Sustained impact of an academic-practice partnership.

Academic-practice partnerships foster innovation and transition to nursing practice in healthcare systems. The purpose of this paper is to describe the impact of a public-private academic-practice partnership for Doctor of Nursing Practice (DNP) education designed to transform a large healthcare system's nursing workforce and model of care. The conceptual framework is organized around Rogers's (2003) principles of diffusion of innovation in organizations. A logic model illuminates how inputs, activities, outputs and outcomes resulted in sustained impact for graduates, the college and the healthcare organization. Partnership outcomes include education of baccalaureate and master's-prepared employed nurses (n = 95) in a DNP program for advanced practice nursing (APN) roles in the healthcare system; dissemination of scholarship; and revision of the healthcare system's research approval process. Sustained impact includes advancement of DNP-prepared graduates to complex leadership and practice roles; development of new programs and advanced practice roles based on scholarly project findings; expansion of population-specific patient programs; and extension of continuum- and access-to-care models in the healthcare organization. Recommendations include continuing development of academic-practice partnerships for transition to practice and advancement of roles and levels of champions to achieve sustained impact of academic-practice partnerships in healthcare organizations.

An innovative teaching model in an academic-practice partnership for a Doctor of Nursing Practice program.

Teaching innovations in Doctor of Nursing Practice (DNP) programs are essential for preparing practitioners for role responsibilities. The purpose of this paper is to describe a teaching model implemented in a public-private academic-practice partnership in which DNP-prepared healthcare organization nursing leaders joined with college of nursing faculty to teach didactic courses in the DNP program. The conceptual framework for this model is organized around Boyer's (1990) principles of the scholarship of teaching, integration, and application, and the American Association of Colleges of Nursing definition of scholarship (2018). A logic model evaluation plan of the teaching model includes a description of inputs, activities, outputs, and outcomes. Outcomes include the attainment of short term goals related to student satisfaction and DNP program completion; faculty and peer satisfaction; and administrator perspectives. Future evaluation will include assessment of long-term impact of the teaching model. The teaching model can be replicated in preparing cohorts of students for advanced practice nursing and cultivating the scholarship of teaching, integration and application.

Optimizing impact through the Tiered Doctor of Nursing Practice Project Model.

Colleges of Nursing (CONs) and health care organizations (HCOs) are increasingly embracing academic-practice partnerships (AcaPP). An HCO's workforce development plan prompted an AcaPP agreement with a CON for the purpose of increasing the number of doctor of nursing practice (DNP) advanced practice nurses in the HCO. Over a period of 6 years, 4 consecutive cohorts of approximately 100 HCO baccalaureate prepared nurses were enrolled in the CON DNP program. The AcaPP environment facilitates large-scale DNP projects among successive cohorts of students. The purpose of this article is to describe the innovative Tiered DNP Project Model, defined as the process by which current students build on and expand select DNP projects implemented by students in initial cohorts. The tiered approach to the DNP project is facilitated by an advising model that occurs in the context of mutually agreed-upon goals and compatible with the HCO strategic plan and CON DNP program objectives. In the Tiered DNP Project Model, select studies are chosen for continuation by DNP students in subsequent cohorts based on nursing leadership guidance of alignment with HCO strategic goals. The model has resulted in driving improvements in HCO patient and systems outcomes, promoted practice scholarship, and contributed to the quality of the CON DNP program.

DNP Practice Improvement Initiative: Staff Nurse Competency Evaluation.

This article describes a practice improvement initiative (PII) demonstrating the impact of doctorate of nursing practice (DNP) skills beyond direct patient care. The Donna Wright Competency Assessment Model, AACN DNP Essentials, and National Organization of Nurse Practitioner Faculties nurse practitioner competencies framed the PII. The DNP graduates planned, implemented, and evaluated an assessment of 1,055 staff nurses on shift hand-off, physical assessment, and hand hygiene. Results indicated that 95% of the staff nurses scored 100% on competency assessment. The PII model was adopted for future competency evaluation.

