Mental Health Nurse Practitioner Research Articles

Psychotherapy Skills for Psychiatric Mental Health Nurse Practitioner Students in the Age of Competency-Based Education.

As the field of nursing moves toward competency-based education, faculty need to adapt teaching and learning strategies to meet standards for assessing core behaviors of graduate psychiatric mental health nurse practitioner students. This article reviews a psychotherapy skills-based learning assignment at Frontier Nursing University that was adapted to meet developing competency-based learning standards. The assignment utilizes prerecorded video scenarios to provide students with opportunities to reinforce psychotherapy skills during didactic coursework. Assessment is conducted via an analytic rubric and specific feedback is given to each student in writing.

Reliability of the Mental Health Nurse Competency Assessment Tool (ECOEnfSM): A pilot study

AimTo evaluate the reliability of the ECOEnfSM scale as a tool to assess the professional competencies of Mental Health Nurse Practitioners (MHNP) in their clinical practice. MethodA pilot study, observational, descriptive and cross-sectional, focuses on MHNP who have completed their Specialized Health Training Program (SHTP) in Spain. The data were collected by general and collaborators mentors of the Multiprofessional Teaching Units (MTUs). The Mental Health Nursing Competency Assessment Tool (ECOEnfSM) was used, which consists of three subscales and eight Competence Units (CU). A reliability and validity analysis were conducted (Cronbach's alpha and Spearman's correlation coefficient). ResultsThe Rotation Assessment subscales showed excellent reliability (r > 0.90) with high and very high correlations (r > 0.6) in all UCs with high levels of significance (P < .01). The Annual Assessment subscale showed good reliability (r > 0.80) with a medium and very high correlation (r > 0.4) with high levels of significance (P < .01). All UCs showed a good to excellent consistency (r > 0.80). The “Home Visits” assessment criterion showed heterogeneity of data due to there are few MTUs that fully develop it. ConclusionThe ECOEnfSM scale showed very high reliability in MHNP during their training program in Spain. The ECOEnfSM is considered the only objective tool in Spain to assess the professional competencies in this population.

Primary mental health care for adults with mild intellectual disabilities: a focus group study of care professionals' perspectives.

GPs and mental health nurse practitioners (MHNPs) often feel ill equipped to provide mental health (MH) care to people with mild intellectual disabilities (MID). This is worrying, as insufficient primary MH care may lead to more severe or chronic problems. To improve primary MH care for this patient group, account must be taken of the experiences and needs of GPs and MHNPs providing the care. To explore GPs' and MHNPs' experiences, needs, and recommendations for improvement regarding primary MH care for adults with MID. A qualitative study was undertaken using focus groups with GPs and MHNPs in the Netherlands. The focus groups were guided by topics based on an interview study with adults with MID receiving primary MH care. Transcripts were analysed by thematic analysis. Four focus groups, with 19 GPs and nine MHNPs, revealed four themes describing the needs and perceived complexity involved in providing MH care to patients with both MID and MH problems: (1) GPs' and MHNPs' struggles with adapting to challenging patient characteristics; (2) importance and difficulties of establishing a good doctor-patient relationship; (3) facilitating and hampering roles of the patient's network; and (4) GPs' and MHNPs' challenges to provide care in the healthcare chain. GPs and MHNPs often experience providing care and support to this patient group as burdensome. It is important to consider the MID throughout the MH trajectory, to invest in a strong doctor-patient relationship, and to establish a stable, sustainable network and coordinated collaborative care around the patient.

