The impact of syringe decriminalization within the Pennsylvania harm reduction community.

INTRODUCTION: Syringe decriminalization is a harm reduction approach to decrease deaths and disease related to drug use. The purpose of this study was to develop an understanding of the impact of syringe decriminalization on the harm reduction community in Pennsylvania. METHODS: Semi-structured interviews were conducted with ten participants identified as harm reduction experts. ANALYSIS: Narrative content analysis to the point of thematic saturation was used to generate themes around harm reduction and syringe decriminalization in Pennsylvania, specifically the meaning of harm reduction, the importance of harm reduction, and the opinions on syringe decriminalization. RESULTS: The following themes reflect the meaning of harm reduction: human compassion; meeting people where they are at; minimizing the risk; and shifting power to the person. The themes of being personally impacted, human compassion, innate imperfection, and respecting human autonomy reflect why participants care about harm reduction. All ten participants support syringe decriminalization in Pennsylvania citing the following rationales: improved health outcomes; decreased costs to society; less involvement of the criminal justice system; and increased engagement into treatment. CONCLUSIONS: Harm reduction is a pioneering approach to drug use that empowers individuals to make positive impacts in their lives. Harm reduction experts in Pennsylvania support syringe decriminalization as a cost-effective way to increase the engagement and improve health outcomes of people who use drugs.

Advanced practice nursing students' perspectives of learning screening, brief intervention, and referral to treatment in interprofessional settings.

ABSTRACT: Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to early intervention for substance use through universal screening. Utilization of SBIRT was taught in an interprofessional setting to nurse practitioner, nurse anesthetist, and dental hygiene students through integrated educational grant projects. A qualitative analysis was done across 10 SBIRT data sets collected over 4 years. The researchers used a nominal group consensus method to review the data, and six themes were identified. Results showed that students desired more training on motivational interviewing techniques. Furthermore, students identified that to effectively work interprofessionally, students must be exposed to such collaboration throughout their professional educational programs.

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.

An evaluation of documentation and follow-up on the use of SBIRT in an outpatient behavioral health clinic through the use of the CRAFFT tool.

BACKGROUND: Substance use among adolescents continues to present as a public health concern. Screening, Brief Intervention and Referral to Treatment (SBIRT) is an effective process that has been proven to identify, reduce, and prevent at-risk use of substances when appropriately applied. The CRAFFT tool is an evidence-based screen used to identify substance use in adolescents aged 12-21 years of age. PURPOSE: The purpose of this project is to assess the rates of substance use in the adolescent population at a behavioral health clinic through the CRAFFT tool while also assessing for provider documentation compliance and overall revenue benefits of SBIRT. METHODOLOGY: A retrospective chart review was used for this practice evaluation. Descriptive statistics were used through assessing frequencies and averages to gain insight not only on the rates of at-risk substance use and documentation compliance, but also on psychiatric diagnoses and medication regimens. RESULTS: Three hundred and forty-one patient encounters were reviewed over a 3-month period. Of these 341 encounters, 63.6% of the visits were in-person and 36.4% were conducted virtually. 72.4% of patient encounters had no documented CRAFFT screen, yet 31% of completed CRAFFT screens were positive for substance use or misuse. For those encounters with no completed CRAFFT screen documented, there was an estimated lost income for potential billings at a rate of $33.41 per encounter for a total of $8252.27. CONCLUSIONS: Substance use and misuse in adolescents continues to exist as a public health concern. The CRAFFT tool can be a feasible means of screening for substance use in adolescents when consistently and longitudinally incorporated.

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.

Viloxazine ER (Qelbree®): A New Non-Stimulant Option in the Treatment of Pediatric Attention-Deficit/Hyperactivity Disorder.

The current article provides a brief overview for psychiatric-mental health nurse practitioners of viloxazine extended-release (Qelbree®) for the treatment of pediatric attention-deficit/hyperactivity disorder. [Journal of Psychosocial Nursing and Mental Health Services, 60(7), 7-9.].

The Need to Prepare Advanced Practice RNs to Deliver Affirmative Care to LGBTQ+ Adolescents.