An Academic-Practice Partnership Model to Grow and Sustain Advanced Practice Nursing.

OBJECTIVE: The aims of this article were to describe the implementation of an academic-practice partnership for healthcare system workforce development and provide preliminary outcomes of the associated pilot study. BACKGROUND: The demand for cross-continuum healthcare delivery models necessitates creation of workforce development structures for advanced practice nursing. METHODS: An academic-practice partnership specified enrollment of 5 cohorts of BSN staff nurses in a 3-year DNP program. Qualitative methods were used to explore pilot data at midpoint of cohort 1 student progression to determine learning outcomes and DNP projects with potential for impact on organization goals. RESULTS: Partnership implementation experiences indicate that contractual agreements and an established evaluation plan are keys to academic-practice partnership success. Pilot study findings suggest that curriculum core courses provide a foundation for designing DNP projects congruent with acute and primary care health system goals. Implementing an academic-practice partnership is a strategy for workforce development to increase retention of advanced practice nurses. CONCLUSION: Academic-practice partnerships can serve as a catalyst for a paradigm shift for changing models of care, thus enhancing workforce development succession planning for sustainable growth in healthcare systems.

An Academic-Practice Partnership to Advance DNP Education and Practice.

During the past decade, the growth of doctor of nursing practice (DNP) programs in the United States has been phenomenal, with most focusing on the preparation of advanced practice registered nurses. Simultaneously, academic-practice partnerships have been a frequent subject of discussion for nursing's leading academic, administrative, and practice organizations. Numerous reports about academic-practice partnerships concerning aspects of baccalaureate nursing education exist, but partnership accounts for DNP programs are essentially nonexistent. The purpose of this article is to describe the initial phase of an academic-practice partnership between a multisystem health care organization and a college of nursing in a public land-grant university in the southeastern United States. The 7-year partnership agreement between Norton Healthcare and the University of Kentucky College of Nursing was designed to prepare 5 cohorts of 20 to 30 baccalaureate-prepared staff nurses as DNP graduates for advanced practice registered nurse eligibility. The description of partnering institution characteristics frames an emphasis on elements of the partnership proposal, contractual agreement, and partner responsibilities along with the logic model evaluation plan. Lessons learned include the importance of proposals and contracts to sustain the partnership, frequent communication to build trust, and strategic analysis for rapid response to challenging situations.

The leadership role of nurse educators in mental health nursing.

Leadership behaviors and actions influence others to act, and leadership in clinical practice is an important mediator influencing patient outcomes and staff satisfaction. Indeed, positive clinical leadership has been positioned as a crucial element for transformation of health care services and has led to the development of the Practice Doctorate Movement in the United States. Nurse educators in health care have a vital leadership role as clinical experts, role models, mentors, change agents, and supporters of quality projects. By enacting these leadership attributes, nurse educators ensure a skilled and confident workforce that is focused on optimizing opportunities for students and graduates to integrate theory and practice in the workplace as well as developing more holistic models of care for the consumer. Nurse educators need to be active in supporting staff and students in health care environments and be visible leaders who can drive policy and practice changes and engage in professional forums, research, and scholarship. Although nurse educators have always been a feature of the nursing workplace, there is a paucity of literature on the role of nurse educators as clinical leaders. This discursive article describes the role and attributes of nurse educators with a focus on their role as leaders in mental health nursing. We argue that embracing the leadership role is fundamental to nurse educators and to influencing consumer-focused care in mental health. We also make recommendations for developing the leadership role of nurse educators and provide considerations for further research such as examining the impact of clinical leaders on client, staff, and organizational outcomes.

Health Behavior Decision-making in African-American Adults Diagnosed with Schizophrenia.

