Mental Health Nurse Practitioner Research Articles

Experience of Psychiatric Mental Health Nurse Practitioners in Public Mental Health.

Expansion of health insurance coverage under the Accountable Care Act has meant that millions of people are now insured for mental health treatment, but with no significant increase in the mental health workforce. Services of psychiatric mental health nurse practitioners (PMHNPs) may be best utilized to improve access to and quality of public mental health services if the financial, political, scope of practice, and treatment model barriers that limit their ability or willingness to practice in these settings are better understood. This article reports qualitative results from a study that assessed barriers and best practices in the use of PMHNPs in county mental health services in California. Results indicate that PMHNPs are valued for their "whole person" perspective, collaborative approach, and interpersonal communication skills, but that significant knowledge gaps, regulatory constraints, and bureaucratic barriers in public mental health systems inhibit PMHNPs from practicing at the top of their scope.

The Spirit and Intent of Motivational Interviewing.

To describe an educational program to improve inpatient psychiatric nursing staff communication skills to better provide patient-centered care throughout patient hospitalization. Delivered and evaluated an educational program to increase inpatient staff knowledge and use of communication skills during patient encounters. Emphasizing the spirit and intent of motivational interviewing in a training program results in a translation of the newly obtained knowledge into nursing practice, as evidenced by observed use of motivational interviewing skills during which patient encounters to strengthen the therapeutic alliance. Advanced Psychiatric Nurse Practitioners can provide an important role of coaching/mentorship for inpatient psychiatric nursing staff to further develop communication skills that are meaningful, patient-centered, and may lead to improved treatment adherence.

Transforming veterans health care through academic-practice partnerships

The Veterans Health Affairs Office of Academic Affiliations (OAA) has invested in the creation of academic-practice partnerships to transform the care of veterans and their families. This article details how a long-standing relationship between the University of Alabama at Birmingham School of Nursing and the Birmingham Veterans Affairs Medical Center grew into such a partnership. The three programs that now exist within the Birmingham Veterans Affairs Nursing Academic Partnership (VANAP) umbrella are described, including an undergraduate VA nurse scholars program that has sustained beyond OAA funding, a VANAP graduate education program for psychiatric mental health nurse practitioners (NPs), and a Mental Health NP Residency. Key features of the programs are noted as are outcomes and lessons learned for building mutual goals and a sustainable academic-practice partnership. With the recent passage of the Veterans Choice Program, the importance of educating all nurses about veterans and veterans' health is stressed.

Patient-Centered Homes and Integrated Behavioral Health Care: Reclaiming the Role of “Consultant” for Psychiatric-Mental Health Nurse Practitioner

The notion of patient-centered care has long been linked with nursing practice since Florence Nightingale. The discipline of nursing is focused on the holistic care of individuals, families, and communities in times of sickness and/or health. However, in psychiatric-mental health nursing, the concepts of mental health and psychiatric illness still remain marginalized in our health care delivery systems, as well as in nursing education, knowledge development, and practice. Even with the concept of patient-centered homes, acute and primary care providers are reluctant to embrace care of those with psychiatric illness in their respective settings. Psychiatric illness was and continues to be in the shadows, hidden and often ignored by the larger community as well as by health care providers. This paper describes a Health Resources Services Administration (HRSA) Advanced Nursing Education (ANE) training grant's objective of reintegrating psychiatric-mental health practice into ALL health care delivery systems using the concept of patient-centered nursing care as a foundation for, and promotion of, the Psychiatric-Mental Health Nurse Practitioner (PMH-NP) as the “navigator” for not only the patients and their families, but also for their acute and primary care colleagues using an Interprofessional Education Model. The major barriers and lessons learned from this project as well as the need for psychiatric-mental health nurses to reclaim their role as a consultant/liaison in acute, primary, and long-term care settings will be discussed. The PMHNP as a consultant/liaison is being revitalized as an innovative advanced practice nursing health care model in North Carolina.

Using Simulation in a Psychiatric Mental Health Nurse Practitioner Doctoral Program.

The use and effectiveness of simulation with standardized patients in undergraduate and graduate nursing education programs is well documented. Simulation has been primarily used to develop health assessment skills. Evidence supports using simulation and standardized patients in psychiatric-mental health nurse practitioner (PMHNP) programs is useful in developing psychosocial assessment skills. These interactions provide individualized and instantaneous clinical feedback to the student from faculty, peers, and standardized patients. Incorporating simulation into advanced practice psychiatric-mental health nursing curriculum allows students to develop the necessary requisite skills and principles needed to safely and effectively provide care to patients. There are no documented standardized processes for using simulation throughout a doctor of nursing practice PMHNP curriculum. The purpose of this article is to describe a framework for using simulation with standardized patients in a PMHNP curriculum. Students report high levels of satisfaction with the simulation experience and believe that they are more prepared for clinical rotations. Faculty feedback indicates that simulated clinical scenarios are a method to ensure that each student experiences demonstrate a minimum standard of competency ahead of clinical rotations with live patients. Initial preceptor feedback indicates that students are more prepared for clinical practice and function more independently than students that did not experience this standardized clinical simulation framework.

