Educating Mental Health Nurse Practitioners on Interprofessional Collaboration and Preparing Them for Collaborative Practice.

BACKGROUND: Although interprofessional collaboration (IPC) has been discussed for over 40 years, in nursing education as well as the majority of health professionals, education continues to primarily take place in silos with curricula that is discipline specific. Educators need to implement models of education that are linked to collaborative practice and team-based care. OBJECTIVES: To introduce the principles from the Core Competencies for Interprofessional Collaborative Practice, the American Association of Colleges of Nursing Essentials of Doctoral Education for Advanced Nursing Practice and the National Organization of Nurse Practitioners Faculties Nurse Practitioner Core Competencies into the coursework. To demonstrate an application process for incorporating collaboration in their future nurse practitioner roles. METHOD: Students in the Doctor of Nursing Practice mental health nurse practitioner program participated in a set of assignments to develop essential knowledge and skills for integration of IPC into practice. A pretest-posttest design was used to evaluate student attitudes towards IPC following immersion in IPC subject matter and experiential learning with other healthcare providers working together to coordinate patient care. RESULTS: There were significant findings for six of the 18 survey questions. This project can serve as an example for successful implementation of IPE in the nursing curricula.

A Quality Improvement Project Using Verbal De-Escalation to Reduce Seclusion and Patient Aggression in an Inpatient Psychiatric Unit.

The use of seclusion is controversial and has been deemed an encroachment on human rights and dignity which can cause psychological trauma and physical injury to patients in the psychiatric setting. This quality improvement project used a quasi-experimental design to implement the TeamSTEPPS educational program, an evidenced-based program to inform nurses about verbal de-escalation to reduce patient aggressive behavior that can lead to patient seclusion. The targeted patient population included all patients admitted 2 months prior to initiation of Team STEPPS (n = 388) and 2 months following completion of the education modules (n = 342). After the implementation of the educational program there was a statistically significant difference in the rate of charting aggressive behavior (p = 0.024). The pre rate was 17.3%, and the post rate was 11.4%. While there was not a statistically significant difference in the rate of seclusion events, (p = 0.349) there was a clinically significant reduction. The pre rate was 5.9%, and the post rate was 4.4%. The results of this study support the importance of educating psychiatric nurses on verbal-de-escalation to reduce patients placed in seclusion and decrease patients' aggressive behavior in the psychiatric settings.

Use of an educational intervention to increase screening for antenatal depression in an obstetrics and gynecology practice.

BACKGROUND: Depression affects approximately 12% of pregnant women and increases maternal and fetal risk during pregnancy and the postpartum period. The United States Preventative Services Task Force and the American College of Obstetricians and Gynecologists recommend that all prenatal care include depression screening. This study assessed the effectiveness of an educational intervention to increase screening for depression during prenatal care. LOCAL PROBLEM: The clinical site serves a socioeconomically and culturally high-risk population. Prior to the intervention, prenatal depression screening was not incorporated into prenatal care. METHODS: Health records of patients presenting for prenatal care to an obstetrics and gynecology clinic were analyzed before an educational intervention on prenatal depression was delivered to providers at the practice site. Data for prenatal depression screening rates, treatment plans, and patient demographic information were extracted and compared to determine compliance with antenatal depression screening guidelines. INTERVENTIONS: The primary intervention of this initiative is the provision of education on the importance of and techniques for prenatal depression screening, diagnosis, and treatment. RESULTS: Prenatal depression screening increased from 0% to 27% of patients following the intervention. No significant correlation was found between factors of age, gestational age, gravidity, parity, or marital status. A total of 2.8% of screened patients scored positive for severe depression, 5.7% indicated moderate depression, and 51% indicated mild depression. CONCLUSIONS: Education and training improves provision of prenatal depression screening, but further work is needed to improve the accurate and timely identification of depression, as well as its appropriate treatment, referral, and follow-up.

Using a Veterans Affairs Posttraumatic Stress Disorder Group Therapy Program With Refugees.