Fiabilidad de la escala de Evaluación de Competencias Enfermeras en Salud Mental: estudio piloto

AimTo evaluate the reliability of the ECOEnfSM scale as a tool to assess the professional competencies of Mental Health Nurse Practitioners (MHNP) in their clinical practice. MethodA pilot study, observational, descriptive and cross-sectional, focuses on MHNP who have completed their Specialized Health Training Program (SHTP) in Spain. The data were collected by general and collaborators mentors of the Multiprofessional Teaching Units (MTUs). The Mental Health Nursing Competency Assessment Tool (ECOEnfSM) was used, which consists of three subscales and eight Competence Units (CU). A reliability and validity analysis were conducted (Cronbach's alpha and Spearman's correlation coefficient). ResultsThe Rotation Assessment subscales showed excellent reliability (r > 0.90) with high and very high correlations (r > 0.6) in all UCs with high levels of significance (p <0.01). The Annual Assessment subscale showed good reliability (r > 0.80) with a medium and very high correlation (r > 0.4) with high levels of significance (p <0.01). All UCs showed a good to excellent consistency (r > 0.80). The “Home Visits” assessment criterion showed heterogeneity of data due to there are few MTUs that fully develop it. ConclusionThe ECOEnfSM scale showed very high reliability in MHNP during their training program in Spain. The ECOEnfSM is considered the only objective tool in Spain to assess the professional competencies in this population.

Psychiatric Mental Health Nurse Practitioner Job and Patient Outcomes: A Scoping Review

Psychiatric–mental health nurse practitioners (PMHNPs) offer a solution to the shortage of mental health care providers in a time of increased mental health demand. However, little is known about their job and patient outcomes. This scoping review aimed to explore PMHNP job outcomes, including satisfaction, burnout, and quality of work life, and patient mental health outcomes of PMHNP-delivered care. Twenty-four articles met the inclusion criteria and were published from January 2002 through October 2023. The existing research suggests that PMHNP-delivered care results in positive patient mental health outcomes for a variety of mental health conditions. For job outcomes, further research is warranted.

Implementation of a Perinatal Mental Health Program in a Private Maternal–Fetal Medicine Practice [ID 2683639

INTRODUCTION: The American College of Obstetricians and Gynecologists (ACOG) recommends that treatment for mental health disorders be equitably available and accessible to all pregnant women. We detail the implementation of a perinatal mental health program within a statewide maternal–fetal medicine (MFM) practice. METHODS: A retrospective quality improvement study was conducted among pregnant patients at a large, private MFM practice in New Mexico from October 2021 to September 2023. The primary outcome aimed to describe implementation of a perinatal mental health program and determine the demand for care of mood and anxiety disorders among pregnant patients being seen for antenatal high-risk obstetric care. RESULTS: In October 2021, an initial psychiatric mental health nurse practitioner (PMH-NP) employed by our MFM practice began providing care to pregnant patients. In June 2022, a second PMH-NP joined and a third was added in February 2023. No advertising of this new program was conducted to better serve existing patients. Patients are screened during each MFM visit with the Patient Health Questionnaire 9 (PHQ-9), a nine-item depression scale. Patients scoring higher than 4 were offered consultation with the PMH-NP and the patient elected to then schedule the visit. Additionally, patients with mood or anxiety disorders listed on their active problem list were queried by a clinician, offered consultation with the PMH-NP, and the patient elected to then schedule the visit. In 2021, 47 patients were seen with a total of 96 visits. In 2022, 284 patients were seen with a total of 1,046 visits. In 2023, 367 patients were seen with a total of 1,331 visits. CONCLUSION: Although ACOG recommends mental health treatment be available for all pregnant women, New Mexico lacks sufficient services. Implementation of a perinatal mental health program integrated within our MFM practice was successful with strong uptake by patients and year-over-year growth.

Advancing Behavioral Health Equity Through Telehealth and Remote Training of Newly Certified Psychiatric-Mental Health Nurse Practitioners.

