeleine Lepore, BSN, RN, PMH-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: As there is an increase in children with psychiatric diagnosis, there is an increase in children boarding on medical floors waiting for appropriate psychiatric level of care. Their bedside nurses do not administer psychiatric meds often. Mental health counselors do not administer meds, nor have medication training but do spend a lot of time around psychiatric patients. Having knowledge of medications can help them understand the patient better and also improve care. SUMMARY OF EVIDENCE: Many staff nursing have voice frustration as they do not feel comfortable working with psychiatric patients as they have not been trained to work with them. Behavioral Response Team can assist with behaviors, but Bedside nursing is responsible for medication. DESCRIPTION OF PRACTICE OR PROTOCOL: Enhancing the knowledge of psychiatric and medical staff nurse, and educating mental health worker and other staff that are not involved in medication administration. Enlighten the care psychiatric borders. VALIDATION OF EVIDENCE: Electronic survey, in which all data is organized. RELEVANCE OF PMH NURSING: Learner has an improved understanding of type of psychiatric medication. FUTURE IMPLICATIONS: Further teaching monthly. With topics alternating. Finding ways to make the teaching more widespread and be able to reach most amount of staff in all psychiatric departments throughout the enterprise
Poster #65: Lean on Me: The Potent Power of Self-Care Among Nursing Students
Brandon Thatcher, MSN, PMHNP-BC; Michael Thomas, DNP, PMHNP-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: There is a need among nursing students for strengthened social connection and increased competence in self-care management. SUMMARY OF EVIDENCE: Poor social connection and stress management skills carry dire health consequences. For nurses, poor social connection and coping skills contribute to worsened mental health, increased turnover, and higher rates of burnout. There is a predicted shortage of 3.3 million nurses by 2031. More than half of nurses surveyed by AACN in 2023 reported symptoms of burnout, with higher rates among less-tenured nurses. Approximately 48% of college students report moderate or severe psychological stress. The AACN has issued calls to action for academic and health care organizations to promote practices to enhance optimal well-being, resilience, and suicide prevention for nurses. Enhancing social connection and self-care practices among nursing students could promote better resilience and well-being among these future nurses. DESCRIPTION OF PRACTICE OR PROTOCOL: Undergraduate wellness courses are a promising low-cost intervention that promotes improved social connection, refined self-care insights, and enhanced well-being. VALIDATION OF EVIDENCE: Brigham Young University College of Nursing has taught two nursing-specific elective self-care courses since 2015. A pilot study evaluating the effectiveness of these courses was completed with promising results, and a larger study is in process. RELEVANCE OF PMH NURSING: This presentation will outline strategies for educators to assist students in achieving the AACN competency to “demonstrate healthy, self-care behaviors that promote wellness and resilience.” FUTURE IMPLICATIONS: Nurse educators must prepare students intellectually and emotionally for their future careers. Educational strategies that promote self-care and social connection can potentially improve the mental health and work satisfaction of the future nursing workforce.
Poster #66: Closing the Gap for Psychiatric Resource Nurse Orientation
Annietra Udoh, BSN, RN; Kelly Bonilla, BSN, RN; Madison McQueen, BSN, RN, PMH-BC; Cornelius Metili, BSN, RN, PMH-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: A nursing orientation program can positively affect new nurses who are joining the organization. The implementation of a new psychiatric nurse role within the hospital system developed the necessity for an orientation program that would provide quality, safe, and positive outcomes. Psychiatric Resource Nurse roles were created within the organization to provide, support, resources, and education to staff regarding patients with behavioral or mental health needs. SUMMARY OF EVIDENCE: A need for a formal orientation program for psychiatric resource nurses was evident through the lack of completion of onboarding requirements. Following onboarding, new staff required an extended orientation. New staff were unable to independently provide adequate patient care. Ongoing studies show that orientation programs motivate nurses to adhere to their required duties. DESCRIPTION OF PRACTICE OR PROTOCOL: An orientation program was created to support the specific role of the psychiatric resource RN to fulfill the need for patient centered care. The initial orientation consisted of shadow shifts, evidence-based online competencies, reviewing general safety guidelines, and policies. Initial gaps were identified and utilized to formulate a new orientation program. VALIDATION OF EVIDENCE: Pre- and post-orientation survey was provided to RN hires to evaluate effectiveness of orientation program for new psychiatric resource nurses. RELEVANCE OF PMH NURSING: The expectations of the program is for the RN to be competent, confident, and comfortable in the psychiatric resource RN role by providing quality care to our patients. FUTURE IMPLICATIONS: Future implications include continuous revisions and improvements to the orientation program that models the evolution of the psychiatric resource RN role and the evolution of patient care.
Poster #67: Making Connections With Motivational Interviewing: An Interprofessional Program
Lori Lynn Vick, PhD, MAT, RN; Katharine E. Harding, MSN, RN-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: A curricular gap exists in patient and provider communication for health-related behavior change. SUMMARY OF EVIDENCE: Educators were looking for an innovation to address barriers to health behavior change during patient care interactions. Motivational interviewing (MI) is used to develop therapeutic alliances and troubleshoot barriers to health-related decision-making. Nurses and physicians collaborated to design a curriculum to facilitate a simulation to prepare first-year medical students for the application of MI in their clinical practice. DESCRIPTION OF PRACTICE OR PROTOCOL: A medical team at a Southeastern medical school sought collaborative support and insight from psychiatric mental health nurses with MI expertise. The curriculum planning procedure included (1) an MI course overview containing student-paced modules; (2) designing simulation content and standardized patient script; (3) volunteer first-year medical student champions participating in a simulated telehealth encounter with peer, standardized patient, and facilitator evaluation and feedback; (4) creating a video enacting each of the principles of MI; and (5) pre- and post-surveys of the students experience. VALIDATION OF EVIDENCE: Students reported a willingness to use MI in their practice post-exposure to the student-paced modules. The students demonstrated successful MI skills in the telehealth simulation and met the criteria of the assessment instrument. RELEVANCE OF PMH NURSING: The use of MI is relevant to the long-term working relationships of health care providers in their daily interactions with clients. FUTURE IMPLICATIONS: This interprofessional collaboration was synergistic and is believed to have the potential to benefit the patient–provider relationship significantly. Replication of this project would strengthen the evidence to support its development and continued use in schools and colleges of nursing and other health care programs.
Poster #68: Teaching Empathy and Communication Skills to Nursing Students: The Nursing Street Medicine Program (NSMP)
Diane Vines, RN, PhD, RRT, PHN, PMHN; Anne E. Lama, DNP, APRN, FNP-C, ACUE; Samantha Duffle, BSN, RN, PCCN
Category: Education
ABSTRACT
PROBLEM STATEMENT: High number of homeless persons in the region; Emergency rooms are utilized for primary care and minor issues; Need for health care services where homeless people live and spend time; Need for no-cost health care; Need for nursing students to develop empathy for homeless persons. SUMMARY OF EVIDENCE: Nursing students rarely engage with homeless people. Street medicine programs often prevent emergency room visits or arrests for unruly behavior. Participation in street medicine increases empathy toward the homeless and those with mental illness or substance abuse. DESCRIPTION OF PRACTICE OR PROTOCOL: The Nursing Street Medicine Program (NSMP) nursing students at all degree levels provide free health care services to homeless people in the Inland Empire California while fulfilling clinical hours and service-learning requirements to complete their degrees. The students develop empathy and communication skills by performing foot soaks for homeless people while engaging in conversation that is free of health care advice and focused on students’ active listening and empathetic responses. VALIDATION OF EVIDENCE: Students take an attitude survey before and after they participate. Satisfaction testimonials from agency partners, homeless persons, students, and faculty. RELEVANCE OF PMH NURSING: Students who have participated in the Street Medicine Program are significantly more comfortable working with homeless individuals and less likely to reduce the amount of time caring for homeless individuals. FUTURE IMPLICATIONS: We hope other nursing schools adopt the model with nurse clinics and foot soaks into their curriculum to continue exposing future health care workers to the struggles the homeless people experience and mitigate the current culture of systematic violence against this marginalized group.
Poster #69: Development of Compassion, Empathy, Spiritual Growth, and Resilience Among Undergraduate Nursing Students Through the Use of Art
Elaine Webber, DNP, PPCNP-BC, IBCLC; Sonya Kowalski, DNP, RN, ACNS-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: The literature indicates nursing students’ rates of depression and anxiety have been increasing and they are not adequately prepared for practice in the complex health care environment. This can lead to an inability of novice nurses to address the emotional needs of patients with compassion, and practice self-care in an often-stressful work environment. SUMMARY OF EVIDENCE: It is not enough to prepare future nurses with conventional pedagogies. Many nursing programs do not directly address the development of compassion and resilience in their students. More needs to be done to facilitate the integration of these subjects into curricula. Art has been shown to foster innovation and creativity in nursing education and can be used to focus on personal spiritual growth, providing a basis for the development of compassion, empathy, and resilience. DESCRIPTION OF PRACTICE OR PROTOCOL: Integrating art projects into an introductory nursing course provided students the opportunity to explore personal spirituality and thoughts on compassionate care. Students were encouraged to “let-go” and allow for free-form, abstract creations following written prompts. The final art project presented to class included an explanation of how their art represented compassion, empathy, spiritual growth, and personal well-being. VALIDATION OF EVIDENCE: Students provided narrative responses to open-ended questions regarding their artwork which were reviewed by faculty and collated into themes. RELEVANCE OF PMH NURSING: Students reported that the art activities provided a means to integrate professional nursing care with compassion, care of the whole person, and spiritual growth. FUTURE IMPLICATIONS: Students overwhelmingly responded favorably to the art activities. Future creative art activities will include prompts to address the broader landscape of emerging wellness curricula.
Poster #70: Empowering Nursing Students: Harnessing Self-Care Strategies for Sustainable Practice
Jacque Williams, MSN, RN, NC-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: The intense nature of clinical work may negatively affect nursing professionals, particularly if they lack social support or do not have self-care strategies that help them deal effectively with job-related stress. Without self-care practice, students’ ability to effectively navigate academic and professional demands can be compromised. While students exhibit these skills, consistency is critical as they move from academia to profession to help mentally prepare them with adequate coping strategies. SUMMARY OF EVIDENCE: Nursing is a high-stress profession where they struggle to manage the day-to-day pressures they face. Nursing students see this while in clinical experiences and reflect on the challenges they will face upon entering the profession. It is vital to implement self-care strategies that are sustainable for the future of health care to help prevent burnout. DESCRIPTION OF PRACTICE OR PROTOCOL: Long-term effects of the intervention can lead to nurses with lower burnout rates, more tools in their toolbox to help mitigate stress, and longevity in the health care field. VALIDATION OF EVIDENCE: Using reflection journals, educators and students can assess progress toward self-care practices for a semester. RELEVANCE OF PMH NURSING: Mental health educators are challenged with additional complications as students often lean on them to help navigate through difficult times in academia. Learning new strategies to introduce in the classroom can help instill early interventions, hoping to mitigate these long-term facts. FUTURE IMPLICATIONS: Further exploration on the impacts of long-term health care professionals who practice self-care regularly and how it affects their sustainability in their career.
Poster #71: Artificial Intelligence (AI) Enhanced Nursing Education
Jacque Williams, MSN, RN, NC-BC
Category: Education
ABSTRACT
PROBLEM STATEMENT: The use of artificial intelligence (AI) models within academia is as controversial as phone adaptations in the learning environment. Current AI models can learn patterns, formulate data, and recognize similar characteristics using internet resources. Many educators are familiar with the simplistic models of AI, such as those with grammatical and spelling capabilities; however, they are unaware of the capabilities of the newer models. SUMMARY OF EVIDENCE: As AI advancements continue, identifying how to incorporate the skills and knowledge is critical to help achieve student learning outcomes while helping academia stay ahead of the potential for academic misconduct. DESCRIPTION OF PRACTICE OR PROTOCOL: Before entering their future health care field, higher education students learn how to navigate the risks and benefits of AI technology in a controlled environment. VALIDATION OF EVIDENCE: Educators can learn to use AI as a valuable teaching assistant, offering resources and support with lesson planning, content creation, and simplistic explanations of student learning material. RELEVANCE OF PMH NURSING: Using an AI platform, educators can create scenarios and introduce difficult content on mental health to students in a format that is understandable to the level of the learner. FUTURE IMPLICATIONS: In utilizing AI technology in the classroom, faculty can foster student learning by shifting the approach to teaching and preparing future nurses. By helping to learn the benefits and risks associated with AI within academia, faculty and students can learn how to incorporate this into the curriculum, navigating the strengths and challenges associated with new technology.
Poster #72: Addressing the Mental Wellness of People Impacted by Cancer: The Making of a Psychiatric Nurse Practitioner Clinic at a University Cancer Center
Rachel H. Adler, PhD, APRN, PMHNP-BC, AGNP-C
Category: Practice
ABSTRACT
PROBLEM STATEMENT: A cancer diagnosis and subsequent treatment come with enormous psychosocial stress for patients and caregivers. Yet there is great demand for clinical providers with psychiatric expertise to care for them. The purpose is to provide psychiatric-mental health nurse practitioners (PMHNPs) with the information needed to consider expanding their practice into psycho-oncology. SUMMARY OF EVIDENCE: Cancer survivors have rates of anxiety, depression, and suicide that are considerably higher than the general population and most oncologists are not trained to manage the psychiatric problems of their patients. PMHNPs can fill a critical need to provide psycho-oncological services to cancer patients and their caregivers. DESCRIPTION OF PRACTICE OR PROTOCOL: We created and initiated a PMHNP-led psychotropic medication management clinic at Mays Cancer Center in San Antonio, TX. This is an extension of the Wellness 360 Clinical Enterprise, a completely nurse-led and staffed practice within the School of Nursing at University of Texas Health Sciences Center at San Antonio. VALIDATION OF EVIDENCE: The clinic started in the fall of 2023 and has had a steady line of patient referrals since its inception. Although it is currently held 1 day per week, it is expected to grow to accommodate more patients and to include caregivers. We will continue to track patient satisfaction and referral rates. RELEVANCE OF PMH NURSING: A nurse-led practice model is significant to psychiatric nursing as it is an ideal way to promote nursing leadership and advance professional development. FUTURE IMPLICATIONS: Expansion of PMHNPs into the field of psycho-oncology will not only fulfill an important clinical need, it will create a niche within our field where there is opportunity for growth.
Poster #73: Xylazine Test Strips: The Effects of Reducing Overdose in Substance Use Disorders
Ijeoma Agwu, RN; Anne Marie Annmarie Terryann Narine-Henderson, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Nurses are increasingly encountering patients presenting with overdose. There has been a phenomenal increase in the number of patients admitted to the inpatient setting due to opioid overdose. SUMMARY OF EVIDENCE: Xylazine test strips are not readily used in inpatient settings as a harm reduction tool. Empirical evidence supporting this intervention is scarce. Patients needed a more reliable tool to prevent relapse post discharge. DESCRIPTION OF PRACTICE OR PROTOCOL: Prior to January 2023, Naloxone kit and Fentanyl strips were the tools given to patients post discharge. In addition to the Naloxone kit and Fentanyl strips, patients receive Xylazine strips. VALIDATION OF EVIDENCE: The evidence of Xylazine test strip usage validates the need for health care providers to receive education and training on harm reduction approaches, including the provision of test strips and related resources. RELEVANCE OF PMH NURSING: The reduction in readmission rate was used to determine the effectiveness of this intervention. FUTURE IMPLICATIONS: Each patient should be given Xylazine test strips post discharge. Further research is needed to determine the effectiveness of this intervention.
Poster #74: From Symptoms to Synapses: A Literature Review of Neuroscience-Based Nomenclature (NbN) for Psychotropic Medications
Courtney Albers, DNP, APRN, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The current nomenclature for psychotropic medications is symptom and disorder-based (i.e., antidepressants, antipsychotics), and does not accurately reflect the use and/or purpose for medications. The current nomenclature classification leads to confusion among patients and providers, and can be stigmatizing. SUMMARY OF EVIDENCE: Neuroscience-based Nomenclature (NbN) for psychotropic medications reflects pharmacology and mode of action-based classification, aligning medication names with their scientific rationale (i.e., serotonin reuptake inhibitor, dopamine antagonist). DESCRIPTION OF PRACTICE OR PROTOCOL: Currently, five international organizations and 11 members of the taskforce are working for widespread adoption of NbN. Implementation of NbN in clinical practice requires buy-in from pharmaceutical companies, insurance providers, and regulatory bodies to set the example. In the meantime, psychiatric mental health providers can contribute by adoption of NbN in their own practices. VALIDATION OF EVIDENCE: The purpose of the literature review is to synthesize the body of published literature for current knowledge and practices related to NbN. The literature review was conducted using the PsycINFO search engine. “Neuroscience-based nomenclature” yielded 29 articles, narrowed by an abstract review for relevance to the topic and 19 articles remained. The remaining 19 articles were synthesized in this review. RELEVANCE OF PMH NURSING: There is an official NbN-3 app to support providers in their quest to adopting NbN. NbN enhances clarity for both patients and providers in understanding the usage of specific medications, thereby promoting medication adherence. FUTURE IMPLICATIONS: There are notable challenges to the implementation of NbN, including overcoming deep-rooted symptom and disordered-based nomenclature for psychotropic medications in clinical settings. Further education and recognition of NbN is needed for a widespread shift in nomenclature.
Poster #75: Screening for Social and Emotional Health Needs in the Dental Clinic: A Quality Improvement Project
Beth Al-Qudah, BSN, RN, PMHNP, DNP Student; Barbara Peterson, PhD, PMHCNS-BC, APRN, FNAP
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Unaddressed depression and anxiety can lead to increased risk of many health complications. Patients in vulnerable populations struggle to access needed services to address mental and social health needs. Patients may be unaware of available services, have insufficient insurance coverage, experience high costs for services, and long wait times. SUMMARY OF EVIDENCE: A strong interrelationship exists between mental, social, and dental health, barriers to health care access, and care coordination. Limited coordination between the dental clinic and mental health services is one barrier to accessing care. DESCRIPTION OF PRACTICE OR PROTOCOL: This project aimed to identify mental and social health needs of new adult patients in the dental clinic of a federally qualified health center and increase access to mental health services. A screening tool was created utilizing validated assessments to determine mental and social health needs. VALIDATION OF EVIDENCE: Patients completed a screening tool upon arrival to their appointment and those who indicated a need were offered a warm hand off to the care coordination team to establish mental health services. RELEVANCE OF PMH NURSING: Increasing the coordination of care within the dental clinic for new dental patients, this project was able to improve access to mental health services. Thirty-eight percent of patients who completed the screening indicated a mental or social health need and were offered a warm hand off. FUTURE IMPLICATIONS: This project identified a patient population that would benefit from further mental and social health screening to increase access to care. Supplying this screening to patients in dental clinics provides an opportunity to increase coordination of care between the dental and mental health services.
Poster #76: Psychiatric-Oncology Care: A Consultation-Liaison Model
Elizabeth Archer-Nanda, DNP, PMHCNS-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Psycho-oncology focuses on the emotional responses of patients and their family members. Psychiatric advanced practice nurses are uniquely capable of delivering high-quality integrated care in oncology and other medical specialty practices. This talk will focus on commonly occurring mental health disorders arising in cancer, including depression, anxiety, and delirium. Medical providers often overlook psychiatric comorbidities, contributing to reduced overall quality of life, poorer treatment adherence, and in some circumstances worsened prognosis. SUMMARY OF EVIDENCE: Psychological studies have shown a wide variety of interventions to improve the co-occurrence of psychiatric comorbidities, including pharmacological and non-pharmacological interventions. DESCRIPTION OF PRACTICE OR PROTOCOL: Integration of non-pharmacological strategies, including cognitive behavioral therapy and supportive psychotherapy, as well as optimizing psychotropic medications can aid in improved clinical outcomes. The use of psychometric screening instruments including the Patient Health Questionnaire 9 (PHQ-9) for depression and Generalized Anxiety Disorders Scale 7 (GAD-7) are helpful for understanding patient mental health needs. VALIDATION OF EVIDENCE: Outcomes will be evaluated through the use of PHQ-9 and GAD-7 at initial visit and follow-up visits. Qualitative feedback will also be incorporated from patient chart reviews. RELEVANCE OF PMH NURSING: Psychiatric nurses are capable of creating triage systems for patients experiencing distress throughout cancer treatment with screening and placement with appropriate psychiatric resources. FUTURE IMPLICATIONS: There is a growing need for the inclusion of nurses with understanding of psychiatric principles into medical models, including oncology care. This presentation will share a model of care incorporating advanced practice nurses and registered nurses into an oncology mental health program.
Poster #77: The Impact a Nurse Recruiter Has on Staffing Shortages and Nurse Manager Satisfaction in an Acute Psychiatric Facility
Johna Rae Arnett, RN, BSN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: To determine whether implementing a sole nurse recruiter will improve the staffing shortages and nurse manager satisfaction in an acute psychiatric facility. Will creating a position that has a main focus on recruiting, interviewing, and hiring make an impact on staffing shortages and reduce the work load and improve the satisfaction of nurse managers? SUMMARY OF EVIDENCE: There was a lack of evidence regarding nurse recruiters specifically in a sole recruiting and hiring role for psychiatric facilities. Although data were collected only for 6 months pre- and post-nurse recruiter implementation, further research will be needed to fully understand its impact. DESCRIPTION OF PRACTICE OR PROTOCOL: Nurse recruiter was implemented. There was not a significant change in time to fill rate or new hire turnover rate 6 months post-nurse recruiter, but there was a reduction in the cost per hire. Nurse manager’s agreed that the nurse recruiter role would benefit other facilities and that it made an impact on staffing shortages at the acute psychiatric facility. VALIDATION OF EVIDENCE: Data collection (time to fill rate, new hire turnover rate, cost per hire) nurse manager satisfaction survey descriptive research design. RELEVANCE OF PMH NURSING: There was not a significant change in time to fill rate or new hire turnover rate 6 months post-nurse recruiter, but there was a reduction in the cost per hire. Nurse managers agreed that it made an impact on staffing shortages at the acute psychiatric facility. FUTURE IMPLICATIONS: More data should be collected over a longer period of time to capture a better picture of its impact.
Poster #78: Implementation of a Primary Nurse Leader Model on an Inpatient Psychiatric Unit
Mollie M. Babich, DNP, APRN, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Feedback from a family advisory focus group in 2019 identified that nursing was the last discipline thought of on the care team. This information suggested a lack of engagement between nursing staff and families, and likely reflected the task-oriented nature of nursing workflows. This gap in relationship-based engagement represented missed opportunities for education and support for patients and families, as well as decreased job satisfaction and high turnover for nurses. SUMMARY OF EVIDENCE: Existing literature supported the use of a primary nursing model with evidence from non-psychiatric inpatient units. Task-oriented nursing activities have led to a lack of nursing relevance for families. Primary nursing models are recognized for centering nurses and the patient experience and helping to improve outcomes. DESCRIPTION OF PRACTICE OR PROTOCOL: We designed and implemented a primary nurse leader model (PNLM) with the goal of having a small, consistent group of nurses to serve as the touchpoint for patients and families during their stay. Through partnership with nursing managers, the project involved changes in staffing models, enhancement of nursing milieu engagement, adjustment of admission processes to establish a strong initial connection with families, and empowering leadership skills among nurses. VALIDATION OF EVIDENCE: Pre- and post-implementation quantitative measurements. Descriptive and bi-variate statistics were used as applicable when interpreting the data. RELEVANCE OF PMH NURSING: Higher staff satisfaction with care provided and improved patient and family experience. Improved nurse autonomy and engagement resulting in more meaningful involvement in patient and family care. FUTURE IMPLICATIONS: Encourage dialogue and development of strategies to enhance the role of PMH nurses as leaders and contributors to patient outcomes.
Poster #79: How Potential and Actual Patient Safety Events Are Impacted by Utilization of a Medication Administration Window on a Child and Adolescent Inpatient Psychiatric Unit
Krystal Obermeier, RN, BSN, PMH-BC; Kristen Sheffey, RN, MSN, CCRN, CNL
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Several areas of the medication administration process were identified as inconsistent, including medication administration location, medication and patient scanning, and confirmation of complete ingestion of medications via patient mouth checks. SUMMARY OF EVIDENCE: Evidence shows that most medication errors happen in the administration stage and that distractions during this stage lead to an increased occurrence of patient safety events. Utilizing a medication window limits distractions during the administration stage and allows RNs to administer medications through a standardized process, consistently. DESCRIPTION OF PRACTICE OR PROTOCOL: Stakeholders for this process change included unit pharmacists and leadership, the hospital’s medication safety council, and floor nurses. Staff received education regarding the new standardized medication administration process, including utilizing the medication window and completing thorough mouth checks after administration. Patient schedules and medication administration times were adjusted to facilitate this change. VALIDATION OF EVIDENCE: Medication-related safety events that were recorded using our internal reporting system are the basis of measuring the effectiveness of the process change. RELEVANCE OF PMH NURSING: Categorizing and comparing medication-related patient safety events prior to and after establishment of a standardized medication administration process revealed a 46.15% decrease in medication-related patient safety events. FUTURE IMPLICATIONS: Future implications include sustained reduction in medication-related patient safety events and continued use of the standardized medication administration process for nursing staff. Ongoing collaboration between identified stakeholders will provide support in identifying further areas of improvement related to medication safety.
Poster #80: Evaluating the Therapeutic Value of Unrestricted Personal Phone Use on and Inpatient Psychiatric Unit
Ezra Bach, BSN, RN; Sophia Aburida, BSN, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The purpose of this research was to investigate nurse’s opinions of personal phone use by patients in an inpatient psychiatric unit and how this may affect the patient’s participation in the therapeutic milieu. SUMMARY OF EVIDENCE: On an inpatient psychiatric unit, patients are allowed unrestricted personal phone access upon signing an electronic device agreement. Access to phones will only be restricted if the patient fails to abide by the agreement. DESCRIPTION OF PRACTICE OR PROTOCOL: The literature suggests that it is uncommon for patients to have unrestricted access to their phones on psychiatric units which can lead to patient dissatisfaction. However, there is scant evidence regarding cell phone use in inpatient psychiatric settings. VALIDATION OF EVIDENCE: A convenience sample of 55 Registered Nurses received a survey consisting of six closed-ended questions, which had possible selections ranging from “never” to “always,” as well as five open-ended write-in questions. A total of 23 Registered Nurses completed the survey (42%). The following themes were explored: engagement with the care team, group engagement, and maintaining a healing environment. RELEVANCE OF PMH NURSING: There was a 100% agreement that personal phones have potential therapeutic value. 69.6% reported that phone use “sometimes” disrupts the milieu and other patients’ healing. 87.1% reported that patients’ phone use is “sometimes” or “always” safe and appropriate. 91.3% reported that patients are “sometimes” or always able to respond to limit setting with phone usage. FUTURE IMPLICATIONS: Further research is needed to compare the efficacy of predictable, structured cell phone use to unrestricted access. Additional research is needed to evaluate the inpatient use of mental health apps as beneficial in patient recovery.
