Factors influencing length of hospital stay among veterans admitted to an inpatient psychiatric unit.

It is well established that Veterans are at increased risk for mental health problems and associated hospitalization. While hospitalization is appropriate for acute stabilization, prolonged stays can contribute to reduced quality of life, increased healthcare expenditures, and trauma exposure with associated trauma-related symptoms. To reduce inpatient psychiatric length of stay and to improve patient outcomes, it is imperative that risk factors for prolonged length of stay are elucidated. The purpose of this retrospective chart review was to examine demographic and clinical characteristics and their association with inpatient psychiatric length of stay in a sample of Veterans. Demographic information collected included age and race. Clinical characteristics collected included primary admitting psychiatric diagnosis, number of psychiatric emergencies during hospitalization, utilization of restraint or seclusion, observation status, 30-day readmission status, adherence to psychiatric follow-up appointments post-discharge, and presence of suicidality. A total of 820 Veterans were included in the analysis. Age, primary psychiatric diagnosis, occurrence of a psychiatric emergency, and observation status were significant predictors of length of stay (F = 24.39, p < .001). There were significant differences in the average length of stay between Veterans with substance use disorders and those with psychotic disorders (B = 0.576, p < .001). Likewise, Veterans with neurocognitive disorders also had longer lengths of stay than those without neurocognitive disorders, respectively (B = 0.014, p < .001). In summary, quality of mental health care can be improved by reducing length of stay, but additional understanding related to risk factors is first needed.

Visualizing Mental Health Through the Lens of Pittsburgh Youth: A Collaborative Filmmaking Study During COVID-19.

Youth mental health has been significantly impacted by COVID-19, with concerns of rising anxiety-related and depressive symptoms and reduced quality of life. This study provides a nuanced understanding of mental health stressors and supports in the lives of youth during the pandemic. Using Collaborative Filmmaking, an embodied, visual, and participatory research method, participants in Pittsburgh, Pennsylvania, were trained to create, analyze, and screen films about mental health. The films elucidated numerous stressors impacting youth mental health, including educational stressors (e.g., academic pressure and relationships with teachers), personal and social stressors (e.g., social and cultural expectations), and current events (e.g., the election and the political system). Supports included individual level supports (e.g., hobbies, self-care, spending time outdoors), and interpersonal level supports (e.g., family and socializing). Several themes were discussed as both stressors and supports, such as family, COVID-19, and social media. Overall, educational stressors are major contributors to adverse mental health symptoms among youth, which have been magnified by the COVID-19 pandemic. Youth discussions of the importance of self-care and engaging in healthy hobbies demonstrated strong awareness about maintaining mental health, though structural-level recommendations are still needed to improve youth mental health. Screening the Collaborative Films with the public illuminated several additional opportunities for action, including structural and social actions (e.g., changing policies and social norms around mental health). Given the structural nature of the stressors mentioned by participants, systemic changes as well as policy level action and programming are needed to address the intersectional nature of current mental health concerns among youth.

Venlafaxine-related galactorrhea in an adolescent female: A case report.

Hyperprolactinemia with galactorrhea is a well-documented adverse effect of some psychotropic medications. While advanced practice psychiatric nurses are likely familiar with hyperprolactinemia with galactorrhea as an adverse effect of antipsychotics, they may be less familiar with hyperprolactinemia with galactorrhea associated with antidepressants, an adverse effect that is far less common. Advanced practice psychiatric nurses must be able to identify hyperprolactinemia and galactorrhea in patients and must be able to evaluate and manage antidepressant-related hyperprolactinemia with galactorrhea. Thus, this case report describes hyperprolactinemia with galactorrhea in a teenage female prescribed venlafaxine for the treatment of major depressive disorder and posttraumatic stress disorder. To our knowledge, this is the first case report that describes galactorrhea related to a reuptake inhibitor (SNRI) in an adolescent.

An Update on Billing and Coding for the Psychiatric-Mental Health Nurse Practitioner.

Nurse practitioners (NPs) possess expert clinical knowledge that can be optimized to ensure delivery of high-quality care. In the United States, NP scope of practice is generally expanding. With expanding scope of practice comes increased revenue potential, and in some cases, entrepreneurial opportunities for NPs. Therefore, NPs must be familiar with current procedural terminology codes to ensure appropriate billing and maximize reimbursement from payers. [Journal of Psychosocial Nursing and Mental Health Services, 60(2), 11-13.].