Expanding the Role of Psychiatric Mental Health Nurse Practitioners in a State Psychiatric System: The New Hampshire Experience.

Psychiatric mental health nurse practitioners (PMHNPs) are assuming increasing clinical responsibilities in the treatment of individuals with mental illness as the shortage of psychiatrists and their maldistribution continues to persist in the United States. States vary widely in their statutes and administrative rules delineating PMHNP's scope of practice. This column describes the legislative process of incremental changes in New Hampshire statute and rules changes over the past 15 years that have significantly expanded PMHNP's ability to treat individuals with mental illnesses in the state mental health system. PMHNPs have worked closely with physician leaders and policy makers to allow this to occur.

School-Based Psychiatric Mental Health Nurse Practitioners to Decrease Inappropriate Psychiatric Pediatric Emergency Rooms Presentations.

An alarming number of children are being referred to pediatric emergency rooms for disruptive behavior disorders (DBDs) such as attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorders. Although presenting symptoms of an exacerbation of disruptive behaviors may be urgent, often they do not require emergency care and could have been efficiently handled through outpatient care. Inappropriate emergency room (ER) referrals have been linked to inadequate school, family, or self-referrals. This article proposes using psychiatric mental health nurse practitioners, known in some states as advanced practice registered nurses, in school-based mental health programs as an intervention with the greatest potential to decrease disparities in access to child psychiatric health care and to offer the psychoeducation and support necessary to prevent inappropriate ER presentations for DBDs.

What Every ED Nurse Should Know About Suicide Risk Assessment

Suicide is internationally recognized as a major cause of preventable death, particularly among older adults and persons with a history of psychiatric and/or substance use disorders. Historical perceptions of suicide still have an impact on modern attitudes, assumptions, and practices. Perceptions about suicide are generally defined by spiritual, cultural, ethnic, and social factors. The Centers for Disease Control and Prevention (CDC) defines suicide as “death caused by self-directed injurious behavior with any intent to die as a result of the behavior” (p. 25). 1 Crosby AE Ortega L Melanson C Self-directed Violence Surveillance: Uniform Definitions and Recommended Data Elements. Version 1.0. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA2011 Google Scholar Deborah Antai-Otong is Continuous Readiness Officer and Psychiatric Mental Health Nurse Practitioner, Department of Veterans Affairs, Arlington, TX.

Policy and Payment Factors Affecting the PMH-NP in the United States

There are unique policy and reimbursement issues pertinent to the Psychiatric Mental Health-Nurse Practitioner (PMH-NP) that are complex and ever-evolving. In the past decade specifically, mental health legislation at the federal level has made, and will continue to make, a serious impact on PMH-NP practice. Pending legislation and policy trends, namely telehealth, affect how and where PMH-NPs will practice and the rates of reimbursement. This article summarizes some recent developments and trends regarding delivery of care and payment that are germane to the PMH-NP. The Center for Medicaid and Medicare Services’ (CMS) guidelines for mental health billing and telehealth also are discussed.

Educating Integrated Family/Psychiatric-Mental Health Nurse Practitioners: Program Development and Evaluation.

This article describes the development, implementation, and outcomes of an integrated family nurse practitioner/psychiatric-mental health nurse practitioner (FNP/PMH-NP) program. The program was designed to help alleviate health professional shortages in rural areas. Faculty from both specialties developed a 3-year integrated curriculum, with attention to course sequencing and removing redundancies. Students completed all FNP and PMH-NP specialty courses and 855 clinical hours. Specialty integration occurred during the final semester through faculty-facilitated integrated case studies and clinical preceptorships with dual-certified rural nurse practitioners. Thirteen students completed the program between 2006 and 2014. A survey of graduates (75% response rate) demonstrated that most were dual certified, and less than half practiced in rural areas. All were very satisfied with their nurse practitioner role. The program successfully prepared graduates to care for patients across the mind-body spectrum in integrated mental health-primary care positions. More work may be needed to market the integrated role and rural practice.

Family Accommodation of Child and Adolescent Anxiety: Mechanisms, Assessment, and Treatment.

