Health Advanced Practice Nurses Research Articles

Nurse Reports of Moral Distress During the COVID-19 Pandemic.

COVID-19 was devastating for many frontline nurses embroiled in health care's response. Most media outlets reported from several large metropolitan areas in New York, California, and Florida, leaving other regions to wonder about the extent to which their nurses were suffering. The purpose of this article was to understand the specific needs and experiences of Northeast Ohio nurses caring for patients with COVID-19 before designing interventions targeting negative mental outcomes. This phenomenological study interviewed 16 Northeast Ohio nurses to understand their experiences of caring for patients with COVID-19. Although not asked about it directly, the participants' stories consistently included details that could be linked to moral distress. Two themes describing their lived experiences included "acquiring moral distress" and "living with moral distress." Additional findings are also reported separately because although they do not represent the lived experience of COVID-19 nursing, they did represent significant concerns that participants had for the future and are reported here to assist other researchers with the intervention design. Furthermore, these participants thought that participation in support groups with other nurses who cared for COVID-19 patients and possibly led by mental health advanced practice nurses offered the best intervention to process their trauma from the pandemic. The long-term effects of moral distress have been discussed routinely in recent literature and are further complicated by the effects of the COVID-19 pandemic. Threats to the shrinking workforce of nurses must be taken seriously and interventions to improve the mental health and morale of frontline nurses must be prioritized and tested.

Inclusion of Psychiatric-Mental Health Advanced Practice Nurses in Federal Behavioral Workforce Planning.

Psychiatric-mental health (PMH) advanced practice nurses have the education, certification, and licensure to address the need for providers who can deliver the full scope of mental health services and thereby increase access to mental health care. Although the PMH nurse practitioner (PMHNP) segment of this workforce is rapidly growing, it has scant visibility in workforce planning and the evolving national behavioral health workforce database. An understanding of PMHNP characteristics and practice roles seems to be lacking. Addressing this limitation demands clear messaging around this workforce's scope of practice and data indicating how PMHNP capabilities meet mental health treatment needs.

The differences between learned and practiced competences among nurses: An international pilot study

AimThe primary aim was to describe differences, if any, between learned and practiced competences among a convenience sample of Italian and Slovenian nursing staff; the secondary aim was to validate an instrument capable of measuring internationally such competences. BackgroundThe distance between competences learned and those practiced as a source of under- or over-education has not been investigated to date at the international level. DesignA explorative observational investigation was performed in 2019 by involving 426 Italian and Slovenian members of the nursing staff working in medical and surgical departments. The study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. MethodsMembers of the nursing staff (health care assistants, general nurses, specialist nurses and advanced nurses) were invited to complete the Nursing Competence Instrument based on the European Federation of Nursing Association’s four categories of the nursing care continuum, from health care assistants to advanced practice nurses. ResultsThe construct validity of the Nursing Competence Instrument indicated the presence of four identifiable dimensions (internal consistency ranging from 0.82 to 0.93). On average, the scores of the competences practiced were interestingly slightly higher than those learned among general care nurses. In contrast, health care assistants, specialist nurses and advanced practice nurses, reported to have learned importantly slightly lower as that practiced. ConclusionsAt the overall levels, nurses tend to apply what they had been thought; additionally, all profiles seem to rate at low ranges both the competences practiced and those learned, suggesting the need to maximise nursing competences, both in the classroom and in the daily practice. Mapping the degree of competences acquired in education, as applied in the clinical practice, might assist clinical nurses, nurse educators and health care managers to identify areas at need of improvement. Moreover, mapping differences (if any) across countries might have research, managerial and educational implications.

Sex Trafficking: A Literature Review With Implications for Health Care Providers.

Sex trafficking often goes unrecognized, yet is a pervasive issue that disproportionately affects marginalized populations. Survivors suffer adverse health effects and often present to health care facilities while still under control of their traffickers. Health care providers, including nurses and advanced practice nurses, lack understanding of risk factors, signs and symptoms, and means of offering assistance. A comprehensive literature search was conducted utilizing EBSCOhost and WorldCat. Studies were considered eligible for inclusion if subject matter dealt directly with domestic sex trafficking and included implications for health care or health care education. There are some identified risk factors that place people at higher risk for victimization and survivors may present for care with a common symptom, including physical and mental health issues. Barriers to care include both survivor and health care system characteristics; however, health care providers can undertake specific actions to help overcome these barriers. Health care providers are in a prime position to identify and assist sex trafficking survivors. However, they need to be aware of common risk factor presentations, and they need to be trained to offer assistance. Ongoing research is needed to determine the best way to develop, introduce, and evaluate these trainings.