Mental wellness among psychiatric-mental health nurses during the COVID-19 pandemic.

Psychiatric nursing providers and their unique challenges in the face of the COVID-19 pandemic are not well-represented in the literature. Therefore, this study sought to describe mental well-being of psychiatric nurses, and sought to elucidate factors related to mental wellness during the COVID-19 pandemic. This study utilized cross-sectional survey methodology to evaluate burnout, mental wellness, COVID-related anxiety, professional fulfillment, depressive symptoms, and anxiety symptoms among psychiatric nurses. There was a total of 151 respondents. A linear regression model was employed to identify predictors of mental wellness. The final regression model included the following predictors: depressive symptoms, burnout, professional fulfillment, and educational status. These predictors together accounted for 73% of the variance for the outcome variable of mental well-being.

Best practices in benzodiazepine prescribing and management in primary care.

ABSTRACT: Despite the lack of evidence on the long-term effectiveness of benzodiazepines and their potential harmful effects, prescriptions of the drug have significantly increased in the US over the past decade. This article reviews best practices regarding primary care benzodiazepine prescriptions and how providers can best prevent and treat benzodiazepine use disorder and other harmful effects.

Treatment-resistant depression: An overview for psychiatric advanced practice nurses.

PURPOSE: Treatment-resistant depression (TRD) can require complex management. The purpose of this paper is to provide an update on the hypothesized neurobiology of depression, and to describe treatment options for patients impacted by TRD. CONCLUSIONS: Recent neurobiological findings support the use of augmenting pharmacological agents, neuromodulation techniques, and esketamine as effective in achieving remission for those with TRD. PRACTICE IMPLICATIONS: First-line interventions for depression can be safely managed by primary care providers. Psychiatric advanced practice nurses must be well versed and capable of treating more complicated cases, including TRD, that may require second- or third-line approaches.

Bipolar disorder: Treatment strategies for women of childbearing age.

PURPOSE: Bipolar disorder is associated with increased rates of morbidity and mortality, magnified in women of childbearing age. The purpose of this paper is to provide an overview of the differential diagnosis and management of bipolar disorder in women of childbearing age. CONCLUSIONS: Differential diagnoses for bipolar disorder include depressive disorders, anxiety disorders, trauma-related disorders, attention-deficit/hyperactivity disorder, and personality disorders. Pharmacotherapeutic options for the treatment of bipolar disorder include lithium, anti-epileptic medications, and atypical antipsychotics. In regard to women of childbearing age, consideration of risks, benefits, and alternative therapies is needed before initiating therapy. PRACTICE IMPLICATIONS: Caring for patients with bipolar disorder, particularly women of childbearing age, requires careful differentiation of bipolar disorder from other mental health problems, and prudent consideration of pharmacotherapeutic options.

Retrospective Analysis of Demographic, Psychiatric, and Physical Characteristics That Impact Length of Stay on an Inpatient Geriatric Psychiatric Unit.

Currently, the aging adult population is rising fast and presenting multiple challenges for the US healthcare system. Older adults present unique challenges in their care of medical and psychiatric conditions. This study retrospectively examined characteristics that are associated with length of stay on an inpatient geriatric psychiatric unit in an urban located psychiatric hospital. A sample of 74 individuals was examined. Factors that influenced length of stay included commitment status and discharge to a different level of care. Reducing the length of stay for geriatric patients can help reduce costs and improve health outcomes.

Modernizing Perinatal Substance Use Management.

The increase in prescription and illicit opioid use since 2000 has become an urgent public health crisis. While the opioid epidemic spans racial, regional, and socioeconomic divides, women have surfaced as one demographic affected by opioid use and related sequelae. Certain federal and state regulations, secondary to the Child Abuse Prevention and Treatment Act, strip pregnant women with opioid use disorders of the ability to engage autonomously with their health care clinician while simultaneously impeding their ability to achieve and sustain recovery. The purpose of this article is to explore current health policy that impacts pregnant women who use opioids. Recommendations to improve care, broadly, will be highlighted to include access to contraceptive services, universal screening for perinatal substance use, and access to appropriate treatment strategies. Policy modifications to facilitate these recommendations are discussed. The Centers for Disease Control and Prevention Policy Analytical Framework was utilized to derive recommendations. The recommendations are relevant to advanced practice registered nurses and midwives who have the potential to treat substance use in women, to women's health and pediatric registered nurses, and to nursing administrators who are involved in decision-making in obstetric and pediatric settings.