Poster #81: Family-Based Treatment for Adolescents With Anorexia Nervosa
Treven Back, DNP, APRN, PMHNP-BC; Andrew Makowski, DNP, APRN, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Anorexia nervosa (AN) is a chronic, disabling, and costly disease with a higher mortality rate than any other psychiatric illness. Because of the need for medical, psychiatric, and nutritional care, treatment is complex. SUMMARY OF EVIDENCE: Family-based treatment (FBT) is recommended as the first-line treatment for adolescents with AN. A gap exists between translating FBT into clinical practice. Literature shows that education and understanding health care providers’ (HCPs) attitudes and beliefs are the first steps to successfully implementing family-based treatments. DESCRIPTION OF PRACTICE OR PROTOCOL: A synchronous educational FBT intervention was presented to health care providers that treat adolescents with AN. Health care providers’ knowledge, anticipatory use, and attitudes related to FBT were examined before and immediately following the intervention. VALIDATION OF EVIDENCE: This project used a quasi-experimental, one-group pretest–posttest design. Data for this project were collected via electronic questionnaires in Qualtrics software. Three different assessments were utilized for evaluation: (1) a 15-item multiple-choice quiz assessing participants’ knowledge of AN and FBT, (2) the “Therapeutic Strategy Checklist for Adolescent Anorexia Nervosa (TSC-AN),” and (3) the “Family-Based Treatment Attitude Scale (FBT-AS).” RELEVANCE OF PMH NURSING: Anorexia nervosa mean knowledge scores increased. Mean scores regarding family-based treatment strategies increased. Attitudes toward family-based treatments also showed more favorability post-intervention. FUTURE IMPLICATIONS: This project showed promise toward an FBT education presentation on improving HCPs knowledge of AN and FBT, the intent to use FBT-consistent strategies, and the attitudes toward FBT. Utilizing web-based training or simple PowerPoints is a practical, convenient, and cost-effective delivery method for educating health care providers.
Poster #82: Providing Music to Reduce the Need for Unscheduled Medications for Agitation
Thomas Ballan-Duran, DNP
Category: Practice
ABSTRACT
PROBLEM STATEMENT: It was identified there was an increased use of PRN antipsychotic and anxiolytic medications to treat agitation in hospitalized adult patients; therefore, an evidence-based intervention was sought. SUMMARY OF EVIDENCE: In fiscal year (FY) 2022, the number of PRN antipsychotic and anxiolytic medications administered to patients for agitation was 1,793, costing the facility $4,334. Addressing a patient’s agitation using music listening can increase patient safety by decreasing unwanted side effects of the PRN medications and benefit the project site by reducing the cost spent on medications. DESCRIPTION OF PRACTICE OR PROTOCOL: Current practice includes de-escalation of agitated behaviors and offering PRN medications. Offering music listening as a holistic intervention showed clinical significance in reducing the number of PRN antipsychotic and anxiolytic medications in an 8-week pilot. VALIDATION OF EVIDENCE: Pearson’s chi-square of the frequencies between the comparative (23, 13%) and implementation groups (17, 12%) showed no statistically significant difference in the unscheduled antipsychotic and anxiolytic medication administered (ꭓ2 [1, N = 329] = .088, p = .767). However, clinical significance was demonstrated by six fewer patients (1%) requiring unscheduled antipsychotic and anxiolytic medications for agitation. RELEVANCE OF PMH NURSING: PMH nursing can implement music listening as a holistic intervention to reduce agitation in patients, providing a safer environment for staff and patients. FUTURE IMPLICATIONS: Future implications are expanding the use of music listening for symptoms besides agitation, utilizing music listening in other care areas, and utilizing music listening for patient satisfaction.
Poster #83: Preventions as Interventions, Identified and Implemented in a Quality Improvement Project, Addressing Workplace Violence in an Acute Inpatient Psychiatric Setting
Amy Jo Barnes, MSN, RN, PMH-BC; Katherine Avery, MSN, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: A post Covid increase in patient violence led to an integrated and multifaceted approach in the implementation of preventions as interventions, to increase psychiatric and mental health (PMH) nursing staff knowledge and skills in the reduction of nursing staff injuries related to workplace violence, in an acute inpatient psychiatric facility. SUMMARY OF EVIDENCE: Patient violence within inpatient psychiatric facilities has significantly increased in this post-Covid society. The increase has far-reaching effects for both patient and PMH nursing staff, and requires careful consideration to not only reduce but also prevent injury to both patient and nursing staff. DESCRIPTION OF PRACTICE OR PROTOCOL: Successful practices implemented include event debriefings, quarterly skills lab, and workplace violence drills. VALIDATION OF EVIDENCE: Despite an increasing number of documented assaults over a 2-year period, decreases were shown in OSHA recordable injuries to nursing staff. RELEVANCE OF PMH NURSING: Fifty percent decrease in OSHA recordable injuries over a 2-year period. FUTURE IMPLICATIONS: Patient violence is not likely to decrease in the immediate future; thus, it is important not to lose ground with current advancements in workplace violence (WPV) injury reductions. It is critical to look for additional opportunities to improve skills labs, event debriefings, and WPV drills, pursuant to further reduce WPV injuries beyond 50%.
Poster #84: The Use of Robotic Babies and Pets as Comfort and Diversion for Older Adults
Kimberly Ann Barnes-Ayers, BSN, MAEd, RN-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Older adults are often admitted to the inpatient psychiatric unit with some degree of agitation and confusion. Many times these patients become more confused and agitated being moved to a different, unfamiliar place. Many actions are taken to prevent agitation, and most are ineffective. During the project phase of the Geriatric Scholar Program, it was decided to utilize Robotic babies, dogs, and cats to sooth, comfort, and prevent agitation in older adults admitted to the geriatric psychiatric unit at a major medical center. The success of the Robotics was immediately noted with patients becoming less agitated once they received the Robotic that resonated with them. SUMMARY OF EVIDENCE: After conducting a literature review, it was determined that robotic pet use among older adults may be an effective solution for eliminating loneliness. Doll therapy is a promising approach for reducing behavioral symptoms in dementia patients. DESCRIPTION OF PRACTICE OR PROTOCOL: Patients who showed signs of agitation were given a robotic toy (doll or pet depending on the patients history). VALIDATION OF EVIDENCE: It was noted these patients became less agitated, smiled more, were calmer, and requested (often nonverbally) the robotic when they did not have it. The patients’ family members were impressed with the robotic. RELEVANCE OF PMH NURSING: Patients engaged with the Robotics, spent hours holding the Robotic and was significantly less agitated. Families wrote letters thanking us for the robotic. FUTURE IMPLICATIONS: Continued use of robotics will yield more information regarding benefits. We will continue to utilize the robotics as appropriate and determine whether our patient satisfaction scores continue to increase.
Poster #85: Implementation of the Substance Use Disorder (SUD) Navigator Program to Reduce Readmissions
Peter Bohlig, BSN, RN; Maria Urias, FNP-BC, RN; Sharon B. De Peralta, PhD, DNP, MBA, BSN, RN, PHN, CPHQ, EBP-C
Category: Practice
ABSTRACT
PROBLEM STATEMENT: To determine the impact of a substance use disorder (SUD) patient navigation program in engaging patients with care transitions post in-patient medicine hospitalization and connecting them with community resources. SUMMARY OF EVIDENCE: Patients with SUD have a high readmission rate. SUD patients have low engagement post discharge from the hospital with up to 60% not showing rate for outpatient mental health programs. Transition of care from the hospital to community resources has been identified as a major barrier to ongoing care. SUD patients often do not follow recommended treatment and medical care. DESCRIPTION OF PRACTICE OR PROTOCOL: SUD Navigation Program is a structured process for incorporating best practices for engaging patients in outpatient addiction recovery and community services. An interprofessional team connected with the veterans with SUD who have been admitted to inpatient medicine and followed them through post hospitalization transition of care where they were connected with community resources. In particular, a nurse navigator assisted and engaged the veterans with SUD treatment during. VALIDATION OF EVIDENCE: Measures included the completed nurse navigator consults, in-patient post hospital discharge engagement score, community care mental health consults, and readmission rates. RELEVANCE OF PMH NURSING: After 4 months of implementation, the nurse completed consults was 100%, in-patient post hospital discharge engagement increased from 75% to 100% pre/post implementation. Inpatient medicine readmission rates decreased from 20 to 1. FUTURE IMPLICATIONS: The navigation program has been effective in keeping the veterans engaged with their care and has been expanded to other departments in the hospital.
Poster #86: Vagus Nerve Stimulation: A “New” Treatment Option for Difficult to Treat Depression
Paula Bolton, MS, CNP, ANP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Vagus nerve stimulation (VNS) was first Food and Drug Administration (FDA) approved in 2005 but was not fully embraced as a treatment option for patient suffering from difficult to treat depression. New studies have reinvigorated this as an adjunct treatment for those suffering the effects of chronic depression. Psychiatric advanced practice registered nurses (APRNs) and registered nurses (RNs) have little experience with setting up practices to manage this re-introduced treatment option. SUMMARY OF EVIDENCE: Ongoing research supports VNS as an adjunct treatment for patients with chronic depression who have had difficulty maintaining remission with other treatments (including medication and various neurotherapeutic therapies). Recent studies have determined that the long-term benefits of VNS for patients with chronic depression offer durability of response from other treatment modalities. DESCRIPTION OF PRACTICE OR PROTOCOL: Strategies for setting up a VNS Service within a Neurotherapeutics Program are discussed and practical approaches for patient identification, education, and management are reviewed. VALIDATION OF EVIDENCE: Patient response, including self-reported monitoring tools and satisfaction surveys, indicates VNS as a viable treatment strategy. RELEVANCE OF PMH NURSING: PMH APRNs are in a unique position to assess patients with difficult to treat depression who may benefit from adjunct VNS treatment and to assist in procuring these devices and monitoring and managing the VNS treatment on an ongoing basis. PMH RNs can assist in the ongoing assessment and treatment protocols and help with case management issues that arise. FUTURE IMPLICATIONS: Expansion of VNS within established practices will allow increase in availability of this treatment option for our patients. Nurses can be instrumental in helping to develop practices to provide this treatment.
Poster #87: Building Nursing Attitudes: Therapeutic Communication
Kelly Bonilla, BSN, RN; Madison McQueen, BSN, RN, PMH-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: A lack of evidence-based therapeutic communication methods create a gap in quality of patient care for patients with a psychiatric diagnosis. Verbalization of general medical nursing staff stating they are uncomfortable in providing therapeutic communication to patients with a psychiatric diagnosis. Therapeutic communication is viewed as a vital element in nursing. SUMMARY OF EVIDENCE: Ongoing literature supports the need for building skills necessary for therapeutic communication. Therapeutic communication has an effect on staff and patient safety. Having therapeutic resources and knowledge generates positive patient outcomes. DESCRIPTION OF PRACTICE OR PROTOCOL: A survey was generated and distributed among nursing staff on general medical floors. The nurses who received the survey provided care to patients with psychiatric diagnoses. Following review of the survey results, a therapeutic communication tip sheet was created by psychiatric nurses. VALIDATION OF EVIDENCE: The survey results indicated that nurses on general medical floors were uncomfortable utilizing therapeutic communication while caring for patients with a psychiatric diagnosis. Discussion and interviews were completed following implementation of tip sheet. RELEVANCE OF PMH NURSING: Therapeutic communication is a foundation to providing quality care to patients. Nurses verbalized confidence in the tools received from psychiatric nurses. A change to nurse’s perspective of providing therapeutic communication to patients with a psychiatric diagnosis. FUTURE IMPLICATIONS: Practice change will include providing tools and resources to nursing staff to increase knowledgeable and quality patient care; allowing nurses on general medical floors to facilitate therapeutic communication; and, therefore, improving patient outcomes.
Poster #88: Partnership of a Clinical Nurse Specialist and Application Analyst to Produce Best Outcomes: The Build and Implementation of a Behavioral Health Acuity Index
Nancy Brasic, MSN, RN, FNP-BC; Dolly Walkup, RN, MSN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The purpose of this project was to build and implement the Behavioral Health Acuity Index (BHAI) into an electronic medical record (EMR) reflecting up-to-date unit and patient acuity. SUMMARY OF EVIDENCE: Psychiatric and mental health inpatient facilities are experiencing increased costs, increased demand for admissions, and an increase in patient acuity. It is recommended that staffing models take into consideration patient acuity, staff skill mix, and patient turnover. Yet, there is not a validated tool for measuring behavioral health acuity. DESCRIPTION OF PRACTICE OR PROTOCOL: The BHAI is composed of items abstracted from existing data and nursing assessment of current and future nursing shifts and interventional needs. Focus groups with bedside nursing staff defined four intervention levels to decrease subjectivity. Data for the BHAI score is sent to a central server where a weight is applied to each component and in turn a score is received and recorded into the EMR. VALIDATION OF EVIDENCE: The scores were reviewed along with the components for comparison. Chart reviews were completed by the CNS and ongoing communication with the Application Analyst prompted build of a reporting system to improve efficiency. RELEVANCE OF PMH NURSING: Clinical staff and Nursing Leadership can view independent patient acuity scores. Nursing leadership can also view the unit level scores. Scores are populated twice daily pulling automatically from data elements in the chart. This minimizes the subjectivity of what defines a patient or units acuity level. FUTURE IMPLICATIONS: The Behavioral Health Acuity Tool, skill mix, direct patient care time, and non-direct care activities will be used to determine staffing for a behavioral health inpatient unit.
Poster #89: Providing Sanctuary: An Evaluation of the Effectiveness of Sanctuary Model Implementation on an Acute Inpatient Pediatric Unit
Michele Bronder, DNP-c, RN, CPN, PMHRN-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The inpatient psychiatry unit at Phoenix Children’s Hospital is implementing trauma-informed care via the Sanctuary Model to provide trauma-responsive care to the patients served. Initial training on the Sanctuary Model was provided to unit employees in 2021 as the new model of care. A decrease in the use of restraints and seclusions and an increase in employee retention rates since initial training indicate the positive effects following a trauma-informed care model can have on both patients and employees. However, there continues to be resistance to full model implementation since initial training. SUMMARY OF EVIDENCE: This Doctor of Nursing Practice (DNP) project aims to evaluate the effectiveness of refresher training sessions on the Sanctuary Model in improving employee understanding and use of trauma-informed care and overall unit culture. DESCRIPTION OF PRACTICE OR PROTOCOL: A 6-hr training was provided to all employees and included pre- and post-training surveys. An optional anonymous survey surrounding perceived unit incivility was also provided for completion. VALIDATION OF EVIDENCE: Mean scores of both surveys were calculated and an analysis of the scores was completed using a single t-test. The statistical analysis models show slightly improved scores in pre- versus post-training sessions. This indicates good retention of the Sanctuary Model and trauma-informed care knowledge before refresher training. RELEVANCE OF PMH NURSING: This retention was an unexpected finding given the perceived resistance to full utilization of trauma-informed care. FUTURE IMPLICATIONS: This continued resistance and lower survey score areas provide insight to areas needing improvement and reinforcement. These changes are necessary to sustain a culture supportive of trauma-informed care.
Poster #90: It Takes a Team-Forging New Ways to Support Women and Families: A Integrative Approach to Perinatal Mood Disorders
Bethany Jean Brown, DNP, CNM, WHNP-BC, PMHNP-BC, EFM-C
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Perinatal mood disorders (PMDs) pose a significant challenge to maternal health, with potential long-lasting impacts on both mother and child. This presentation addresses gaps in care for PMDs, emphasizing the need for comprehensive nursing interventions. SUMMARY OF EVIDENCE: Evidence suggests that early identification and intervention significantly improve outcomes for women experiencing PMDs. However, health care systems often lack consistent screening procedures or resources leading to underdiagnoses and delayed treatment. Moreover, the evidence highlights the importance of collaborative care models involving nurses, obstetricians, psychiatrists, and other health care professionals. DESCRIPTION OF PRACTICE OR PROTOCOL: Current practices collectively aim to address the gaps in PMD promoting ongoing support for maternal mental health. These include screening protocols, interdisciplinary collaboration, education and awareness, community resources, telehealth services, postpartum planning, and political advocation. VALIDATION OF EVIDENCE: Nursing practice emphasizes establishing a trusting and open relationship with patients, creating a conducive environment for disclosing mental health concerns. Collaborative care models, involving nurses alongside other health care professionals, align with the evidence suggesting that a multidisciplinary approach yields more comprehensive and effective outcomes for mothers experiencing PMDs. RELEVANCE OF PMH NURSING: Nursing practice, grounded in a holistic understanding of patients, can leverage this evidence to implement creative and personalized interventions that address both the physical and psychosocial aspects of maternal well-being. FUTURE IMPLICATIONS: In summary, the future of perinatal mood disorder care holds promise for more personalized, accessible, and integrated approaches. The combination of scientific advancements, technological innovations, and a holistic understanding of maternal well-being is expected to shape a more comprehensive and effective landscape for addressing PMDs.
Poster #91: The Impact of an Educational Training to Front-Line Nurses and Providers to Reduce Seclusion and Restraint: Assessing Knowledge, Practices, and Attitudes
Kevin Bryant, DNP
Category: Practice
ABSTRACT
PROBLEM STATEMENT: While generally agreed upon that the use of seclusion and restraint (SR) should be employed as a last resort in patient care, a majority of nurses perceive SR as necessary interventions in managing certain symptoms of mental illness. SUMMARY OF EVIDENCE: Existing research on staff attitudes and knowledge regarding SR in psychiatric settings has primarily focused on educating nurses or providers separately. There is a noticeable gap regarding studies that investigated the impact of providing education to both nurses and providers collectively. DESCRIPTION OF PRACTICE OR PROTOCOL: Project utilized a quasi-experimental design with a one-group pre- and post-test approach to assess the impact of targeted education on knowledge and attitudes toward the use of SR among front-line nurses and physicians. In addition, this project assessed for improvements in seclusion and restraint rates post-implementation. VALIDATION OF EVIDENCE: A quasi-experimental design with a pre- and post-test evaluation was utilized to assess the impact of targeted education on knowledge, practices, and attitudes. Paired t-test was used for significance. RELEVANCE OF PMH NURSING: Project found that participants showed significant increases in attitudes regarding the use of SR post-education, including greater willingness to acknowledge patients’ rights and the emotional impact of SR use. Increases observed in the comprehension of appropriate SR practices and the impact of staffing levels on SR utilization. Decreases were observed in hospital-wide SR rates. FUTURE IMPLICATIONS: Positive shift in front-line nurses’ and providers’ attitudes toward SR practices following targeted educational interventions highlights the importance of ongoing training and education in promoting patient-centered care and reducing the use of SR in clinical settings.
Poster #92: Moving Connections: Case Studies of Overcoming Barriers in Linking to Care at Discharge
Katlin Bussy, MS, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Patients with serious mental illness can face many challenges when planning for connection to psychiatric care after inpatient hospitalization. These challenges can be particularly difficult for patients who have experienced hospitalization geographically distant from the intended discharge location. SUMMARY OF EVIDENCE: Limited evidence is available regarding best practices and nurses’ knowledge in navigating complex discharges. Case studies involving complex discharges present opportunities for expanding knowledge and developing skills. DESCRIPTION OF PRACTICE OR PROTOCOL: A framework of integrating patient preferences, identifying potential problems, and initiating proactive planning was applied to overcome barriers to discharge. VALIDATION OF EVIDENCE: Best practices suggest that involving patients and families in discharge planning can improve discharge outcomes. In the primary case presented, effectiveness was identified as clozapine continuation and completed intake to new outpatient mental health. RELEVANCE OF PMH NURSING: By using patient- and family-centered approaches, psychiatric and mental health (PMH) nurses and nurse practitioners may be able to improve outcomes by utilizing these techniques in working to overcoming barriers to connection to outpatient mental health care. FUTURE IMPLICATIONS: Learning about overcoming barriers to establishing successful outpatient connection for patients with serious mental illness is likely to result in future improved discharge planning efficacy and improved patient outcomes.
Poster #93: Are Black or African American Patients Secluded or Restrained More Than Their White Peers?
Kimberly Ayers, BSN, MAEd, RN-BC; Lisa Mattox, DNP, MSN, RN-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: After leadership participated in a yearlong Diversity, Equity, and Inclusion training series, we began to wonder if unconscious bias was present in our use of seclusion and/or restraint. SUMMARY OF EVIDENCE: It is well known that there are disparities in treatment and accessing health care for minority populations in the United States. We embarked on examining our seclusion and restraint data by race. DESCRIPTION OF PRACTICE OR PROTOCOL: The team gathered and discussed baseline data in regard to seclusion and restraint rates by race. Our preliminary data review demonstrated that while White patients account for more inpatient patient days, Black or African American patients account for a greater percentage of our total restraints. We looked at the top 20 patients with the most restraint episodes and 85% of those patients are Black or African American. VALIDATION OF EVIDENCE: We will continue to further investigate the factors influencing potential disparities in the treatment of minority patients. RELEVANCE OF PMH NURSING: It is important for psychiatric nurses to examine treatment disparities especially as it relates to restraint and seclusion. FUTURE IMPLICATIONS: This project could shed light and provide greater awareness among mental health professionals of existing and potential disparities in treatment. Furthermore, this analysis will help us acknowledge our potential for unconscious bias and the implications that has on the care our patients receive.
Poster #94: Implementation of a Wearable Tracking Device for Patient Monitoring in an Acute Inpatient Psychiatric Hospital
Lisa Mattox, DNP, MSN, RN-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Many inpatient psychiatric hospitals have a manual rounding process for patient safety. With the traditional manual/paper rounding process for Q15 and 1:1 monitoring, there is ample room for human error and complacency. SUMMARY OF EVIDENCE: We have experienced patient safety events due to lack of adherence to our rounding policy. These events demonstrated staff missed rounds and/or performed inaccurate documentation. DESCRIPTION OF PRACTICE OR PROTOCOL: We currently have a manual/paper rounding document and process for q15 and 1:1 rounding. There is wide variation and lack of standardization among staff. We also lack real-time data about compliance with our rounding policy. We implemented a wearable tracking device for our patients to ensure validated compliance for staff rounding. This provides proactive and streamlined communication about late or missing rounds. This ensures compliance and mitigates ability to falsify rounding documentation. VALIDATION OF EVIDENCE: We are surveying our staff prior to implementation, in April 2024. We will survey staff 60 to 90 days post implementation to evaluate their perception of compliance with rounding and also their perception of unit safety. We will also analyze the rounding compliance data post implementation. RELEVANCE OF PMH NURSING: Rounding is an essential element of patient safety in the inpatient psychiatric setting. Outcomes of the intervention will be determined post-implementation. FUTURE IMPLICATIONS: With patient safety as a top priority, this implementation could be replicated and extended to other organizations and other inpatient psychiatric units. Implementation of this system could assist organizations in meeting regulatory requirements, preventing patient harm, human errors, and adverse patient events.
Poster #95: Music in Psychiatric Mental Health Practice
Rebecca Sanford, PMHCNS-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Listening and participating in music interventions have demonstrated that music can be a stress reliever for nurses and others who work in acute care settings. Psychiatric mental health nurses may not possess the knowledge and skills to utilize music as a tool for self-care and to help patients reduce stress. SUMMARY OF EVIDENCE: Music has been shown to increase connectivity between the auditory cortical system and the reward system. The striatum and other important reward system structures become activated when listening to pleasing music. The neurotransmitter dopamine increases while participating in music as well as other neuromodulators and oxytocin. DESCRIPTION OF PRACTICE OR PROTOCOL: Educating nurses to use music to engage with patients and colleagues who are stressed has the potential to increase use of music in acute care settings. Protocols can increase music interventions which are low cost and easy to implement. Music is a universal language that is understood by all. VALIDATION OF EVIDENCE: Music interventions have been shown to lower heart rate and blood pressure. Successful music interventions have been used to treat anxiety, depression, addiction, dementia, agitation, and symptoms of cancer. RELEVANCE OF PMH NURSING: Psychiatric mental health nurses working in acute care settings are prone to stress and burnout. Using music in practice may work to reduce burnout in nurses and improve engagement with patients. FUTURE IMPLICATIONS: More research is needed to understand how music can affect nursing practice, prevent nursing burnout, and promote de-escalation.
Poster #96: Bringing Connection Between Non-Behavioral Health Hospital Nurses and Persons With Mental Health Needs
Anita Catlin, PhD, FNP, CNL, FAAN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Community hospitals serve patients for medical-surgical and obstetric purposes. Housekeepers, security guards, nurses, and office workers interact daily with patients having co-occurring mental health issues. Internal data reported 15% of daily inpatients and 47% of outpatient visits were for patients with co-occurring mental health needs. Personnel received mental health training in initial professional education or not at all. SUMMARY OF EVIDENCE: After Columbine shooting, unable to agree on gun control, US Congress allocates funds to teach public recognition, assessment, and referral of those in mental health crisis. DESCRIPTION OF PRACTICE OR PROTOCOL: Nurse-led SAMHSA grant is training all hospital personnel in Mental Health First Aid. Evidence-based course includes self-care. VALIDATION OF EVIDENCE: Post-training data report 100% satisfaction with program and statistically significant improvement on ability, comfort, and knowledge in working with persons in mental health crisis. Knowledge of local resources increased 66%. Success in stigma reduction reported. Attendees report course helps with own life, family needs, and confidence building. RELEVANCE OF PMH NURSING: Connecting physical and mental health needs in community hospital patients has potential for cost-saving and overall improvement. FUTURE IMPLICATIONS: Revisioning of the in-hospital response to mental health crisis is imperative.
Poster #97: Connecting Calling to Life-Work: Serving With Students in the Community
Sherri H. Chatman, DNP, FNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Through self-reflection and personal beliefs, one’s calling is revealed. Many of those caring for others often have the desire to lessen health disparities by integrating calling into a vocation. SUMMARY OF EVIDENCE: As faculty participate in their life work, they introduce opportunities to students to meet the needs of vulnerable populations in rural, suburban, and urban communities. The community health clinic, church-based mental health clinic, and homeless day shelter clinical sites were designed to assist in filling the gap for individuals living in surrounding communities who are experiencing unmet mental and physical medical needs because of health care inequities. DESCRIPTION OF PRACTICE OR PROTOCOL: These practice settings afford opportunities for interprofessional educational experiences among individuals such as nursing students and other professionals. VALIDATION OF EVIDENCE: Aligning personal mission and vision with like-minded community stakeholders cultivates a spirit of creativity for service to others. RELEVANCE OF PMH NURSING: Mental health services are being offered to uninsured and underinsured patients. The census of patients is growing as trust is established. Collaboration with other community agencies is strengthening our clinic. The main goals of our clinic are to meet the mental health needs in our community as well as the ongoing development of relationships with resources for this patient population. FUTURE IMPLICATIONS: The transportation burden is reduced by establishing a local presence in the government housing community where free mental health services are provided. Improved free access to quality mental health services may positively affect social determinants of health.
