Mental Health Nurse Practitioner Research Articles

An Update on Billing and Coding for the Psychiatric-Mental Health Nurse Practitioner.

Nurse practitioners (NPs) possess expert clinical knowledge that can be optimized to ensure delivery of high-quality care. In the United States, NP scope of practice is generally expanding. With expanding scope of practice comes increased revenue potential, and in some cases, entrepreneurial opportunities for NPs. Therefore, NPs must be familiar with current procedural terminology codes to ensure appropriate billing and maximize reimbursement from payers. [Journal of Psychosocial Nursing and Mental Health Services, 60(2), 11-13.].

Community Focus Groups Inform Culturally Sensitive Nursing Telehealth Training Curriculum Development

Racial and ethnic minority youth and young adults experience disparities in mental health treatment. This study assessed mental healthcare needs among young adults to align graduate psychiatric mental health nurse practitioner (PMHNP) clinical training to community needs when practicing tele-psychiatry.

Where is the psychotherapy content in PMHNP programs?

Psychotherapy is the essence of the Psychiatric-Mental Health Nurse Practitioner (PMHNP) role. Yet much debate exists within programs as to the best way to include psychotherapy in an already loaded curriculum. Two large midwestern universities review their approaches to psychotherapy education; student evaluations measure the quality and effectiveness. Data revealed a high level of student satisfaction. Programs will vary on how to teach psychotherapy skills, but the use of psychotherapy within the PMHNP role is crucial and informs the entire practice. Examples of how others teach psychotherapy can inform educators of innovative ways to prepare PMHNP students to practice psychotherapy.

Intimate Partner Violence Standardized Patient Simulation for Nurse Practitioner Students.

Intimate partner violence (IPV) is a serious public health threat in the United States, affecting millions of individuals and families. The American Association of Colleges of Nursing recommends that nursing programs, both baccalaureate and graduate, provide students didactic training and clinical experience in the assessment and management of IPV. Our goal was to expose Psychiatric Mental Health Nurse Practitioner (PMHNP) students and Family Nurse Practitioner (FNP) students to a simulated IPV scenario so they are prepared to respond appropriately to a survivor's disclosure of IPV when they begin clinical practice. We integrated a patient simulation scenario into our PMHNP and FNP curriculum. A combined group of PMHNP and FNP students participated in a simulation in which the standardized patient provided an unlikely explanation for her injuries. If students inquired about abuse, the patient revealed that she had experienced IPV. A pre- and posttest survey was used to evaluate student knowledge gain before and after the participating in the scenario. A Related Samples Wilcoxon Signed Rank Test was used to evaluate the results. Compared with pretest scores, students demonstrated improved confidence in screening for IPV as well as responding to a disclosure of IPV. Simulation provides a method to enhance student knowledge of incidence, risk, and best practices in relation to the screening, assessment and management of IPV.

Psychiatric Emergencies and the Potential Role of Psychiatric-Mental Health Nurse Practitioners.

Emergency departments (EDs) are experiencing a worsening crisis of overcrowding, especially during the coronavirus pandemic. Persons experiencing psychiatric emergencies must be evaluated medically and screened for risks of harm to self or others before they can be cleared for transfer to inpatient units or discharged. Severe shortages of inpatient psychiatric beds can lead to hours or even days of costly boarding in the ED. The purpose of this article is to examine the potential role of psychiatric-mental health nurse practitioners in psychiatric ED care, from initial intake and medical clearance, screening for suicide risk, de-escalation, stabilization, and discharge. [Journal of Psychosocial Nursing and Mental Health Services, 59(3), 7-12.].

SBIRT and MI Training among School Nurses and Psychiatric Mental Health Nurse Practitioner Students: A Pilot Study of Competency and Acceptability

Madridge Nursing Journal is an excellent investment for nursing professional, hospitals, libraries, and academic institutes. This journal include general publications of interest to all those working in the nursing field. Reports of original work, research, reviews, and policy papers focusing on professional nursing are published.

Psychiatric mental health nurse practitioner student perceptions of integrated collaborative care.

To explore the outcomes of threading the Patient-Centered Integrated Behavioral Health Care Principles and Tasks Checklist (AIMS Checklist) into the curricula and experiential setting. A qualitative exploratory descriptive method with a constructivist epistemology was used to obtain in-depth student perspectives about their understanding, experiences, and process of applying Integrated Collaborative Care within the clinical setting. 24 Psychiatric Mental Health Nurse Practitioner Students (PMHNP) were divided into focus groups that yielded seven main themes and seven subthemes. Three of the identified themes emerged as opportunities for curriculum enhancement. The checklist was found to be a valuable tool in not only evaluating collaborative care but in closing the gap between didactic and clinical education in fostering student-preceptor discussion.