Women of Childbearing Age and Fetal Alcohol Spectrum Disorder Prevention: A Position Paper.

It is the position of the International Nurses Society on Addictions that all nurses, in all settings, should be prepared to provide care to patients with alcohol use problems, especially for women of childbearing age.

Preparing nurse practitioners to combat the opioid epidemic: A survey of nurse practitioner academic programs in the United States.

ABSTRACT: Between 1999 and 2017, nearly 400,000 individuals died from opioid-related overdoses in the United States. Nurse practitioners (NPs) can be instrumental in providing care for those with opioid use disorders (OUDs) but must be adequately prepared to do so. Currently, there is limited evidence regarding how NP programs are preparing their graduates to address opioid use. The purpose of this study was to evaluate how NP programs have addressed the opioid epidemic within their curricula, and to evaluate barriers to and facilitators of curricular modifications. Electronic surveys were distributed to all 444 NP program directors in the United States. The survey consisted of 10 questions and inquired about curricular modifications made in regard to OUDs, barriers and facilitators of such modifications, and perceived importance of addressing the opioid epidemic within NP programs. A total of 130 (29.3%) of program directors responded to the survey. Of the program directors who responded, 89 (76.1%) reported that curricular modifications were made to address OUDs. Barriers to curricular modification included limited time, lack of faculty expertise or confidence, and stigma in regard to opioid use. Facilitators included faculty champions, availability of external educational resources, student interest, and financial incentives. Nurse practitioners can treat patients with OUDs, mitigating significant barriers to care reported in light of the opioid epidemic. Graduate NP programs should assure that curricula adequately cover opioid use and related management.

Climate Change and Mental Health: Implications for Nurses.

Climate change has received public health attention over the past 3 decades. It is well established that climate change is associated with myriad health issues, but less has been mentioned in public health discourse about the impacts of climate change on population mental health. The purpose of the current article is to provide an overview of the impacts of climate change on mental health, and to discuss opportunities for mental health nurses to reduce health problems related to climate change. Acute events and chronic consequences of climate change can impact mental health outcomes and contribute to depressive disorders, anxiety, and trauma-related disorders. The nursing profession must be prepared to address climate change to promote best health outcomes for individuals around the globe. It is critical that mental health nurses act as leaders in understanding and addressing climate change to improve the mental health of populations. [Journal of Psychosocial Nursing and Mental Health Services, 58(9), 25-30.].

Intimate partner violence in adolescents: Preventive strategies for psychiatric-mental health nurse practitioners.

TOPIC: Intimate partner violence (IPV) remains a significant public health problem that is associated with high rates of morbidity and mortality. IPV has become increasingly prevalent in adolescents, with 20% of adolescents between 13 and 18 years reporting physical IPV, and 9% reporting sexual IPV. To assure the best outcomes for adolescents at-risk for or experiencing IPV, it is critical for psychiatric-mental health nurse practitioners (PMHNPs) to implement preventive interventions, spanning from primary to tertiary prevention, to address IPV. PURPOSE: The purpose of this paper is to provide an overview of primary, secondary, and tertiary preventative strategies needed to improve outcomes for adolescents experiencing IPV within the context of the socioecologial model. SOURCES USED: Utilizing PubMed, CINAHL, and PsycINFO, a literature review was conducted to identify relevant publications spanning from 2015 to present. Reference lists of identified articles were also searched. CONCLUSIONS: PMHNPs must be competent in psychoeducation and counseling, screening, and management of comorbidities and safety planning to assure best outcomes for adolescents exposed to IPV.

Technology-Based Educational Approaches to Address Opioid Use Management by Advanced Practice Registered Nurses.