Anxiety disorders are the most common mental health concern for youth. Unfortunately, a substantial number of children and adolescents do not respond positively to current evidence-based interventions and/or relapse. As pediatric anxiety disorders are fundamentally a systemic phenomenon, focusing on the ways in which parents become involved in their children's anxiety symptoms may be a promising alternative approach to treatment. To inform psychiatric mental health nurse practitioners (PMHNPs) about the phenomenology, associated neurobiology, and assessment of family accommodation (FA) as well as clinical interventions targeting FA. FA refers to ways that parents adapt their own behaviors to reduce their children's anxiety-related distress. A literature search was performed using Psyc-INFO and PubMed. Current findings indicate a high prevalence of FA associated with pediatric anxiety disorders. FA has a potentially deleterious impact on course of illness and treatment response and is associated with greater caregiver burden. Potential neurobiological underpinnings of FA include dysregulation of parent cortico-limbic circuitry and the oxytocinergic system. PMHNPs are in a unique position to identify families engaged in problematic FA, educate their clientele, provide psychotherapy services with the goal of reducing FA, and consult with multidisciplinary team members.

Integrating Psychiatric Nurse Practitioners Into Psychiatric Practice Settings.

Introduction by the column editors: This column is based on the use of an electronic mailing list (e-list) to generate a collaborative problem-solving process. For this column, Dr. Theccanat put together responses from himself and other e-list alumni of the Columbia University Public Psychiatry Fellowship to questions posed by Vanessa Bobb, M.D., who works at a free-standing licensed mental health clinic and for the first time wanted to hire a part-time psychiatric nurse practitioner to see adult clients. Dr. Bobb wanted to know what the typical salaries are for psychiatric nurse practitioners and the typical number of medication visits that they schedule per day. She also sought advice on places to advertise and to post announcements. Readers are invited to submit suggestions for e-list discussions of management problems to column editor Jules Ranz, M.D. (e-mail:

Collaborative Training in Fellowship: Implications for Psychiatric Workforce Development.

As of 2013, the American Association of Nurse Practitioners (AANP) “NP Fact Sheet,” 2014, reported that the population of nurse practitioners (NPs) in the USA was approximately 189,000; psychiatric NPs represented 3.2 % (just over 6000) of this total [1]. Per the “AANP National NP Sample Survey,” the number of psychiatric NPs increased by roughly 34 % (1548) in the 3-year period starting in 2010 and by around 60 % compared with 2004 [2]. By comparison, the number of medical students entering the first year of general psychiatry residency programs between 2004 and 2012 increased by just 9.4 % from 979 to 1080 and by only 5 total individuals in the 3-year period between 2010 and 2012 [3, 4]. With approximately 450 new psychiatric NP graduates in 2011–2012, they now represent about 30 % of the graduates entering psychiatric practice annually [5]. Given these trends, which suggest that the proportion of the psychiatric workforce represented by NPs’ promises to grow significantly over the next decade, interdisciplinary collaboration within psychiatry demands increased attention and study. Although collaborative relationships between physicians and advanced practice nurses (APNs) are beneficial to patients, providers, and the healthcare system, little information exists on how to formally establish a valuable working relationship [6–10]. The literature-base exploring collaborative relationships between APNs and physicians is small and largely confined to nursing journals. Meanwhile, state-based legislative guidelines provide minimal practical guidance and vary significantly state to state. The lack of a clearly defined collaborative care model has led to confusion and misperceptions about role and scope of practice, particularly regarding APNs, within interdisciplinary teams. Our literature search did not uncover any publications on models of collaborative training for psychiatrists and psychiatric APNs, nor, more broadly, of collaborative training for physicians and APNs of any disciplines. As APNs enter the workforce at an accelerated rate, the need for interdisciplinary education has accelerated as well: quality of care, system costs, and provider satisfaction are likely to improve if future generations of physicians, and APNs are educated and trained collaboratively.

Building a Model of Mental Health Nurse Practitioner–led Service Provision in Australia

In Australia, the nurse practitioner (NP) role remains in the early stages of development. The first NP was endorsed in 2000, and in 2014 the Australian College of Nurse Practitioners announced the endorsement of the 1,000th NP. The future challenge is to ensure the continued growth and sustainability of NP models within the local health care system. This brief report documents the research processes and stages involved in establishing a mental health NP-led team based in the emergency department of an inner city teaching hospital in Sydney. Early and ongoing consultation with key stakeholders and a systematic process of evaluation and publication were pivotal to gathering support for the service and constructing a model that meets the needs of patients, clinicians, and the organization.

Monitoring Compliance to Promote Quality Assurance: Development of a Mental Health Clinical Chart Audit Tool in Belize, 2013.