Poster #98: Development of a Repetitive Transcranial Magnetic Stimulation Program for Adults suffering With Major Depressive Disorder on an Inpatient Psychiatric Unit
Kateleen Collins, RN, BSN; Tetyana Lenko, Mental Health Technician; Britty John, Mental Health Technician; Natalie Ramirez, BSN, RN-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment that has been used as a treatment option for depression. It has minimal side effects during and after treatment and is a 1-week treatment series which is short compared to many psychiatric treatment options. SUMMARY OF EVIDENCE: rTMS is a treatment that involves mapping the location of the patients. DESCRIPTION OF PRACTICE OR PROTOCOL: Transcranial magnetic stimulation (TMS) is often done as an outpatient treatment titrated similarly to ECT as a neuromodulation treatment series. rTMS offers an opportunity to condense the treatments and give it while on the inpatient setting 10 treatment/day for 5 days by a trained TMS technician. VALIDATION OF EVIDENCE: The rTMS program was developed by nursing leadership in collaboration with psychiatrists who administered the outpatient TMS program, and unit educators. TMS technicians were trained over 6 months while the program was being developed. Several rounds of training from the psychiatrist were offered followed by a room walk through, tip sheet development and simulation practice to ensure knowledge, skill, and smooth process flow. RELEVANCE OF PMH NURSING: PMH nurses need to be aware of treatment options and alternatives for mental health disorders. Many patients go through different medication trials and treatment options. Our patients who underwent rTMS showed an improvement in symptoms of depression. They varied in rates of sustainability of improvement. FUTURE IMPLICATIONS: rTMS is being reviewed as a treatment for posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), Tourette syndrome, and various other movement disorders. There are also treatments reviewed to target deeper brain regions eliciting a stronger response.
Poster #99: Creating a Safer Place—Behavioral Health Units Initiative to Improve Contraband Discovery Upon Admission
Yerayewa Beatrice Coulibaly, DNP, RN, PMH-BC; Kimberly Davis, BSN, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: An adolescent inpatient psychiatric unit identified a gap in process with screening for contraband upon admission. Due to this gap, a patient was admitted with an item that was later used to harm themselves. SUMMARY OF EVIDENCE: The evidence shows that contraband poses a threat to patient safety. A patient event exposed a gap in the technique used in the admission screening process. The literature supports the development of a structured process to create policies and procedures for appropriate search, seizure, and inventory of contraband to prevent unsafe items from entering the unit. DESCRIPTION OF PRACTICE OR PROTOCOL: Strategies included developing guidelines and competency checklist to ensure that nurses and mental health technicians had the skills and knowledge needed to ensure safety of the environment. Education was conducted in person and a video emailed to the team as a resource to reinforce the new practice. There was a marked decrease in contraband entering the unit following the implementation of a structured admission screening process. VALIDATION OF EVIDENCE: Incident reporting system was audited quarterly for contraband discovery at admission. These data were compared with the previous year data to determine the impact of the intervention. The results were analyzed and demonstrated the effectiveness of the initiative. RELEVANCE OF PMH NURSING: The outcomes include a significant decrease in contraband-related safety events attributed to improved staff knowledge of proper technique for screening. FUTURE IMPLICATIONS: The structured process has helped us decrease the number of contrabands. We will continue to improve and modify our process as patients admitted to the unit become more creative in hiding contrabands.
Poster #100: Mortality Rates for Community Mental Health in the State of Delaware
Melissa Davis, RN, ASN; Lyza Song, RN, BSN; Melissa Davis, RN, ASN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: An opportunity for improvement became clear when reviewing data for the morality rates of outpatient community mental health clients in the State of Delaware. SUMMARY OF EVIDENCE: Increased numbers of clients’ death in the community for outpatient mental health clients. Deficiencies were noted in coordination of care and follow-up. Lack of referrals for higher level of care. Poor documentation. DESCRIPTION OF PRACTICE OR PROTOCOL: DSAMH Policy and Compliance audits critical incidents and deaths for community mental health for Delaware. All incidents are reviewed and determined if a provider investigation is required. DSAMH supplies providers with corrective action plans when standards are not met. Corrective action plans are followed up on for completion. As well as yearly on-site audits by our Quality Assurance team who follow up on corrective actions plans and new complaints. VALIDATION OF EVIDENCE: Providers change policies and procedures to remain in compliance as well as change practice to meet the needs of community mental health clients. Compared prior years data on mortality rates to current data. RELEVANCE OF PMH NURSING: Improved community mental health clients’ outcomes. Decreased number of community mental health clients. Appropriate and timely referrals for treatment and care. FUTURE IMPLICATIONS: Improve the quality of life for all community health clients in the State of Delaware.
Poster #101: Enhancing Patient and Family Experiences: Use of ECT Support Groups and Update on Cognitive Retraining Program: ENCODE
Vona Davis, MSN, PMHNP; Paula Bolton, MS, CNP, ANP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Providing support group programming for patients receiving electroconvulsive therapy (ECT) and their families is not routinely offered. The opportunity to connect with staff and peers in group settings is lacking. In addition, an intervention based on strategies to improve cognitive functioning and cope with memory loss can contribute greatly to patient recovery and overall well-being of ECT patients, but not common practice. SUMMARY OF EVIDENCE: Research has shown that support programs for people with mental illness are beneficial. This is evident in our practice, with consistent participation and request for increase in frequency. In addition, the need for a structured interventional curriculum-based group program patients’ experiencing memory loss with ECT is validated by ongoing research by our ENCODE team and the publication of pilot study, 2023. DESCRIPTION OF PRACTICE OR PROTOCOL: Interventions include ECT Support and Education groups offered 2x month for outpatients, inpatient education groups, and ENCODE Program: a specialized, curriculum-based, six-session group that focuses on strategies to improve cognitive functioning and cope with memory loss. Stakeholders include patients, families, clinical staff, and ECT services outside of McLean Hospital. VALIDATION OF EVIDENCE: Support groups for ECT patients are well received and well attended. In regard to ENCODE: New data from additional cohorts has been collected and is being analyzed to further support its value. RELEVANCE OF PMH NURSING: Having PMH nurses available in a supportive role can help de-stigmatize treatment, allow for clarification of information, and provide feedback on patient experience to improve quality of care. FUTURE IMPLICATIONS: Expand group programming at Mclean and through manualizing our programs and presenting at APNA, allowing replication across ECT services.
Poster #102: STOP5: Implementation of a Post-Event Debriefing Tool for the Behavioral Emergency Response Team at a Veteran Hospital
Sharon B. De Peralta, PhD, DNP, MBA, BSN, RN, PHN, CPHQ, EBP-C
Category: Practice
ABSTRACT
PROBLEM STATEMENT: To determine the impact of an evidence-based “STOP5” tool on the number of debrief monitors and post-event debriefings after a behavioral emergency response known as Code Green in the acute inpatient units and emergency department (ED) at a Veteran’s hospital. SUMMARY OF EVIDENCE: Debriefing post critical incident such as Code Green can improve performance and appears to work well among teams and individuals. Debriefing allows for the team to come together and reflect upon what was done well and needed improvement to enhance patient quality and safety. “STOP5” is a clinical debriefing tool used in the ED for post critical event. Adapting similar approach to a critical event crisis, this tool was utilized to debrief post Code Green event. DESCRIPTION OF PRACTICE OR PROTOCOL: The STOP5 framework includes S, summarize the case; T, things that went well; O, opportunities to improve; and P, points to action and responsibilities. This tool was incorporated in the debriefing process after a Code Green event. The code team was educated about STOP5. Any member of the code team may lead the debriefing process. VALIDATION OF EVIDENCE: Measures included debriefing monitors, post event debriefing, restraints use, staff injury, and police escalation within 30 days pre- and postimplementation. RELEVANCE OF PMH NURSING: Debriefing monitors increased from 2 (17%) to 11 (92%) and post event debriefing went from 0 (0%) to 12 (100%). There was a reduction in restraint utilization from 3 (38%) to 1 (8%), staff injury 2 (25%) to 1 (8%), and police escalation from 3 (38%) to 0 (0%), respectively. FUTURE IMPLICATIONS: Continuation of STOP5 tool as part of the code green debriefing process is warranted.
Poster #103: Practicing to Deceive: Can Lying to Clients Serve Therapeutic Ends?
Maureen Donohue-Smith, PhD, MSN, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: As members of the most trusted profession, nurses are bound by ethical principles including fidelity, beneficence, non-maleficence, and respect for autonomy. Clinical realities create competing demands that pose true “ethical dilemmas,” where the nurse must honor one of these principles ahead of others. SUMMARY OF EVIDENCE: The literature describes the “compassionate lie,” the use of placebos, and deliberate failure to disclose medical errors as three types of client deception. DESCRIPTION OF PRACTICE OR PROTOCOL: There is limited evidence to guide nurses in determining when, or whether, to circumvent the truth in service to the client. VALIDATION OF EVIDENCE: Case histories are provided to discuss the conditions in which “therapeutic lying” may result in more benefit to the client than “brutal honesty.” RELEVANCE OF PMH NURSING: Psychiatric nurses provide both direct client care and consultation to staff caring for clients with cognitive impairment or to clients reluctant to adhere to treatment recommendations, including medication. The advanced practice registered nurses (APRNs) may also be responsible for obtaining informed consent for care. FUTURE IMPLICATIONS: Incorporate a framework for incorporating ethical decision-making into undergraduate and graduate curricula. Establish guidelines for the use of deception in clinical settings.
Poster #104: Developing an Attention-Deficit/Hyperactivity Disorder (ADHD) Screening Protocol for the Veteran Population: A Quality Improvement Project
Joy Eguavoen, MSN, APRN, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Adult attention-deficit/hyperactivity disorder (ADHD) incidence and prevalence rates continue to rise, more so among Veteran population. Effective screening protocols vary significantly and a singular protocol has not been established. This QI project was designed to address these inconsistencies and improve the assessment and early detection of ADHD. SUMMARY OF EVIDENCE: Adult ADHD is estimated to affect roughly 5.2% of the U.S. population, and this number has been steadily increasing. Among Veterans, military studies reports close to double the general U.S. rate of up to 9%. Adult-specific rating scales are crucial support tools for metrics, but studies on their use are lacking in studies with Veterans. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently, most providers manage adult ADHD through various assessment tools. The protocol was developed after review of project site policy and systematic literature review. An educational intervention including pre and post-questionnaires was used to evaluate participants and foster awareness and then integrate the protocol into practice. VALIDATION OF EVIDENCE: Preliminary results showed that out of the convenience sample (n = 9), 67% reported that “no standardized protocol” and “lack of time” were major barriers. In total, 100% of participants agreed that a protocol would help improve the care of veterans. RELEVANCE OF PMH NURSING: Chart-review outcomes showed improvement of screening practices and documentation validated by increased and correct use of rating scales (Pre: 14%, Post: 50%). This is important for psychiatric and mental health (PMH) nurse practitioners in improving practice and continuing education. FUTURE IMPLICATIONS: Implementing this protocol would allow for increased inter-rater reliability of ADHD evaluation and ultimately avoid delays in care. Focus should be to expound current data and improve quality of life for adults with ADHD.
Poster #105: Updates in Psychiatry: Navigating Drug Approvals and DSM-5 Text Revisions
Erin Ellington, DNP, PMHNP-BC; Lyons Hardy, EdD, MSN, PMHNP
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Over the past few years, major changes have occurred in psychiatry that affect the way we assess, diagnose, and treat mental health conditions. Notable changes include the release of the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR) and new Food and Drug Administration (FDA)-approved medications in psychiatry. SUMMARY OF EVIDENCE: In March 2022, the DSM-5-TR was released with changes in 70 of the diagnoses and the addition of Prolonged Grief Disorder. Several of the updates served as clarifications for existing diagnoses. Since 2022, the FDA has approved 92 novel drugs, five of which pertained to psychiatric conditions. Concurrently, 14 psychiatric medications received expansions of their indications and many brand medications became generic. DESCRIPTION OF PRACTICE OR PROTOCOL: This presentation provides an overview of the updates in psychiatry over the past 2 years since the publication of the DSM-5-TR in March 2022. An overview of the process of drug approvals in the United States will also be discussed. VALIDATION OF EVIDENCE: The evidence from recent updates in psychiatry validates the practice change by underscoring the importance of continuous education and adaptation in psychiatric nursing. RELEVANCE OF PMH NURSING: As Psychiatric Mental Health Nurse Practitioners (PMHNPs) and psychiatric nurses play a pivotal role in comprehensive care, being knowledgeable about these updates in psychiatry equips us with the necessary tools to provide optimal care. FUTURE IMPLICATIONS: Participants will leave with a more nuanced understanding of DSM-5-TR diagnoses and their treatment, including the FDA drug approval process, ultimately leading to better patient care, enhanced treatment efficacy, and improved health outcomes.
Poster #106: Follow-Up Phone Calls Following Discharge From an Inpatient Psychiatric Facility
Magyn El-Sayed, BSN; Debra Livingston, RN, MS
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Potential adverse outcomes following discharge from an acute care psychiatric setting, including failure to keep follow-up appointments or fill prescriptions, can lead to readmission. The purpose of this quality improvement project was to determine whether we could effectively mitigate against these and other outcomes that lead to readmission. SUMMARY OF EVIDENCE: Studies show readmission rates for mental health patients to be as high as 43%. Failure to fill medication prescriptions or to keep follow-up appointments can contribute to increased readmission rates. There is a strong need for additional support when transitioning clients from an inpatient psychiatric setting back to the community. DESCRIPTION OF PRACTICE OR PROTOCOL: Volunteers partnered with a clinical nurse educator to make follow-up phone calls to discharged patients. The volunteers asked questions about discharge medications, appointments, and safety, in order to ensure they transitioned appropriately back to the community. Volunteers provided local resources for appointments, assistance with obtaining work/school notes, and assistance with obtaining medications. These calls helped the inpatient units bridge the gaps with outpatient facilities and with the patients. VALIDATION OF EVIDENCE: Readmission rates were monitored—they decreased from a quarterly average of 5.4% (July 2022–September 2022) to 3.9% (October 2023–December 2023). RELEVANCE OF PMH NURSING: More than 16 months, 838 patients were discharged. Forty-seven percent (N = 390) of these patients successfully completed the call. Of the 390, 42 required follow-up assistance of varying types, including work-notes, reminders of appointments, and assistance filling medications. FUTURE IMPLICATIONS: A protocol for follow-up calls can be implemented at other similar facilities in order to increase quality of care and reduce readmissions.
Poster #107: Behavioral Emergency Response Team (BERT): 5-Year Review
Valerie Ervin, RN-BC; Kerry Notter-Chambers, RN-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: With violence toward health care workers on the rise, it is imperative that hospital systems develop a safe and cost-efficient way to decrease violence toward health care workers. SUMMARY OF EVIDENCE: Prior to development of a Behavioral Emergency Response Team (BERT), OSU Medical Center was seeing increased number of security calls, workman’s comp claims for assault, and restraint/sitter usage. DESCRIPTION OF PRACTICE OR PROTOCOL: Since implementation 5 years ago, BERT has responded to more than 11,000 calls. We have transitioned our covering hours from 24/7 to 0700-2300. We have refined our documentation process and perfected our data collection to track call details including location, duration, and outcomes. We have failed to grow our team to more than eight staff members due to administrative restrictions, but we have one of the highest staff retention rates in the department. VALIDATION OF EVIDENCE: Outcomes and effectiveness are tracked for every BERT call. Five-year data review shows 84.98% of BERT calls have a positive outcome, revealing only 15.02% of calls resulting in negative outcome (restraint/security needed, patient left AMA, or BERT unsuccessful). RELEVANCE OF PMH NURSING: Within the first year of implementing BERT, OSU saw a 22.95% decrease in staff assaults and a 36.8% decrease in security calls for assaultive patient behavior. In 5 years, we have responded to more than 11,000 calls, spanning across all departments/services throughout the medical center. FUTURE IMPLICATIONS: Expansion of BERT to The James, OSU East, Outpatient clinics. Expanded hours past 2300. Possible addition of new roles (NP, LISW, etc.)
Poster #108: Code Blue HELP: A Medical Emergency Response Training for Psychiatric Nurses
Lisette Matutina Espana, MAN, RN, PMH-BC; Eleanor Tomas Lagmay, MSN-Ed, RN, PMH-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Medical emergency simulation and didactic training enhances staff preparedness, improves team performance, and ensures safe patient care in psychiatric setting. The Nursing Learning Needs Assessment (FY 2021–2023) revealed practice gaps during medical emergencies in a psychiatric unit. SUMMARY OF EVIDENCE: People with mental illness are disproportionately affected by comorbid physical health conditions such as cardiometabolic and respiratory diseases. Psychiatric patients on the unit represent a high-risk group that requires clinical vigilance when addressing physical needs. Having mock code training for staff with active participation and debriefing can enhance team performance and preparedness. A structured simulation course is also useful for changing attitudes and increasing confidence and knowledge that could benefit the care team and patients. DESCRIPTION OF PRACTICE OR PROTOCOL: Phases of educational training: (1) Planning includes review of literature, learning needs assessment, and medical code reports; preparation of education materials, meeting with medical code team and unit stakeholders; (2) Implementation includes staff education through learning modules and simulation; and (3) Evaluation includes participant engagement and course evaluation. VALIDATION OF EVIDENCE: Outcome data were obtained from course evaluation, learning needs assessment, debrief reports, and staff feedback during simulation. RELEVANCE OF PMH NURSING: It is vital for nursing staff to receive training on managing medical emergencies to increase staff comfort level and self-confidence during these situations. Staff self-reported increased knowledge and skill on unit readiness, role identification, and teamwork. FUTURE IMPLICATIONS: Staff education advocates provision of safe and effective patient care during crisis situations.
Poster #109: Integrating Cognitive Behavioral Therapy in Obstetric Care for Postpartum Depression Treatment and Prevention
Leia Getchell, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Postpartum depression (PPD) affects 10% to 20% of new mothers globally, with a low rate of treatment and recovery. Thus, enhanced screening and treatment of PPD is needed through the inclusion of psychiatric mental health nurse practitioners (PMHNPs) in obstetric care. SUMMARY OF EVIDENCE: Significant gaps exist in scientific literature regarding mental health care of primiparous women with a history of mental illness. Nevertheless, research suggests that cognitive behavioral therapy (CBT), delivered individually, via telehealth, or in peer-led groups, effectively reduces PPD symptoms. DESCRIPTION OF PRACTICE OR PROTOCOL: Enhancing mental health well-being for birthing people involves investigating patients’ perspectives on health care, mental health, therapy, and barriers to treatment at obstetric clinics. This approach helps identify specific areas in patient care that require focused attention and collaboration with PMHNPs. VALIDATION OF EVIDENCE: CBT is a thoroughly researched therapy, based in learning theory and cognitive appraisal theory, with emphasis on empowering patients with skills for autonomy beyond the therapist’s office. When applied to existing obstetric practice, patient’s EPDS scores decreased significantly. RELEVANCE OF PMH NURSING: Psychiatric nurse practitioners (PMHNPs) in collaboration with obstetricians should identify and diagnose PPD, provide family education on maternal mental health, address PPD stigma, and deliver evidence-based CBT in a method accessible to the patient. FUTURE IMPLICATIONS: PMHNPs should strive to decrease barriers to care experienced by patients with PPD by challenging public policy to extend paid maternal leave, improve childcare access, address limited family leave benefits to mitigate economic insecurity, and mandate mental health screening.
Poster #110: Implementation of an Evidence-Based Bedside Mobility Assessment Tool in Geriatric Behavioral Health Patients: A Standardized Assessment to Promote Safe Patient Mobility and Decrease Falls
Melissa Goad, MSN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Standardizing patient mobility among the geriatric behavioral health patients is an ongoing priority in a southeastern hospital. Falls committee leaders theorize the lack of a mobility assessment tool may be contributing to the increased fall incidence. During the admission interview, the nurse relies on the patient to tell them what level of assistance is needed for ambulation. This forces the nurse to use their clinical judgment in determining a patients mobility level, without any guidance to what safe patient handling equipment is needed to safely ambulate the patient. Often, the nurse will depend on physical therapy to complete an assessment for mobility level and will avoid mobilizing their patient until a physical therapist assesses the patient. With patients being admitted on nights and weekends, and with limited physical therapists available, it is unrealistic to rely on physical therapy to assess each patient before mobilization. Nurses need to be empowered to make decisions that will positively affect the patients they serve. Implementing BMAT can allow them to decide a patients mobility level while removing the guesswork and eliminating the need to rely on physical therapy before mobilizing the patient. Discussions among the falls committee led by the chair of the corporate falls team identified a practice gap: the need for a validated tool to measure mobility levels in the geriatric behavioral health population. Objective data show continued falls with injury in geriatric behavioral health areas. Subjective data indicate the lack of a validated mobility assessment tool could contribute to patient falls. SUMMARY OF EVIDENCE: Immobility can be a vital indicator of functional decline in the hospital setting. Hospitalized patients who do not mobilize regularly can suffer a 20% loss of muscle strength per week, contractures, depression, and constipation, among other consequences. In addition, studies show increased falls, functional and psychological decline, and pressure ulcers related to low mobility. Implementing a standardized, evidence-based bedside mobility assessment tool for nurses in conjunction with a falls screening tool has been shown to decrease falls and improve patient outcomes. According to Montero-Odasso, a multifactorial falls assessment should include a mobility assessment, falls prevention and management interventions, muscle strength assessment, review of medications, assessment for orthostatic hypotension, dizziness, functional ability, and need for walking aids. The American Nurses Association’s (ANA’s) Safe Patient Handling and Mobility standards support using a standardized tool such as the BMAT to promote early and frequent patient mobilization. More research is needed on the use of the BMAT among geriatric behavioral health patients. The BMAT was chosen for this specific patient population because it is a simple tool to administer, takes less than 2 minutes, and can be completed as part of the admission assessment. DESCRIPTION OF PRACTICE OR PROTOCOL: The clinical nursing team participating in this project includes behavioral health nursing team members. The project team distributed preimplementation surveys measuring baseline team member knowledge, attitudes, and perception of barriers to mobility via Survey Monkey. The Johns Hopkins Patient Mobilization Survey identifies team member perceived barriers in three domains: knowledge, attitudes, and perception of barriers. The BMAT tool was built into the electronic medical record through collaboration with the facility informatics team. Education was disseminated on use of the tool and the importance of early and frequent mobility in the geriatric behavioral health population. Compliance data were collected monthly through a report extracted from the medical record. Survey results was analyzed using descriptive statistics. The project team will compare 6 months of falls data before implementing the mobility assessment tool to 6 months of falls data after implementation. The target population for this pilot program include patients aged 65 and above, admitted to a behavioral health unit with a diagnosis of mental illness. Project interventions and implementation strategies include interprofessional collaboration with nursing informaticists, stakeholders, and leaders, creation and dissemination of education on the bedside mobility assessment tool, building the BMAT into the electronic medical record, clinical support, and unit implementation. Virtual huddles and in-person unit huddles with the clinical team were conducted to promote use of the tool. Barriers to implementation will be monitored regularly through discussions with nursing leaders, team members, and unit champions. Permission for use of the instruments was obtained prior to project implementation. VALIDATION OF EVIDENCE: Anticipated findings for this DNP project include consistent use of the BMAT tool as evidenced by an 80% compliance rate over a 6-month period, and decreased falls within the geriatric behavioral health population postimplementation. In addition, understanding baseline knowledge of mobility, attitudes, and identifying perceived barriers to mobility is important to determine prior to implementing an evidence-based project. It is expected to see an increase in team member knowledge, and a decrease in attitudes and perception of barriers to mobility postimplementation. RELEVANCE OF PMH NURSING: The desired outcomes include 80% compliance in use of the BMAT tool, a reduction in falls, an increase in team member knowledge of the importance of early and frequent mobility and decreased perceived barriers allowing the nurses to feel confident to safely mobilize their patients. FUTURE IMPLICATIONS: If the project demonstrates consistent tool use, an increase in the team’s mobility knowledge and a reduction in falls; the plan will be to use the BMAT tool in all geriatric behavioral health areas within the organization.
Poster #111: Providing Consistent Communication for a Safer Environment
Kathleen Gora, RN, BSN, PMH-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: We identified the challenge as inconsistent communication from shift to shift. This led to a knowledge deficiency regarding pertinent patient history. The change in practice was proposed after multiple staff assaults occurred due to insufficient communication regarding a patient’s assaultive history. Overtime, staff became less vigilant about passing this information along. When it was no longer being communicated consistently during inter shift, the unit again became vulnerable. SUMMARY OF EVIDENCE: The data collected identify staff injuries reported due to patient assaults. This information supports the dangerousness of the population we serve and the importance of consistent communication. DESCRIPTION OF PRACTICE OR PROTOCOL: Our current practice is to utilize an inter-shift report called IPASS. This is generally limited to only providing what happened over the last two shifts. It is time-consuming to run and is not consistently utilized. We created a hand-off tool to be utilized along with IPASS in support of hospital policy. This tool provides pertinent patient history not otherwise included in IPASS. The proposed change in practice was presented to the Unit Coordinators, members of administration, and the EHR committee for approval. The tool was then piloted on select units which is still in progress. VALIDATION OF EVIDENCE: Collection of evidence is ongoing. We anticipate a decrease in staff injuries. Quantitative data may be skewed due to inconsistent reporting, so we are measuring outcomes with qualitative data via anonymous surveys. RELEVANCE OF PMH NURSING: Inpatient psychiatric mental health (PMH) nursing often involves treatment of patients demonstrating significantly dangerous behaviors. Results pending. FUTURE IMPLICATIONS: This initiative is ongoing. We expect positive results, leading to safer practices.
Poster #112: Addressing Violence as an Interdisciplinary Approach
Rachael Howe, BSN, PMH-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Workplace violence in the health care setting continue to rise. SUMMARY OF EVIDENCE: Emergency psychiatry remains as one of the highest risk areas in the health care settings for workplace violence not just for nursing staff but, all disciplines. DESCRIPTION OF PRACTICE OR PROTOCOL: Interventions to address workplace violence included addition of violence flagging system within the electronic medical record, violence protocol of prioritizing evaluation of patients with a violence flag, individualized milieu management plans for patients with a violence flag, and monthly meetings between emergency psychiatry staff and Department of Public Safety Officers. Stakeholders include all nursing staff, clinical evaluators (SW/MHT), providers, and Department of Public Safety Officers. VALIDATION OF EVIDENCE: Effectiveness of interventions measured by comparison of restraint data, patient on patient assaults, patient on staff assaults, and violence protocol compliance report from pre- and postimplementation. RELEVANCE OF PMH NURSING: The goal of all interventions is to utilize a proactive interdisciplinary team approach to address workplace violence by giving staff tools of recognizing patients who are at an increased risk of violent acts, interventions to safely engage with known violent patients, and formalized settings for a collaborative approach from a diverse interdisciplinary team. FUTURE IMPLICATIONS: Having a proactive approach to workplace violence contributes to a safer environment for not only staff, but the patients being cared-for.
