Evaluating De-Escalation Training for Direct and Indirect Employees Caring for Residents With Huntington's Disease.

INTRODUCTION: Little is known about reducing the challenges for caregivers and patients with Huntington's disease (HD). HD creates behavioral disturbances, cognitive decline, and motor disorder progression over the lifetime requiring some individuals to need long-term facility care. AIMS: There are concerns about safety and confidence of employees caring for residents with HD. METHODS: Nursing staff, administrators, and auxiliary employees were recruited from a long-term care (LTC) facility in rural Iowa, from July 2020 to August 2020. A de-escalation training intervention was delivered. The 1-day intervention included resident behaviors, planning and safety, teamwork, communication, and included role play and simulation. A pre- and post-survey measured confidence and competence in caring for people with HD before and after a training intervention. A resident medical record audit explored challenging behaviors before and after the training intervention. RESULTS: Of 25 participants, six were registered nurses/licensed practical nurses (RNs/LPNs; 24%), four administrators (16%), eight nursing assistants (32%), and seven auxiliary employees (28%). There was improvement in employees perceived safety (33.3%), co-workers enjoyment working with HD residents (54%), understanding symptoms of HD (44.4%), confidence in job abilities (21.0%), and confidence in ability to care for patients with HD (26.3%). A medical record audit showed decreased documentation of resident aggression and care refusal post-intervention. CONCLUSIONS: These findings suggest de-escalation training in LTC facilities increased perception of job safety, co-workers' enjoyment, understanding HD symptoms, confidence in ability to care for patients with HD, and decreased resident agitation and care refusal.

Pharmacological Treatment for Pediatric Anxiety Disorders.

Pediatric anxiety disorders (PADs) occur in up to 20% of youth and can cause impairment across the lifespan. Coronavirus disease 2019 (COVID-19) added unique pressures on those with PADs, as children and adolescents endured the longest pandemic restrictions, stymieing their ability to develop socially, emotionally, and cognitively. Although first-line treatment for PADs is psychotherapy, those with severe anxiety symptoms will require pharmacological interventions. Selective serotonin reuptake inhibitor and serotonin norepinephrine reuptake inhibitor (SNRI) medications are effective in treating PADs, yet only duloxetine (a SNRI) is approved by the U.S. Food and Drug Administration for children aged >7 years with generalized anxiety disorder. Treatment of children and adolescents with benzodiazepines for PADs presents unique challenges with potential paradoxical reactions. Caution must be observed as well due to risk for misuse related to long-term use of benzodiazepines with PADs. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 6-9.].

How PMHNP Program Directors Facilitate Psychotherapeutic Skill Acquisition.

BACKGROUND: The use of psychotherapy has a long history within psychiatric-mental health nurse practitioner (PMHNP) practice. Underutilization of psychotherapy in practice has potentially led to a reduced emphasis in the PMHNP curriculum. To date, no national survey has solely evaluated how PMHNP programs ensure psychotherapy skill acquisition. AIMS: Survey the PMHNP programs within the United States on how psychotherapy skill acquisition is achieved, including (a) psychotherapeutic curricular content; (b) psychotherapy related clinical practicum hours, including simulation and preceptor-delivered hours; and (c) student interest in psychotherapy skills. METHOD: Three rounds of e-mail invitations were sent to all PMHNP programs within the United States. Descriptive statistics and reflective thematic analysis were used to examine survey content. RESULTS: There were 39 (27%) respondents, representing the U.S. regions equally. The most common forms of psychotherapy taught were cognitive-behavioral and motivational interviewing. The content was most often delivered through a hybrid program (65.8%). Psychotherapy clinical hours most often used in psychology and social work were varied (0-720, SD 132.9) and were usually (63.89%) separate from other clinical hours. Qualitative responses focused on increased emphasis on the use of psychotherapy within PMHNP programs and the need to develop competency checklists for psychotherapy skill acquisition to use with simulation. CONCLUSION: This survey reported on both similarities and differences in how PMHNP programs ensure student competency in the skill acquisition of psychotherapy. While this article focuses on what skills are needed in psychotherapy education, direction on how programs deliver this content to their students to ensure this skill will be retained in practice is a critical next step.

Where is the psychotherapy content in PMHNP programs?

PURPOSE: Psychotherapy is the essence of the Psychiatric-Mental Health Nurse Practitioner (PMHNP) role. Yet much debate exists within programs as to the best way to include psychotherapy in an already loaded curriculum. CONCLUSION: Two large midwestern universities review their approaches to psychotherapy education; student evaluations measure the quality and effectiveness. Data revealed a high level of student satisfaction. PRACTICE IMPLICATIONS: Programs will vary on how to teach psychotherapy skills, but the use of psychotherapy within the PMHNP role is crucial and informs the entire practice. Examples of how others teach psychotherapy can inform educators of innovative ways to prepare PMHNP students to practice psychotherapy.

ADHD: From childhood to young adulthood.

Attention-deficit hyperactivity disorder (ADHD) affects approximately 11% of children between the ages of 4 and 17 years. This article discusses performing a comprehensive assessment for ADHD, the use of validated tools to make an accurate diagnosis, physical exam findings that may be suggestive of certain conditions, and ADHD treatment options.

Decreasing Rates of Pediatric Bipolar Within an Outpatient Practice.

PROBLEM: Pediatric bipolar disorder (PBD) prevalence is estimated to be 1-3%. Nationally and internationally, rates of PBD have increased by over 400%. However, in Iowa and at one psychiatric clinic in Iowa, from 2008-2013, there was a decrease in PBD diagnosis of 33 and 51.2% respectively. This study examined the diagnosing practices of PBD by local providers in one outpatient mental health center. METHOD: Parents completed a screening packet to differentiate between PBD and attention deficit hyperactivity disorder (ADHD) using three tools: Child Mania Rating Scale (CMRS), Child Behavior Checklist-Mania Scale (CBCL-MS), and the NICHQ Vanderbilt. Symptom agreement analysis between the screeners and the provider's clinical diagnoses was performed using ANOVA and Tukey HSD posthoc analysis. FINDINGS: A 19.6% of the participants were positive for PBD on the CMRS and 55.9% were positive on the CBCL-MS.  A total of 36.60% were positive for ADHD on the Vanderbilt.  The screening data compared to the provider's clinical diagnosis showed no diagnostic agreement for PBD (p < .05). Providers' rates of diagnosing PBD did not match the rate of PBD symptoms identified by the screeners. CONCLUSION: Further evidence to determine the criteria and use of current screening measures for PBD is needed to guide practice for distinguishing PBD from related disorders.