Advanced Practice Psychiatric Nurses Research Articles

Diverse Geriatric Workforce Education History, Needs, and Opportunities: Focus on Psychiatric Advanced Practice Nurses

Primary TopicAdvanced Practice Nursing History and Current State of Education Update Secondary TopicExploration of opportunities for filling educational gaps for subspecialty geriatric psychiatry training in Diverse WorkforceThis symposium is sponsored by the AAGP IDEA Committee.Advanced practice nurses are continuing to grow as partners of care for the geriatric psychiatry patient population. With increasing specialty workplace shortages across acute, ambulatory, and long-term care settings and growing numbers of geriatric psychiatrists retiring and less coming into the field, there is need to increase interprofessional collaboration with advanced practice nurses. The variety of advanced practice nurses practicing in the field has led to understandable confusion surrounding educational standards and experience from physician colleagues.Advanced nursing education has evolved over decades adapting to the needs of the ever-changing healthcare system and patient needs. Advanced practice nurses came in existence to assist in providing care to the underserved and often rural populations that struggled to maintain physician employment. The first advanced practice nurse specializing in the field of psychiatry was the certified nurse specialist. This role originally encompassed a larger focus on psychotherapy. Over decades and changes in healthcare, there was a larger call for psychiatric prescribers due to psychiatrist shortage, leading to the development of the psychiatric nurse practitioner role. Psychiatric nurse practitioners are board certified to provide psychiatric healthcare across the lifespan but are considered generalists until provided experience and training in specialty areas. Psychiatric nurse practitioners specializing in geriatric psychiatry do not currently have any additional academic institution driven training, but become specialists through mentorship from geriatric psychiatrists, nurse practitioners, or physician assistants within depth knowledge in geriatric mental healthcare. They also engage with continuing medical education, professional organization involvement, and gain clinical experience at bedside and in advanced practice nursing. Some advanced practice psychiatric nurses come into geriatric psychiatry practice from a calling and passion for this population, while others find their career gravitates towards this population as a response to a call from the community in need of care. There is desire and need for increased standardized educational opportunities for advanced practice nurses who are passionate about caring for the mental health needs of older people, and a hope that geriatric psychiatrists may offer assistance and guidance with the interprofessional united goal to improve access to quality care to our geriatric patients.

Addressing Psychiatric Workforce Shortages: The Role of Advanced Practice Psychiatric Nurses and Physician Assistants.

Back to table of contents Previous article Next article Controversies in Psychiatric ServicesNo AccessAddressing Psychiatric Workforce Shortages: The Role of Advanced Practice Psychiatric Nurses and Physician AssistantsRachel M. Talley, M.D.Rachel M. TalleySearch for more papers by this author, M.D.Published Online:7 Feb 2023https://doi.org/10.1176/appi.ps.20220599AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Metrics KeywordsNursing/psychiatricEconomicsstaffingPDF download History Published online 7 February 2023

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.

Hope-inspiring competence as a high-quality mental health nursing care in recovery-oriented practice

IntroductionHope should be fostered by providing information to help service users develop an understanding of psychological difficulties and encourage an active role in their self-care. This might include providing an open caring environment, nurse presence, comfort/pain relief, and involving patients in their care.ObjectivesTo analyze the critical importance of hope-inspiring competence as a high-quality mental health nursing care in recovery-oriented practice.MethodsThis was a reflective and discursive study based on experiential aspects of hope in mental health recovery.ResultsHope and hopelessness are important determinants of mental health. Hope has a positive influence on people’s mental health, on increasing comfort and satisfaction with life and on reducing negative emotions and suicide, decreasing the predisposition to addiction, and preventing family exhaustion, with a predictive effect on subjective well-being and protection of mental health. The concept of hope-inspiring competence is introduced to denote a relatively high level of the Advanced Practice Psychiatric Nurses ability to instil and maintain hope for recovery in people with mental health disorders.ConclusionsThe evidence seems to point to the importance of incorporating hope in collaborative strategies to promote mental health and manage mental health disorders. Despite this recognition of the role of the specialist nurse in psychiatric-mental health in training for hope, the way it develops in the context of specialized practice lacks evidence and visibility. A vision of recovery from mental illness exists, and hope, trust and self-determination should be incorporated into all treatment models.DisclosureNo significant relationships.