Integrating behavioral health and substance use models for advanced PMHN practice in primary care: Progress made in the 21st century

The integration of behavioral health and substance use assessment and treatment has advanced in primary care settings in the 21st century yet the roles and practice of nursing remain unclear. This paper focuses on the Institute of Medicine (2011) Report on the “The Future of Nursing: Leading Change, Advancing Health”, and to what degree specialty of Psychiatric-Mental Health Nursing has advanced as it pertains to behavioral health integration. Each of the four domains (practice, education, leadership and policy) in the Report will be highlighted with recommendations for how Psychiatric-Mental Health Advanced Practice Nurses can lead the way in 2020 and beyond.

Advanced practice nurses led clinic in a psychiatric hospital: An outcome evaluation in Singapore

BackgroundAgeing population and rising patients' expectations, coupled with the shortage of physicians and the increasing pressure to contain health care costs, have resulted in rapid growth of advanced practice nurses (APNs), and the gradual shift of care from physicians to them. Though it was reported that APNs can provide safe, effective and quality care for patients, the evidence in mental health is lacking both locally and internationally. ObjectivesThis study evaluated the effectiveness of mental health APN-led clinic through examining the participants' clinical outcomes, satisfaction and perceived recovery. MethodsPre-post test study design was used, whereby 100 participants were surveyed by questionnaires, in addition to retrospective review of participants' medical records. Comparison was made from data obtained two years prior to and two years after participant's first consultation with APNs. ResultsParticipants had their psychiatric symptoms well-controlled (M = 24.71, SD = 1.18). There was no significant difference in readmissions (p = 0.320) and the emergency room visits (p = 0.320) over two years before and two years after participants' first consultation with APNs. However, there was a significant difference in default rates (p = 0.020). Participants seen by APNs had better attendance for their appointments than those seen by doctors. Participants reported being satisfied with APNs (M = 121.07, SD = 10.82), had good adherence to medications (M = 7.26, SD = 2.42), good perception of mental health recovery (M = 94.43, SD = 12.53) and had confidence in achieving their goals (M = 31.44, SD = 5.78). Characteristics of participants were not correlated with outcomes, with exception that age was correlated to drug adherence (p < 0.001). Satisfaction with APNs was also noted to correlate with mental health recovery (p < 0.001) and general self-efficacy (p < 0.001). ConclusionThis study supported the evidence that mental health advanced practice nurses can provide safe, effective and quality care for patients.

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.

Organizational Characteristics of Veterans Affairs Clinics With High and Low Utilization of Clozapine.

Twenty to thirty percent of patients with schizophrenia experience treatment resistance. Clozapine is the only medication proven effective for treatment-resistant schizophrenia. However, in most settings less than 25% of patients with treatment-resistant schizophrenia receive clozapine. This study was conducted to identify facilitators of and barriers to clozapine use to inform development of interventions to maximize appropriate clozapine utilization. Seventy semistructured phone interviews were conducted with key informants of clozapine processes at U.S. Department of Veterans Affairs medical centers in various U.S. regions, including urban and rural areas, with high (N=5) and low (N=5) rates of clozapine utilization. Interviewees included members of mental health leadership, psychiatrists, clinical pharmacists, and advanced practice nurses. Interviews were analyzed by using an emergent thematic strategy to identify barriers and facilitators related to clozapine prescribing. High utilization was associated with integration of nonphysician psychiatric providers and clear organizational processes and infrastructure for treatment of severe mental illness, for example, use of clozapine clinics and mental health intensive case management. Low utilization was associated with a lack of champions to support clozapine processes and with limited-capacity care systems. Obstacles identified at both high- and low-utilization sites included complex, time-consuming paperwork; reliance on a few individuals to facilitate processes; and issues related to transportation for patients living far from care facilities. Implementation efforts to organize, streamline, and simplify clozapine processes; development of a multidisciplinary clozapine clinic; increased capacity of existing clinics; and provision of transportation are reasonable targets to increase clozapine utilization.

