The Impact of Measurement-Based Care in Psychiatry: An Integrative Review.

BACKGROUND: The quality of mental health treatment has not progressed to the same extent as physical health treatment. Suboptimal mental health outcomes may be attributed to the lack of a systematic approach to tracking and measuring patient progress. In psychiatry, Measurement-Based Care (MBC) offers an objective, systematic approach to monitor clinical progress, evaluate treatment efficacy, and inform clinical decisions, yet remains seldom used in daily practice. AIMS: To identify the clinical impact of using MBC in psychiatry. METHODS: Using the Johns Hopkins Nursing Evidence-Based Practice Model as a guideline, this integrative review focused on the research query, "What is the clinical impact of Measurement-Based Care when treating patients with mental illness?" RESULTS: A total of nine articles met the inclusion criteria for this integrative review. The articles ranged from 2008 to 2021. The following themes were identified from the analysis of these articles: (1) the clinical impact of MBC, (2) provider attitudes about MBC, and (3) barriers to MBC implementation. CONCLUSIONS: MBC, augmenting usual standard care, provides an objective, systematic approach using quantifiable data to monitor symptom severity and treatment effectiveness. This review highlights the clinical benefits of MBC, including increased remission rates, lower risk of relapse, improved medication adherence, and strengthening the therapeutic alliance. Although this review provides an overview of the benefits of MBC in psychiatry, there remains a substantial practice gap warranting further investigation. Strategies must be developed to address barriers at the individual and organizational levels which impede the successful adoption of MBC.

Standardized Patients Versus Mannequins in Mental Health Simulation.

BACKGROUND: Mental health nursing simulation using various modalities can be useful in increasing student confidence, satisfaction, knowledge, and communication skills. Studies comparing the benefits of mental health nursing simulation using standardized patients versus mannequins are scarce. AIMS: The purpose of this study was to explore differences in knowledge, clinical learning, clinical reasoning, communication, confidence, and learner satisfaction when conducting mental health nursing simulation with standardized patients compared to mannequins. METHODS: A convenience sample of 178 senior level baccalaureate nursing students enrolled in the mental health nursing course participated in this study. Of the total sample, 41.6% (n = 74) participated in high-fidelity mannequin simulation and 58.4% (n = 104) in standardized patient simulation. Measures included a knowledge assessment, Satisfaction with Simulation Experience Scale (SSE), and a simulation evaluation survey. RESULTS: While knowledge levels increased regardless of simulation modality, clinical reasoning, clinical learning, communication, realism, and overall rating of the simulation experience were significantly higher among participants in standardized patient simulation compared to mannequins. CONCLUSIONS: Mental health simulations can be a useful learning tool for engaging in mental health scenarios in a safe simulated learning environment. While both mannequins and standardized patient modalities are helpful in increasing mental health nursing knowledge, standardized patient simulation has a greater impact on several other aspects including clinical reasoning and communication. Future multisite studies with larger samples are needed, including a wider variety of mental health scenarios.

Supporting the Safe Use of the Dorsogluteal Intramuscular Injection Site: An Evidence-Based Quality Improvement Project.

INTRODUCTION: Administering intramuscular (IM) injections is common in the adult mental health patient care setting, using the deltoid, vastus lateralis, ventrogluteal, or dorsogluteal site. Mental health nurses frequently use the dorsogluteal site to administer short and long-acting IM injections as specified in the drug package insert or because of patient agitation. However, the site is often not recommended due to the potential risk of nerve injury. AIMS: Aims of this evidence-based quality improvement project were to (1) determine the best evidence for supporting the safe use of the dorsogluteal site for short and long-acting IM injections and (2) implement this evidence through nurse education. METHOD: This project had two phases: Determining best evidence through an integrative literature review and implementing the recommendations to use the dorsogluteal site when directed by the drug package insert, clinical need, nursing judgment, or patient preference. Implementation followed the Plan-Do-Study-Act quality improvement process and involved written resources and simulation. RESULTS: Evidence supported the use of the dorsogluteal site in four instances and the importance of education. Nurses were highly satisfied with the education and opportunity to practice their skills with feedback during return demonstration. After studying nurses' follow-up survey results, a refresher simulation and medical center guideline were completed. There were no reports of IM injection patient injuries after 2 years and approximately 768 dorsogluteal and ventrogluteal IM injections in the academic medical center. CONCLUSION: Pursuing recent and possibly overlooked evidence provided guidance in supporting the safe use of the dorsogluteal site for IM injections.

Applying Bowen Theory to Psychiatric Assessment and Disposition in the ED.