Effective Partnership Care Models with Advanced Practice Psychiatric Nurses.

The unmet behavioral health treatment needs of children and adolescents have become a public health crisis in the United States, with only 20% of youths obtaining assessment and intervention when indicated. Workforce shortages, including mental health professionals who can provide pharmacologic intervention within an appropriate biopsychosocial context, directly impede our ability to address this crisis. The authors examine the history, education, regulation, and practice of advanced practice psychiatric nurses and consider models of collaborative practice that can be beneficial across treatment settings in order to provide better care of vulnerable youth in ways that foster partnership rather than competition.

Specialization Within a Specialty: Advanced Practice Psychiatric Nursing Pathways for the Greatest Good.

Dr. Hildegard Peplau's theory on the primacy of the therapeutic interpersonal relationship remains central to the role of the psychiatric-mental health advanced practice nurse (PMH APN). In 1989, Peplau published her thoughts on how World War II (WWII) shaped early PMH APN practice. Following WWII and the return of hundreds of thousands of previously mentally healthy service members with combat-related psychiatric symptoms and disorders, the prevailing societal beliefs about mental illness began to shift from an innate/inherited etiological perspective to a broader appreciation of the additional contributions of social and environmental factors to mental well-being. With that awareness came a decrease in stigma and a shift from housing patients in psychiatric hospitals to treating them in community settings. The coronavirus 2019 (COVID-19) pandemic has likewise affected societal beliefs through exposure to the mental toll of massive infection rates, loss of life, social isolation, and other downstream consequences. During these times of crises, psychiatric nurses and educators are challenged to provide innovative solutions to meet the increased demands for psychosocial care. [Journal of Psychosocial Nursing and Mental Health Services, 59(10), 13-18.].

Is There a Geriatric Mental Health Specialist in the House?

Is There a Geriatric Mental Health Specialist in the House?

Adaptation or Revolution: Telemental Health and Advanced Practice Psychiatric Nursing During COVID-19.

This article will describe the current COVID-19 crisis and the evolving mental health concerns associated with it, discuss how mental health practice has changed, and ways in which psychiatric mental health nurse practitioners (PMHNPs) can adapt and prepare for the future. A search of current literature on the COVID-19 crisis, and topics relevant to the mental health components associated with the pandemic are reviewed. Telemental health (TMH) and PMHNP practice are discussed as they relate to the unfolding picture of the viral pandemic. The COVID-19 crisis is having far-reaching implications for mental health treatment and in particular for PMHNPs in practice settings. There have been widespread consequences of the containment measures used for the protection and mitigation of the disease. One such result has been the inability of patients to have face-to-face contact with their providers. The role of TMH has become increasingly important as an adaptation in professional practice. Technology has rapidly transformed traditional practice due to the COVID-19 crisis and there is strong evidence that it is well accepted by patients and providers. It is incumbent on PMHNPs to embrace TMH and become educated on best practices and TMH services.

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

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. Recent neurobiological findings support the use of augmenting pharmacological agents, neuromodulation techniques, and esketamine as effective in achieving remission for those with TRD. 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.

Exploring the thinking, reasoning and clinical approach of expert child psychiatric nurses.

Expert nurses are characterized by their deep knowledge of patient situations and understanding of patients in the context of their total situation. We know of no studies that have focused on the expert practice of child/adolescent (C/A) psychiatric mental health (PMH) advanced practice nurse. The purpose of this study was to gather information on how expert C/A advanced practice psychiatric nurses (APPNs) view their role and assess/treat children and adolescents with complex mental health issues. Expert C/A APPNs were interviewed by one of the two investigators using a semi-structured interview guide. All interviews were audiotaped and transcribed. This was a qualitative descriptive study and in line with that method, interview content was open-coded and examined for themes that were collapsed into categories. Fifteen C/A PMH APPNs were interviewed. Initial categories that were distilled included descriptions of their commitment to the population, development of families as partners, an expanded approach to medication management, and how they demonstrate expertise. Expert nurses adopt an invaluable approach to children and families-inherently patient and family-centered. They view the child/teen in terms of the multiple contexts of their lives.

An Old Treatment for an Even Older Problem: Does Psychoanalysis Have a Role in the Treatment of Addictive Disorders? A Review of the Literature.