Rural communities are disproportionately impacted by acute shortages of mental health providers. This problem, combined with complex behavioral health conditions, elicited the need for a university-based, remote telepsychiatric traineeship for newly board certified psychiatric-mental health nurse practitioners (PMHNPs). The Psychiatric Advanced Practice Registered Nurse TechNology Enhanced Residency (PARTNER) Program was developed to advance behavioral health equity by increasing state-wide access to care, removing geographical barriers, and enhancing PMHNP workforce readiness by strengthening trainees' ability to manage complex behavioral health conditions. In a southeastern state over a period of 3 years, six PMHNPs cumulatively provided behavioral health services to 1,195 patients, managed >118 diagnoses, and completed 3,535 visits, with 95.6% of visits comprising provision of care to patients residing in rural areas. Care was provided through the implementation of a collaborative-interdisciplinary-care model provided by route of telehealth and comprising a partnership between PMHNPs and patients' primary care providers. The training program enhanced providers' clinical proficiency, improved patient outcomes, and increased the number of skilled providers trained to manage patients with complex behavioral health conditions. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 19-24.].

The psychiatric-mental health nurse practitioner as coordinating practitioner in the Netherlands: A multiple case study.

Psychiatric-mental health nurse practitioners (PMHNPs) in the Netherlands have been allowed to perform the role of coordinating practitioner (CP) since 2018. This role is reserved for mental health care specialists who are trained and qualified at the master's degree level. Earlier studies have not addressed how PMHNPs perform that role and what mechanisms and contextual factors determine their performance. This understanding could help optimize their performance in this role and promote effective deployment of PMHNPs in mental health care. To understand how PMHNPs perform this role and what mechanisms and contextual factors underlie that performance. A multiple case study involving PMHNPs who work in various settings as CPs. Data were collected and analyzed using the realistic evaluation approach. We identified four mechanisms related to the performance of PMHNPs in the role of CP: (1) autonomous performance; (2) unique expertise; (3) accessibility, availability, and professional involvement; and (4) additional roles. The extent to which these mechanisms are present is largely determined by organizational factors, team factors, and individual factors. Psychiatric-mental health nurse practitioners are seeking to identify and interpret the role of CP. This study helps to elucidate the mechanism of role performance by PMHNPs and what they should focus on to deliver effective and patient-centered mental health care. Policymakers, health care professionals, and educators should consider the mechanisms and contextual factors to facilitate and support PMHNPs' employment and training in the role of CP.

Descriptive Analysis of Student Diagnostic and Documentation Skill Development in a low Fidelity Simulation in Psychiatric Nurse Practitioner Education.

Nursing educators face challenges in helping registered nurses prepare to be psychiatric nurse practitioners. Nursing educators must consider the variation of students' skill sets, experience levels, and the shortage of preceptors. Simulations can help overcome limited clinical sites and standardize skill acquisition. High-fidelity simulations can be helpful but are labor-intensive and expensive. Low-fidelity simulations are adaptable to fit the learning needs of psychiatric nurse practitioner students but little research has evaluated these simulations. This paper evaluates a series of low-fidelity interventions used to help students learn diagnostic criteria, treatment decisions, and documentation. A retrospective descriptive analysis was performed on the results of all students in five cohorts in a psychiatric nurse practitioner course (n=68) on 45 low-fidelity online simulations over five years during the course on advanced psychiatric nursing of adults. Diagnostic notes were graded on four criteria by a psychologist or a psychiatric nurse practitioner. A representative sample of grades on eight notes were analyzed for this manuscript. Survey responses from the students in one cohort were obtained to evaluate their confidence levels and perceptions of simulation utility and responses were analyzed using descriptive and qualitative methods. The overall mean of description, detail, completeness, and professionalism increased from 7.6 (out of 10) to 9 over the semester with statistically significant improvements in all four areas. The strongest correlation was between detail and completeness and the weakest correlation was between professionalism and description. Students reported that they found significant value in the low-fidelity simulation exercises. This analysis demonstrates one of the first efforts to analyze low-fidelity simulations for psychiatric nurse practitioner students. The data indicate these simulations can help students improve their confidence and skills in several areas.

Comparison of industry payments to psychiatrists and psychiatric advanced practice clinicians in the USA, 2021: a cross-sectional study

ObjectivesTo compare industry payment patterns among US psychiatrists and psychiatric advanced practice clinicians (APCs) and determine how scope of practice laws has influenced these patterns.DesignCross-sectional study.SettingThis study used the publicly...