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.

Development of integrated mental health care: Critical workforce competencies

In integrated care, a person will have his or her medical and behavioral health needs addressed within one health care system. Support for integrated models has grown with the increasing awareness of how the medical comorbidities of individuals with serious mental illness contribute to their morbidity and mortality, the prevalence of mental health problems in the general population, and the mental health issues among those with chronic medical problems. The enactment of effective integrated care will demand developing clinicians who are trained to work with mental health needs at various levels of intensity, who are capable of addressing complex comorbidities, and who operate from a person-centered approach to care. In this light we argue that given their unique skill set and clinical training, Psychiatric-Mental Health Advanced Practice Nurses could play a critical role in integrated care and present policy recommendations which support the development of the Psychiatric-Mental Health Advanced Practice Nurses role in such models.

Parenting Enhancement, Interpersonal Psychotherapy to Reduce Depression in Low-Income Mothers of Infants and Toddlers

Depressive symptoms and clinical depression are highly prevalent in low-income mothers and negatively affect their infants and toddlers. The aim of this study was to test interpersonal psychotherapy combined with parenting enhancement on depressive symptoms and parenting behavior, compared with an equal attention-control condition. Mothers (n = 226) of Early Head Start infants and toddlers from the southeastern and northeastern United States were randomized to the intervention delivered in-home by psychiatric mental health advanced practice nurses or an equal attention-control condition delivered by generalist nurses. Rigorous clinical depressive symptom and depression assessments and videotaped, coded mother-child interactions were used as baseline and 14-, 22-, and 26-week postintervention measures. Both the intervention and control groups had significantly reduced Hamilton Rating Scale for Depression scores at each subsequent time point compared with baseline (p < .0001). However, only mothers receiving the intervention showed a significant increase in positive involvement with their child, as measured by closeness, positive effect, affection, and warm touch at T4 (t = 2.22, df = 156, p < .03). Both intervention and control conditions resulted in symptom reduction, but only the intervention mothers showed significant interaction changes with their child, an essential step in reducing the negative child outcomes associated with maternal depressive symptoms. Results suggest that a combination of generalist and specialist nurses could be used to treat depressive symptoms in these mothers. Further study with longer postintervention observation is needed to see if, over time, the intervention led to longer-lasting symptom reduction.

DSM-5: Implications for Mental Health Nursing Education

Three broad areas related to changes in DSM-5 are addressed in this article, and their implications for mental health nursing (MHN) education are discussed. The first area is the changes in structure and in the classification and description of mental disorders; knowledge of these is necessary so that nurse educators can teach students about the new faces of pathology in DSM-5 and what these changes mean for their future practice. Second, nurse educators must prepare advanced practice nurses to deal with the realities of the issues, criticisms, and concerns surrounding use of the DSM, including the influence of market forces on diagnosis, the validity and reliability of diagnosis, and cultural bias in diagnosis. Finally, there are additional concerns in preparing primary care nurses (nurse practitioners [NPs]) for the changes to DSM-5. It is not only psychiatric mental health (PMH) advanced practice nurses who must be aware of DSM changes and issues. The majority of mental health care in the United States is given in primary care settings and NPs must be prepared to assess and diagnose psychiatric disorders. The challenge to PMH nursing education is twofold: upholding the clinical role of advanced practice nurses in delivering mental health care, and maintaining the humanism and emphasis on quality care that has long characterized PMH nursing practice.

Alternate Reality Conceptualization: Venturing Along the Fine Line Between Genius and Madness

Using A Beautiful Mind, a film about the troubled life of Nobel laureate John Forbes Nash as its focal source, this paper considers the difficulties people with mental illness struggle with in perceiving and experiencing reality. Relationships among the concepts of genius, madness, and alternate reality conceptualization are explored to establish perspective for a model illustrating the progression of paranoid schizophrenia. The importance of empathy in treating mental illness and the role that psychiatric mental health advanced practice nurses play in managing the care of people with paranoid schizophrenia are underscored. Topics for additional research are suggested.