Opioid overdose remains the leading cause of accidental death, with 64,000 deaths attributable to opioid-related overdoses in 2016 and a 20% increase in mortality since 2015. Advanced practice registered nurses (APRNs) are now eligible to prescribe buprenorphine. The purpose of this project was to develop educational training materials regarding opioid use management; widely disseminate these materials; monitor reach and intervention efficacy in precipitating practice change; and to evaluate barriers and facilitators of buprenorphine prescribing. The authors developed a three-webinar series pertaining to opioid use management. A broad marketing and dissemination approach was utilized. Demographic data was collected when individuals registered to participate in the webinar series. Follow-up data was collected post-webinar and sought to assess practice change, and barriers to and facilitators of buprenorphine prescribing. Of the 670 individuals that viewed one or more of the live webinars, 218 (32.5%) completed a portion of one or both of the follow-up surveys (at 3- and 6-months post-webinar). Of the respondents, 39 (18%) had obtained the DATA 2000 (buprenorphine) waiver since viewing the webinar series, and 11 (5.1%) were in the process of obtaining the DATA 2000 waiver. Barriers to buprenorphine prescribing included regulatory factors, patient-specific factors, and provider-specific factors. Facilitators to buprenorphine prescribing included institutional support and mentorship, collaboration with professional organizations, increased community awareness, and patient outcomes. APRNs should be abreast of best practices in the management of opioid use disorders. Barriers to and facilitators of buprenorphine prescribing must be understood and addressed.

Substance Use and Exposure to Adverse Childhood Experiences in Undergraduate and Graduate Nursing Students[Formula: see text].

BACKGROUND: Substance misuse remains a public health crisis and contributor to morbidity and mortality. The nursing workforce is not immune to the impacts of substance misuse as rates are thought to mirror those of the general population. Additionally, as substance misuse often begins in adolescence or early adulthood, prevalence of misuse among practicing nurses highlights the fact that students are also at risk. OBJECTIVES: The purpose of this study was to examine rates and patterns of substance use and adverse childhood experience (ACE) exposure among nursing students while also examining associations between substance use and ACE exposure. METHOD: This study utilizes a cross-sectional and descriptive design through the provision of email surveys to nursing students. Email surveys consisting of the Alcohol Use Disorders Identification Test, the Drug Abuse Screening Tool 10-item survey, the ACE Questionnaire, and a demographic inquiry were distributed via Qualtrics survey software. RESULTS: A total of 662 individuals participated in the survey, the majority of whom self-identified as female, were undergraduate students, and were between 18 and 21 years. Moderate- to high-risk alcohol use was identified in 20% of students, while moderate- to high-risk drug use was identified in 3.6% of students. More than half of students endorsed exposure to at least one ACE. Significant associations were found between the Drug Abuse Screening Tool 10-item survey and the ACE Questionnaire. CONCLUSIONS: The results of this study have significant implications for nursing educators and must inform groundwork for the development of policies and interventions that are evidence based, nonpunitive, and trauma informed.

Management of mental health conditions in refugee youth: An overview for the psychiatric-mental health nurse practitioner.

TOPIC: In 2017, there were a total of 70 million forcibly displaced individuals or refugees, worldwide. Unfortunately, over 50% of refugees are under the age of 18 years. Refugee youth are at-risk for a variety of mental health conditions. PURPOSE: The purpose of this report is to provide psychiatric-mental health nurse practitioners (PMHNPs) with an understanding of unique cultural implications in refugee youth, risk factors towards the development of psychiatric illness, and means to identify those at-risk for sequelae or those meeting diagnostic criteria. Also presented are foundational treatment and management implications to ensure the provision of culturally sensitive and efficacious care to this unique population. SOURCES USED: Utilizing PubMed, CINAHL, and PsycINFO, a literature review was conducted to identify relevant publications pertaining to mental health issues in refugee youth spanning from 2013 to present. Reference lists of identified articles were also searched. CONCLUSIONS: A variety of risk and protective factors are discussed, spanning from premigration, during flight, and postsettling periods. PMHNPs must be proficient in screening and diagnosis of mental health conditions in refugee youth and implementation of pharmacological and psychotherapeutic interventions. PMHNPs must also be well versed in community-based resources that can be utilized to promote optimal outcomes.

Shifting the Paradigm for Opioid Use Disorder: Changing the Language.

Morbidity and mortality associated from opioid use have been on the rise, exemplifying a major public health epidemic. Despite public health interventions, opioid-related morbidity and mortality have yet to plateau or decrease. One explanation for this phenomenon is the presence of barriers to evidence-based pharmacotherapies. Stigma has only recently been identified as a barrier to treatment. The purpose of this report is to evaluate language utilized to describe opioid use disorder and associated pharmacological treatment. Nurse practitioners must emerge as leaders in assuring that patient-centered and non-stigmatizing language is utilized, in order to improve patient outcomes.