The current article describes an educational intervention that seeks to improve advanced practice RNs' (APRN) ability to provide high-quality, affirmative care to lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) adolescents. Components of the educational intervention (i.e., simulation scenarios, educational videos) are made available online for APRN educator use. [Journal of Psychosocial Nursing and Mental Health Services, 60(8), 9-10.].

Incorporation of Child & Adolescent Mental Health Standardized Patient Simulations to Provide Interprofessional Education for Graduate Students.

Substantial need exists to prepare healthcare professionals to manage the increasing prevalence of mental health conditions, specifically in the child and adolescent population. The primary purpose of this study was to enhance knowledge of health care professionals in the assessment and treatment of common mental health disorders in children and adolescents through the delivery of workshops that provided both didactic and simulation training. This study utilized a repeated measures, quasi-experimental design. A total of 131 students representing counseling, pharmacy, PMHNPs and FNPs participated in the four workshops. Positive changes in the perceptions of interdisciplinary teamwork importance were noted.

An overview of buprenorphine prescribing for the advanced practice psychiatric nurse.

PURPOSE: Rates of at-risk opioid use, opioid use disorder, and opioid overdose remain alarmingly high. There are medications that can be used to treat opioid use disorder, including methadone, buprenorphine, and naltrexone, although access to care remains difficult. This review seeks to provide advanced practice psychiatric nurses (APPNs) with an overview of buprenorphine prescribing, with an emphasis on novel, long-acting delivery systems. CONCLUSIONS: APPNs should be familiar with best practices regarding buprenorphine prescribing. Some patients may benefit from long-acting delivery methods, such as subdermal implants, or subcutaneous injections. PRACTICE IMPLICATIONS: APPNs can reduce barriers to buprenorphine access and should be familiar with best practices related to buprenorphine prescribing.

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.].

Atypical antipsychotics: Managing adverse effects.

PURPOSE: The purpose of this article is to provide an overview of common adverse effects and management strategies related to atypical antipsychotic use. CONCLUSIONS: Atypical antipsychotics are commonly prescribed. While effective, atypical antipsychotics are associated with metabolic syndrome, extrapyramidal symptoms, and tardive dyskinesia, among others adverse effects. Management strategies can mitigate adverse effects and promote optimum quality of life. PRACTICE IMPLICATIONS: To be able to identify and manage adverse effects associated with the use of atypical antipsychotics, it is important to build a supportive therapeutic environment at each interaction with patients and their caregivers.

Associations Between Adverse Childhood Experiences and Substance Use in Nursing Students.

Adverse childhood experiences (ACEs) are a public health problem, and exposure to ACEs can lead to negative health consequences, including substance use. Little is known about ACEs and substance use in the nursing student population. The purpose of the current study was to describe the types of ACEs encountered by nursing students and the rate at which they occur; and examine associations between individual ACEs and alcohol and drug use. This study uses a cross-sectional, descriptive design. Measurements were used to assess and quantify ACEs and alcohol and drug use. There were small to medium associations between alcohol use and ACE items, and more modest associations found between drug use and ACE items (p < 0.001). Findings highlight the need for a trauma-informed approach to nursing education. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 43-47.].

Effect of Standardized Patient Simulation on Nursing Students' Attitudes Toward Psychiatric Nursing and Patients With Mental Health Problems.

The purpose of the current study was to evaluate changes in attitudes toward psychiatric nursing and mental health problems in a sample of nursing students after exposure to high-fidelity standardized patient (SP) simulation scenarios. This study used a quasi-experimental, single-group pre-/post-survey approach. Immediately before and after exposure to SP simulation scenarios, undergraduate nursing students completed Attitudes to Mental Illness (AMI) and the Attitudes to Psychiatry (ATP) surveys. There were significant improvements in the following ATP domains: psychiatric career choice and psychiatric teaching (p = 0.046 and 0.007, respectively). There were no significant changes in the AMI survey, but items related to social stigma improved following the simulation. Findings of this study suggest a potential benefit of SP simulation on nursing students in developing their attitudes toward psychiatry and mental health problems. [Journal of Psychosocial Nursing and Mental Health Services, 59(8), 15-21.].

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.