Poster #114: Oh My! Obsessive Compulsive Disorder in Children and Adolescents
Dianna Inman, DNP, APRN, CPNP-PC, PMHS, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Children and Adolescents live with obsessive compulsive symptoms for an average of 2.5 years before seeing a mental health provider. There are unique developmental periods in which obsessive compulsive symptoms are more likely to be present. This session will provide the participant with an overview of DSM5-TR diagnostic criteria, recognize obsessive compulsive disorder (OCD) earlier to improve outcomes for children and adolescents, provide evidence-based treatment and resources for practitioners and families. SUMMARY OF EVIDENCE: OCD affects 1% to 3% of children and adolescents and often goes unrecognized causing a delay in treatment. The developmental trajectory of children may impede an earlier diagnosis. By providing education, the practitioner will be better informed to recognize and treat this disorder. DESCRIPTION OF PRACTICE OR PROTOCOL: Psychiatric mental health nurse practitioners (PMHNPs) may have limited educational experience related to this topic in their formal educational programs. VALIDATION OF EVIDENCE: This is an educational session. Practice guidelines will be discussed. RELEVANCE OF PMH NURSING: This is an educational session. Psychiatric Mental Health Nurse Practitioners that evaluate children and adolescents will be better informed on current practice guidelines and treatment for OCD. FUTURE IMPLICATIONS: Improved identification of OCD in children and adolescents. Improved outcomes for children and adolescents living with OCD.
Poster #115: Accelerated Intermittent Theta Burst Stimulation for Depression
Eudora Jones, DNP, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Transcranial magnetic stimulation (TMS) is a noninvasive neuromodulation technique that has gained popularity as a treatment option for major depressive disorder (MDD). However, despite the increased use of conventional TMS as a treatment for MDD, its effect sizes have been modest. Only one-third of patients experience remission. SUMMARY OF EVIDENCE: Intermittent theta burst stimulation (iTBS) is a form of TMS that utilizes repeated high-frequency bursts to stimulate cortical neurons. Research has shown that iTBS is noninferior to conventional TMS, yet modest treatment outcomes persist. Thus, there is a need to develop innovative TMS interventions that strive to optimize and expand effective treatment outcomes. DESCRIPTION OF PRACTICE OR PROTOCOL: Two patients who were diagnosed with MDD received accelerated iTBS, which consisted of 10 sessions of iTBS daily for five consecutive days (50 sessions). One of the patients received neuronavigated connectivity-based accelerated iTBS. VALIDATION OF EVIDENCE: A prior open label trial of the Stanford Neuromodulation Therapy (SNT) high dose accelerated magnetic resonance imaging guided iTBS protocol demonstrated a 52.5% reduction of baseline MADRS scores. The robust antidepressant efficacy and short treatment duration of SNT-related protocols are ideal for settings where rapid acting treatments are necessary. RELEVANCE OF PMH NURSING: Psychiatric nursing roles in interventional treatment modalities such as TMS continue to evolve and expand to independent and collaborative nursing interventions. Therefore, psychiatric nurses must remain knowledgeable about research advances in TMS practice. FUTURE IMPLICATIONS: Scientists should continue to investigate and compare accelerated iTBS to other treatment modalities, which can provide an opportunity to improve patient outcomes and expand access to care.
Poster #116: Enhancing Knowledge and Attitude of Supports to Support Patient Care- Support for Supports
Eduardo II A. Kabristante, MSN, Gero-BC, PMH-BC, CRRN; Alice Mukunjura, MSN, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Nursing staff must discuss the details of the psychiatric unit, care team, and treatment components with patients and their support system during admission and discharge planning; however, information can be lost. The Medical Psychiatry unit noted that insufficient knowledge and supportive attitude of family and significant others had decreased their involvement in caring for patients with mental illness and helping them recover. SUMMARY OF EVIDENCE: Initial evidence for closing this gap is mainly empirical. Nurses observed that caregivers often have numerous recurring inquiries about care, treatment, and unit procedures. Literature shows that families want to understand mental illness and treatment to provide better care. The project was initiated by considering the recovery model and employing DMAIC process. DESCRIPTION OF PRACTICE OR PROTOCOL: No structured caregiver education was established in the unit; thus, a weekly hour-long education was offered to caregivers. A group unit nurse facilitates this session, which covers unit-specific information, generalized diagnosis and treatments, and posthospitalization needs. End-of-class forums for significant others to ask questions and handouts on many topics are also available. VALIDATION OF EVIDENCE: Pre and postsurvey mean scores showed an increase in perceived knowledge and improved attitude of caregivers. RELEVANCE OF PMH NURSING: Mental health care has progressed like other medical professions; however, this growth is hindered in patient and public education. Psychiatric mental health (PMH) nursing has a vital role in breaking the psychiatric stigma and improving holistic care through education. FUTURE IMPLICATIONS: PMH Nursing should strengthen mental health education and materials for the public. Educational opportunities include open discourse, dispelling myths, and changing attitudes and actions regarding mental illness.
Poster #117: Championing the “Me” in Treatment: Quality Improvement to Increase Individual Patient Participation in Treatment Planning in an Inpatient Behavioral Health Facility
Erin Liebman, DNP, BS, RN, APN, AGCNS-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Inpatient behavioral health often lags behind other medical specialties in the involvement of bedside staff and patients in shared decision-making. This quality improvement project aimed to increase nurse and individual patients in treatment planning while supporting the development of realistic and actionable goals during inpatient treatment. SUMMARY OF EVIDENCE: CMS, SAMHSA, WHO, and IHI have incorporated patient-driven treatment planning goals and SDM into policies and guidelines for facilities serving persons with mental and behavioral disorders to support comprehensive, individualized treatment plans. DESCRIPTION OF PRACTICE OR PROTOCOL: Daily treatment team meetings were relocated to the inpatient units. Staff education, supportive materials on SMART goal criteria, and resources to support efficiency of the treatment team meeting were implemented. RESULTS: directly quoted SMART goals increased from 41% to 92% of treatment plans. Patient satisfaction remained ≥80% qualitative feedback emphasized the importance of nurse involvement in the treatment planning process. VALIDATION OF EVIDENCE: There was a clear correlation between staff education and adequate patient goal documentation and patient satisfaction remained above the established goal of 75%. Treatment team meetings remained within the established timeframe. RELEVANCE OF PMH NURSING: Findings may inform quality improvement strategies to promote shared decision-making and increase patient satisfaction in inpatient behavioral health to maximize favorable patient outcomes. FUTURE IMPLICATIONS: Future QIP and research studies are needed to correlate shared decision-making and SMART goals with specific patient outcomes. While the evidence for SDM exists, behavioral health would benefit from more specific implementation practice guidance to maximize favorable patient outcomes such as strengthened patient autonomy, enhanced self-efficacy, increased satisfaction with treatment, and improved adherence to treatment.
Poster #118: Understanding Complex Posttraumatic Stress Disorder: A Guide for Identifying and Differentiating Clinical Manifestations
Jessica Livingston, DNP, APRN, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Conflicting diagnostic models of complex posttraumatic stress disorder (CPTSD) per the ICD-11 and the DSM-5 has led to frequent misdiagnosis of CPTSD for other mental health disorders that often changes the approach to treatment in a way that negatively impacts recovery of daily life functioning. SUMMARY OF EVIDENCE: The misinterpretation of DSO (disturbances of self-concept) often result in the misinterpretation of the clinical manifestations and leads to a frequently missed diagnosis of CPTSD. Misdiagnosis could change the course of treatment and result in ineffective care leading to significant negative effects on functional impairment. DESCRIPTION OF PRACTICE OR PROTOCOL: The information being presented is the result of an evolutionary concept analysis of CPTSD which identified multiple areas of need for practice improvement, most specifically in clinical identification of the specific symptoms of DSO within CPTSD. Misdiagnosis (or missing a CPTSD diagnosis) can have significant implications for the recovery and stability of our patients due to differences in treatment approaches. VALIDATION OF EVIDENCE: In this concept analysis, a substantial literature review was completed. RELEVANCE OF PMH NURSING: Recognizing the differences in how symptoms manifest in differing mental health diagnoses is imperative to psychiatric mental health nurse practitioner’s (PMHNP’s) ability to correctly diagnosis and apply the most effective/beneficial treatment modalities. FUTURE IMPLICATIONS: Continued recognition of the differentiating manifestations and the individual aspects that make CPTSD a recognizable diagnosis apart from posttraumatic stress disorder (PTSD) is needed in the mental health care community.
Poster #119: Biologic Mechanisms Predisposing Patients With Schizophrenia to Morbidity and Mortality From Extreme Heat Events: Caring for Our Community in a Changing Global Climate
Colleen Marie Lopez, BSN, RN-C; Kerry Peterson, PhD, DNP, APRN, PMHNP-BC, FAANP
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Research is beginning to demonstrate the significant impacts of climate change on mental health. Patients with schizophrenia may be especially at risk, and psychiatric mental health (PMH) nurses must be prepared to care for this vulnerable population. SUMMARY OF EVIDENCE: As ambient temperatures increase globally in the form of extreme heat events (EHEs), mental health conditions have been found to significantly predispose individuals to increased morbidity and mortality, as well as increased hospitalizations and financial burdens. Patients diagnosed with schizophrenia specifically have been found to have 3 times the odds of EHE mortality. DESCRIPTION OF PRACTICE OR PROTOCOL: While the American Nurses Association (ANA) has released a position statement on the importance of the nursing role in response to climate change, little education exists to translate this into practice. By understanding factors increasing risk for patients with schizophrenia, more targeted interventions can be utilized to reach this goal. VALIDATION OF EVIDENCE: Impaired cognition, altered autonomic function, and neuroleptic medication usage are factors central to schizophrenia that increase risk of mortality following an EHE. Practice changes targeting these risk factors can reduce their impact. RELEVANCE OF PMH NURSING: This topic highlights how increased PMH nursing awareness can benefit its most marginalized patients who are impacted by climate change at a significantly higher rate than the general community. FUTURE IMPLICATIONS: This presentation will explore the need for PMH nurses to adapt their practice in a changing global climate. Future implications for incorporating PMH nurses in climate change response and advocacy injustice efforts will also be discussed.
Poster #120: Nurse Perspective on Navigating the Complex Landscape of Childhood-Onset Schizophrenia: A Case Report
Daniel Lovasz, DHA, MSN, BSN, RN, PMH-BC, CNE
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The problem involves the critical need for early diagnosis and effective management of childhood-onset schizophrenia (COS) by psychiatric nurse. Psychiatric nurses identify symptoms of COS early, provide objective data to clinicians to support diagnosis and avoid a lengthy trial-and-error approach. SUMMARY OF EVIDENCE: Published evidence indicates that achieving an accurate diagnosis of COS requires 2 years after the initial psychotic event. Symptoms—such as auditory hallucinations, diminished emotional expression, delayed speech response, anhedonia, social withdrawal, and apathy are distinguishing COS from other disorders. Notably, children with COS present lower levels of depressed mood but commonly experience auditory hallucinations. DESCRIPTION OF PRACTICE OR PROTOCOL: To address the challenge of delayed diagnosis of COS, nurses should receive specialized training focused on the early recognition of COS symptoms and differential diagnosis. VALIDATION OF EVIDENCE: Implementing routine assessments of high-risk children facilitate earlier identification and prompt timely referral for psychiatric evaluation resulted in early start of antipsychotics. RELEVANCE OF PMH NURSING: Children with COS often show early behavioral and cognitive disturbances, including language and motor delays, affecting their social and academic abilities. There’s a significant opportunity to enhance the training of nurses to provide accurate assessments that aid in the timely and precise diagnosis of COS, leading to improved treatment and patient outcomes. FUTURE IMPLICATIONS: This should emphasis the need of psychiatric nurses to enhance their assessment skills and collaboration with treatment team by training and seeking certifications (such as PMH BC). Distinguishing COS from other neurodevelopmental or impulse control disorders results in an improved prognosis.
Poster #122: Implementing a Peer and Mentor Transition Support Program for New Graduate PMHNPs
Christina Nora Maroone, DNP, MPA, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The lack of a comprehensive transition framework for new psychiatric mental health nurse practitioners (PMHNPs) leads to transition shock, contributing to job dissatisfaction and high turnover. Evidence supports mentoring, support groups, and role transition workshops within the first 6 months of graduation to address this gap. SUMMARY OF EVIDENCE: A review of current literature suggests new graduate APRNs identify a lack of support, contributing to emotional distress and poor confidence. Implementation of structured support reduces turnover rates, improves perceived health, and enhances job satisfaction. DESCRIPTION OF PRACTICE OR PROTOCOL: The current practices often lack comprehensive support frameworks, leading to transition shock and suboptimal performance. To address this, I implemented a mentorship and support program for new graduate PMHNPs, providing one-on-one mentoring, support groups, and role transition workshops within the first 6 months of practice. The outcomes included reduced transition shock, improved role clarity, enhanced performance, and increased confidence. Stakeholders included new graduate PMHNPs, experienced PMHNPs serving as mentors, and health care institutions supporting the program implementation. VALIDATION OF EVIDENCE: The three-pronged approach effectively addressed new PMHNPs’ initial low confidence, leading to significant improvement upon program participation. Brief mentorship with experienced PMHNPs notably contributedto boosting overall confidence. RELEVANCE OF PMH NURSING: This program enhances new PMHNP readiness, confidence, and job satisfaction, bridging education-practice gaps and fostering resilience. It highlights mentorship’s importance in nursing education and practice, impacting health care delivery. FUTURE IMPLICATIONS: The success of this program highlights the importance of mentorship and structured transition plans for new graduate PMHNPs. Expanding this model can further elevate the quality of PMHNP care, addressing ongoing challenges in health care delivery and workforce development.
Poster #124: Care Gaps for U.S. Military Leading to Chronic Untreated Posttraumatic Stress Disorder
Stacy McGee-Wheat, BSN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Posttraumatic stress disorder (PTSD) can be a debilitating disorder, especially when untreated. Unfortunately, there are gaps in care related to treatment. This presentation aims to identify barriers to care and highlight PTSD treatment options for military service members. SUMMARY OF EVIDENCE: Evidence-based guidelines recommend PTSD treatment to include trauma-focused therapies. However, trauma-focused therapies have high rates of nonadherence, dropout, and nonresponse among military members. Barriers to care include trauma-associated issues, access, and past experiences. Nearly 50% of veterans refuse trauma-focused therapy and prefer alternative methods, such as yoga and supportive therapy. DESCRIPTION OF PRACTICE OR PROTOCOL: Trauma-focused treatments require disclosure of trauma. However, many military members with PTSD report difficulty in discussing their trauma. This may be due to the severity or classified nature of the events, causing fear of legal, occupational, or personal repercussions. Fear of treatment can be more harmful and result in poor outcomes. VALIDATION OF EVIDENCE: Research supports the use of nontrauma-focused therapies to treat PTSD, such as dialectical behavior therapy, behavioral activation, and cognitive therapies among military members. One study showed present-centered group therapy (PCGT), compared with trauma-focused group therapy, to be equally effective in reducing symptoms. Importantly, the dropout rate for the PCGT group was significantly lower than the trauma-focused group. Finally, alternative methods, such as yoga, mindfulness, and psychedelic-assisted therapies show to be effective. RELEVANCE OF PMH NURSING: Psychiatric mental health (PMH) nurses must be knowledgeable about treatments for PTSD, as well as factors that can contribute to treatment nonadherence and willing to offer alternative options. FUTURE IMPLICATIONS: Continued research is needed to explore the effectiveness of various PTSD treatment options.
Poster #125: Clinical Practice by a PMHNP Within a Collaborative Care Model
Janet Meda, DNP, FNP-C, PMHNP-BC; Vanndy Loth, DNP, MPH, PMHNP; Lynda Creighton-Wong, MS, RN, PMHNP
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Collaborative Care (CoCM) is an integrated care model designed for the primary care setting to successfully address the gap in care for treating mental health conditions. Providers in primary care clinics are experiencing an increase in demand and pressure to treat behavioral health conditions beyond mild depression and anxiety. Long waitlists related to referrals to specialty mental health and time limitations in a medical visit creates a unique opportunity for psychiatric mental health nurse practitioners (PMHNPs) to integrate into primary care as part of a collaborative care model. SUMMARY OF EVIDENCE: CoCM was tested in more than 90 randomized controlled trials in the United States and abroad and has a robust evidence base that has improved depression and anxiety compared with usual care in primary care. This model is cost-effective. DESCRIPTION OF PRACTICE OR PROTOCOL: Referrals from PCPs are triaged by an integrated CoCM team within the clinic. They must have a PHQ-9 greater than 10 and rescreened in each session within CoCM. After three visits, PMHNP stabilizes symptoms, establishing a medication regimen for clients and PCP continues to manage the maintenance phase. PMHNP is available for ongoing consultation. VALIDATION OF EVIDENCE: Results have shown decreased PHQ-9 and GAD-7 scores after 3 months. Timely access is significantly improved. RELEVANCE OF PMH NURSING: The addition of PMHNPs through CoCM is beneficial in a primary care setting. FUTURE IMPLICATIONS: The CoCM provides a structure for primary care clinics to adapt, with limited community mental health resources, to address the mental health needs of their clients.
Poster #126: Adverse Childhood Experience (ACE) Screening in a Midwest Suburban Pediatric Primary Care Setting: A Quality Improvement Project
Jodi Menninga, BSN, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Adverse childhood experiences (ACEs) are attributed with a lifespan of health and behavioral consequences. While research has identified several screening and supportive strategies to combat ACE occurrence, the absence of process impedes screening and identification practices universally. SUMMARY OF EVIDENCE: The cost of ACE-related illness is an estimated US$748 billion, annually. ACEs are attributed to adolescent and adult mental health disorders, substance use, suicide, poverty, cancer, and death. Although ACE awareness has improved, deficits surrounding ACE knowledge, confidence, scope, and procedure exist as barriers in ACE prevention and reduction. DESCRIPTION OF PRACTICE OR PROTOCOL: A midwestern suburban pediatric primary care clinic was chosen as the site for this QI project. Staff had limited ACE knowledge, and did not screen for ACEs. A process for ACE screening was developed, and staff were educated on the clinical problem and procedure for screening which included eligibility criteria, screening tool information, scripting and interpretation guidelines, a provider toolkit with interventional resources, and educational handouts. VALIDATION OF EVIDENCE: Outcome was measured by compliance with the design process, number of patients screened, ACE score results, needs identified, resources given, and staff feedback. RELEVANCE OF PMH NURSING: Process improves ACE identification and intervention when followed as designed. When the design is only partially followed, ACEs might still be identified but opportunities to improve ACE consequence is missed, limiting the success of prevention and reduction efforts which are key to the success of overall health improvement. FUTURE IMPLICATIONS: Ongoing use and success of ACE screening process highly depends on employee engagement.
Poster #127: Resilience Through Reading: Assessing the Effectiveness of Bibliotherapy on an Inpatient Adult Psychiatric Unit
Jacob Merkel, MSN, RN-BC; Susie Clinton, OTR/L, MS; Mackenzi Lain, RN, BSN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Access to recovery-oriented books is limited in current practice. Before the implementation of recovery-oriented books, patients had limited access to books and magazines, with reading options limited to personal donations or reading material brought in by patients’ visitors. This presentation examines the experiences of thirty patients on a locked, adult psychiatric unit, who chose a recovery-oriented book from a library of curated books related to various mental health topics, and how this impacted their mental health. SUMMARY OF EVIDENCE: Bibliotherapy is the therapeutic approach to therapy that incorporates books and story-telling as a way for the reader to improve their mental health. Current literature suggests that bibliotherapy projects on inpatient psychiatric units increase patients’ resilience and hopefulness through identification and inspiration. This presentation illustrates program implementation, utilization of functionality, operational difficulties, and future opportunities. DESCRIPTION OF PRACTICE OR PROTOCOL: Thirty-three recovery-oriented books were carefully selected and purchased for the bibliotherapy library. A variety of book topics were identified based off patient population and most commonly seen diagnoses, including: schizophrenia, bipolar disorder, depression, anxiety, autism, borderline personality disorder, trauma, gender dysphoria, and addiction. Patients who met certain criteria including ability to read and having sufficient time to complete the book were chosen as participants in the project. These selected patients completed the Herth Hope Index survey before and after reading the book to assess changes in their responses related to hopefulness, self-esteem, and resilience. VALIDATION OF EVIDENCE: The data revealed moderate increase in patients’ report of hopefulness, feelings of resilience, and self-esteem after reading their selected book. Access to these books will be increased as the books are made available on bookshelves in the dayrooms of the units for all patients to consider reading without needing to be enrolled by project facilitators. RELEVANCE OF PMH NURSING: High acuity, decreased access to preferred activities, disconnect from one’s social support, and circumstances surrounding hospitalization can all be sources of distress for a patient hospitalized on a psychiatric unit. Having access to a therapeutic book and being able to read this book in the privacy of their room has shown to be a safe, cost-effective intervention for patients experiencing exacerbation of mental illness. Books that foster themes of hope and recovery from mental illness or that share one’s personal experience with recovery can offer patients an opportunity to identify, relate to, and reflect on their life and their illness. In turn this may lead to higher level of satisfaction from their hospitalization overall. FUTURE IMPLICATIONS: Based on positive patient and staff responses, low cost, and low risk for harm, it is expected that the use of bibliotherapy as a supplemental intervention for patients will continue to increase.
Poster #128: Implementation of a Violence Risk Assessment and Postseclusion Debriefing in the Emergency Department: Reducing Workplace Violence and Improving Inpatient Psychiatric Facility Quality Reporting Seclusion Rates
Jennifer Miller, MSN, RN, NPD-BC, PMN-BC; Joshua Moran Jiménez, BSN, CPAHA, PMH-BC, CARN, CPHQ, NE-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Though there is no universally identified benchmark of acceptable rates of seclusion, the April to September 2023 preintervention rate of seclusion hours on a psychiatric emergency department (ED) unit at a public state hospital in the southeast was 5.57/1,000 patient care hours, exceeding current comparison data from CMS for calendar year 2022 with a national average, 0.35/1,000 patient care hours. SUMMARY OF EVIDENCE: Evidence supports a multicomponent intervention to reduce seclusion rates, including debriefing and assessment tools, leadership engagement, and protocols incorporating safety initiative programs such as Six Core Strategies. The site has a policy for seclusion of patients presenting imminent risk of harm but there is no standardized preventive screening process for all patients. DESCRIPTION OF PRACTICE OR PROTOCOL: The purpose of this project was to reduce workplace violence (WPV) and seclusion rates in a psychiatric ED through the implementation of an evidence-based protocol that includes assessment of violence risk using a validated tool, identifying de-escalation and coping techniques, and postincident debriefs. The identified information was communicated for admitted patients in hand-off report to nurses of the inpatient units. VALIDATION OF EVIDENCE: WPV and seclusion rates among the emergency psychiatric and inpatient psychiatry units were the outcome measures. RELEVANCE OF PMH NURSING: There was a 45.83% decrease in WPV reports. A 5.01% decrease in the combine Inpatient Psychiatric Facility Quality Report (IPFQR) seclusion rates was seen across the adult inpatient psychiatry units that received the communicated Violence Assessment Tool (VAT). FUTURE IMPLICATIONS: Early identification of violence risk, patient specific agitation factors, and de-escalation preferences may decrease WPV and IPFQR seclusion metrics.
Poster #129: Ketamine or ECT? Finding the Right Modality for Treatment-Resistant Depression
Courtney Miller, ADN, BA, RN; Jonathan Foley, RN; Paula Bolton, MS, CNP, ANP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: This presentation will present a broad overview of ketamine treatments (both IV and intranasal) and ECT for patients with treatment-resistant depression. It will discuss the different neurotherapeutic modalities and provide audience members with knowledge to understand different treatment options for their patients. Case studies will be discussed. SUMMARY OF EVIDENCE: ECT and ketamine have proven safe and effective, and they offer adjunct therapy for those with treatment-resistant depression. Validated rating scales will be utilized to demonstrate effectiveness of each treatment. DESCRIPTION OF PRACTICE OR PROTOCOL: Our patient-centered Neurotherapeutics department provides consultation and education for patients, interface with primary psychiatric providers and insurers, and patient-centered treatment planning with adaptation of protocols to meet patient needs. Nurses provide assessment, monitoring, case management and participate in treatment planning conferences to assure safe, efficient care of patients throughout all modalities of the department. VALIDATION OF EVIDENCE: Nursing and clinician assessments, including medical metrics and validated depression scales are used to monitor treatment progress, side effects, and other factors as patients progress through the phases of treatment. RELEVANCE OF PMH NURSING: ECT and ketamine treatments have been shown to be safe and effective and should be part of the adjunct therapies considered by APRNs working with patients with treatment-resistant depression. Psychiatric nurses should be knowledgeable about the services available to their patients. FUTURE IMPLICATIONS: As experience provides information about the safety profile and efficacy of neurotherapeutic modalities, nurses can reliably refer and/or provide these much-needed services to patients. Nurses, both staff nurses and APRNs should become familiar with treatments and the hope they provide for patients.
Poster #130: Leveraging Psychiatric Nurse Consultants to Reduce Assaults on Nursing
Kelly Mohn, MSN, RN, PMH-BC; Carrie Cheston, BSN, RN, PMH-BC, SANE
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The assault rate on nursing personnel was more than double the average of like-sized hospitals. While a process was in place to notify staff in the electronic medical record (EMR) that a patient was prone to violence against health care workers, clinical staff did not have the skillset to enter enough information into the EMR to prevent future events. SUMMARY OF EVIDENCE: Nurses are at a higher risk of violence as compared with other disciplines within health care organizations. As workplace violence has physical and psychological impact, a better solution is needed. DESCRIPTION OF PRACTICE OR PROTOCOL: Previously, nursing requested security assistance to manage patients once they became violent. Proactive behavioral management rounding allowed for early identification of high-risk patients so nursing interventions could be established prior to patient escalation, resulting in the reduction of nursing staff assault injuries. VALIDATION OF EVIDENCE: The total number of injury assaults and staff feedback were utilized to evaluate the success of the rounding program. Also, the number of patients with behavior plans in place prior to the event, and whether the behavior plan was followed by staff was collected. RELEVANCE OF PMH NURSING: As a result of the targeted rounding and behavior plans implemented, the rate of violent events involving inpatient nursing staff decreased by 16% and injury assaults decreased by 23%. FUTURE IMPLICATIONS: Strategic and early deployment of Psychiatric Nurse Consultants to support clinical nurses in identifying patient specific triggers and de-escalation tactics, and communication of behavior plans can aid in supporting nurses while caring for these challenging patients.
Poster #131: A Feeling of Inexpressible Disaster: Disordered Eating and Body Dysmorphia in Men
Lee Moore, DNP, MEd, ARNP, PMHNP-BC, CNE
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Historically, various social forces have led to less emphasis being placed upon the evaluation and consideration of disordered eating and body dysmorphia as they relate to men and mental health care. SUMMARY OF EVIDENCE: With the rise of social media and constant communication, it has become easier for individuals to compare themselves to the “ideal” as it may be portrayed within media. This has led to higher rates of reported disordered eating patterns and body image-related concerns that, while concerns unto themselves, often lead to comorbid mood concerns, anxiety concerns, and beyond. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently, health care practitioners may not focus on evaluating these types of concerns within men in particular. Men may not be aware that certain practices are “abnormal” or may also wish to hide their related thoughts and emotions for fear of judgment and shaming. By considering social forces and contexts alongside the factors unique to the individual, the health care provider can both properly evaluate and offer treatment within this realm. VALIDATION OF EVIDENCE: Healthy relationships with food and body image support overall wellness. RELEVANCE OF PMH NURSING: Eating behaviors are inherent to maintaining life and health and are something that an individual must consider on a daily basis; for this reason, disordered eating can also come to dominate a person’s thoughts and emotions. By considering the whole person, the psychiatric mental health (PMH) nurse can support recovery here. FUTURE IMPLICATIONS: By building and supporting the provision of competent care, more men may be properly evaluated and cared-for in this realm; this can then support positive functioning in terms of home, school, work, and beyond.