The fact that addictive disorders have a significant negative impact on the health of the global population is well documented in contemporary health literature. What is less well documented is the uncomfortable realization that the tools in our armament to help individuals who struggle with addictive disorders are limited. Many individuals will spend their lives "cycling" through the addiction treatment continuum only to again be met with relapse. Third-party reimbursement for addiction treatment has focused on time-limited treatments and "brief" therapies with an additional emphasis on support group attendance (aka "free" services) with minimal focus on the fact that brief therapies have poor evidence for efficacy. In this article, we explore an alternative to brief therapies by reaching back to the earliest and most comprehensive treatment we have for behavioral change-psychoanalysis. This article engages in a literature review to determine whether sufficient evidence exists for the use of psychoanalysis as a treatment for addictive disorders. Implications for advanced practice psychiatric nurses are discussed.

Designing and revising a cognitive behavioral group intervention for psychological distress among female university students

Background: Psychological distress in the form of depression and/or anxiety has been found to be common among university students, especially in females. Roughly one in five of Icelandic female university students exhibit elevated psychological distress, yet less than 30% of them do receive professional mental health care. To ameliorate the psychological distress a cognitive behavioral group therapy was designed to target the distress. The purpose of this paper is to describe the main steps in designing the respective intervention and the revisions made by the expert panel based on the validation of the preliminary intervention and the experience of the advanced practice psychiatric nurses therapists.Methods: The intervention design took place in four phases. Initially psychological distress was defined, secondly a literature review was conducted to see if there were effective interventions available to solve the problem. Thirdly the drafting of the intervention took place based on theory and evidence and finally the intervention was validated with quantitative and qualitative methods. The intervention was provided by two advanced practice psychiatric nurses in 4 sessions in groups of 5 to 8 females. An expert panel of 6 psychiatric nurses was formed to guide the intervention design, the delivery of the intervention and intervention validation.Results: The quantitative and qualitative validation of the preliminary intervention showed that psychological distress decreased and was acceptable to participants.Conclusions: The validation of the preliminary intervention provided the expert group with rationale for modifying the content and structure of the intervention in nine categories.

The chronic sorrow experiences of caregivers of clients with schizophrenia in Taiwan: A phenomenological study.

The aim of the article is to explore the chronic sorrow experiences of the caregivers of clients with schizophrenia in Taiwan. Descriptive, phenomenological, and purposive sampling and one-to-one, in-depth, and unstructured interviews were used. Data saturation was achieved after interviewing 12 participants. Narratives were analyzed using Colaizzi's (1978) method. Three themes and eight subthemes emerged, including encountering sorrow (disordered life, disintegrated self-esteem, little prospect for hope, and collapsed sense of security), talking with sorrow (cognitive change and transformation of action), and living with sorrow (living with defects and living with responsibilities). Advanced practice psychiatric nurses should take the emotional stability of caregivers into consideration. Caregivers should be encouraged and taught effective culture-oriented strategies for living with sorrow.

Experiences and Attitudes Among Psychiatric Mental Health Advanced Practice Nurses in the Use of Telemental Health: Results of an Online Survey.

Telemental health (TMH) growth is driven by recent trends in health delivery systems and disparities in access to mental health services. There are currently no standard educational guidelines to prepare psychiatric mental health advanced practice nurses (PMH-APRNs) in TMH delivery. To survey practicing PMH-APRNs across the United States about their experiences and attitudes about use of TMH. Eighty-three participants from the American Psychiatric Nurses Association online discussion board completed a nine-item survey. Length of time practicing as a PMH-APRN, TMH use in practice, populations served, and TMH background. A majority had been practicing as a PMH-APRN for less than a decade and had used TMH, although most reported no prior education or training in this delivery method. Participants did indicate a desire for TMH education. This survey affirms the prevalence of TMH use among PMH-APRN providers, lack of formal training, and necessity for standardized educational guidelines in TMH delivery.

Psychiatric Mental Health Nursing Advanced Practice Workforce: Capacity to Address Shortages of Mental Health Professionals.