The Effect of Supervision Waivers on Practice: A Survey of Massachusetts Nurse Practitioners During the COVID-19 Pandemic.

While optimal utilization of the nurse practitioner (NP) workforce is an increasingly popular proposal to alleviate the growing primary care shortage, federal, state, and organizational scope of practice policies inhibit NPs from practicing to the full extent of their license and training. In March of 2020, NP state-specific supervisory requirements were temporarily waived to meet the demands of the coronavirus disease 2019 (COVID-19) pandemic in Massachusetts. The objective of this study was to examine the impact of temporarily waived state practice restrictions on NP perception of care delivery during the initial surge of the COVID-19 pandemic in Massachusetts. Mixed methods descriptive analysis of a web-based survey of Massachusetts NPs (N=391), conducted in May and June 2020. The vast majority (75%) of NPs believed the temporary removal of practice restriction did not perceptibly improve clinical work. Psychiatric mental health NPs were significantly more likely than other NP specialties to believe the waiver improved clinical work (odds ratio=6.68, P=0.001). NPs that experienced an increase in working hours during the pandemic surge were also more likely to report a positive effect of the waiver (odds ratio=2.56, P=0.000). Temporary removal of state-level practice barriers alone is not sufficient to achieve immediate full scope of practice for NPs. The successful implementation of modernized scope of practice laws may require a collective effort to revise organizational and payer policies accordingly.

The use of telehealth to increase mental health services access and promote medication adherence in rural locations.

Fifteen million residents living in rural locations in the United States struggle with mental illness, substance dependence, or comorbid conditions, and are not receiving adequate health care (CDC, 2017). Approximately 55% of the 3,075 rural communities in the United States lack psychiatric providers. A specialty mental health treatment facility in northeast Florida cannot meet the needs of the patients because of limited psychiatric-mental health nurse practitioner (PMHNP) on site. By design, patients are expected to be seen in the clinic every three months. A pilot project was initiated using telehealth as a venue for patient care as an alternative to a face-to-face consultation with a PMHNP. The project was implemented with adults diagnosed with schizophrenia, bipolar disorder, major depression, posttraumatic stress disorder, anxiety, and/or substance abuse. A 3-month pilot of telehealth consultations with a remote PMHNP tracking access, medication adherence at 30 and 60 days after the consultation, appointment follow-up, and patient satisfaction. Access increased from 4.86% to 10.19% following implementation of the telehealth model. Medication adherence was 82% at 30 days and 77.5% at 60 days, compared to a benchmark of 80%. In addition, 89% of patient responses indicated comfort with telehealth and a willingness to continue to see PMHNPs in this venue. Telehealth with PMHNPs was shown to be a viable option in rural locations to meet the needs of mental health and dual diagnosis patients. Because of this project, the facility increased to three remote PMHNPs in the telehealth role.

Psychiatric-Mental Health Nurse Practitioners in the Role of Coordinating Practitioners: A Survey Study

Psychiatric-Mental Health Nurse Practitioners in the Role of Coordinating Practitioners: A Survey Study

Should Pediatric Behavioral Health Issues be Treated by Primary Care Providers?

Should Pediatric Behavioral Health Issues be Treated by Primary Care Providers?

Challenges in Treating Children With Autism Spectrum Disorder: Implications for Psychiatric-Mental Health Nurse Practitioners.

Children who present to behavioral health care with autism spectrum disorder (ASD) often have overlapping symptoms and co-occurring disorders, such as attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, sleep-wake disorders, and/or emotional/behavioral dysregulation. The challenge for psychiatric-mental health nurse practitioners is to identify the modifiable symptoms and diagnosable disorders and develop a comprehensive treatment plan that reduces risk factors and promotes improved functioning. The current article presents an overview of evidence-based treatment strategies for co-occurring conditions. A child- and family-based collaborative approach with clear treatment goals in the context of an inter-professional care team, which includes the primary care provider, therapists, other relevant specialists, and teachers, has been shown to support children with ASD in becoming more successful in managing everyday stressors and regulating emotions and behaviors. Evidence-based assessment, monitoring, and educational resources for clinicians and parents are provided. [Journal of Psychosocial Nursing and Mental Health Services, 58(12), 7-12.].