Little is known about the factors that influence health behavior decision-making among people with schizophrenia. The purpose of this qualitative study was to describe the processes used by 10 African-American adults with schizophrenia when making health behavior decisions and identification of perceived barriers and facilitators to health. Three phases of health behavior decision-making were identified: Recognizing Complex Components of Health, Personalizing Components of Health, and Tracking Health Status. Findings may guide clinicians' efforts to improve the health status of patients, as well as influence future research in understanding health behavior decision-making among vulnerable populations.

Challenges of implementing a medication management evidence-based practice in a community mental health setting: results of a qualitative study.

The Medication Management Approaches in Psychiatry (MedMAP) is a medication management evidence-based practice (EBP) to guide the use of psychotropic medications in the treatment of schizophrenia. This qualitative study examined facilitators and barriers to implementing MedMAP in community mental health treatment settings. Audio-taped qualitative interviews were conducted with practitioners and administrators involved in a MedMAP implementation project conducted in six community mental health centers. Data analysis was conducted using thematic analysis of transcribed interviews. Findings indicate that facilitators to MedMAP implementation included practitioner recognition of the value of MedMAP, consumer involvement, collaboration, continuity of care, and fidelity assessments. Barriers to MedMAP implementation included problematic technology, work flow issues, lack of flexibility in prescribers' ability to implement MedMAP guidelines, regulatory and financial barriers, and consumer insurance status. Recommendations for improving future implementation efforts of MedMAP emphasize technological readiness, development of innovative models of care delivery, an emphasis on treatment guided by outcomes, and active leadership to promote EBPs within organizations and academic settings.

Organizational fidelity to a medication management evidence-based practice in the treatment of schizophrenia.

Organizational support is essential for successful implementation of evidence-based practice (EBP) in clinical settings. This 3-year study used a mixed qualitative and quantitative design to implement a medication management EBP in the treatment of schizophrenia in six community mental health clinics in a south-central state of the United States. Findings from organizational fidelity assessments indicate that support for EBP implementation was moderate. Organizational support was highest for prescriber access to relevant patient information at each medication visit, scheduling flexibility for patients' urgent problems, and availability of medication guidelines. Organizational support was lowest for medication availability and identification of treatment refractory patients. Findings suggest that leadership is essential to support successful implementation. Nurse educators can incorporate implementation research and leadership training into graduate nursing programs to facilitate successful EBP implementation in practice settings.

Medical and psychiatric comorbidities in children and adolescents: a guide to issues and treatment approaches.

Chronic medical illness among children and adolescents is a growing concern with implications for informal and formal caregivers. When coupled with a psychiatric comorbidity, implications grow exponentially. Nurses who care for child and adolescent populations play a crucial role in optimizing physical and mental health when they interface with patients and their caregivers. Evidence-based interventions can promote positive outcomes and enhance quality of life, whereas failure to use evidence-based approaches has serious consequences to the health of youth with medical and psychiatric comorbidities.

Medical illnesses in people with schizophrenia.

The physical health of people with schizophrenia is poor, and the challenges in finding effective treatment and optimizing health outcomes are significant. However, it is likely that people diagnosed with schizophrenia can be partners in the treatment of their physical health problems. Research suggests that many people with schizophrenia value physical health and will participate in health-related behaviors when they are provided with the opportunity to do so.

Prescriber fidelity to a medication management evidence-based practice in the treatment of schizophrenia.

OBJECTIVE: Medication Management Approaches in Psychiatry (MedMAP) is an evidence-based practice developed to guide the management and monitoring of psychotropic medications for individuals with schizophrenia. This article reports prescriber fidelity to MedMAP principles in a public mental health service system. METHODS: This three-year longitudinal intervention study implemented MedMAP in six community mental health centers in Kentucky. Nine psychiatrists and five advanced practice psychiatric nurses with prescriptive authority participated in the study. Prescribers were trained in the use of MedMAP about one month before implementation, and MedMAP principles were reinforced throughout the study. Four posttraining assessments were conducted at each site at approximately four-month intervals over a period of 30 months. An 18-item scale was used to assess baseline and posttraining prescriber fidelity over a period of 30 months in 900 randomly selected medical records. RESULTS: Average fidelity scores improved significantly over baseline at each of the four postimplementation fidelity assessments. Training effects were most evident at the second posttraining fidelity assessment, but effects persisted over the course of the study. There was considerable variability in scores across items both at baseline and subsequently. Posttraining improvement was greatest in patient education, documentation of illness and medication history, and simplification of medication regimen. CONCLUSIONS: Implementation and monitoring of MedMAP were feasible in these community mental health settings. Additional implementation projects are crucial for advancing evidence-based practice in clinical settings.