Poster #132: Development of Psychiatric Nursing Roles, Bridging Gaps in Care and Services by Meeting the Immediate Needs for Mental Health, SUD, and Medical Health Care of the Unhoused and Vulnerable Population in a Rural Community
Janet Nickolaus, MN; Viola Ware, RDA, CIS
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Initially developed to address Arrest and Jail Alternatives, reducing recidivism rates, expanded including FD, addressing frequent emergency room (ER) visits. Grants include supporting case management and long acting antipsychotic injections and MOUD services. Referrals are provided from FD, PD, and local jails, allowing addressing their needs immediately upon release. This includes restarting insurance, labs, medications, applying for housing, facilitating substance use disorder (SUD) assessment and inpatient treatment programs. The ability to “meet them where they are” bridges a service gap. The development of the psychiatric mental health nurse practitioner (PMHNP) role in the streets and the shelter population, and out in the field in camps, and upon release from jail improves outcomes. SUMMARY OF EVIDENCE: Bridging a service gap breaks down barriers to care, bringing the needs directly to the individual, improving outcomes. This reduces both ER visits, police interactions, jail encounters and overall community costs. Educational Needs: Mental health professionals with health assessment and street knowledge, peer support, and outreach staff, MA and RN. DESCRIPTION OF PRACTICE OR PROTOCOL: Stakeholders are both vulnerable clients and the rural community, as well as first responders and medical providers. VALIDATION OF EVIDENCE: Reduced jail incarceration after stabilization. Reduced ER visits. Reduced 911 responses. Reduced unhoused population. Reduced overdoses in the community. RELEVANCE OF PMH NURSING: This programs brings psychiatric mental health (PMH) nursing to the streets, jails, and care gaps. Reduced barrier to care reduces community costs on all levels; jail costs, emergency room costs, and so on. FUTURE IMPLICATIONS: Improved MH outcomes for a vulnerable population in a rural community Decreased costs to all rural agencies. Improved interagency coordination of care Utilizing individuals with lived experienced to facilitate trust
Poster #133: 1, 2, 3 . . . Safety Down!!!
Shasha Niederhaus, BSN, RN, ONC; Tiziana S. Grunden, BSN-RN-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Workplace violence is a significant problem affecting health care organization. It includes physical assaults, verbal abuse and other harmful behaviors. The extent of the issue varies, it jeopardizes employee well-being and also impacts productivity and organizational culture. SUMMARY OF EVIDENCE: Addressing this problem requires collaborative strategies including training, policies and a fostering a culture of respect. Nursing presence can help reduce workplace violence, by providing a supportive environment, promoting open communication, and implementing preventive measures such as safety rounding. DESCRIPTION OF PRACTICE OR PROTOCOL: The Psychiatric Emergency Department (PED) consists of 20 patients in the dayroom. The PED can be very unpredictable at times. Having a consistent nursing presence in the dayroom is to reduce workplace violence and to ensure the safety of the patients and the staff. Four Registered nurses are assigned to the 20 patients. Four Mental Health Technicians (MHTs) are present during each shift. This setup allows the team to have complete view of the patients in the PED. VALIDATION OF EVIDENCE: Nursing presence out in the dayroom allows staff to intervene early and attempt to verbally deescalate when a patient begins to escalate. This also reduces the number of behavioral emergencies, therefore lessening the amount of restraints/seclusion, and the risk of patient and staff injury. RELEVANCE OF PMH NURSING: Nursing presence and rounding each hour in the dayroom has shown that the nurses promote team collaboration and reduce workplace violence in the PED. FUTURE IMPLICATIONS: Team collaboration has created a calming effect in the dayroom which improves the care for the patients, creating a safer environment and better outcomes for the patients and staff.
Poster #134: Promoting Palliative Care for Patients With Dementia in an Acute Geriatric Psychiatric Unit
Araceli Nunez, MSN, RN; Ryan McConnell, BSN, RN; Lisette Espana, MAN, RN, PMH-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: In 2022, there were only two palliative care consults (PCCs) at a geriatric psychiatric unit. The purpose of this project was to implement a psychiatric nurse-driven palliative care algorithm. SUMMARY OF EVIDENCE: Life-threatening psychiatric illnesses such as dementia currently lacks guidelines on PCCs for patients in a psychiatric setting. Nurses play a key role for recommending PCCs when developing and operationalizing PCCs triggers as frontline clinicians at the bedside. The palliative care indicators were adopted from the Necesidades Paliativas (NECPAL) tool. DESCRIPTION OF PRACTICE OR PROTOCOL: Three phases of the project were (1) Planning: literature review; consulted with palliative experts, and meeting with unit stakeholders. (2) Implementation: algorithm presentation, staff education, and multidisciplinary meetings. VALIDATION OF EVIDENCE: Pain and comfort levels were the primary patient outcomes measured using the PAINAD and Likert-type scale. Psychiatric nurses recommend PCCs using the algorithm. RELEVANCE OF PMH NURSING: The algorithm was effective in improving patient’s pain and comfort level. Only three psychiatric nurses recommended PCCs during multidisciplinary team rounds. For sustainability, it is essential to have palliative multidisciplinary meetings and continuous collaboration between the psychiatric team and the palliative experts. FUTURE IMPLICATIONS: By emphasizing on introducing the algorithm as a tool for nurses to recommend PCCs, the quality of life of dementia patients in a psychiatric setting may be optimized.
Poster #135: Prioritizing the Mental Well-Being of Medical Providers in Abortion Care
Vivian Chinyere Obi, MSN, APRN, FNP-C
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Medical professionals working in abortion care are subjected to stigma, discrimination, and job stressors, which impacts their mental health. Institution-based mental health interventions to assist this group is limited. This literature review explores the potential for weekly counseling sessions over the duration of 3 months, in decreasing work-related anxiety, violence, and anti-abortion actions, when compared with providers who do not receive this intervention SUMMARY OF EVIDENCE: Facilitated work groups presented a safe environment for medical professionals working in abortion care to discuss their stressors and support each other. The provider share workshop examined the effects of compassion satisfaction, compassion fatigue, and burnout on the stigma of working in abortion care. Videoconferencing presents a helpful tool to provide emotional support for medical staff. DESCRIPTION OF PRACTICE OR PROTOCOL: In-person meetings enabled face to face interactions between participants of the facilitated work group and provider share workshop. Videoconferencing and phone calls helped build resilience among the voluntary colleague support group. VALIDATION OF EVIDENCE: A literature review was conducted using Cochrane and PubMed databases. Gaps in the literature existed. One quantitative study and two qualitative studies were reviewed. RELEVANCE OF PMH NURSING: The expertise of the psychiatric mental health nurse practitioner (PMHNP) can offer medical providers in abortion care a safe group space. This helps identify the individual’s specific need for psychotherapy or pharmacological interventions. FUTURE IMPLICATIONS: Strengthening the mental health of abortion providers is essential. Medical institutions can play a critical role in this process by implementing provider share workshops and videoconferencing support groups, to reinforce the resilience of this unique population.
Poster #136: Needs Assessment: Understanding Beliefs and Barriers to Seeking Mental Health Care Among Immigrant Population
Ujaranne Renee Onuorah, PMHNP-BC, FNP-C, APRN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Issues of the disconnect between immigrant pts and providers led to this project. Concerns about not being understood, mental health discussions and interactions with providers, or individualized cultural care were identified practice practice-setting problems. SUMMARY OF EVIDENCE: Migration to a new country and an environment with different values, morals, culture, and language are all factors that contribute to the continual rise of mental health disorders in the immigrant population. Understanding the barriers and beliefs of the immigrant seeking mental health care from their perspective is imperative to having a positive mental health outcome. DESCRIPTION OF PRACTICE OR PROTOCOL: The outcome consensus was the need for a trusting relationship, treated with respect, dignity, and a sense of belonging especially in their new country. A positive impact on the practice site with culturally sensitive and appropriate mental health screening, and recommendations to staff, increasing cultural awareness and competent care. VALIDATION OF EVIDENCE: Through a QI initiative and utilizing the Plan-Do-Study-Act (PDSA) method, data were collected through a 10-question semi-structured questionnaire, for 4 months through convenience sampling. An inductive thematic analysis was used to develop new theories and identify related themes through an iterative process to mental health and its role in this population. RELEVANCE OF PMH NURSING: Three main core themes: Stigma; Mental Health Literacy and Knowledge; and Barriers and Beliefs. Factors such as language, culture, spirituality, transportation, and income were stated as barriers, and grouped under the Barriers and Beliefs theme identified during this assessment. FUTURE IMPLICATIONS: The need to focus on improving current practice, mental health practice, and providing appropriate culturally competent care to our immigrant populations.
Poster #137: Integrating Patient Portal Use on a Psychiatric Medical Unit
Elyse Paxson, MSN RN, PMH-BC; Casie Sultana, MSN, RN, CNL, PMH-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Patient portal use has increased over the years due to developing technology, especially within hospital systems. Patient portals allow hospitalized patients to view their medications, read and watch educational materials, view their treatment team, and complete hospital questionnaires. Historically, there is a disconnect between providers and the mental health population due to a perception that access to medical records will affect care and treatment. Currently, patient portal use is not widely known and not encouraged as common practice of bedside staff. SUMMARY OF EVIDENCE: Patient portal use has been associated with lower length of stay and readmission rates, especially in those with chronic illness. Portal use also has potential to increase trust with providers, increase engagement in care, and facilitate transitions of care in behavioral health patients. DESCRIPTION OF PRACTICE OR PROTOCOL: Utilizing a “train the trainer” approach, select staff among specialties of nursing, case management, social work, and activity therapy were educated on patient portal use and then trained other staff. After training was completed, patients were shown the patient portal technology using at-the-elbow teaching by staff. VALIDATION OF EVIDENCE: Audits were completed monthly to assess patient portal account activations and use of the patient portal during an inpatient admission. RELEVANCE OF PMH NURSING: Portal use increases trust and transparency among patients and providers and should be offered and encouraged for the behavioral health population. FUTURE IMPLICATIONS: Additional studies or research should be conducted to understand the impact of patient portal use among the behavioral health population.
Poster #138: Innovative Strategies for Sepsis Prevention in Psychiatric Inpatient Settings: Integrating Nurse and Occupational Therapist Collaboration for Enhanced Patient Safety
Natalie Ramirez, BSN, RN; Florence Glass, OTR/L, MOT; Amanda Meffert, BSN, RN; Sarah Sperberg, PMHN-BC, BSN, RN; Kateleen Collins, BSN, RN; Emily Smith, MSN, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The nurses have difficulty identifying the early stages of sepsis for infection. SUMMARY OF EVIDENCE: Nurse survey, and event report data. DESCRIPTION OF PRACTICE OR PROTOCOL: Due to being out of practice with physical assessment, psychiatric nurses may miss the signs and symptoms of sepsis, which leads to patients becoming critically ill and being sent to a medical unit or intensive care unit (ICU). VALIDATION OF EVIDENCE: Based on different report data and nurse survey there is a gap in comfort and knowledge. RELEVANCE OF PMH NURSING: This is based on data collected from an inpatient psychiatric unit. FUTURE IMPLICATIONS: To reduce safety/sentinel events related to sepsis, and infection.
Poster #139: Beyond Resilience: Strategies to Enhance the Path to Wellness
Mamilda Robinson, DNP, APN, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Change in measures to posttraumatic stress disorder (PTSD) recovery beyond resilience. SUMMARY OF EVIDENCE: There is a gap between measures to mitigate trauma based exclusively on resilience and the actual lived experience of persons that have sustained trauma. While it is known that resilience is a key component to psychotherapy; the long-term outcome of this approach should be evaluated further. A cross-sectional study revealed that resilience does have a positive but partial impact on managing PTSD. In addition, a systematic review conducted by Galatzer-Levy et al. found trajectory models with resilience to be a key component, but other components to the recovery process such as the fluctuation of symptoms, delayed onset and were involved in final recovery and wellness. DESCRIPTION OF PRACTICE OR PROTOCOL: This presentation depicts resilience of PTSD as a key component but not the ultimate outcome in trauma-informed care. This approach is transformative, holistic and reflective of patient’s need for full recovery and wellness manifested in all aspects of their lives. VALIDATION OF EVIDENCE: Multiple sources in the literature have addressed not just resilience but other measures to define positive patient outcomes to trauma. A case study will be presented that depicts each phase of the trajectory of PTSD, resilience, and a path to recover using psychotherapeutic measures. RELEVANCE OF PMH NURSING: This topic provides a means to adjusting patients goals and expectations, and augments supportive care during all phases of PTSD. FUTURE IMPLICATIONS: Improved psychotherapeutic approach to support all phases of PTSD care.
Poster #140: MDMA-Assisted Psychotherapy for the Treatment of PTSD: Comparisons and Considerations
Nearco Rodriguez, BSN, FNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The theoretical framework for this study draws upon the neurobiological and psychological mechanisms associated with Methylenedioxymethamphetamine (MDMA) and selective serotonin reuptake inhibitors (SSRIs) in addressing posttraumatic stress disorder (PTSD) symptoms. SUMMARY OF EVIDENCE: In light of the limited efficacy of conventional therapies, this body of research is essential to the exploration of substitute methods for improving the quality of life for people with PTSD. DESCRIPTION OF PRACTICE OR PROTOCOL: A review of research was conducted using the National Institute of Health (NIH) Library. These included a randomized controlled trial comparing the outcomes of patients treated with MDMA versus those receiving SSRIs published by Mithoefer et al. and Mitchell et al. Preliminary results suggest that MDMA demonstrates promise in reducing flashbacks when compared with SSRIs. VALIDATION OF EVIDENCE: It is crucial to note that the use of MDMA in PTSD treatment is still a subject of evolving research, and the evidence for its efficacy and safety continues. The study incorporates standardized assessment tools to measure the frequency and intensity of flashbacks, providing a quantitative basis for comparison. RELEVANCE OF PMH NURSING: The findings contribute valuable insights to psychiatric mental health nursing practice by opening avenues for innovative and personalized therapeutic approaches. The learning objective of this project is to gain an understanding of the potential benefits and limitations of MDMA compared with SSRIs in managing flashbacks among adults with PTSD, fostering informed decision-making in psychiatric mental health nursing practice FUTURE IMPLICATIONS: The implications of this study extend beyond the direct comparison, suggesting a potential paradigm shift in PTSD management.
Poster #141: Behavioral Telehealth Triage: A Fragmented Process Remedied by a Standardized Approach
Asya Shah, BSN, RN, PMH-BC; Erika Hill, BSN, RN, PMH-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: A behavioral telehealth environment without a formal safety assessment tool in place to triage communication from patients in crisis, resulted in opportunities in delays in patient care. SUMMARY OF EVIDENCE: The literature shows improvement in patient outcomes through a formalized safety triage completed by the outpatient registered nurse in collaboration with the treatment team improved response time to patients in crisis, increased opportunities for safety planning, and improved access to mental health care within the organization. DESCRIPTION OF PRACTICE OR PROTOCOL: A fragmented process of triaging crisis calls resulted in incomplete assessments informing the coordination of care. Registered nurses owning the assessment process, equipped with a standardized tool, were able to ensure appropriate triage of information communicated to the provider. VALIDATION OF EVIDENCE: The literature review supported the use of a standardized tool to ensure adequate triage of crisis calls in behavioral telehealth. Provider and nurses’ perception of effectiveness of the tool was measured utilizing a Likert-type scale survey. RELEVANCE OF PMH NURSING: Patients benefit from a standardized approach of nurses working to the top of their scope and collaborating directly with providers to decrease fragmented care. As a result of creating a standardized tool nurses were empowered to triage patients based on clinical judgment and expertise. This process resulted in an increase in provider satisfaction and overall care coordination. FUTURE IMPLICATIONS: Identifying gaps early in the behavioral telehealth workflow will improve mental health care for patients along the continuum of care. Empowering behavioral telehealth nurses with effective assessment tools increases the opportunity for safe triage and contributes to better outcomes.
Poster #142: The Psychological Effect of Continuous Glucose Monitoring and How to Support Individuals With and Without Diabetes Utilizing These Devices
Amanda Lyn Sheehan, MSN, BSN, BS, FNP-BC, NP-C
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Patients with and without diabetes are increasingly utilizing continuous glucose monitoring (CGM). Psychiatric mental health nurse practitioners (PMHNPs) are uniquely suited to help support patients in the safe use of these devices and help prevent both nonadherence, anxiety, frustration, as well as obsessional behaviors that compromise safety. Patients may maladaptively use CGM to perpetuate unrealistic glucose fixation/obsession, or eating disorders. CGM can also negatively impact levels of anxiety without education and support. PMHNP providers can help by providing support around what are normal / target glucose patterns, helping patients “sit with” exposure to fluctuations in levels, and develop adaptive responses. For patients with diabetes or hypoglycemia, increasing provider understanding of use and interpretation of these devices can support their overall treatment plan. Ultimately if we can increase support, provide cognitive, behavioral, mindfulness tools, we can improve the safe use of these devices to improve overall health. SUMMARY OF EVIDENCE: CGM has well described effects on glycemic control in individuals with diabetes. However, potential psychological effects may include increased anxiety, impaired sleep, and depressive symptoms. Fear of hypoglycemia may decrease, though satisfaction and quality of life (QoL) do not necessarily increase. In addition, while we understand the metrics for healthy individuals wearing CGM, there are no clinical practice guidelines for CGM use in healthy individuals. Clinical experience demonstrates individuals at risk may become distressed and obsessed with CGM monitoring. Some may adopt maladaptive behavioral changes that compromise health and safety. DESCRIPTION OF PRACTICE OR PROTOCOL: N/A. VALIDATION OF EVIDENCE: Evidence RELEVANCE OF PMH NURSING: N/A. FUTURE IMPLICATIONS: Critically, advanced practice registered nurses (APRNs) need to be aware of, assess for, and treat CGM-related effects and maladaptive use.
Poster #143: Beyond the Atypical: Antidepressants in the Management of Negative Symptoms of Schizophrenia
Ronald Shpata, MS, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Schizophrenia is a complex illness that causes significant distress. A current trend in the pharmacologic management of schizophrenia is managing both positive and negative symptoms with atypical antipsychotics. While the atypical antipsychotics often prove efficacious for both sets of symptoms, improvement may be incomplete or unsatisfactory, especially in the management of negative symptoms. SUMMARY OF EVIDENCE: There is evidence that some patients with schizophrenia continue to have distressing negative symptoms even with standard antipsychotic therapy. Although there is existing literature examining the use of antidepressants in the management of schizophrenia, some providers may be unfamiliar with this use. Increasing provider knowledge of available literature may cause practice changes resulting in improved patient outcomes. DESCRIPTION OF PRACTICE OR PROTOCOL: We seek to inform providers of the role of antidepressants, in combination with standard antipsychotic treatment, in managing negative symptoms of schizophrenia. Current practices may overlook the role of these drugs in managing often refractory symptoms. VALIDATION OF EVIDENCE: We will conduct a narrative literature review to ascertain and discuss the role of antidepressant therapy in treating negative symptoms of schizophrenia, in combination with standard antipsychotic therapy. RELEVANCE OF PMH NURSING: The poster presentation seeks to familiarize psychiatric mental health (PMH) providers with the role of antidepressants in managing negative symptoms of schizophrenia. Patients with schizophrenia commonly receive care from psychiatric mental health nurse practitioners (PMH NPs) and registered nurses (RNs). FUTURE IMPLICATIONS: Additional research should be conducted to validate the role of antidepressant treatment in managing the negative symptoms of schizophrenia.
Poster #144: Reduction of Readmission Rates After Pediatric Behavioral Health Admissions
Anna M. Simon, DNP, MBA, CPNP-PC, PMHS
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Insufficient focus has been directed toward enhancing the transition from hospital care to home environments for youth admitted with mental health disorders. SUMMARY OF EVIDENCE: Between 2006 and 2011, there was a sharp increase in pediatric inpatient admissions for mental health disorders in the United States. One-fifth of all pediatric admissions are attributed to mental health illness; mood disorders surpass asthma as the most common diagnosis for admission in children. Although pediatric hospitalization rates have decreased, mental health admissions have increased. Pediatric preventable readmission rates range from 3% to 23%. Evidence suggests that readmission rate is an effective quality measure. DESCRIPTION OF PRACTICE OR PROTOCOL: Chart reviews were conducted on patients discharged with a behavioral health diagnosis for 3 months before project implementation. A standardized phone script was used to complete phone calls 48 to 72 hours postdischarge and readmission rates for pre- and postintervention groups were compared. VALIDATION OF EVIDENCE: 69 participants were included. A chi-square resulted in 0.118, p> .05. 79.4% postdischarge calls were completed, with an average of 8 minutes for call completion. RELEVANCE OF PMH NURSING: Although the results did not achieve statistical significance, they remained pertinent for informing nursing practice. FUTURE IMPLICATIONS: Findings from this project support the utilization of postdischarge phone calls to patients and caregivers 48 to 72 hours after behavioral health discharge to review discharge instructions, medications, follow-up, and overall status to guide practice and help decrease the rate of 30- and 60-day readmission.
Poster #145: Treating Individuals With Racist Delusions: How to Support Staff When Words Hurt
Erika Springer, BSN, RN, PMH-BC; Timothy Meeks, MN, RN, PMH-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: An individual was admitted for inpatient behavioral health treatment for agitation and danger to others. The patient had delusions with racist content: She believed that her skin would burn if she were touched by a Black person. Initial efforts focused on limiting contact with Black staff members to avoid agitating the patient and upsetting employees. Staff members were unhappy with this decision as they felt this practice reinforced the patient’s delusion and provided secondary gains. SUMMARY OF EVIDENCE: Patients who have delusions based on race, gender, ethnicity, or religion in behavioral health are common. These patients deserve treatment even when their delusions are hurtful. In some cases, their treatment is court mandated. DESCRIPTION OF PRACTICE OR PROTOCOL: After meeting with the Director of Equity, Diversity, and Inclusion, the decision was made to empower staff to independently determine whether they wished to work with the patient. Furthermore, an examination of the medical system’s policy on allowing patients to choose caregivers based on race, gender, age, ethnicity, or religion revealed that this practice was prohibited. VALIDATION OF EVIDENCE: After empowering employees to make their own decision about working with the patient, staff members indicated that they felt supported and more prepared to interact with the individual. RELEVANCE OF PMH NURSING: In a short period of time, the patient stopped refusing to work with Black staff members and was able to discharge home. FUTURE IMPLICATIONS: Distinguishing patient preferences based on delusions versus preferences based on cultural factors or trauma is key. After this incident, leadership realigned how they manage staff assignments by considering multiple factors.
Poster #146: Connecting Patients to Life Through Improving Restorative Sleep and Satisfaction With Life, Using Evidence-Informed Relaxing Music
Star N. Tangyie-Che Niba, DNP, PMHNP; Kathleen T. McCoy, DNSc, PMHNP-BC, PMHCNS-BC, FNP-BC, FAANP
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Inpatient settings do not promote restorative sleep. This population has a high incidence of sleep-related disorders which if not managed adds to psychiatric distress and physiological imbalance. Hypnotics are not necessarily the best plan for every inpatient. A nonpharmacological approach using evidence-informed relaxing music prior to the hour of sleep was instrumental in assisting patients with improvements in restorative sleep and satisfaction with life at low cost. SUMMARY OF EVIDENCE: Inpatient settings prevent and/or interrupts sleep and sleep quality. About 50% to 80% of the inpatients do not achieve restorative sleep. Establishing an environment best supports attainment of restorative sleep, and enhances quality of life, promoting psychiatric recovery, and discharge. DESCRIPTION OF PRACTICE OR PROTOCOL: Current inpatient practices typically include intrusive noise ATC; including routine and spontaneous safety checks, use of HS psychotropics and unit interrupting ATC admissions. The adaption of evidence-informed relaxation music was individually implemented for willing patients. Stakeholders include patients, families, staff, administration, and third-party payers. VALIDATION OF EVIDENCE: Evidence-informed relaxing music assisted patients with needed higher quality sleep for recovery/discharge by incorporating this evidence-informed nonpharmacological approach helped patients achieve better restorative sleep, improved mood and satisfaction with life. RELEVANCE OF PMH NURSING: Integrating evidence-informed relaxing music into psychiatric mental health (PMH) nursing practice can enhance restorative sleep and satisfaction with life for the patients. The results of the project indicated that relaxing music therapy may lead to clinically important improvement in restorative sleep (60%), mood (50%), and satisfaction with life (50%) among adult inpatients. FUTURE IMPLICATIONS: Future nonpharmacologic nursing approaches may include evidence-informed relaxing music as a cost-effective approach to inpatient care.
Poster #147: Inpatient Benzodiazepine Detox: Evaluation of the CNSDP
Nicole E. Taylor, DNP, APRN, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: At an acute inpatient psychiatric hospital within a large academic medical center, dual diagnosis patients presenting with withdrawal from benzodiazepines (BZD) are prescribed a structured dosing of phenobarbital per the Central Nervous System Depressant Protocol (CNSDP), although there is variation in implementation of the protocol. Anecdotal evidence suggested that this may result in poor outcomes, creating concern that variance may impact quality of care. Hospital and unit leadership partnered with the School of Nursing for initial data analysis as a part of a DNP scholarly project. SUMMARY OF EVIDENCE: Literature specific to benzodiazepine detox is limited but suggests efficacy and safety of phenobarbital with some concerns for possible adverse events. The findings of this synthesis reinforce the need for additional focus on inpatient benzodiazepine detoxification as existing literature is likely not reflective or inclusive of the average patient body. DESCRIPTION OF PRACTICE OR PROTOCOL: Currently, there is no nationally accepted, standardized BZD detox protocol. By providing information on total dosage and adverse outcomes, this will not only inform practice within this academic medical center but also identify best practices for dissemination of findings in an area with scant literature available. VALIDATION OF EVIDENCE: A descriptive statistical analysis of a 6-month retrospective review of aggregate data was performed to identify trends between dosing and patient outcomes. Institutional review board (IRB) approval obtained from Vanderbilt University Medical Center RELEVANCE OF PMH NURSING: The data evaluated suggest that the current practice of CNSDP using phenobarbital on this unit does not result in adverse outcomes. FUTURE IMPLICATIONS: Additional studies are needed with larger sample size and evaluation of additional variables, particularly concurrent buprenorphine administration.