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.

Empowering Psychiatric Mental Health Nurse Practitioners to Expand Treatment Opportunities for Veterans With Opioid Use Disorder.

Few veterans with opioid use disorder receive effective treatment despite the Veterans Health Administration's efforts to expand treatment by offering buprenorphine, a medication to treat opioid use disorder (MOUD). An insufficient prescribing workforce contributes to the underutilization of buprenorphine; however, nurse practitioners (NPs) can now obtain a waiver to prescribe this medication. This quality improvement project aimed to expand the prescribing workforce by educating psychiatric mental health NPs (PMHNPs) working in an emergency setting at a Veterans Affairs Health Care System about free MOUD training and empowering them to utilize buprenorphine treatment. Eleven PMHNPs were asked for their perception of prescribing buprenorphine. They were asked if they had an MOUD waiver and/or were aware of the free waiver training. The PMHNPs were educated on the importance and process of obtaining the DEA-X waiver, and then a post-intervention discussion was completed to determine if they completed the waiver training. At baseline, all 11 PMHNPs believed offering MOUD was important, but only three had the waiver to prescribe buprenorphine. After the education, three additional PMHNPs obtained the waiver and 10 planned to have the waiver in the next year. The department is planning to trial offering buprenorphine treatment, and PMHNPs at this facility are privileged to prescribe buprenorphine. In addition, five new PMHNP residents started or completed the training. This project shows the potential to increase veteran access to MOUD by emphasizing education and empowering PMHNPs to initiate treatment. Providing education regarding the importance of buprenorphine treatment in the emergency setting and delivering information about the free waiver training facilitated workforce preparedness.

Challenges Faced by New Psychiatric-Mental Health Nurse Practitioner Prescribers.

One of the main challenges that psychiatric-mental health nurse practitioner (PMNHP) students experience is preparing to prescribe medications by demonstrating psychopharmacological competency. To examine the challenges as they relate to this issue, self-reflective journaling narratives were evaluated from two cohorts of Post-Master's PMHNP program graduates, across each of two semesters of pediatric and adult clinical experience. The most prominent challenges reported by students were in regard to medication treatment adherence, decision making, and monitoring symptom-related outcomes. The narratives also demonstrate that reflection, combined with faculty- and preceptor-supported clinical education, assists PMHNP students in developing psychopharmacological competency. All PMHNP students described in this article were nurse practitioners before they began the program. By seeking to augment their competencies and through continued self-reflective learning and practice, they will improve access to mental health care for the populations they serve. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 7-11.].

Psychiatric Nurse Practitioners as Leaders in Behavioral Health Integration

With up to 70% of primary care visits prompted by psychosocial concerns, busy primary care clinics are increasingly addressing complex behavioral health (BH) needs. Substantial evidence demonstrates that the integration of BH into primary care improves access and outcomes, yet clinics face significant challenges in real-world implementation. This collaborative care integration project used psychiatric mental health nurse practitioner faculty as integration and BH specialists at an urban primary care clinic serving a diverse and largely indigent population. The project weathered leadership changes, information system shortcomings, and a shift to telehealth during coronavirus disease 2019. The initial outcomes include increased levels of integration and improved depression and diabetes metrics.

A brief cognitive behavioural intervention is cost-effective for primary care patients with medically unexplained physical symptoms compared to usual care

Objective: To assess the cost-effectiveness of a brief cognitive behavioural intervention for patients with medically unexplained physical symptoms (MUPS) provided by a mental health nurse practitioner (MHNP) in primary care in comparison with usual care.Methods: We performed an economic evaluation from a societal perspective alongside a cluster randomised controlled trial with 12 months follow-up. The primary outcome was quality-adjusted life-years (QALYs). Secondary outcomes were the RAND-36 physical component summary score (PCS), somatic symptom severity (Patient Health Questionnaire (PHQ-15), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale (HADS)). Missing data were imputed using multiple imputation. We used non-parametric bootstrapping to estimate statistical uncertainty. The bootstrapped cost-effect pairs were used to estimate cost-effectiveness planes and cost-effectiveness acceptability curves.Results: Mean total costs in the intervention group were significantly lower than in the usual care group (mean difference − 2300€, 95% CI -3257 to −134). The mean difference in QALYs was 0.01 (95% CI −0.01 to 0.04), in PCS 2.46 (95% CI 1.44 to 3.47), in PHQ-15 -0.26 (95% CI -0.81 to 0.28), and in HADS -0.07 (−0.81 to 0.67). At a willingness to pay of 0 € per additional unit of effect, the probability of the intervention being cost-effective was 0.93 for QALYs and 0.92 for PCS, PHQ-15 and HADS scores.Conclusion: Our intervention is cost-effective compared to usual care for patients with MUPS. Implementation of the intervention has the potential to result in a significant decline in costs. However, large scale implementation would require increased deployment of MHNPs.