Scales to evaluate quality of medication management: development and psychometric properties.

This paper describes the psychometric properties of two fidelity scales created as part of the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored medication management toolkit and their metric properties when used in 26 public mental health clinics with 50 prescribers. A 23-item scale, based on chart reviews, was developed to assess whether prescribers are following good medication practices, in conjunction with a 17-item scale to assess organizational support for and evaluation of prescriber adherence to recommended medication-related practices. Fundamental gaps in routine practice, including poor documentation of medication history and infrequent monitoring of symptoms and side effects were found.

The care and outcomes management plan and Kardex. A design for improving documentation of nursing plan of care and patient outcomes.

The gradual transition from paper records to electronic records presents challenges for nurses. In particular, split paper/electronic records can interfere with staff communication during shift change reports. A project was implemented to facilitate documentation of individualized care plans and improve staff communication during shift change report. The hospital's critical pathway was incorporated into Kardex to create a single electronic medical record for use during shift change report. This combined electronic outcomes plan and Kardex improved access to patient information during shift report and facilitated nurses' ability to update the care plan with the most current patient information. Future strategies will include collaboration with the hospital's information systems staff to make the COMPdex compatible with the hospital's electronic documentation system, so that pertinent patient data will populate from the current electronic chart into the COMPdex forms for printing and to include patient outcome data in the electronic medical record.

Assessment and management of hospitalized suicidal patients.

Suicide in inpatient psychiatric settings is a critical problem. A comprehensive literature review was performed to determine risk factors for inpatient suicide, instruments for assessing suicide, and treatment of hospitalized suicidal patients. Findings suggested that root causes of inpatient suicide were factors related to the treatment environment, failure to assess patient behavioral characteristics, and staff reliance on no-suicide contracts. Recommendations include assessing suicide risk regularly throughout hospitalization, including on admission, during changes in a patient's mental or physical status, after a change in observation level, and before discharge. Orientation and inservice education for all staff and additional research on the psychometric properties of available suicide assessment instruments are also essential.

Predictors of satisfaction among adult recipients of medicaid mental health services.

This study measured service satisfaction, perceptions of service quality and general health, and overall quality of care among 787 adult recipients of Medicaid mental health services. Methods included cross-sectional retrospective design and stratified random sampling technique. Respondents were satisfied with consumer-provider relationships and were dissatisfied with functional outcomes resulting from treatment. Satisfaction was positively correlated with ratings of mental health care and the mental health component score of the SF-12. Predictors of satisfaction included ratings of mental health care and overall health. Recommendations include coordination of services that promote patient functioning and measurement of consumer satisfaction as an indicator of quality.

Comorbid medical illnesses and perceived general health among adult recipients of Medicaid Mental Health Services.

The purpose of this retrospective, cross-sectional, descriptive study was to measure self-reported frequencies of medical problems, overall health, and health-related quality of life among mental health consumers. The sample included 787 adults who had received a mental health service paid for by Medicaid over a one-year period. The self-administered questionnaire included the 12-item Medical Outcomes Study (MOS) Short-Form (SF) Physical and Mental Health Summary Scales, and items about physical health problems and health-related quality of life. The majority of respondents (83.3%) reported that their general health was poor or fair. Frequently reported medical problems included arthritis, migraines, and high blood pressure. Knowledge of physical problems in persons with mental illness is essential for advanced practice nurses.