Poster #148: Improving Mental Health Literacy and Stigma Among the Hmong
Mayche Vang-Kue, DNP, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: One in five adults in the United States suffers from mental illness. Negative social influences in the Hmong community stigmatize those who have mental health challenges and mental health outcomes are impacted by poor mental health literacy. SUMMARY OF EVIDENCE: Health disparities across racial and ethnic groups continue to be a prominent issue and little is known about subgroups like the Hmong. Language barriers, conflicting traditional beliefs, and Western concepts of health contribute to low mental health literacy and willingness to seek professional mental health services among the Hmong. DESCRIPTION OF PRACTICE OR PROTOCOL: Mental Health First Aid (MHFA) was implemented to a group of 41 Hmong adult church leaders in local Detroit, Michigan. Four objectives were developed to measure the impact of MHFA regarding mental health literacy and stigma. The Plan-Do-Study-Act model guided this change process. Stakeholders were church pastors, board members, and church leaders. VALIDATION OF EVIDENCE: The Mental Health Literacy Scale (MHLS) and Community Attitudes Towards Mental Illness (CAMI) Scale were utilized to measure objective outcomes. A short Qualtrics survey given at 6-weeks postinterventions was used to measure longitudinal objectives. RELEVANCE OF PMH NURSING: The results showed 91.7% of participants had increased mental health literacy and 83.3% had decreased stigma immediately after training. Three out of four objectives were met. FUTURE IMPLICATIONS: MHFA continues to demonstrate successful implementation across many settings and populations. This project also highlights the needs for more culturally appropriate and tailored version of MHFA so that the tools and skills are more accessible. More research is needed to expand on mental health and the Hmong.
Poster #149: Evaluation of Altered Milieu Schedule on a Pediatric Inpatient Psychiatric Unit to Improve Care and Reduce Compassion Fatigue
Lara Walker, MS, RN, PMH-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: We aim to develop, implement, and evaluate a systematic change in the approach to the daily schedule for nursing staff on an Inpatient Pediatric Psychiatric Unit. The goal is to maintain a consistent group of staff including registered nurses (RNs), Psychiatric Technicians, and Mental Health Therapists (MHTs) and Psychologists to promote the building of rapport, patient goal setting, and follow through, along with decreasing burden on nursing staff by providing a dependable schedule. With the present practice of inconstant hourly assignments, patients often do not spend significant time with their nursing staff team and nurses have little time to properly assess the safety and progress of patients during their shift. SUMMARY OF EVIDENCE: With feedback from nursing staff and a need for staffing the unit in a safe and effective manner, the unit leadership team including the Nurse Manager, Assistant Nurse Managers, and Clinical Director developed a new daily schedule to be implemented in March 2024. DESCRIPTION OF PRACTICE OR PROTOCOL: Clinical practices differ depending on unit and milieu engagement. Outcomes to be determined after pilot. VALIDATION OF EVIDENCE: Feedback will be sought before, during, and after pilot program has been implemented to aide in possible changes to meet the needs of the unit. RELEVANCE OF PMH NURSING: By creating teams of RNs, Psychiatric Technicians, MHTs, and Psychologists for set groups of patients, a higher level of care can be provided and ideally reduce the stress that staff currently feel with the variable milieu schedule currently in place. FUTURE IMPLICATIONS: Modeling a successful daily nursing schedule could lead to possible changes on other units within our department and elsewhere.
Poster #150: Confidence in a Crisis: A Deliberate Approach to Emergency Medical Response Training on an Inpatient Psychiatric Unit
Amy Weaver, MHA, BSN,RN, CEN, PMH-BC; Natalie Ramirez, BSN, RN, PMH-BC; Tiara Stepp, BSN, RN, PMH-BC; Kateleen Collins, BSN, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Data have been reported that 24% to 80% of acutely ill psychiatric patients also have medical complexities. One study revealed 64 different cases of patients admitted to psychiatric units who had unrecognized medical emergencies, 43 of which resulted in death. Patients with mental illness are at an increased risk for medical comorbidities. The psychiatric nurse’s ability to recognize and respond to medical signs and symptoms for early intervention is just as vital as being able to respond appropriately during an active medical emergency. SUMMARY OF EVIDENCE: A simulation study was done to evaluate nurse and mental health tech competence during a medical emergency that required CPR. A mannequin that could collect data on CPR effectiveness was utilized during a simulation. Data were collected during the first simulation, feedback was provided during a debriefing and data was collected during the second simulation. Comparison of data was shared with the team noting gaps and opportunities for additional training. DESCRIPTION OF PRACTICE OR PROTOCOL: Data revealed the need for a standardized respond to medical emergencies to ensure all vital requirements for prompt patient care, code activation, crash cart and other emergency supply delivery, etc. were streamlined. VALIDATION OF EVIDENCE: Pre- and postsimulation data were measured and compared. Gaps in knowledge and skills were addressed to standardize medical emergency response. RELEVANCE OF PMH NURSING: For the past few years, there has been a steady increase in medical comorbidities in the psychiatric population. The likelihood of medical emergencies occurring is significant. Staff confidence during medical crisis can improve mortality and morbidity outcomes. FUTURE IMPLICATIONS: Need for integrated care and emergency response.
Poster #151: Screening and Management of Postpartum Depression and the Impact on the Breastfeeding Family
Elaine Webber, DNP, PPCNP-BC, IBCLC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Postpartum depression (PPD) is a condition with significant consequences for parents, infants, and families. Women with PPD are less likely to have a positive breastfeeding experience while successful breastfeeding is associated with decreased rates of PPD. SUMMARY OF EVIDENCE: Evidence suggests physical and psychological stressors increase inflammation which is considered a significant risk factor for depression. Mothers experience a multitude of stressors putting them at risk for PPD. Recognizing the correlation between breastfeeding challenges, increased stress, and PPD, it is important that mothers displaying signs of depression also be assessed for lactation difficulties. DESCRIPTION OF PRACTICE OR PROTOCOL: Medications are a common management strategy for PPD. The breastfeeding mother may be reluctant to consider medications due to concerns regarding the potential impact on the infant. Improved success with breastfeeding has been shown to decrease incidence of PPD and a plan of care is best achieved when health care providers (mental health [MH] professionals, pediatric providers, and lactation specialists) collaborate. VALIDATION OF EVIDENCE: Published reports of a multidisciplinary approach to early identification and management of breastfeeding challenges have been shown to decrease PPD with lower scores on depression screening tools. RELEVANCE OF PMH NURSING: MH providers play an integral role in identifying women with PPD who may also be experiencing breastfeeding difficulties. They are in a unique position to provide mental-health counseling, medication management, as well as refer women for lactation support, leading to improved health outcomes. FUTURE IMPLICATIONS: Postpartum depression occurs frequently, is often underreported, and has significant long-term negative consequences. Early detection can lead to improved management, promoting the health and well-being of women, infants, and families.
Poster #152: Effective Standardized Suicide Assessment and Intervention at a Mental Health Clinic for People Experiencing Homelessness
Margaret C. Wilk, DNP, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Suicide remains a major cause of death in the United States, and adults who are homeless are estimated to be 18 times more likely to attempt suicide in the past year than housed adults. Suicide, including attempts, costs the United States approximately US$70 billion annually. SUMMARY OF EVIDENCE: The Joint Commission and the Centers for Disease Control and Prevention (CDC) recommend a standardized suicide screening followed by a comprehensive risk assessment tool, and the Joint Commission emphasizes safety planning and lethal means counseling. A chart audit at a mental health clinic for individuals experiencing homelessness revealed that only 35% of charts had evidence of a comprehensive suicide assessment. DESCRIPTION OF PRACTICE OR PROTOCOL: A standardized, comprehensive suicide assessment and management tool was implemented over four, 2-week Plan-Do-Study-Act cycles in the outpatient therapy clinic. Stakeholders included the outpatient therapy team, clinic leadership, and the clients utilizing services. VALIDATION OF EVIDENCE: An effective care log was used to check for essential elements of suicide assessment and management in clinical documentation. Quantitative data were organized into run charts and analyzed for evidence of significant change. RELEVANCE OF PMH NURSING: The team assessed only 37% of unique clients seen, and the mean effective care log score was only 58%. However, 43% of assessed clients had an elevated risk for suicide. Overall, project goals were not achieved, and staff work distress appeared to increase. FUTURE IMPLICATIONS: Staffing dynamics and potential workflow issues likely affected project outcomes, indicating a need for a revised approach for assessing and managing suicide in the high-risk population at the clinic. However, the project tools appeared effective at identifying suicide risk.
Poster #153: Mental Health on the Mission Field: Effective Single Session Strategies
Donna Lee Williams, DNP, PMHNP-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Nurses are vital members of short-term medical mission (STMM) teams. Usually, the focus of STMM is primary, dental, and surgical care. STMM teams can also provide mental health care promotion. SUMMARY OF EVIDENCE: Mental health disorders are a major contributor to the global burden of disease. Approximately 12.6% of the world’s population experienced a mental health disorder in 2019, with depression being the most common. In Latin American countries, mental and substance use disorders resulted in over 120,000 (2%) deaths in 2019. DESCRIPTION OF PRACTICE OR PROTOCOL: As mental health care is typically absent from the expressed care offered during STMM, its inclusion has the potential to positively affect the mental well-being of citizens in countries with limited access to mental health resources. VALIDATION OF EVIDENCE: Almost 80% of clients who attend single session therapy (SST) claim they receive sufficient benefit from one session and decline offers to schedule additional sessions. RELEVANCE OF PMH NURSING: Recognizing that one session may be all that is available on STMM, psychiatric mental health nurse practitioners (PMHNPs) can use the SST framework to counsel/conduct therapy which maximizes the session’s efficacy. During SST, evidence-based resources, skills and strategies are reviewed and taught to clients/supports, for example, clergy, caregivers for immediate and sustainable positive outcomes. FUTURE IMPLICATIONS: Florence Nightingale, an early nurse missionary, tended to the wounds of British soldiers and then left behind needed supplies. Today’s nurses continue to lead STMM and leave resources behind. Using an SST framework, PMHNP team members can promote mental/emotional well-being by helping clients identify their resources, strengths, and skills; practice strategies to get unstuck; and engage in positive psychology interventions.
Poster #154: Improving Kept Appointment Rates in a Mental Health Center
Augusta Williams, MSN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Problem Statement: High rates of missed appointments (5%-30%) in outpatient mental health care compared with other specialties negatively impact patient outcomes, health care efficiency, and staff productivity. SUMMARY OF EVIDENCE: Evidence of Practice Gap: Despite evidence highlighting the repercussions of no-shows on patients and health care institutions and the efficacy of SMS and telephone reminders in enhancing appointment attendance rates, the project practice site lacks such measures to address forgetfulness and improve kept appointment rates. DESCRIPTION OF PRACTICE OR PROTOCOL: THEORETICAL FRAMEWORK: The Theory of Planned Behavior (TPB) will guide the project, aiming to understand and influence patient behavior toward keeping appointments. Lewin’s change model will support the implementation process by fostering collaboration and addressing potential resistance. Stakeholders include health care providers, administrative staff, and patients. Strategies for implementation included training staff on using the reminder systems, integrating reminders into existing appointment scheduling processes, and obtaining patient consent for receiving reminders. VALIDATION OF EVIDENCE: METHODS AND DESIGN: Retrospective chart reviews were conducted before and after 6 weeks of project implementation. Data on shows and no-shows were compared using the chi-square test to evaluate the impact of SMS and telephone reminders on appointment attendance rates. RELEVANCE OF PMH NURSING: Implications for Practice: The QI project outcome demonstrated a significant reduction in missed appointments following the implementation of SMS and telephone call reminders. FUTURE IMPLICATIONS: Implications for Future Research: Successful implementation could inform broader adoption of reminders in mental health care settings, potentially leading to improved patient outcomes and health care system efficiency.
Poster #155: Decreasing Patient Falls at the Virginia Treatment Center for Children (VTCC)
Caisha Williams, DNP, PMHNP-BC, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The Joint Commission requires hospitals to implement a fall risk assessment as a patient safety measure. The Virginia Treatment Center for Children (VTCC) utilizes the Humpty Dumpty Falls Scale (HDFS), a fall risk assessment validated for pediatric patients; however, this assessment is not validated for use in pediatric behavioral health and is ineffective in consistently identifying fall risks for patients at VTCC. SUMMARY OF EVIDENCE: VTCC has experienced an increase in inpatient falls and falls with injuries. In 2023, VTCC reported more than 59 patient fall occurrences. Postfall complications included head pain, leg pain, and a sprained ankle. DESCRIPTION OF PRACTICE OR PROTOCOL: Registered nurses (RNs) completed the HDFS and the BHFR-P twice daily to compare scores and assess the accuracy of identifying fall risks. Nurses provided recommendations on criteria that may be beneficial to add to the score categories, such as including additional psychiatric diagnoses (i.e., bipolar disorder and attention deficit/hyperactivity disorder) and allotting additional points for the use of multiple psychiatric medications. VALIDATION OF EVIDENCE: Before the implementation of the BHFR-P into nursing practice in 2023, there were no available evidence-based fall assessments validated in pediatric behavioral health. RELEVANCE OF PMH NURSING: The BHFR-P provides an opportunity to decrease fall rates in the pediatric behavioral health population. Since the implementation of the BHFR-P at VTCC in 2023, RNs have identified additional fall risk factors for consideration. FUTURE IMPLICATIONS: Collaboration with the authors of the BHFR-P will continue to fine-tune the sensitivity and specificity of the assessment through improved identification and stratification of fall risks in inpatient pediatric behavioral health.
Poster #156: Treatment Engagement in Tele-Psychiatry
Keith C. Williams, BSN, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: COVID-19 led to a rapid expansion of the use of tele-psychiatry. Additional research is now needed to determine the effectiveness of tele-psychiatry in relation to treatment engagement. The aim of this review is to explore the following: What is the effect of tele-psychiatry compared with in-person meetings on engagement in treatment within a 12-month period for individuals experiencing psychiatric disorders. SUMMARY OF EVIDENCE: The response to tele-psychiatry has demonstrated mixed results regarding engagement in treatment for both patients and providers. While there is evidence indicating improvement in patient engagement through telehealth, there remains a need to address whether such engagement can be sustained. Data interpretation was hindered by the rapid transition to tele-psychiatry occurring within the pandemic period. DESCRIPTION OF PRACTICE OR PROTOCOL: Tele-psychiatry continues to be utilized, but will require further examination to determine treatment engagement levels. The importance of continuing to identify and engage those who would benefit the most from tele-psychiatry is needed to improve outcomes. VALIDATION OF EVIDENCE: A literature review consisting of randomized controlled trial’s (RCT), systematic analyses, and meta-analyses was undertaken utilizing the databases PubMed, Cochrane Library, Embase, and the Miner Library (University of Rochester). RELEVANCE OF PMH NURSING: To encourage treatment engagement when delivering care via tele-psychiatry the psychiatric mental health nurse practitioner (PMHNP) must ensure a safe, supportive, trauma-informed, and culturally sensitive environment. The goal is for the PMHNP to identify and utilize appropriate interventions that foster treatment engagement. FUTURE IMPLICATIONS: Tele-psychiatry is continuing well past the COVID-19 pandemic. The PMHNP will need to continue to further improve upon the skills necessary to establish and engage participants in tele-psychiatry treatment.
Poster #157: From Overload to Optimal: A Structured Approach to Deprescribing Antipsychotics in Polypharmacy
Blaine Winters, DNP, ACNP-BC, PMHNP-BC; Stacie Woolley, SN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Previously considered a challenge predominantly affecting older adults, polypharmacy in psychiatry is now extending its reach to younger generations. The marked increase in mental health issues across all age groups has broadened the prevalence of polypharmacy, making it a concern for a more extensive segment of the population. The purpose of this presentation is to provide a structured guide that may be used to manage or prevent polypharmacy in patients with severe mental illness taking psychotropic medications. SUMMARY OF EVIDENCE: Besides antipsychotics and mood stabilizers, patients with severe mental illness often receive unnecessary medications like sleep aids and antidepressants. Rising antipsychotic prescriptions raise concerns about polypharmacy risks, including adverse reactions and hospitalizations, prompting the need for safer deprescription practices among health care providers. DESCRIPTION OF PRACTICE OR PROTOCOL: Many clinicians resort to an ad hoc approach rather than adhering to structured guides for deprescribing psychotropic medications, resulting in recurring cycles of trial and error for each specific patient. VALIDATION OF EVIDENCE: Structured approaches to deprescribing have been shown to help discontinue unnecessary or potentially harmful medications, thereby mitigating the risks associated with psychotropic medication polypharmacy. RELEVANCE OF PMH NURSING: Managing or preventing polypharmacy of psychotropic medications will lead to enhanced safety, increased focus on individual patient needs, improved medication adherence, and ultimately, improved psychiatric nursing and patient care. FUTURE IMPLICATIONS: Structured guides for deprescribing psychotropic medications are expected to improve overall patient care for those with severe mental illness in conjunction with polypharmacy.
Poster #158: Quiet Time: Will It Keep Down the Fights?
Kentoinette L. Wright, RN, BSN; Maribeth Desuyo, MHA, MSN, PMH-BC
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The opportunity to increase overall unit safety for staff and patients is the focus of this presentation. Patients present with aggressive escalating behaviors during shift change hours. SUMMARY OF EVIDENCE: Workplace violence has increased over the past year. Many hospitals have put policies and procedures in place to protect staff, patients, and visitors. Psychiatric emergency rooms and units are often the target of episodes of escalating physical and verbal aggression resulting in physical and emotional injuries. Quiet time is often underutilized as a de-escalation tool. DESCRIPTION OF PRACTICE OR PROTOCOL: The focus of this project is to determine if quiet time will decrease verbal and physical assaults to staff and patients in inpatient psychiatry by 5%. VALIDATION OF EVIDENCE: Data will be monitored on the number of aggressive events during shift change, and measure if quiet activities will decrease the amount of aggression noted. (1) Note techniques that deescalate harmful behaviors before any injuries occur. (2) Challenge staff to promote interventions increase de-escalation. (3) Compare before and after data to measure effectiveness. RELEVANCE OF PMH NURSING: Safety and prevention of trauma-related events are relevant to all psychiatric fields. FUTURE IMPLICATIONS: Promote safety in other areas of health care.
Poster #159: Improving Symptom Recognition and Treatment Initiation for Pediatric Obsessive Compulsive Disorder (OCD)
Allison Wurscher, BSN, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: Obsessive compulsive disorder (OCD) often begins in childhood and has high variations of symptomatology, resulting in late or misdiagnosis of up to 50%. This practice gap leads to delayed diagnosis and treatment. Screening for OCD is not routine in pediatric outpatient settings. SUMMARY OF EVIDENCE: Over 50% of individuals diagnosed with OCD experience symptoms in childhood, with upward of a 17-year treatment gap. Screening for pediatric OCD leads to timely diagnosis and treatment. The Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) is a reliable and validated screening tool that can be administered in outpatient settings. DESCRIPTION OF PRACTICE OR PROTOCOL: This practice change included implementation of a standardized process for screening pediatric OCD using the CY-BOCS for new intakes in an intensive outpatient mental health program. Positive screenings were referred to cognitive behavioral therapy (CBT), an evidence-based treatment for OCD. VALIDATION OF EVIDENCE: Administration of the CY-BOCS and subsequent CBT referrals were documented in patient charts. Retrospective chart reviews were conducted to assess completion. RELEVANCE OF PMH NURSING: 100% of new patients received the CY-BOCS prior to their appointment, with a 25% return rate. No CBT referrals were made. Patients who did not complete a CY-BOCS either had a parent state the screening did not apply to their child, or did not encourage their child to complete it. FUTURE IMPLICATIONS: Baseline CY-BOCS administration is recommended to improve timely diagnosis and treatment. Screenings may be more accurate if completed by a clinician rather than a family member due to potential child and family accommodation and parental bias.
Poster #160: Why Aren’t You in Class? Implementing Mental Health Screening for Students Who Present Frequently in the School Health Office
Erika Lynne Yoney, RN, LSN, PMHNP Doctoral Candidate
Category: Practice
ABSTRACT
PROBLEM STATEMENT: While we hear about a mounting mental health crisis facing students, mental health screening has been difficult for schools to implement. Through this project we provided mental health screening to student population that is self-identifying and missing academic time while examining barriers to implementing mental health screening. SUMMARY OF EVIDENCE: Universal mental health screening in schools has been a recommended evidence-based practice for over 20 years and yet only 12% of American schools have implemented it. There is a subset of students experiencing internalized symptoms that are often under identified until there is a substantial crisis. DESCRIPTION OF PRACTICE OR PROTOCOL: We developed a system to monitor frequent health office use, implement a health history review, process for parental consent, implementation of an evidence-based mental health screening tool and a process for referral when student scores demonstrated a need. We also incorporated ongoing interprofessional collaboration to partner with school support team and community agencies through Plan-Do-Study-Act (PDSA) cycles. VALIDATION OF EVIDENCE: Measured outcomes were parental consent, completion of screening and timely referrals. We also measured larger systems changes that were implemented as a result of barriers faced. RELEVANCE OF PMH NURSING: Families were receptive to screening but time and available staff presented an ongoing problem with completing screening and timely referrals. Using interprofessional PDSA helped solve these problems. Addressing systemic problems reduced time demands as well. FUTURE IMPLICATIONS: Nurses have an important place in education to provide comprehensive health assessments and interventions. Health office overuse is a unique identifier of student distress and should be utilized to implement appropriate support.
Poster #161: Implementation of CRAFFT+N and Evaluation of SBIRT and Brief Motivational Interviewing Counseling for Pediatric Patients in a Psychiatric Practice
Shawna Witt, BSN, RN
Category: Practice
ABSTRACT
PROBLEM STATEMENT: The intervention arose from deficiencies in screening for substance and nicotine use among adolescents in outpatient psychiatric settings, alongside poor documentation and billing practices. SUMMARY OF EVIDENCE: Evidence indicated low screening rates and inadequate documentation, highlighting gaps in practice regarding comprehensive screening and documentation for substance use. Challenges in virtual visits also underscored the need for protocol adaptation. DESCRIPTION OF PRACTICE OR PROTOCOL: The intervention implemented the CRAFFT+N screening tool and Brief Motivational Interviewing counseling. Preimplementation meetings and staff education ensured effective integration. Stakeholders included health care providers, managers, and administrative staff. VALIDATION OF EVIDENCE: Outcomes were assessed through retrospective chart reviews, analyzing documentation compliance and screening rates. Descriptive and comparative statistical analyses were conducted. Cost analysis evaluated billing practices. RELEVANCE OF PMH NURSING: The intervention significantly improved screening rates and documentation compliance. However, challenges persisted in virtual visits. The project highlighted the importance of systematic screening and documentation in addressing adolescent substance use, aligning with psychiatric mental health (PMH) nursing goals of holistic care and early intervention. FUTURE IMPLICATIONS: Future directions include ongoing staff education, protocol refinement for virtual visits, and continuous quality improvement efforts to sustain improvements in screening and documentation practices.
Poster #162: Social Media and Adolescents: A Case Control Study of Both Risk and Protective Factors
Jamie Zelazny, PhD, MPH, RN
Category: Research
ABSTRACT
PROBLEM STATEMENT: In 2021, suicide was the second leading cause of death in 10 to 24 year olds. We see trends of increasing numbers of young females dying by suicide. Social media use is nearly ubiquitous among American youth. Much alarm has been raised about the effects of social media use on the mental health of our youth. THEORETICAL FRAMEWORK: The interpersonal theory of suicide METHODS AND DESIGN: We report on a pilot study of 20 youth suicide attempters and 20 youth with no history of suicide attempt or serious mental illness. Youth underwent psychiatric diagnostic assessment and history of suicidal thoughts and behavior via clinical interview. They also completed a self-report battery about their subjective social media experiences. RESULTS: As many current research studies are reporting, the results are mixed. Youth suicide attempters were significantly more likely to experience problematic social media use, perceived sleep disturbance and negative upward social comparisons. However, there were no significant differences between attempters and controls in self-reported measures of support and belongingness obtained from social media. IMPLICATIONS (PRACTICE): While youth experiencing depression and suicidal ideation may experience negative effects of social media, they also derive a great deal of support from interactions on social media. It is important to thoroughly explore both the positive and negative effects of social media on youth mental health. IMPLICATIONS (RESEARCH): Additional research is needed to determine which youth are more vulnerable to the negative effects of social media.
Poster #163: The Reliability and Validity of the 10-Item ACEs Questionnaire for Screening Adverse Childhood Experiences Among Individuals Living With Mental Illness Who Use Tobacco: Connecting Research Evidence With Psychiatric Mental Health Nursing Practice
Bassema Abu-Farsakh, PHD, MSN, RN, NCTTP
Category: Research
ABSTRACT
PROBLEM STATEMENT: Approximately 40% of individuals diagnosed with mental illnesses (MI) experience Adverse Childhood Experiences (ACEs). The 10-item ACEs questionnaire is widely used to assess ACEs. However, the psychometric proprieties have not previously been examined among individuals with MI. This study aimed to examine the reliability and validity of the ACEs questionnaire among a community sample of individuals diagnosed with MI. THEORETICAL FRAMEWORK: This review was guided by the ACE pyramid and the eco-bio-developmental framework. METHODS AND DESIGN: People who stated having any MI, aged 18 years and above, used cigarettes, and comprehended English were eligible to complete an online survey. Reliability was tested by examining the Kuder-Richardson coefficient and item analysis. Validity was examined through exploratory factor analysis and hypothesis testing with depression and social support. RESULTS: Participants (N = 169) were mostly male, White Non-Hispanic, with a college degree, and employed. The reliability analysis yielded a Kuder–Richardson coefficient of .549, and item-total correlations between .033 and .377. The exploratory factor analysis yielded two factors and the hypothesis testing supported the construct validity of the questionnaire when correlated with depression and social support. IMPLICATIONS (PRACTICE): Psychiatric mental health nurses can use this instrument to assess for ACEs in clinical practice, however they cannot rely on it to discern specific adverse experiences that influence the overall ACEs index. IMPLICATIONS (RESEARCH): Future research should examine the reliability and validity of the 10-item ACEs questionnaire among individuals diagnosed with MI in different settings and with different reliability measures.
Poster #164: Self-Compassion in Action: Promoting Well-Being in Nursing Education
Jennifer M. Ahlquist, DNP, ANP-BC, FNP-BC; Andrea Kwasky, DNP, PMHNP-BC, PMHCNS-BC; Mary Serowoky, DNP, FNP-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Self-compassion interventions provide evidence for improving positive psychology and wellness for health care professionals. Nurse educators are charged with supporting student well-being and mental health with an emphasis on sustainable strategies that address increased levels of burnout currently facing the nursing workforce. This presentation will introduce the concept of self-compassion and its application as a tool to reduce burnout and improve well-being. An overview of results from a pilot study of a self-compassion program for prelicensure and graduate nursing students will provide participants with a framework to implement a self-compassion intervention in the university setting. THEORETICAL FRAMEWORK: The Self-Compassion Curricular Model and domain 10.1 of The AACN’s Essentials for Nursing Education inspired application of the self-compassion course. METHODS AND DESIGN: The evidence-based Self-Compassion for Healthcare Communities course was implemented in a synchronous online format for a sample of undergraduate and graduate nursing students. Measures of self-compassion, well-being, burnout, and program satisfaction were assessed. RESULTS: The pilot study provides preliminary evidence for the use of self-compassion programs with nursing students and supports the growing body of research related to self-compassion interventions. The benefit of implementing self-compassion training and feasibility findings from the pilot program will be shared. IMPLICATIONS (PRACTICE): The AACN has called academic nurse leaders to promote and contribute to an educational environment that enhances self-care behaviors and well-being. The pilot study supports a philosophy of well-being in health care communities. IMPLICATIONS (RESEARCH): Implications for program replication and sustainability in the university setting and other environments will be described.