Exploring Readiness for Teleprecepting in Psychiatric Mental Health Nurse Practitioner Training.

Telehealth offers a solution to many challenges in health care, including the shortage of psychiatric providers. Recently the need to limit patient and provider exposure to coronavirus disease 2019 (COVID-19) has escalated implementation of telehealth across the globe. As telehealth utilization expands, its role in nursing education and training requires systematic evaluation. Since publication of the National Organization of Nurse Practitioner Faculty white paper supporting telehealth in health care delivery and nurse practitioner education, several studies have demonstrated successful didactic instruction and training in telehealth. However, a recent literature review found no studies evaluating the use of telehealth technology as a means of precepting in clinical training. This small-scale qualitative study investigates the readiness of one behavioral health clinic to provide teleprecepting to psychiatric mental health nurse practitioner students. Two preceptors and one student were interviewed using a peer-reviewed semistructured interview guide using video chat. Responses were reviewed, coded, and categorized into themes. Thematic analysis of the interviews revealed three categories for consideration in establishing teleprecepting. Clinical factors, logistics, and comparison with traditional precepting are discussed. Interviewees viewed teleprecepting as a viable method of increasing access to clinical training. This project supports teleprecepting as a feasible strategy for improving access to clinical training and as a technological resource that merits systematic evaluation. Practice guidelines are needed for teleprecepting of advanced practice registered nurse students, and both preceptors and students may benefit from training to support best practices prior to implementation.

An Innovative Approach for Graduate Education for Psychiatric Nurse Practitioners.

A major transformation in nurse practitioner (NP) education is the emergence of post graduate residencies; their foci include (a) educating NPs in population health; (b) increasing clinical proficiency; and (c) incorporating quality and safety into practice. We describe a psychiatric NP residency program supported by an academic-practice partnership, known as the Veterans Affairs Nursing Academic Partnership for Graduate Education (VANAP-GE) between the Birmingham Veterans Administration Medical Center (BVAMC) and the University of Alabama at Birmingham (UAB) School of Nursing (SON) for a population of Veterans with complex mental and physical health needs. Topics which are covered include risks of suicide among Veterans, post-traumatic stress disorder, depressive and anxiety disorders, and substance use disorders. During this one-year traineeship during the first year after NP certification, residents engage in development of crucial skills for improving the future of U.S. health care. All residents are newly licensed PMHNPs, but some are also pursuing DNP degrees. For residents who are simultaneously enrolled in BSN to DNP programs, the additional clinical training afforded by NP residency education provides a natural laboratory for their projects with foci of quality and safety, leadership, and clinical scholarship. Reduction in NP turnover as well as cost savings of orientation and recruitment are significant benefits for the practice partner with zero vacancies since the partnership's inception. These multiple successes predict increased establishment of residencies as viable post graduate pathways for NPs.

Intimate partner violence in adolescents: Preventive strategies for psychiatric‐mental health nurse practitioners

Intimate partner violence (IPV) remains a significant public health problem that is associated with high rates of morbidity and mortality. IPV has become increasingly prevalent in adolescents, with 20% of adolescents between 13 and 18 years reporting physical IPV, and 9% reporting sexual IPV. To assure the best outcomes for adolescents at-risk for or experiencing IPV, it is critical for psychiatric-mental health nurse practitioners (PMHNPs) to implement preventive interventions, spanning from primary to tertiary prevention, to address IPV. The purpose of this paper is to provide an overview of primary, secondary, and tertiary preventative strategies needed to improve outcomes for adolescents experiencing IPV within the context of the socioecologial model. Utilizing PubMed, CINAHL, and PsycINFO, a literature review was conducted to identify relevant publications spanning from 2015 to present. Reference lists of identified articles were also searched. PMHNPs must be competent in psychoeducation and counseling, screening, and management of comorbidities and safety planning to assure best outcomes for adolescents exposed to IPV.