BACKGROUND: A number of variables have been shown to influence whether an individual who experiences an emergency psychiatric assessment is admitted to a psychiatric hospital. This study focused on the theoretical orientation of the assessing clinician as a possibly influential variable. The theoretical orientation being studied was Bowen family systems theory or Bowen theory (Bt). Overall the Bt perspective looks at the family as the primary crucible that generates symptoms but at the same time as the natural unit and the best built-in resource to deal with those symptoms. AIMS: This study examined whether the theoretical orientation of the nurse psychiatric assessor would affect her inpatient admission rate of patients seen for psychiatric evaluation in an emergency department (ED). METHOD: A clinician/researcher with extensive experience applying Bt in clinical practice worked in a Crisis Management Service providing psychiatric evaluation and disposition in a busy community hospital ED. Given Bt's emphasis on the system rather than individual pathology, the clinician researcher hypothesized that her psychiatric hospitalization rate would be lower than the other clinical nurse specialists. A retrospective chart review analyzed 1 year of cases from all referrals that might have resulted in psychiatric hospitalizations (n = 1,801). RESULTS: The clinician/researcher's psychiatric hospitalization rate was significantly lower (p = .004) than the other clinicians. CONCLUSION: An approach to psychiatric assessment in the ED applied a Bt perspective in a way that significantly reduced psychiatric hospitalizations.

Utilization of an Innovative Psychoeducational Group for Veterans With Severe Mental Illness: A Program Evaluation of a Quality Improvement Initiative.

INTRODUCTION: Cognitive impairments-episodes of mania or psychosis, paranoia, and substance use-are common effects of serious mental illness, which can lead to stigmatization, social isolation, and a decrease in interaction with health care providers. These consequences can obstruct a person with serious mental illness ability to comprehend diagnosed mental disorders and to fully participate in treatment. Consistent with the Substance Abuse and Mental Health Services Administration Recovery Model for Disease Management, nurse practitioner residents in a mental health nurse practitioner residency program developed an interactive psychoeducation series to improve veteran health self-efficacy and self-management. AIM: The overall purpose of this sequential quality improvement initiative was to develop and deliver a psychoeducational series, which is both veteran centric and recovery oriented. METHODS: Series I of the project produced psychoeducational sessions based on collaborative interactions among veterans and members of the treatment team, with a focus on neurobiology, pharmacology, and evidence-based treatment recommendations. Through an innovative and interactive framework, Plan-Do-Study-Act cycles were utilized to bring about foundational themes and inherent changes in the psychoeducation delivery. With veterans' feedback and collaboration, Series II of the project was developed within the continuous improvement evaluations from Series I. RESULTS: Treatment collaboration between veterans and providers was fostered as veterans experienced learning, symptom recognition, and empowerment. CONCLUSION: This project is unique in that it is the first known review of a quality improvement initiative to incorporate concurrent changes in psychoeducational session delivery, involving veterans and their providers to foster collaboration.

Exploring Substance Use Disorder Nursing Competency in the Italian Context.

BACKGROUND: In Italy, the majority of people treated in Addiction Treatment Service are heroin users. Nurses represent a strategic position in the multiprofessional and multidisciplinary Addiction Treatment Service team. AIMS: To describe the addiction nurses' competency in the Italian context. METHOD: This research uses the qualitative approach to describes the addiction nurses' competency. The research was divided into two steps: ethnographic, to identify activities, habits, settings, critical issues and other distinctive features characterizing addiction nursing specific competencies, and a subsequent phenomenological semistructured interview to understand the lived and the meanings of the experience. RESULTS: The meaning units identified could be organized as follows: ability to manage unexpected events, work organization, and teamwork relationships, professional responsibility. CONCLUSIONS: Many of these described competencies, if considered in general terms, relate to any area of the profession. It is possible to understand their specificity by investigating the meanings and the values attributed to the personal experience This study attempts to develop and define an Italian addiction nursing competency framework.

Medical Cannabis and Psychiatric Disorders: Implications for Psychiatric Nurses.