Poster #165: The Association Between Trauma Exposure and Risky Alcohol Use Among Health care Providers: A Systematic Review
Jarrah Al-Kayed, RN
Category: Research
ABSTRACT
PROBLEM STATEMENT: Health care providers are more vulnerable to trauma and risky alcohol use compared with the general population. Moreover, given the significant association of risky alcohol use with health burdens (e.g., heart and liver diseases), productivity impairment, and financial costs, a lack of attention to the association can reduce the quality of treatment to patients and may lead to the collapse of the health care system. In view of this, our study will highlight the opportunity to address the association between trauma exposure and risky alcohol use among health care providers, potentially inspiring future research to decrease both trauma and risky alcohol use among those populations. THEORETICAL FRAMEWORK: The Lazarus Stress and Coping Theory proposes that psychological stress can impact a person ability to cope with adversity. This theory can guide and understanding of the relationship between trauma exposure and substance use behavior. METHODS AND DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement will guide our systematic review. We will search PubMed and PsycINFO databases. We only will include published studies in peer-reviewed journals to assess the association between trauma exposure and risky alcohol use among health care providers up to February 24, 2024, with no restrictions on the setting and method of studies. Nevertheless, we will exclude studies that are published in languages other than English. RESULTS: The results are in process. We expect that the results of our systematic review will provide evidence of the association between trauma exposure and risky alcohol use among health care providers. In addition, the prevalence of risky alcohol use and kind of trauma exposure will vary between health care providers. IMPLICATIONS (PRACTICE): There is an opportunity to enhance the awareness of health care providers, in particular psychiatric mental health nurses, for alcohol use related to trauma. Furthermore, health care organizations can provide support and referral to treatment for health care providers affected by trauma and substance use. IMPLICATIONS (RESEARCH): Researchers can conduct studies in the future that may help health care providers cope with common trauma exposure and risky alcohol use.
Poster #166: The Effect of Kentucky’s Tele-Mental Health Expansion on Medicaid Providers’ Delivery of and Satisfaction With Tele-Mental Health
Zainab Almogheer, MSN, BSN, RN
Category: Research
ABSTRACT
PROBLEM STATEMENT: Kentucky’s proactive initiative in 2018 to authorize telehealth use was designed to ensure continuous health care access.1 The expansion of telehealth services among Medicaid providers holds particular significance in mental and behavioral health care. However, it is imperative to scrutinize the utilization of and satisfaction with tele-mental health services by Medicaid providers, contributing to the well-being of individuals living with mental and behavioral health problems. THEORETICAL FRAMEWORK: The Theory of Planned Behavior (TPB) 2 posits that intentions toward a behavior are influenced by attitudes, subjective norms, and perceived behavioral control. Measures to evaluate telehealth usage among providers were developed based on the principles outlined in the TPB. METHODS AND DESIGN: This cross-sectional study will employ an online survey to anonymously assess providers’ utilization of and satisfaction with tele-mental health across five Community Mental Health Centers (CMHCs) in Kentucky. The surveys are the Telehealth Usability Questionnaire 3 and a questionnaire based on the TPB. Data analysis will involve t-tests, analyses of variance (ANOVAs), or linear regression analyses as appropriate. RESULTS: We anticipate that the expansion of tele-mental health has enhanced providers’ delivery of care with high telehealth platform satisfaction. IMPLICATIONS (PRACTICE): The study’s findings might indicate that tele-mental health options can support the provision of mental and behavioral health care services for Medicaid beneficiaries, and subsequently enhance beneficiary adherence to treatment and health outcomes. IMPLICATIONS (RESEARCH): Future studies should explore interventions to enhance tele-mental health use, address access barriers, and enhance health care utilization for Medicaid beneficiaries.
Poster #167: Adaptation Experiences of Black Female Service Members Returning Home From Iraq and Afghanistan
April Cecelia Ames-Chase, PhD, RN, PMH-BC, CARN, CNL
Category: Research
ABSTRACT
PROBLEM STATEMENT: Opportunity for improvement: It is important to ask Black females if they served in the military and how they are doing, especially after returning home from a wartime campaign. THEORETICAL FRAMEWORK: Roy’s Adaptation Model Concepts: Interdependence, Coping, Role Function, Adaptation Superwoman Schema METHODS AND DESIGN: A set of qualitative questionnaires was developed incorporating Roy’s concepts to collect the data. Collaizi’s seven-step approach was used for data analysis. Ten female veterans (former active duty service members in the U.S. Army and Air Force) were interviewed for data collection. RESULTS: Ineffective coping has led to posttraumatic stress in a population of Post-9/11 military service members. Black females often use spirituality as a means of coping with stress. Spirituality practices provide a sense of connection for Black women. Key findings suggest that Black female veterans in this study overwhelmingly identify as strong. The historical nature of their culture and identifying with their mothers and grandmothers often leads to this Strong Woman Phenomenon. This strong identity allows them to handle difficulties or multiple traumatic events, such as the chaotic circumstances surrounding military deployments. A few of the participants deployed twice to Iraq and Afghanistan. Although both deployments were located in the Middle Eastern Region, the participants experienced different environmental factors at each separate location. IMPLICATIONS (PRACTICE): This study is needed to help transform the care rendered to military servicewomen. IMPLICATIONS (RESEARCH): This research has implications for positive social change for Black female service members being seen in the VA and the community. More studies need to be conducted with underrepresented female veterans
Poster #168: The Medication Access and Training Expansion (MATE) Act of 2023 Removed the X-Waiver to Buprenorphine Prescribing, but Barriers Remain. What Will Be the X-factors to Facilitating Buprenorphine Prescribing?
Joann Bartlett, MS, RN, PMHNP-BC; Ann M. Quinn, RN, MSN, FNP-C
Category: Research
ABSTRACT
PROBLEM STATEMENT: Opioid overdose deaths remain high with predicted 232 daily overdose deaths in the United States over a 12-month period ending September 2023. Treating substance use disorder (SUD) costs billions annually. Treatment of opioid use disorder (OUD) with buprenorphine increases abstinence and decreases risk of opioid overdose. Over 1 million in the United States lack access to this effective evidence-based treatment. The MATE Act of 2023 increased buprenorphine potential use by removing the X-waiver requirement for DEA prescribers. However, Medicaid deregulation of buprenorphine prescribing in 2021 surprisingly did not increase prescriptions. THEORETICAL FRAMEWORK: The biopsychosocial theoretical framework provides a holistic reference toward substance use disorder treatment and addressing individual, structural and systemic stigma. METHODS AND DESIGN: PubMed and EMBASE databases were searched. Six studies were included in exploring the facilitators and barriers to prescribing buprenorphine. RESULTS: Review of research highlighted the importance of mentorship, educational support and addressing stigma, in removing barriers to prescribing buprenorphine for OUD. IMPLICATIONS (PRACTICE): Psychiatric Mental Health nursing practice warns about opioid risk and supports harm reduction. This includes addressing the SUD stigma and barriers to effective treatment. IMPLICATIONS (RESEARCH): Further study of peer mentorship programs in buprenorphine prescribing and reducing stigma is needed.
Poster #169: Psychiatric Mental Health Nurse Practitioner Perceptions of How Providing Patient Care During the COVID-19 Pandemic Affected Their Own Mental Health
Linda Cabage, PMHNP-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Psychiatric mental health nurse practitioner (PMHNP) mental health during COVID-19 pandemic THEORETICAL FRAMEWORK: The interpretive description (ID) method of qualitative research was used to investigate the phenomenon of interest. ID is philosophically aligned with the interpretivist orientation, which is underpinned by the naturalistic paradigm. The naturalistic paradigm is grounded in social science research and supports the study of phenomena in their natural context METHODS AND DESIGN: ID was used to explore the personal experiences of PMHNPs who provided patient care during the COVID-19 pandemic. Thorne created the ID method of qualitative research to generate knowledge from within the clinical context of nursing and other applied sciences. RESULTS: Exploring extant literature revealed limited data regarding PMHNPs. Findings revealed PMHNPs’ thoughts, emotions, and coping methods and suggest future focus on their well-being would support mental health maintenance and burnout prevention. IMPLICATIONS (PRACTICE): Lack of literature on PMHNPs indicated a knowledge gap in the body of nursing literature. This study’s findings offer insight into the mental status of nurse practitioners during a pandemic and lay a foundation for future research. IMPLICATIONS (RESEARCH): To date, no studies focused on the mental health of PMHNPs have been identified. This research aimed to shed light on their well-being in the context of a pandemic and to understand the meanings of their stories. Nursing science would benefit from future studies focused on building the body of knowledge for PMHNPs, including a focus on theoretical assumptions of PMHNPs during a pandemic such as their foundational beliefs guiding clinical practice.
Poster #170: Self-Administered Screening Tool Compared With Structured Clinical Interview: Implications for Practice
Krystyna de Jacq, PhD, PMHNP-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Recent studies demonstrate that nurses are at an exponentially higher risk for suboptimal psychological health including depression compared with other clinicians and the general public. It is essential that screenings provide valid and reliable measurement of depression risk. Yet it is unclear if a self-administered measure is reliable as compared with a structured clinical interview with a professional. The purpose of this study was to correlate a self-administered screening tool with a clinician-guided interview to provide. THEORETICAL FRAMEWORK: N/A. METHODS AND DESIGN: We recruited 25 registered nurses to participate in this two-phase validation study. Participants completed the Beck Depression Inventory II (BDI_II) online (Qualtrics). Next, participants completed a Structured Clinical Interview for DSM-5 disorders (SCID-V) with a board certified psychiatric -mental health nurse practitioner. BDI-II is a 21-item test to screen the severity of depression. BDI-II scores were dichotomized as positive or negative for data analysis. We used descriptive statistics and Pearson correlations to analyze associations between measures. RESULTS: All 25 participants completed the BDI-II questionnaire and 24 completed SCID-5 interview. BDI-II identified 11 respondents (44%) as screening positive for depression while SCID-5 interview identified 11 respondents (45.8%) as having a depressive disorder. BDI-II misidentified three respondents (12%) as screening negative for depression, while during SCID-5 interview these respondents were diagnosed with a depressive disorder. IMPLICATIONS (PRACTICE): BDI-II is a good tool to screen patients for depression. Practitioners may use the BDI-II as an objective measure to monitor changes over time. IMPLICATIONS (RESEARCH): More research is needed to understand potential response bias when using self-administered measures in mental health research.
Poster #171: Exploring the Psychosocial Distress of Families of Children and Youth With Special Health care Needs
Giovanna C. De Oliveira, PhD, MSN, ANP-C, PMHNP-BC, RN; Angel J. Solorzano Martinez, PhD, DNP, MSN, MBA, CNS, PMHNP-BC; Regine Placide Reaves, PhD, MPH, MSN
Category: Research
ABSTRACT
PROBLEM STATEMENT: Parents and caregivers of Children and Youth with Special Health Care Needs (CYSHCN) experience significant psychosocial distress. This study seeks to gain further insight into parents’ and caregivers’ perspectives on the psychosocial impacts of caring for CYSHCN to identify gaps in health care systems and strengthen systems of support. THEORETICAL FRAMEWORK: The Socioecological Model of Public Health. METHODS AND DESIGN: A qualitative descriptive design to describe the lived experience of parents and caregivers caring for CYSHCN. Convenience and purposive sampling were used. Colaizzi’s method of analysis was used to analyze the data. The sample included 16 caregivers of CYSHCN. RESULTS: Six themes emerged from this study: (1) Stigma and Isolation, (2) Religion as a Coping Mechanism, (3) Financial Challenges, (4) Bearing the Burden, (5) Familial Denial, and (6) System-Related Concerns. Psychosocial distress was experienced in the form of anxiety and depression, which affected both the child and family. IMPLICATIONS (PRACTICE): Community health, mental health, and nurse care coordinators can collaborate to better serve parents and caregivers by providing education about the process of requesting services, completing applications, and accessing insurance benefits for health care services needed for their child. Support groups can help families share their experiences, enhance their coping skills, reduce stigma, and feel connected with others undergoing similar circumstances. IMPLICATIONS (RESEARCH): Further qualitative and quantitative studies would have us a better understanding of the phenomenon and would strengthen its importance. Studies should include screening parents of CYSHCN for depression and anxiety, to objectify their psychosocial distress.
Poster #172: A Correlation Study Between Hospital Nurses Daily Spiritual Experiences and Degrees of Burnout
Linda Denke, PhD, RN, CCRC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Our organization provides an optional multidisciplinary group peer support program known as Navigating Our Multifaceted Acute Distress (NOMAD), a session with a trained professional to work through and debrief a crisis, traumatic event or situation. As sessions rise, a group of nurse researchers conducted a study between nurses’ depression and anxiety, and found scores increased between baseline and 9 months during the pandemic, increasing nurses burnout. Many nurses reported an increase in alcohol and food consumption, which are precursors to burnout. The study findings and the review of the literature evidence support there is an association between burnout and mental wellness & faith. THEORETICAL FRAMEWORK: The theoretical framework is burnout concepts of depersonalization, emotional exhaustion and personal accomplishment can be mitigated if organizational spiritual climate is fostered by leaders and spiritual care and support ministry. Spiritual climate is defined as the processes in which an organization fosters spirituality. METHODS AND DESIGN: Correlational design statistics of the survey results from 409 nurses scores from Burnout Inventory and the Daily Spiritual Experience Scale. RESULTS: The findings revealed there is a strong negative correlation or individuals reporting higher levels of these spiritual experiences tend to experience lower levels of burnout, and a range of spiritual experiences are associated with a reduction in feelings of burnout. IMPLICATIONS (PRACTICE): Inpatient psychiatric nurses require nourishment in spirituality to sustain purpose and value at work. IMPLICATIONS (RESEARCH): Test a spirituality intervention program for spiritual self-care.
Poster #173: Preteen Suicidal Thoughts and Behavior: A Scoping Review of the Literature
Hannah Marie Flanagan, BSN Student
Category: Research
ABSTRACT
PROBLEM STATEMENT: There is an increasing rise in rates of preteen suicide. This issue poses a pressing need for support and resources. THEORETICAL FRAMEWORK: The Transactional Theory of Development recognized biological, psychological and social factors within the framework of suicidal ideation and behavior. METHODS AND DESIGN: The search engine PubMed was used to obtain my articles. Three searches were made for my scoping review: “preteen suicidality,,” “preteen suicide,,” and “preteen suicide attempts..” Eligibility was determined by the inclusion of participants between the ages of 10 to 12, along with publication within the last 5 years and findings related to suicidality within this population. Seven of the articles found were deemed eligible. RESULTS: Through evaluation of the eligible articles, it is apparent that preteen psychiatric needs are higher than ever. Along with this need, it is an underresearched, underresourced, and overall disadvantaged area of care. IMPLICATIONS (PRACTICE): As a health care system dedicated to providing necessary care, it is crucial that we listen to this increasing need from the preteen population. We can elevate our care by providing more frequent screening across all practice settings and allocating more resources toward this growing issue. IMPLICATIONS (RESEARCH): As for future research, the next step is better understanding the associated risk factors with preteen suicidality. The review found that there is a relationship with suicidality and a gender identity that is noncisgender, being female, preteen attention deficit/hyperactivity disorder (ADHD), and/or a presence of diagnoses of anxiety and depression. With an expansion upon these preliminary findings, an increased ability to assist this age group with prevention, control and support will be obtained.
Poster #174: Assessing Prevalence of Loneliness in Patients With Substance Use Disorders
Kate Gates, MSN, APN/CNP
Category: Research
ABSTRACT
PROBLEM STATEMENT: Loneliness is a significant public health problem associated with poor physical and mental health outcomes. In 2023, the U.S. Surgeon General issued an advisory that outlined the harms of loneliness and social isolation on individual and societal health. There is limited research of loneliness among adults with substance use disorders (SUDs). This study aims to identify current prevalence and potential mental health implications associated with loneliness in patients with SUD at a Community Health Center located in Colorado. THEORETICAL FRAMEWORK: The guiding theoretical framework for this project is the Loneliness Model which suggests that loneliness is a self-reinforcing loop that activates neurobiological and behavioral mechanisms that contribute to adverse health outcomes. METHODS AND DESIGN: A cross-sectional correlational study design will be used to determine prevalence of loneliness and mental health symptoms. Data will be collected from eligible patients with SUD seen in the clinic over a 3-month period from March to May 2024 using validated screening measures to evaluate loneliness (UCLA-3), depression (PHQ-9), and anxiety (GAD-7). RESULTS: It is hypothesized that loneliness will be associated with increased depression and anxiety symptoms among study participants. IMPLICATIONS (PRACTICE): The knowledge to be gained involves further understanding the impact of loneliness on mental health in patients with SUD. Psychiatric mental health nurses can play an important role in addressing this public health problem, including leading interventions to decrease loneliness and improve mental health. IMPLICATIONS (RESEARCH): Implications for future research and potential interventions to improve outcomes for patients amid this newly deemed public health emergency of loneliness will be discussed.
Poster #175: Melatonin Utilization and Prescribing Practice Patterns Among Pediatric Health care Providers
Marissa Gray, DNP, PMHNP-BC, IMH-E, E-RYT/YACEP; Tracee Ridley-Pryor, DNP, PMHNP
Category: Research
ABSTRACT
PROBLEM STATEMENT: The Melatonin QI Project was developed to gather current melatonin prescribing and recommendation trends in the pediatric community. The data analysis represents current knowledge and confidence in melatonin treatment utilization. The interdisciplinary pediatric community’s participation in this survey aids in the development of continuing education training and future research opportunities for integrated pediatric care. THEORETICAL FRAMEWORK: Increasing rates of pediatric sleep-related disorders and comorbid symptomology has been named the “Sleeping Giant of Pediatric Public Health” warranting further investigation into current sleep assessment and treatment methods. Where possible, assessment and support of sleep hygiene, and when necessary, treating with nonaddictive sleep aids should be explored with safety and consistency in care. METHODS AND DESIGN: 18 question survey targeting the current level of confidence of melatonin and use in medical practice to determine if there is a consensus on the use of melatonin as a safe, effective treatment for sleep-related symptomology. RESULTS: The data collected from the survey informing the research determines if there is a current medical consensus surrounding melatonin treatment as well as an opportunity to increase awareness and education around the complexity of sleep-related symptomology in pediatric patients. IMPLICATIONS (PRACTICE): Learning the current prescribing and recommendation practices in an interdisciplinary research approach will highlight current prescribing/recommendation trends, continuing educational opportunities, and evidence-based treatment for the pediatric population. IMPLICATIONS (RESEARCH): Continuing education in sleep symptomology assessment, correlation to psychological and behavioral concerns, and effective medication management are implications for future research.
Poster #176: Correlates of Food Insecurity in Outpatients With Schizophrenia and Related Disorders (SRDs)
Christian Ketel, DNP, RN-BC, FNAP
Category: Research
ABSTRACT
PROBLEM STATEMENT: Food insecurity affects 800+ million people globally. Health consequences include metabolic syndrome, heart disease, and diabetes. THEORETICAL FRAMEWORK: We examined correlates of food insecurity in SRD outpatients from the Southeastern United States. METHODS AND DESIGN: 64 outpatients with SRDs completed demographics and surveys of food security, social support, self-efficacy, anxiety, and depression. RESULTS: Participants were mostly white (n = 40, 62.5%), males (n = 43, 67.2%) with schizoaffective disorder (n = 36, 56.3%). Most were single (n = 49, 76.6%), unemployed (n = 53, 82.8%) and disabled (n = 49, 76.6%). Most reported low or very low food security (n = 38, 59.4%). Almost 30% of food insecure persons did not receive food stamp assistance (n = 11, 28.9%). Greater than expected number of persons with low and very low food insecurity were overweight (body mass index [BMI] 25–29.9; χ2 = 12.6, df 6, p = .047). Greater than expected numbers of persons with low and very low food security were smokers (χ2 = 9.9, df 2, p = .004). A significantly higher proportion of disabled persons reported low food security compared with nondisabled persons (χ2 = 6.8, df 2, p = .03). No significant associations were observed between food insecurity, employment status (yes/no), self-efficacy, social support, depression, or anxiety. IMPLICATIONS (PRACTICE): Our findings confirm data from the general population, in which food insecurity is associated with disability, obesity, and smoking. IMPLICATIONS (RESEARCH): We call for colleagues to extend this work using larger more diverse samples with the ultimate goal of designing evidence-based interventions to support food security in this vulnerable group.
Poster #177: Compassionate Leadership in Nursing: The Relationship between Nurse Managers’ Compassionate Leadership Behaviors and Clinical Nurses’ Job Satisfaction and Turnover Intentions: A Review of the Literature
Kenneth Kilemi, MSN, MBA, RN, CMSRN, CENP, NEA-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Opportunity for nursing leadership improvement to optimize clinical nurses’ job satisfaction and reduce turnover. THEORETICAL FRAMEWORK: The ABC Framework Model will be used to guide the conceptual orientation of the proposed research study. METHODS AND DESIGN: The literature search strategy utilized electronic databases, including the Cumulative Index to Nursing, and Allied Health Literature (CINAHL), MEDLINE, PubMed, Web of Science, and The Cochrane Library. Gray literature was searched, including journals of corporate leadership, business schools’ publications on leadership, and Harvard Business Review. The search was restricted to articles published in English between 2018 and 2023. However, due to the scarcity of research on several concepts of interest, the timeframe was broadened to include research studies from 2015 to 2023. RESULTS: The studies reviewed showed that compassionate leadership is an important concept in nursing, as it promotes empathy, understanding, and caring toward patients, colleagues, and the health care system. However, scant literature connects compassionate nursing care and compassionate nursing leadership. Furthermore, no research study exists that aims to solely describe and derive an understanding of the relationship between nurse managers’ compassionate leadership behaviors and clinical nurses’ job satisfaction and nurse turnover intention. IMPLICATIONS (PRACTICE): Nursing leadership challenges are the same across all practice settings. IMPLICATIONS (RESEARCH): This literature review suggests and supports the need to investigate the relationship between nurse managers’ compassionate leadership behaviors and clinical nurses’ job satisfaction and turnover intention. As nurse burnout and turnover remain challenging for health care institutions, future research must focus on finding a lasting solution to this issue.
Poster #178: Start Using Cognitive Restructuring in Your Clinical Practice Today
Chelsea Landolin, MS, RN, PMHNP-BC, ANP-C
Category: Research
ABSTRACT
PROBLEM STATEMENT: Cognitive behavioral therapy (CBT) is considered the gold standard of psychotherapeutic treatment of a wide array of psychiatric illnesses, such depression, anxiety disorders, and insomnia, supported by extensive research on its efficacy as a short-term treatment modality. The straightforward approach used in CBT is adaptable and empowering to patients. However, due to limited access to psychotherapists able to provide high-quality CBT, few patients are able to benefit from it. To combat this problem, nurse therapists can learn core techniques of CBT, such as cognitive restructuring, and offer it regularly to patients. THEORETICAL FRAMEWORK: Aaron Beck’s cognitive model is the chief framework used in this workshop. METHODS AND DESIGN: This workshop is adapted, with permission, from the Beck Institute’s CBT training on cognitive restructuring. RESULTS: Extensive research supports the efficacy of cognitive behavior therapy for reduction in symptoms and improvement in functioning in a variety of psychiatric disorders. IMPLICATIONS (PRACTICE): This workshop teaches a core technique of CBT, cognitive restructuring, to nurse therapists in order to expand access to CBT, particularly to those unable to pay out of pocket for therapy. IMPLICATIONS (RESEARCH): Research on the impact of teaching nurse therapists to perform cognitive restructuring is warranted.
Poster #179: Fly Fishing as an Integrative Approach to Decrease Symptoms of PTSD in Veterans
Nancyruth Leibold, EdD, RN, MSN, PHN, CNE, AHN-BC; Mary Bemker, PhD, PsyS, RN, LPCC, CNE, CCFP
Category: Research
ABSTRACT
PROBLEM STATEMENT: Posttraumatic stress disorder (PTSD) occurs in individuals impacted by a traumatic event. In 2023, the U.S. Department of Veteran Affairs reported that 14% of recent combat military veterans experience PTSD. Integrative therapies for PTSD are worthy of research to study effectiveness. THEORETICAL FRAMEWORK: Leisure-coping and nature-based recreation conceptual frameworks guided this research study. METHODS AND DESIGN: The study used a mixed methods systematic review design following PRISMA and Cochrane guidelines to explore the effectiveness of fly fishing as an integrative health intervention for U.S. military veterans to decrease the symptoms of PTSD. A search of 10 major databases from 2005 to 2023 for studies related to fly fishing as a treatment for PTSD in combat veterans found 167 articles, but six relevant articles remained after four phases of rigorous screening. RESULTS: Quantitative findings demonstrated significant reductions in PTSD symptoms (re-experiencing, hyperarousal, avoidance, and perceptual stress). Participants reported improvements in functional impairment, sleep quality, self-assuredness, joy, and decreased levels of depression, anxiety, guilt, hostility, fear, and sadness. Qualitative findings highlighted additional benefits such as camaraderie, relaxation, peacefulness, reduced worry, and improved coping. IMPLICATIONS (PRACTICE): The project informs nurses of the early findings that support the integration of fly fishing into the therapeutic milieu when treating veterans with PTSD. IMPLICATIONS (RESEARCH): Future research is needed to examine the effects of fly fishing as an intervention. Robust study designs to explore the therapeutic intervention of fly fishing in greater depth are warranted in the future.
Poster #180: The Effect of Baduanjin on the Insomnia of Older Adults: A Systematic Review and Meta-analysis
Qingfang Liang, MSN, RN; Chizimuzo T. C. Okoli, PhD, MPH, APRN, PMHNP-BC, FAAN
Category: Research
ABSTRACT
PROBLEM STATEMENT: Insomnia is extremely common among older adults and has a serious negative impact on their physical and mental health, social activities, and quality of life. However, commonly used treatment modalities, such as cognitive behavioral therapy for insomnia (CBT-I) are inaccessible for most older adults with insomnia and their caregivers. Baduanjin is a safe, simple, and effective complementary method to alleviate insomnia. However, there is a lack of relevant systematic evaluations. THEORETICAL FRAMEWORK: Traditional Chinese medicine’s theory of “body-spirit co-maintenance” can guide psychosomatic regulation. Baduanjin is one of the representative methods of physical and mental regulation. METHODS AND DESIGN: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Four Chinese and four English databases were searched respectively. Methodological quality was guided by the Cochrane Handbook for Evaluation of Intervention Systems 5.1.0. RESULTS: Participants (N = 789) of 10 studies were included. The meta-analysis showed that Baduanjin was effective for older adults with insomnia as measured by the Pittsburgh Sleep Quality Index (PSQI) [WMD = −2.20, 95%confidence interval (CI) (−2.87, −1.74), p = .000], and 12 weeks or more of treatment effect was superior to less than 12 weeks. Moreover, there were significant differences in all dimensions of the PSQI between experimental and control groups. However, the overall methodological quality was moderate. IMPLICATIONS (PRACTICE): Using Baduanjin as a complementary therapy option for older adults with insomnia is important for psychiatric mental health nursing practice. IMPLICATIONS (RESEARCH): Future research may focus on methodological quality of studies and optimal Baduanjin intensity, duration, and frequency for different populations.