Just Another Patient? Student Reflections on Providing Mental Health Care to Transgender and Gender Expansive People During Simulated Encounters.

This study analyzed psychiatric-mental health nurse practitioner (PMHNP) students' reflections following a virtual simulated encounter with a patient who identified as transgender or gender expansive (TGE). To reduce mental health disparities, PMHNP students must be prepared to deliver affirming care. Engaging in and reflecting on simulated encounters with standardized patients can improve PMHNP students' affirming care competency. A thematic analysis process was used to analyze student reflections during simulation debriefings. Five themes emerged: application of affirming care principles, recognizing minority stressors, treating all patients the same, desire to learn more, and valuing authentic practice. PMHNP students' reflections on the experience of providing care to a standardized patient who identified as TGE support the use of virtual simulations to prepare future providers to deliver affirming, person-centered care.

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.

Student-Led Stress Reduction Support Groups: A Qualitative Program Evaluation.

Burnout and attrition in nursing have been accelerated by the coronavirus disease 2019 (COVID-19) pandemic. Nursing students experience greater stress than non-nursing students but often lack adequate institutional support to build resiliency. Support groups are an effective strategy for processing stress that are underused in nursing education. An innovative online stress impact course was developed at a college of nursing to address students' stress during the pandemic. The course culminated in a voluntary virtual support group led by a Psychiatric Mental Health Nurse Practitioner graduate student. The aim of this qualitative program evaluation was to determine how graduate nursing students experienced the stress support group. This study used qualitative exploratory analysis of support group reflections from 47 graduate nursing students. Four themes emerged: (1) Making Positive Connections; (2) Leveraging Skills to Manage Stress; (3) Beneficial; and (4) Facing Trauma. Graduate student-led support groups are a feasible and effective strategy to mitigate stress and improve nursing student resiliency. [J Nurs Educ. 2023;62(12):711-715.].

Perspectives on APRN prescribing of medications for opioid use disorder: Key barriers remain

IntroductionDeaths from drug overdoses are rising dramatically in the United States. Treatment for opioid use disorders may include behavioral treatments as well as medications for opioid use disorders (MOUD). Buprenorphine can be prescribed by physicians, nurse practitioners (NPs), other advanced practice registered nurses (APRNs), and physician assistants (PAs) and required a training and a federal waiver until recently. The number of NP MOUD prescribers grew steadily over the past decade, but research has identified state-level scope of practice regulations as a barrier to NP MOUD prescribing. This article explores the contributions of, and remaining barriers faced by NP and other APRN MOUD prescribers. We describe qualitative findings from a study of NPs and other key stakeholders involved in MOUD treatment in four states with two differing levels of regulatory structure. MethodsIn this qualitative study, we conducted site visits and semi-structured interviews with NPs and other APRNs, physicians, clinic managers, and regulators in four states including New Mexico and West Virginia (full practice authority for NPs), and Ohio and Michigan (which require physician supervision). Interview notes were entered into a qualitative software package and coded and reviewed by two members of the research team. Data were grouped into key themes. ResultsA total of 76 participants participated in individual or small group interviews in the four states. We found key themes and several subthemes that describe NP practice in MOUD. Participants described key contributions of NP engagement in MOUD, including increasing access, serving rural areas, the unique role of psychiatric NPs, and the value of the nursing model of care in working with people with substance use disorders (SUD). Participants also identified barriers including scope of practice regulations, other regulatory barriers, stigma, and lack of supportive services to address psychosocial needs. ConclusionsThe waiver requirements were eliminated at the end of 2022 in federal budget legislation. Other barriers for NP and other APRN prescribers remain and should be addressed in practice, and in state and federal regulations. Research needs to explore the impact of the waiver elimination on MOUD prescribing and access to services.

Psychiatric mental health nurse practitioner student knowledge and perceptions of pharmacogenetic testing.