The PTSD Recovery Program, an intervention based on guidelines for the treatment of combat Veterans diagnosed with posttraumatic stress disorder (PTSD) that includes group therapy as adjunctive treatment to medication and individual therapy, was used for the treatment of PTSD in refugees at a clinic in central Texas. Eighteen clients diagnosed with PTSD completed 10 weekly group therapy sessions in addition to individual therapy and medication use. An in-service presentation educated providers on the PTSD Recovery Program and the group therapy intervention. Data were collected using a pre- and postintervention questionnaire. Statistical analysis supports the effectiveness of the PTSD Recovery Program as an adjunctive treatment for PTSD in the refugee population. Participant statements and provider satisfaction are included as qualitative data. Participant statements about symptom improvement, as well as providers' reported satisfaction with the PTSD Recovery Program, support this intervention as an effective adjunctive treatment for PTSD in the refugee population. [Journal of Psychosocial Nursing and Mental Health Services, 57(5), 21-28.].

Implementation of Nurse-Driven Standardized Protocols to Reduce Behavioral Health Patients' Length of Stay Within the ED: A Quality Improvement Initiative.

BACKGROUND: Patients presenting to the ED, with behavioral health crises in the United States, are frequently held for hours to days awaiting evaluation, medical clearance, and transfer to a behavioral health facility or discharge from the ED. Extended boarding of behavioral health patients can create an unsafe and potentially dangerous environment, placing additional demands on EDs. OBJECTIVE: Identify and improve processes that delay treatment for mental health patients in the ED. METHODS: A nurse-driven protocol was created to reduce wait times and length of stay for the behavioral health patients in the ED setting. The protocol has nursing initiate orders to reduce the time for ordering labs to receiving lab results leading to more timely medical clearance of behavior health patients. RESULTS: Over a 2-month time frame there was decrease in mean minutes from arrival of the patient to laboratory/diagnostic orders being placed and labs results available (time Pre N = 27.16 minutes; time Post N = 23.47 minutes;(p = .171). While not significant, there was an overall decrease in mean minutes of diagnostic results which decreased medical clearance minutes from pre-to post-implementation (time Pre N = 253.46 minutes; time Post N = 114.74 minutes; p = .546). DISCUSSION: While not statistically significance behavioral health patients experienced decreased length of stay in the ED creating improved patient care. IMPLICATION FOR NURSING: The expansion of the nursing role through standardized protocols provides appropriate and timely care to behavioral health patients.

Educating Nurses to Use a Brief Tobacco Cessation Intervention With Patients on a Mood Disorder Unit in a Midwestern U.S. Hospital.

BACKGROUND: Evidence shows that smoking cessation interventions are effective in reducing individual's smoking behavior. Despite tobacco cessation efforts, individuals with mental illness smoke more than do members of the general population. OBJECTIVE: This study's objective was to determine whether educating nurses to use an evidence-based brief tobacco intervention would improve educating patients on smoking cessation and lead to more patients accepting nicotine replacement therapy (NRT). METHODS: This study was conducted on a 28-bed mood disorder unit of a Midwestern U.S. psychiatric teaching hospital and used a pre/postchart review. Fourteen nurses participated in the education program that included a PowerPoint presentation, handouts, and weekly e-mails. RESULTS: Eight weeks after the educational program, statistically significant increases were found in nurses' electronic health record documentation of providing patient education on smoking cessation and patients' acceptance of NRT. CONCLUSIONS: This study's education program was successful in promoting smoking cessation education among psychiatric nurses, with an increase of patients accepting NRT. IMPLICATIONS FOR NURSING: Training nurses to use a brief tobacco intervention proved to be an effective short-term method for addressing the high rate of smoking among a group of psychiatric patients.

Improving patient education about tobacco withdrawal and nicotine gum use by registered nurses in inpatient psychiatry: A feasibility study.