Poster #181: Is an Open or an Enclosed Nursing Station Better, and For Who?
Sydney Lauren Long, BSN, RN; Mona M. Shattell, PhD, RN, FAAN
Category: Research
ABSTRACT
PROBLEM STATEMENT: Gaps in research are the therapeutic benefit of enclosed versus open nursing stations. THEORETICAL FRAMEWORK: Concepts of human geography, space and place, work environment, nurse–patient engagement, and safety will be discussed. METHODS AND DESIGN: This systematic literature review synthesized the state of the science on architectural best practices to enhance the therapeutic milieu. Studies of nursing station designs on adult inpatient psychiatric units were the target for this review. Peer-reviewed journal articles published between 2016 and 2024, and written in the English language and sourced from PubMed, ScienceDirect, Cumulative Index to Nursing, and Allied Health Literature (CINAHL), and ProQuest were reviewed. Qualitative and quantitative studies in this review consisted of data collected from nurses and nursing staff, and clients. RESULTS: Preliminary results suggest that hospitalized clients have a strong preference for open nursing stations; nurses and nursing staff have a slight preference for open nursing stations. Nursing stations with a physical plexiglass barrier were reported to feel less inviting and stigmatizing by clients. Interestingly, this literature review revealed a decrease in nurse and client safety in units with enclosed nursing stations. Nurses and nursing staff who are averse to open nursing stations express anxiety about their safety and a lack of client-free space. IMPLICATIONS (PRACTICE): This research may explain client perception of a nontherapeutic environment and a sterile feeling milieu, lack of positive interaction with nursing staff, and client’s inability to have needs attended to promptly. IMPLICATIONS (RESEARCH): Further research is needed to identify a standard of practice for future creation of therapeutic unit infrastructure for architectural best practices for a safe and therapeutic milieu.
Poster #182: Triangulation of Qualitative and Quantitative Data to Understand Early Signs and Symptoms of Relapse in Opioid Use Disorder
Esther Moon, PhD, MSN, RN
Category: Research
ABSTRACT
PROBLEM STATEMENT: The treatment of opioid use disorder (OUD) frequently encounters relapses, underscoring the importance of understanding and managing early signs and symptoms (ESS) of relapse. This mixed methods pilot study aimed to comprehensively explore the ESS of relapse among adults with OUD. In this presentation, we explore exemplary methodological triangulation, integrating qualitative and quantitative data analyses. THEORETICAL FRAMEWORK: The cognitive behavioral model of relapse guided the study. METHODS AND DESIGN: Employing a prospective observational design, convenience sampling was used to recruit adults receiving medications for OUD from outpatient settings. Over 8 weeks, participants completed focus group interviews, questionnaires, and wore a wearable device to measure the ESS of relapse (cravings, self-efficacy, emotional distress, coping, and heart rate variability). Descriptive and thematic analyses were conducted, integrating quantitative and qualitative approaches through methodological triangulation. RESULTS: Twenty-three adults participated in seven focus group interviews and baseline data collection. The mean age of the participants was 40.1 ± 11.2 years, with 60.8% being female and 86.9% identifying as white. Significant decreases in self-efficacy and coping, as well as increased depression, were observed (ps < .05), alongside negative correlations between heart rate variability, craving, and emotional distress (ps < .05). Qualitative findings identified four emerging themes: (1) relapse as a cognitive behavioral control process, (2) risk factors, (3) protective factors, and (4) challenges. The qualitative findings confirmed, expanded, and clarified the quantitative findings. IMPLICATIONS (PRACTICE): The triangulation of findings deepen understanding of relapse, highlighting detailed insight into patient experience. IMPLICATIONS (RESEARCH): Future studies explore diverse recovery perspectives and develop strategies to enhance interventions to effectively minimize the ESS of relapse.
Poster #183: Examining Differences in Antipsychotic Treatment Adherence by Schizophrenia Spectrum Disorder Diagnosis (Schizophrenia vs. Schizoaffective Disorder)
Chizimuzo T. C. Okoli, PhD, MPH, APRN, PMHNP-BC, NCTTP, FAAN; Shane W. Landis, BSN Student
Category: Research
ABSTRACT
PROBLEM STATEMENT: People with schizophrenia spectrum disorder are more likely to be nonadherent to medication regimen. This increases the risk of hospitalization and poor mental health recovery. However, long acting injectable antipsychotic medications can improve medication adherence. Few studies have examined the difference in long acting antipsychotic medications when comparing people with schizophrenia versus schizoaffective. THEORETICAL FRAMEWORK: Agency Theory proposes that individuals rely on other parties to make health care purchasing decisions for them. This theory may describe the use of LAIs by Medicaid beneficiaries. METHODS AND DESIGN: A cross-sectional analysis of Kentucky Medicaid Dataset was analyzed to assess the outcomes of treatment adherence. Chi-square analyses were used to examine the differences in adherence of LAIs versus Orals by schizophrenia or schizoaffective disorder diagnosis. RESULTS: Data were obtained from people with schizophrenia who are Medicaid beneficiaries (N = 999), mostly male (52.3%) with a mean age of 43 (SD = 14.0). Only 11.8% of the sample used LAI treatment. Compared with those with schizoaffective disorder, those with schizophrenia had higher adherence rate to LAI treatment (18.5% vs. 13.5%), but these differences were not statistically significant. IMPLICATIONS (PRACTICE): LAIs are underutilized, though they are equally as effective as Orals in treatment adherence for both those with schizophrenia and schizoaffective disorder. IMPLICATIONS (RESEARCH): Future research may examine patient and provider perceptions of LAI use among those with schizophrenia and schizoaffective disorder
Poster #184: Recovery Challenges Survey: Development and Validation of an Evaluation Tool for Implementation of the Recovery-Oriented Care Model in Clinical Practice
Janet M. B. Passley-Clarke, PhD, DNP, MS, RN, PMHNP-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Recovery-oriented care was stated to be the “gold standard” of mental health care over a decade ago. Since that time, there have been no evidence-based assessment tools of the challenges of fully implementing recovery-oriented care in the clinical setting. To conduct such assessments effectively, researchers need objective professional tools that address the barriers of implementation among health care professionals. THEORETICAL FRAMEWORK: The development of this presentation is based on Peplau’s Theory of Interpersonal Relations and Graham’s Knowledge to Action. METHODS AND DESIGN: The study was divided into stages: (1) initial questionnaire content proposal, (2) expert validation, (3) sampling of participants, and (4) item and exploratory factor analysis. RESULTS: Exploratory factor analysis analyzed four factors, namely, (1) Policy and Empowerment, (2) Educational Deficits, (3) Formalized Educational, and (4) Recovery Language. These four factors explained, respectively, 37.9%, 11.2%, 8.4%, and 12.1% of the total variance. The four explained 69.5% of the total variance together. The overall questionnaire reliability was .90. All correlation coefficients displayed moderate positive relationships among the subscales. IMPLICATIONS (PRACTICE): The assessment tool developed in this study showed reliability and validity in identifying the challenges of implementing recovery-oriented care in the clinical setting. IMPLICATIONS (RESEARCH): The study developed a scale to measure the challenges of implementing the recovery model in the clinical setting and to measure its psychometric properties. Further studies are needed to estimate the reliability and validity of the RCS for larger more diverse samples across provider types in health care/academic setting.
Poster #185: Relationships Between Family Functioning, Mental Health, and School Engagement in Latino Immigrant Youth
Barbara Peterson, PhD, PMHCNS, APRN, FNAP
Category: Research
ABSTRACT
PROBLEM STATEMENT: Latino immigrant families face multifaceted stressors, high rates of anxiety and depression when adapting to the host country. b do Many barriers limit access to mental health treatment; Latino immigrant adolescents are at increased risk of mental health disorders and academic difficulties. Family support and school connectedness may serve as protective factors. This study examined relationships of family functioning with mental health and school engagement among Latino immigrant youth. Cultural humility education is often insufficient in nursing school; these findings support the need for deeper knowledge. THEORETICAL FRAMEWORK: The McMaster Model of Family Functioning encompasses the six elements of the theory to assess interactions between family members which may correlate with student-teacher relationship, academic performance, mood, anxiety. METHODS AND DESIGN: This study involved a secondary analysis of survey data from Project PECAY (Promoting Effective Coping Among Youth), a cross-sectional examination of a sample of 306 Latino youth. Pearson correlation of variables and sample description are reported. RESULTS: Higher family function scores were associated with a lower likelihood of depression and anxiety. Student–teacher relationships demonstrated a positive correlation with family function. There was no clear correlation between family functioning and academic performance. IMPLICATIONS (PRACTICE): Knowledge of cultural nuances within Latino immigrant families is crucial for psychiatric nurses. Increased awareness can minimize bias, promote culturally sensitive care and support mental health in this population. IMPLICATIONS (RESEARCH): Longitudinal studies to analyze changes over time can offer additional insights into the developmental changes within a family and school context. Our results demonstrate other potential confounding variables. Interventional research can identify innovative supportive treatments.
Poster #186: Connecting for Collaboration: Networking for Scholarship
Kathryn Phillips, PhD, APRN; Kosuke Niitsu, PhD, ARNP, PMHNP-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Nurses in all settings (administration, practice, education) want to conduct research, but may not know how to get started. Even nurses who work in a research capacity frequently need support in developing their ideas. THEORETICAL FRAMEWORK: The theory of interdependence indicates there are costs and benefits to being in a relationship. The outcome of the relationship, or transformation that happens with the people coming together, may be equally beneficial to both or more beneficial to one or the other in the relationship. Finally, there is the option of maximum outcome where both parties cooperate for the best outcome for both. The idea in this workshop is to discuss ways to obtain low cost, high benefit relationships that reach maximum benefit for both parties. METHODS AND DESIGN: The literature was searched for the benefits of networking at nursing conferences. RESULTS: The literature indicates nurses’ careers can benefit significantly from networking at conferences. IMPLICATIONS (PRACTICE): Networking can provide a way to enhance your professional network while catapulting your research forward. IMPLICATIONS (RESEARCH): Future studies can assess the best practices in networking for nursing scholarship.
Poster #187: Identifying Areas Impacting Burnout and Work Satisfaction in Residential Mental Health Direct Care Employees to Improve Patient Care Outcomes
Amanda J. Richardson, DNP, APRN, CNP, PMHNP-BC, RN
Category: Research
ABSTRACT
PROBLEM STATEMENT: Feelings of burnout are on the rise as direct care workers are continually expected to “do more with less.” Before we can address the issues impacting burnout levels, satisfaction levels, and dissatisfaction levels, we must understand them from the viewpoint of the direct care mental health care staff and their perceived levels of burnout. By identifying where direct care staff are experiencing burnout and issues with workplace satisfaction, interventions can be devised and implemented to elevate burnout and increase work satisfaction. THEORETICAL FRAMEWORK: Herzberg’s Two-Factor Theory was used to attempt to describe, explain, and predict the factors that influence job satisfaction. METHODS AND DESIGN: A convergent mixed method design was implemented on direct care workers and administrators who worked in a youth residential mental health facility in the Midwest region of the United States. Data were measured using the Maslach Burnout Inventory—Human Services Survey, the Areas of WorkLife Survey, and through conducting two semi-structured focus groups. RESULTS: Direct care workers experience moderate levels of burnout and work satisfaction that requires leadership to take initiative to meet the direct care workers’ unmet needs. These needs involve communication, work life balance, support from supervisors, and a reduction of workplace violence. IMPLICATIONS (PRACTICE): If issues with direct care staff burnout and turnover can be rectified it reduces the strain on nurses in these settings, decreasing their burnout and improving work life balance. IMPLICATIONS (RESEARCH): Based on the findings of this study, interventions could be designed and tested to see how they improve the areas of burnout identified in this project.
Poster #188: Moral Distress in Psychiatric Nurses: A Scoping Review
Julia A. Smith, EdM, RN, PMHNP-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Moral distress is a significant concern, resulting in detrimental effects to nurses, patients, and organizations. Increasing demands on an already overloaded mental health system are imminent, underscoring the need to support the psychiatric workforce. While much is known about moral distress in other nursing specialties, comparatively less is known about psychiatric nurses. Therefore, the purpose of this scoping literature review was to describe experiences of moral distress in psychiatric nurses. THEORETICAL FRAMEWORK: The Bioecological Model and Moral Distress Theory were used to guide this review. METHODS AND DESIGN: A scoping review was conducted by using search terms in the databases CINAHL and PubMed. No limitations were set for publication date or study type. Studies examining dimensions of moral distress in psychiatric nurses were included for review. Ultimately, 18 sources were included and reviewed. RESULTS: Moral distress in psychiatric nurses is influenced by factors at multiple levels, including individual, organizational, and social/political. These nurses face ethical dilemmas unique to psychiatric care, and they experience moral distress related to stigma surrounding mental health. Resultant symptoms adversely affect nurses and patients. IMPLICATIONS (PRACTICE): While overlap exists with moral distress described in other nursing specialties, the experiences of psychiatric nurses appear to possess distinct characteristics; it is critical to support nurses experiencing moral distress, decrease detrimental effects on well-being, and reduce burnout. IMPLICATIONS (RESEARCH): These findings contribute to additional research aimed at understanding moral distress in psychiatric nurses, addressing underlying problems and supporting nurses. Given unique characteristics of the psychiatric care environment, it is imperative to consider perspectives of psychiatric nurses in subsequent research.
Poster #189: The Effect of a Community Resiliency Model (CRM) Workshop on Resilience, Psychological Empowerment, and Well-Being on Behavioral Health Nurses
Lorrie Smith-Esterle, BSN (DNP Student)
Category: Research
ABSTRACT
PROBLEM STATEMENT: An improvement in resilience is needed to achieve optimal psychological empowerment and well-being. Better patient care, improved productivity, reduced adverse events, burnout, turnover rates, and health care costs can result from optimizing well-being. THEORETICAL FRAMEWORK: Bandura’s Social Cognitive Theory METHODS AND DESIGN: The study design for this DNP project was a quasi-experimental one-group pretest/posttest design. Behavioral health nurses from Eastern State Hospital (ESH), Good Samaritan Hospital (GSH), and Kentucky Children’s Hospital (KCH) were invited to participate in the 6-week project. This intervention had three components: (1) a pretest survey sent to participants by email with a link to the prerecorded educational and training module, (2) a 20-minute Community Resiliency Model (CRM) training video including instructions for iChill application use, and (3) a posttest survey sent to participants by email during the last week of the project. Pretest and posttest surveys using the Spreitzer Psychological Empowerment Scale, CD-RISC-10, and WHO-5 results were used to assess changes after the intervention. RESULTS: The CRM Workshop Survey indicates that behavioral health nurses found CRM skills helpful in coping with stress. Nurses also found CRM skills valuable enough to share with others. Well-being scores increased in the independent and paired t-test samples postintervention. IMPLICATIONS (PRACTICE): Learning CRM skills helped nurses cope with stress and improved overall well-being. IMPLICATIONS (RESEARCH): Future research utilizing a video format may benefit from periodic in-person meetings by the primary investigator to prevent ambiguity about the project origin and purpose. Larger sample and longitudinal studies are warranted for future research.
Poster #190: Causes of Alcohol Use Among Latino Farmworkers: A Literature Review
Angel Solorzano Martinez, PhD, DNP, MSN, MBA, RN, CNS, PMHNP-BC; Giovanna De Oliveira, PhD, MSN, APRN, PMHNP-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Alcohol use research conducted with Latino Farmworkers is limited. This poster will highlight major causes that exacerbate the consumption of alcohol among Latino Farmworkers. This information can help bridge the gap about causes of alcohol use in this vulnerable population. It will help inform, both, registered nurses (RNs) and psychiatric mental health nurse practitioners (PMHNPs) with knowledge they can use to better care for this population. THEORETICAL FRAMEWORK: Ray’s Transcultural Caring Dynamics in Nursing and Health Care Theory guided the review of the evidence. METHODS AND DESIGN: CINAHL, PubMed, and PsycINFO were the databases for the review PRISMA MMAT tool to screen articles. RESULTS: Alcohol use among Latino Farmworkers is multifactorial such as: Personal Preferences Co-Morbidities Cultural Influences Environmental Influences. IMPLICATIONS (PRACTICE): This literature review will highlight key findings about the use of alcohol in this population. These findings can inform current nurses and PMHNPs about the various influences that exacerbate alcohol use in this population. Recommendations for nursing education, practice, and research will be provided. IMPLICATIONS (RESEARCH): More research is needed in this population. Nurse researchers should conduct research studies to identify other causes that may exacerbate the use of alcohol in this population.
Poster #191: Concept Analysis of Early Adolescent Social Media Users’ Body Image
Allison Walsh, BSN, RN
Category: Research
ABSTRACT
PROBLEM STATEMENT: Early adolescents, ages 11 to 13, are vulnerable to depressive symptoms due to physical and psychosocial factors associated with their developmental stage (e.g., bodily change, peer scrutiny, altered self-image) and social media use. To advance research and treatment guidelines concerning early adolescent mental health, this presentation aims to clarify the concept of early adolescent social media users’ body image. THEORETICAL FRAMEWORK: Thompson’s Tripartite Influence Model which depicts the linkage between media, body dissatisfaction, and poor mental health was used to guide this analysis. METHODS AND DESIGN: Rodgers’ evolutionary method of concept analysis was used to clarify the concept and its defining attributes, antecedents, and consequences. RESULTS: The defining attributes of early adolescent social media users’ body image are body perception, internalization of sociocultural ideals, appearance comparison, and curation of a dynamic self-view. The antecedents are individual characteristics, interpersonal communication, sociocultural messaging, and media use. The consequences include significant impacts on adolescents’ health consisting of a preoccupation with appearance, body-changing behaviors, affective turmoil, and poor mental health. IMPLICATIONS (PRACTICE): Psychiatric nurses must understand the factors surrounding early adolescent social media users’ body image, assess their patients for these factors, and provide evidence-based intervention if problems are identified. This knowledge is particularly relevant to psychiatric mental health nurses in the child and adolescent setting. IMPLICATIONS (RESEARCH): This concept analysis provides a specific definition to help in standardizing early adolescent body image research, possibly resulting in an increased ability to operationalize early adolescent body image, clarify measurement tools, and compare study results meaningfully.
Poster #192: Race as a Predictor for Substance Use Disorders (SUD) “Relapse Potential” in the Rural South of the United States
Serge Wandji, PhD, MSN, MBA, RN-BC, NEA-BC, CNL
Category: Research
ABSTRACT
PROBLEM STATEMENT: There is critical need for research in order to advance our understanding our understanding of factors associated with SUD among rural African American (AA) men in the South. The Concept of Perceived Need for Substance Use Disorder (SUD) Treatment has been directly linked to Positive Treatment Outcomes, due to Increased Treatment Acceptance (TA) and Decreased Relapse Potential (RP). THEORETICAL FRAMEWORK: This research study was guided by the Andersen’s Behavioral Model of Health Services which looks at the “WHY” and “HOW” individuals use health services. METHODS AND DESIGN: A quantitative cross-sectional study using a descriptive predictive correlational design. Data on the variables were collected at admission using the ASAM Criteria software (American Society of Addiction Medicine). RESULTS: The multivariate analysis with ALL participants found that Race was statistically significant by Relapse Potential (p-value < .04). We found that AA were 2 times more likely to relapse compared with Whites. Analyzing only AA men we found that AA men who were concerned about their support system and living conditions were almost 6 (1/.17) times more likely to relapse compared with AA men with good supporting system. IMPLICATIONS (PRACTICE): This study findings indicates that closing the disparity gaps in the areas of their “Living conditions /Support System” factors along with addressing Mental health issues, will greatly improve rural AA men’s SUD recovery experience. IMPLICATIONS (RESEARCH): This study has the potential of informing the design of a contextual and culturally responsive nurse-driven intervention model of SUD care among rural AAs in the South, which would increase capacity building through strategic partnerships.
Poster #193: How One Study Resulted in a Comprehensive Psych-Medical Training Program and Integrated Nursing Care at an Academic Medical Research Hospital
Amy L. Weaver, MHA, BSN, RN, CEN, PMH-BC; Mable Koshy, BSN, RN, PMH-BC; Natalie Ramirez, BSN, RN; Emily Smith, MSN, RN; Kateleen Collins, BSN, RN; Tiara Stepp, BSN, RN, PMH-BC; Sarah Sperberg, BSN, RN, PMH-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: In the United States, 51.5 million people have a mental illness. People with psychiatric illness are at an increased risk for medical comorbidities and a higher mortality rate that decreases length of life by 10 to 15 years when compared with the general population. Although acute psychiatric treatment is sought among this population, diagnosis and treatment of their accompanying medical conditions tend to go untreated. It is expected that in 6 years, depression will become the primary burden of disease worldwide. SUMMARY OF EVIDENCE: In order to meet the growing medical complexities of psychiatric patients, a training program that integrates medical care is needed. The APNA has released a position paper on the importance of being able to address the deficiency in “knowledge, skills, and resources” to equip mental health providers with the competencies needed to feel confident in their ability to provide integrated care that meets the mental health, physical, social, and cultural needs of the psychiatric patient population. DESCRIPTION OF PRACTICE OR PROTOCOL: N/A. VALIDATION OF EVIDENCE: N/A. RELEVANCE OF PMH NURSING: N/A. FUTURE IMPLICATIONS: N/A.
Poster #194: Psychiatric Mental Health Registered Nurses’ Perceptions of Justified Coercion: Instrument Validation and Psychometric Properties
Zane Robinson Wolf, PhD, RN, CNE, ANEF, FAAN; Beth M. King, PhD, APRN, PMHNP-BC; Maureen Donohue-Smith, PhD, PMHNP-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Many health care providers use coercive interventions to accomplish care outcomes intended to benefit the well-being of patients with psychiatric disorders, yet no instrument exists that measures registered nurses’ perceptions of coercive or forceful actions when they give direct care to patients receiving acute care services. THEORETICAL FRAMEWORK: Nursing as Caring Theory framed this study. Nursing situations are complex and troubling, because patient autonomy is often breached when providers take charge of difficult situations and use coercive actions. METHODS AND DESIGN: Instrument Development Design: Content analysis methods generated draft items and determined face validity; focus group (N = 5) feedback and experts’ judgments (N = 7) established content validity. A purposeful sample of psychiatric nurses (N = 12) with acute, psychiatric experience completed the revised 23-item instrument in a pilot study. The revised 23-item instrument was administered to psychiatric nurses (N = 213/249), using vignettes to evaluate extent or forcefulness of coercion on a scale of 1 to 5, with 1 = not coercive at all to 5 = very coercive. RESULTS: Exploratory factor analysis revealed a four-factor solution. The preliminary domains include trauma-informed, soft/subtle, hard/explicit, and coercive threat. IMPLICATIONS (PRACTICE): Caring actions before, during, and after coercive interventions for patients and providers may mitigate some of the negative effects of coercive actions. IMPLICATIONS (RESEARCH): Further testing of instrument to establish reliability with other populations/settings.
Poster #195: Eastern State Hospital: Celebrating 200 Years of Connecting to Ourselves, Those We Serve, and Each Other Through Psychiatric Nursing Excellence in Kentucky
Marc A. Woods, DNP, RN, NEA-BC; Chizimuzo T.C. Okoli, PhD, MPH, APRN, PMHNP-BC, FAAN; Tanna McKinney, DNP, RN, PMH-BC, NEA-BC
Category: Research
ABSTRACT
PROBLEM STATEMENT: Psychiatric mental health nursing (PMHN) practice and roles has evolved over time, and U.S. public psychiatric hospitals are integral to this evolutionary process. A historical review of PMHN practice over time is crucial to learn from past challenges and successes, while pointing toward the future. As the second oldest psychiatric hospital in the United States, Eastern State Hospital (ESH) presents an important case study to view PMHN practice evolution. THEORETICAL FRAMEWORK: Transformational Theory of organizations guided the methods of this study. METHODS AND DESIGN: Historical case study is a form of diachronic analysis used to address questions related to change, continuity, development, and evolution. Historical data analysis with narrative data, graphical arts, and historical documents was used to examine the case of PMHN practice at ESH. Content analysis of these data sources informed context, meaning, and patterns in the case. RESULTS: Overtime, ESH has transformed from a hospital that mainly focused on practice, to incorporate administrative enhancements, educational innovations, and research/scholarly outputs. Themes related to PMHN practice and roles at ESH include leadership structure (with nursing as a core), academic-practice partnerships to enhance staff education and careers, interdisciplinary focused research aimed at enhancing evidence-based practice, and recognition as the first behavioral health hospital with magnet status for excellence in patient care IMPLICATIONS (PRACTICE): Understanding the evolution of PMHN through the ESH case study can support innovative practice models and professional identity IMPLICATIONS (RESEARCH): Future historical research methods may be used to demonstrate the advances in PMHN practice administration, education, and scholarship
Poster #196: Acquiring Resourcefulness Skills: Formal Versus Informal Training
Jaclene A. Zauszniewski, PhD, RN-BC, FAAN
Category: Research
ABSTRACT
PROBLEM STATEMENT: Although resourcefulness has been taught successfully during formal training programs, it can also be acquired informally through life experiences. Family caregivers may learn to be resourceful on their own and those who participate in research may acquire knowledge or skills that increase their resourcefulness. The effects of such differential experiences on resourcefulness have not been examined over time. This study compared changes in resourcefulness over time in caregivers who received no intervention, an educational program, biofeedback, and Resourcefulness Training. THEORETICAL FRAMEWORK: Zauszniewski’s middle-range theory of resourcefulness specifies contextual factors and process regulators (perceptions, emotions, and cognitions) promote resourcefulness. METHODS AND DESIGN: This longitudinal analysis of data from a randomized controlled trial involved 219 caregivers of persons with bipolar disorder who completed the Resourcefulness Scale prior to receiving no intervention, an educational program, biofeedback, or resourcefulness training and after 6 and 12 months. Differences and patterns across groups were examined using a four-group-by-three-datapoint repeated measures analysis of variance (RMANOVA). RESULTS: Overall caregivers increased linearly in resourcefulness over time, F(1, 215) = 4.836, p = .015. Although each group did show some improvement in resourcefulness, caregivers who received Resourcefulness Training showed the greatest improvement in resourcefulness from baseline (Estimated M = 88.244) to both 6-months (Estimated M = 92.610, p = .026) and 12-months postintervention (Estimated M = 95.049, p = .003). IMPLICATIONS (PRACTICE): Although all four caregiver groups improved in resourcefulness over time, those who received Resourcefulness Training demonstrated resourcefulness sooner and to a greater extent, thereby providing rationale for formal Resourcefulness Training programs. IMPLICATIONS (RESEARCH): Future mixed methods research should investigate factors associated with the informal acquisition of resourcefulness skills in larger, more diverse samples of caregivers.