OBJECTIVE: Cannabis use for medical condition has significantly increased over the past 20 years with 33 states and the District of Columbia passing laws legalizing medical cannabis. Five qualifying psychiatric disorders have been identified. The objective of this review article is to present a brief history of medical cannabis, the evidence for the qualifying psychiatric conditions, and to discuss the implications for psychiatric nurses. METHOD: A review of the literature on the five qualifying psychiatric disorders was conducted. Databases searched included CINAHL, PubMed, Cochrane Library, MedLine Plus, and EMBASE. Keywords were cannabis, medical cannabis, delta-9-tetrahydrocannabinaol, cannabidiol, and psychiatric disorders. RESULTS: The evidence that medical cannabis or cannabinoids is an effective treatment for the qualifying psychiatric disorders (e.g., posttraumatic stress disorder, agitation in Alzheimer's disease and other dementias, Tourette's syndrome, anxiety, and obsessive-compulsive disorder) is too weak and of low quality to recommend as an intervention at this time. A discussion of the implications of these findings for psychiatric nurses is offered based on the published guidelines by the American Nurses Association and National Council of State Boards of Nursing. CONCLUSION: There is a significant gap between evidence supporting the effectiveness of medical cannabis for psychiatric disorders and patient interest and use of cannabis for such conditions as well as other psychiatric symptoms. There are tremendous opportunities for psychiatric nurses to make an impact both clinically and be conducting research in this emerging field. We need to educate ourselves and our patients about the benefits and risks of medical cannabis and to help patients make informed decisions about their health care.

Psychiatric Nursing Workforce Survey: Results and Implications.

OBJECTIVE: The last national survey of psychiatric-mental health (PMH) nurses was conducted in 2016 and was limited to advanced practice registered nurses (APRNs). Data on the demographic and employment characteristics of the PMH workforce could inform how to optimize the PMH nursing workforce to address increasing demands for mental health services. The objective was to conduct a national survey of PMH registered nurses (RNs) and PMH-APRNs to gather data on their demographic, educational, and practice characteristics. METHODS: An email survey was administered between October 2020 and February 2021 to all members of the American Psychiatric Nurses Association and to all PMH-APRNs certified by the American Nurses Credentialing Center. Separate surveys included 51 questions (RN) and 52 questions (APRN). Survey questions were informed by several sources including the Minimum Data Set for the Behavioral Health Workforce. RESULTS: Surveys were completed by 4,088 PMH-RNs and 5,158 PMH-APRNs, with a combined response rate of 12.1%. Findings suggest that the workforce is aging but has increased slightly in diversity. In all, 62.4% of RNs reported a hospital as their primary employment setting, while the majority of APRNs (70.4%) practice in outpatient settings. Forty-four percent of the PMH-APRN respondents indicated that most of their patients receive federal insurance. CONCLUSIONS: Nursing must plan for significant retirements in the PMH workforce in next 5 years. Hospital-based practice continues to dominate PMH-RN roles but might be expanded to community-based settings teaming with PMH-APRNs in outpatient sites. Increasing the diversity of the workforce should be prioritized.

How Counseling Based on Acceptance and Commitment Therapy and Supported With Motivational Interviewing Affects the Perceptions of Treatment Motivation in Patients Diagnosed With Schizophrenia: A Qualitative Study.

BACKGROUND: Lack of motivation is a common phenomenon in treatment of schizophrenia. Despite information that various psychosocial approaches may help overcome lack of motivation, their content and nature remain uncertain. However, in recent years, there is an increasing interest in psychosocial interventions such as acceptance and commitment therapy (ACT) and motivational interviewing (MI) techniques in approaching individuals diagnosed with schizophrenia (IDSs). In this study, the therapeutic models of ACT and MI were combined to create an innovative integrative approach to address the problem of lack of motivation in IDSs. AIMS: This study was conducted to determine how a counseling program based on ACT and supported with MI affected the perceptions of treatment motivation in IDSs. METHOD: This study addressed the qualitative aspects of a doctoral dissertation designed as a quasi-experimental study that gathered both quantitative and qualitative data. RESULTS: As a result of the content analysis, three main themes and 10 categories that motivated IDSs for compliance with regular treatment were developed. The participants in the experimental group expressed a focused treatment motivation to participate in daily life activities and social relations, acceptance of illness, satisfaction with life despite side effects and leading a value-oriented life in comparison with the control group. CONCLUSIONS: Counseling based on ACT and supported with the MI technique is effective in improving treatment motivation in IDSs. This counseling may be implemented as an effective psychiatric nursing intervention for IDSs.

Telehealth and the Psychiatric Mental Health Nurse Practitioner: Beyond the COVID-19 Pandemic.

OBJECTIVE: Examine the advantages, disadvantages, and challenges of telehealth for the psychiatric mental health nurse practitioner (PMHNP) in practice and student education. Describe areas for future research and policy development regarding telehealth in PMHNP practice and training during and beyond the COVID-19 pandemic. METHODS: Review current evidence, standards of practice, and education for the PMHNP. RESULTS: Recent rapid pandemic-related shifts in utilization of telehealth for clinical practice and student education have highlighted the advantages, disadvantages, and areas in need of additional study. CONCLUSIONS: Postpandemic telehealth care delivery will likely persist or expand. PMHNPs must advocate for high practice and education standards.