Psychotropic medications are typically prescribed in a trial-and-error fashion, and some providers are beginning to utilize pharmacogenetic testing (PGx) as a supplemental prescribing tool in treatment decision making. PGx testing shows potential in enhancing provider insights into personalized prescribing for patients by examining genetic information related to drug metabolism. Literature points to providers' lack of knowledge in PGx interpretation as a main barrier, including psychiatric mental health nurse practitioners (PMHNPs). The aim of this study was to measure a difference, if any, in the knowledge and perceptions of PGx after implementation using a pre-post design. This study implemented an educational intervention on graduate nursing students (n = 15). Data were collected by using a pre- and post-interventional questionnaire. Results demonstrated a significant difference in findings related to students' knowledge (p < 0.001), students' skills related to pharmacogenetics, (p < 0.001), as well as students' perceived ability to implement pharmacogenetics into their practice, (p = 0.028). The authors propose that the knowledge gained from the study demonstrates the importance of introducing PGx education into the PMHNP curricula and to prepare future PMHNPs to confidently utilize PGx in their clinical practice.

Medications for opioid use disorder: An interactive educational program developed for the nurse practitioner curriculum.

Opioid overdose deaths remain a major public health concern in the United States and led to the recent changes in regulations that allow nurse practitioners (NPs) to prescribe buprenorphine without the previously required Drug Addiction Treatment Act waiver. Previously, waiver requirements included 24 hours of opioid use disorder (OUD) and medications for OUD (MOUD) training. Although this training is no longer required, NPs need education related to providing nonstigmatizing care to individuals with OUD and safe MOUD prescribing practices. A combination of online didactic modules, in-person simulation activities, and experiential learning was provided to psychiatric mental health NP (PMHNP) and family NP (FNP) students enrolled in a Doctor of Nursing Practice (DNP) program. OUD was presented through a chronic care lens to normalize treatment and decrease stigma, and harm reduction principles were included to increase safe prescribing of MOUD. Fifty-six students completed the didactic training, 51 students participated in the simulation, and 11 students completed shadowing experiences with an experienced MOUD provider. Psychiatric mental health NP and FNP graduates of this DNP program have the knowledge and skills to provide MOUD to individuals struggling with OUD, thus potentially increasing access to care and decreasing overdose deaths.

Improving Anxiety and Depression in Pregnant Mothers Participating in Nurse Home Visitation.

The perinatal period is a time of significant adjustment for mothers, which may lead to alterations in mood that affect maternal mental health, which may also impact child development. The current article details the effectiveness of the addition of a psychiatric-mental health nurse practitioner (PMHNP) and mental health training for nurses on the anxiety and depression screening scores of mothers enrolled in a home visitation program. For clients with elevated anxiety and depression scores, the percentages of those who were referred to and received mental health services increased after the program's addition of the PMHNP and mental health training. Implications for future research and practice include continued focus on maternal mental health with improved access to assessment and treatment for all clients within home visitation. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 49-55.].

Use of Simulation to Integrate Behavioral Health Into Primary Care Nurse Practitioner Programs.

Identifying and treating acute and chronic behavioral health conditions is integral to primary care practice, yet primary care nurse practitioner (NP) training models do not meet the demand for integrated behavioral health practices. Simulation offers an effective pedagogical tool for integrating behavioral health training in primary care. With support from federal funding and external consultants, new didactic and complementary simulation curricula in integrated behavioral health care were introduced in the primary care and psychiatric mental health NP programs at a school of nursing. Two rounds of this curricular innovation were implemented and evaluated across specialties. Ninety-seven students participated in the training and reported enhanced behavioral-health assessment and hand-off skills, greater confidence in applying core content, and improved communication skills. Thoughtfully designed simulation offers an important tool for developing integrated behavioral health competencies that will help prepare future primary care clinicians meet the needs of patients and communities. [J Nurs Educ. 2024;63(2):128-133.].

Guidance on Entering Into Agreements With Psychiatric Nurse Practitioners

Guidance on Entering Into Agreements With Psychiatric Nurse Practitioners

In Case You Haven't Heard…

In Case You Haven't Heard…