There is a recognized shortage of mental health professionals licensed to provide the full scope of mental health services, including assessment, diagnosis, and prescribing. Psychiatric mental health advanced practice nurses (PMH APNs) have the education and licensure to provide these services, address provider shortages and increase access to services. Unfortunately, federal reports and mental health workforce studies inaccurately depict important characteristics of PMH APNs, particularly their scope of practice, a situation that creates misunderstanding and impedes workforce planning. This Open Forum provides an accurate depiction of the PMH APN workforce, its size, scope of practice, and its capacity to increase access to mental health services. Also considered are the implications of using integrated care to increase access to mental health treatment. PMH APNs could increase the reach of these collaborative care models, which require constructing interprofessional teams in which each provider practices to the top of his or her license.

Bearing Witness: The Lived Experience of Sitting With Patients

There is abundant literature focused on the practice of using hospital sitters as part of standard patient safety care. However, minimal attention has been paid to understanding the actual experiences of hospital workers as they sit with distressed and often agitated patients. With the overwhelming number of hospitalized patients who require sitters, attention must be paid to the healthcare workers' perspective. In this study a phenomenological approach was used to elicit the perceptions of these hospital sitters. Themes which emerged from the participant's lived experiences of sitting included: Accepting them, It's not about me, You're not alone, Taking it to heart, Lifts me up, and Supporting role, with an overarching focus of Bearing witness. Nursing implications for this study suggest that using advanced practice psychiatric nurses in med–surg settings may help to support the hiring and training of skilled sitters and lead to improved psychological nursing care. In addition, identifying health care workers who best "fit" the sitter profile may promote the role from one of safety surveillance to one of therapeutic engagement.

We are different: the voices of psychiatric advanced practice nurses on the performance of their roles

Background: Many studies have affirmed that psychiatric advanced practice nurses (APNs) perform multifaceted roles. However, only a limited amount of research has been conducted on their perceptions of the performance of their roles.Aim: To explore the lived experiences of psychiatric APNs concerning the performance of their roles.Design: Data were collected from individual semi-structured interviews and analysed using the interpretative phenomenological analysis method.Methods: The study was conducted in a hospital cluster in Hong Kong. Thirteen psychiatric APNs were purposively recruited.Results: Three themes were discerned, namely, ‘We are different’, ‘Who am I?’, and ‘I am who I am’.Conclusions: The findings can help psychiatric APNs and nurse administrators to better understand the needs of the role-bearers (APNs) and to develop strategies to support the development of advanced psychiatric nursing practices in Hong Kong and worldwide.

Communicating with colleagues and patients about acute bipolar disorder.

Patients with bipolar disorder require a collaborative care approach involving primary care doctors, psychiatrists, nurses, social workers, therapists, and other support to manage their illness. Psychiatric mental health nurses and advanced practice nurses provide important psychoeducation to patients regarding their diagnosis, medications, and other treatment strategies. Communication among the care team is critical to ensure that patients are adhering to treatment, being monitored for symptoms and adverse effects, and receiving follow-up and support to improve their functioning.

Recognizing signs and symptoms of bipolar disorder.

Psychiatric mental health nurses and advanced practice nurses play an important role in the assessment and care of patients with bipolar disorder. Using appropriate rating scales and diagnostic criteria can aid in the assessment of patients who present with a variety of symptoms. In this game-based CME activity, you will assume the role of a psychiatric mental health advanced practice nurse who must recognize the signs and symptoms of bipolar disorder and select appropriate treatment for a 20-year-old patient with suicidal thoughts.

Pediatric obsessive-compulsive disorder: an update for advanced practice psychiatric nurses.

Obsessive-compulsive disorder (OCD) may have an onset in childhood or adolescence resulting in significant functional impairment and disability into adulthood. There are frequently developmental differences in the content of the obsessions and compulsions in youth compared to adults. Lack of insight or shame may result in failure of the youth to seek treatment. This delay in treatment may lead to the development of other psychiatric comorbidities, including suicide. Evidence-based treatments for OCD include cognitive behavioral therapy and exposure/response prevention, and in moderate to severe cases, use of selective serotonin reuptake inhibitors is indicated. Advanced practice psychiatric nurses are in a unique position to provide psychoeducation, psychotherapy, and medications, if indicated, to youth with this condition to improve functioning and reduce morbidity and mortality. This article will provide an overview of the diagnostic criteria for OCD, etiologies, assessment strategies, differential diagnoses, common comorbidities, and evidence-based treatment options.