A Call to Action for Evidence-Based Military Women’s Health Care: Developing a Women’s Health Research Agenda That Addresses Sex and Gender in Health and Illness

Women in the Army, Navy, Air Force, and Marines are serving in complex occupational specialties that sustain national policy and ensure combat effectiveness of our forces. Their roles have evolved from supportive roles during early conflicts to active roles in combat support and counterinsurgency operations today. Although women have received military health care over the past three decades, sex- and gender-specific care has been limited to reproductive needs and has rarely addressed military-specific health risks and outcomes. The complexity of military jobs and increased deployments to combat operations has led to increased occupational and health risks for women. As differences have been noted between men and women's deployment-related health outcomes, it is incumbent on the Military Health Care System (MHS) to create an evidence base that addresses sex and gender differences in the health of its service members. A working group of military women's health advanced practice nurses (APN) and research experts proposes to address this gap in knowledge and practices through sex- and gender-specific research. A sex-and gender-based research agenda for military women's health will be a valuable instrument to those who are dedicated to the health of this population, including members of the Army, Navy, and Air Force military nursing community. Using the knowledge that the research agenda generates, military health care providers can develop clinical practice guidelines, influence policy, and participate in program development to improve the health of servicewomen. Shaping a sex- and gender-specific military women's health research agenda will create the foundation for future evidence-based care.

Psychopharmacologic First-Line Strategies in the Treatment of Major Depression and Psychosis: A Survey of Advanced Practice Nurses

Developments in psychopharmacology have led to a broad range of medication choices for prescribing clinicians. Although there have been advances in drug development, less is known about the prescribing strategies used by psychiatric-mental health advanced practice nurses or the extent to which these practices reflect existing practice guidelines. This study examined the prescribing practices of advanced practice nurses attending a psychopharmacology continuing education program. Participants were surveyed about (a) first-line strategies for the treatment of major depression and first-episode psychosis and (b) choices for managing insomnia and the side effect of weight gain. Participants completed an onsite questionnaire regarding advanced practice characteristics and management of specific clinical situations. The majority of prescribing advanced practice nurses surveyed were psychiatric-mental health specialists. Approximately two thirds (65.9%) of the advanced practice nurses prescribed psychotropic medications, most often for depression. First-choice agents for depression and first-episode psychosis were selective serotonin reuptake inhibitors (97.3%) and atypical antipsychotics (93.9%), respectively. Interventions for insomnia and medication-related weight gain were more varied. For the advanced practice nurses surveyed, first-line strategies for depression and first-episode psychosis appear consistent with literature and practice guidelines. Future studies and educational offerings would benefit from addressing dosing and switching strategies and optimizing approaches for managing side effects. J Am Psychiatr Nurses Assoc , 2008; 14(2), 144-151. DOI: 10.1177/1078390308316124.

Perspectives on Psychiatric Consultation Liaison Nursing Psychiatric-Mental Health–Advanced Practice Nurses: Transforming Nursing Practice

Perspectives on Psychiatric Consultation Liaison Nursing Psychiatric-Mental Health–Advanced Practice Nurses: Transforming Nursing Practice

Using Data to Increase the National Presence of Psychiatric Mental Health Nursing

NURSES ARE PIVOTAL to safe patient care. It is projected that by bringing registered nurse (RN) ratios up to the staffing level of the top hospitals, 70,000 adverse outcomes could be avoided (Needleman, Buerhaus, Stewart, Zelevinsky, & Mattke, 2006). In addition to their contribution toward safe patient care, nurses provide a potential solution to the problems of the underserved and their lack of access to mental health care (Hanrahan & Sullivan-Marx, 2005). Psychiatric Mental Health (PMH) Advanced Practice Nurses (APNs) provide mental health services to the poorest and to the oldest of the old (Wilk et al., 2004), and, in at least 20 states, the proportion of APNs working in rural health settings almost double that of psychiatrists working in these settings (Hartley, Hart, Hanrahan, & Loux, 2004).

Advanced Practice Nursing in Home Health

Advanced practice nurses play an important role in the delivery of home health care. They possess the advanced knowledge and skills to improve the quality of care given to clients. The increasingly complex needs of those receiving home health services today make access to these providers imperative. Many clients may not have this clinical expertise readily available to them because of the relatively small number of certified home health advanced practice nurses. Programs in home health graduate education prepare nurses for this very much needed advanced practice role.