WHAT IS KNOWN ON THE SUBJECT?: Many psychiatric inpatients use tobacco, but most psychiatric hospital units prohibit tobacco use. Psychiatric nurses do not receive adequate education about how to teach patients to best manage tobacco withdrawal symptoms. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Psychiatric nurses who receive a brief educational intervention about tobacco withdrawal symptoms and best practices for using nicotine gum may be more prepared to teach patients about these topics. In turn, patients may use nicotine gum more often during their hospitalization, leading to improved outcomes for them as well as for staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A simple educational intervention aimed at psychiatric nurses can result in positive outcomes for psychiatric inpatients who use tobacco. Patients who have a positive experience with stopping tobacco use while hospitalized may be more likely to commit to lifelong tobacco cessation afterwards. The results of this feasibility study demonstrate that additional research that builds on the work presented here is warranted. ABSTRACT: Introduction Tobacco use is prohibited in most psychiatric facilities in the United States, yet many psychiatric inpatients are tobacco users. Psychiatric nurses have reported inadequate education about best practices for managing tobacco dependence. Aim To explore the feasibility of an educational intervention for psychiatric nurses designed to improve their ability to educate patients about best practices for managing tobacco dependence, as well as effective use of nicotine gum. Method Fourteen nurses on a psychiatric inpatient unit at a community hospital were educated about the targeted topics. Chart reviews of nonequivalent pre-intervention and post-intervention patient groups were conducted to explore the outcomes of the intervention. Results Patients received more teaching, and used nicotine gum more often, following the intervention. However, no statistically significant differences between the pre-intervention and post-intervention patient groups were found. Discussion Educating nurses about best practices for managing tobacco withdrawal symptoms may have positive outcomes. Existing research suggests that such interventions may be most effective when support and structure are provided to ensure long-term practice changes. Implications for practice This feasibility study demonstrates that a brief nurse education intervention has the potential to improve the experience of tobacco withdrawal for psychiatric inpatients. Future research that expands upon the current project is warranted.

Complementary and Integrative Health Practices for Depression.

The current article reviews selected complementary health approaches for the treatment of depressive symptoms. Complementary and integrative health (CIH) focuses on the whole person with the goal of optimal health-body, mind, and spirit. Patient use of integrative health practices and products is increasing; therefore, providers must understand these practices and products and be able to recommend or advise for or against their use based on research and guidelines. Difficulty with the current limitations of research on CIH practices is discussed, as these studies often may not have the same rigor or scientific weight as conventional treatment research. Although some individuals may use certain treatment options alone, such as massage therapy, meditation, and supplements to diet, the article discusses ways to combine CIH with allopathic care. Nurse practitioners should be open to considering complementary practices for health care and knowledgeable to guide patients in making safe health decisions. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 22-33.].

Assessing Depression in the Primary Care Setting.

Depression affects almost 10% of the adult population in the United States but often goes unrecognized and untreated. The World Health Organization predicts depression soon to be the second leading cause of disability. Recognizing the signs and symptoms of depression and then feeling confident to treat are limitations many primary care providers acknowledge. In this study, significantly more patients were identified as moderately to severely depressed using the Patient Health Questionnaire-9 (PHQ-9) screening tool as compared to the clinic's usual care practice of patient self-report. This study examines the PHQ-9, an evidence-based screening tool, to assist primary care providers in identifying depression. It also offers evidenced-based algorithms and websites to assist primary care providers with treatment protocols. The purpose of this article is to evaluate whether screening patients for depression using the PHQ-9 questionnaire is an effective tool in identifying patients with depression compared to the clinic's usual care practice of self-report. Implementing an evidence-based screening tool in the primary care setting assisted identifying those at risk for depression. This study of 200 patients in the primary care setting demonstrated the effectiveness of using the PHQ-9 as an efficient and accurate depression screening tool. Results of this study were chi-square analysis revealed that a significantly higher proportion of patients were newly diagnosed with depression in the study group than in the comparison group, χ2(1, N = 200) = 9.96, p < .01.

Primary care management of depression in children and adolescents.

Depression is the most common mental health disorder in children and adolescents, and primary care is often the first point of contact for children and adolescents with depression. Depression impacts all areas of life, impairing academics and interactions with family and friends. The purpose of this article is to help NPs identify and treat children and adolescents presenting with depression in the primary care setting.

An application of Bowen family systems theory.

While nurse practitioners initially work with the identified patient, Murray Bowen maintains it is the reciprocal functioning of all the members of the family which contributes to the emotional intensity of the patient. The emotional symptoms of an individual are an expression of the emotional symptoms of the family, which are often embedded in patterns of behaviors from past generations. The purpose of this paper is to facilitate understanding Bowen's theoretical concepts of family systems theory and apply these concepts to a family in therapy.