Belize trained psychiatric nurse practitioners (PNPs) in the early 1990s to provide mental health services throughout the country. Despite overwhelming success, the program is limited by lack of monitoring, evaluation, and surveillance. To promote quality assurance, we developed a chart audit tool to monitor mental healthcare delivery compliance for initial psychiatric assessment notes completed by PNPs. After reviewing the Belize Health Information System electronic medical record system, we developed a clinical audit tool to capture 20 essential components for initial assessment clinical notes. The audit tool was then piloted for initial assessment notes completed during July through September of 2013. One hundred and thirty-four initial psychiatric interviews were audited. The average chart score among all PNPs was 9.57, ranging from 3 to 15. Twenty-three charts-or 17.2%-had a score of 14 or higher and met a 70% compliance benchmark goal. Among indicators most frequently omitted included labs ordered and named (15.7%) and psychiatric diagnosis (21.6%). Explicit statement of medications initiated with dose and frequency occurred in 47.0% of charts. Our findings provide direction for training and improvement, such as emphasizing the importance of naming labs ordered, medications and doses prescribed, and psychiatric diagnoses in initial assessment clinical notes. We hope this initial assessment helps enhance mental health delivery compliance by prompting creation of BHIS templates, development of audits tools for revisit follow-up visits, and establishment of corrective actions for low-scoring practitioners. These efforts may serve as a model for implementing quality assurance programming in other low resource settings.

Cyberbullying: implications for the psychiatric nurse practitioner.

The purpose of this article is to inform and educate psychiatric nurse practitioners about the pervasiveness of the rapidly increasing problem of cyberbullying. As more children and adolescents obtain access to the Internet, mobile devices, and social networking sites, the exposure to bullying in the virtual format increases. Cyberbullying is a growing public health concern and can affect mental health and school performance. Cyberbullying often results in a range of psychiatric symptoms and has been linked to suicide attempts and completions. The psychiatric nurse practitioner is uniquely prepared to provide a range of interventions for patients, families, and communities who have experienced cyberbullying.

Identifying the Differences Between Quality Improvement, Evidence-based Practice, and Original Research

Emergency nurses are in a unique position to improve care through several forms of scientific inquiry. Nurses can participate in research in the emergency department in at least 3 ways. First, at the clinical practice level, ED nurses call upon a vast array of scientific knowledge to help guide clinical decision making on a daily basis. Second, at a more formal and systematic level, ED nurses participate in quality improvement (QI) projects and in evidence-based practice (EBP) reviews. Third, nurses can initiate or participate in original nursing research. Despite the increasing amount of research activities in ED settings, much confusion still exists regarding the characteristics that distinguish QI/performance improvement (PI) projects, EBP reviews, and original nursing research. Correct identification of the type of scientific inquiry that is being conducted helps in selecting appropriate methodologies and in implementing the results of any project. In this article we describe the differences between QI/PI projects, EBP reviews, and original nursing research and examine the role each form of scientific inquiry plays in advancing the science of emergency nursing. Kathy M. Baker, Member, Central Virginia Chapter, is Nursing Director, VCU Health System, Richmond, VA. Paul R. Clark, Member, Kentuckiana Chapter, is System Educator, Norton Healthcare Institute for Nursing, Louisville, KY. Deborah Henderson, Member, Greater Los Angeles County Chapter, is Associate Professor, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA. Lisa A. Wolf, Member, Pioneer Valley Chapter, is Director, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL. Margaret J. Carman, Member, Cardinal Chapter, is Assistant Professor, Duke University School of Nursing, Durham, NC. Anne Manton, Member, Mayflower Chapter, is Psychiatric-Mental Health Nurse Practitioner, Cape Cod Hospital-Cape Psychiatric Center, Hyannis, MA. Kathleen E. Zavotsky, Member, West Central New Jersey Chapter, is Director, Nursing Research, Advanced Practice and Education, Robert Wood Johnson University Hospital, New Brunswick, NJ.

Searching the Literature: What Is Known (and Not Known) About Your Topic?

In the previous articles in this series (appearing in the November 2012, March 2013, and May 2013 issues), 1 Wolf LA Carman MJ Henderson D et al. Ten things we might not want to do anymore: how research changes nursing practice. J Emerg Nurs. 2012; 38: 589-591 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 2 Wolf LA Carman MJ Henderson D et al. Evaluating evidence for practice. J Emerg Nurs. 2013; 39: 197-199 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar , 3 Carman MJ Wolf LA Henderson D et al. Developing your clinical question: the key to successful research. J Emerg Nurs. 2013; 39: 299-301 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar we have discussed how evidence can change practice, how to evaluate evidence, and how to develop a clinical question. At this point in the process, you need to find out more about your problem to create workable interventions. For example, who is the best health care professional to perform triage? This is a good question; however, what do you know about this problem and possible solutions that are already in use? Before you can begin to plan to address a clinical problem, you must know what is known and not known about your particular problem. Mary Kamienski, Member, Northern New Jersey Chapter, is Chair, Primary Care Department, and Associate Professor, Graduate Programs MSN, The University of Medicine & Dentistry of New Jersey, Newark, NJ. Margaret J. Carman, Member, Cardinal Chapter, is Assistant Professor, Duke University School of Nursing, Durham, NC. Lisa A. Wolf, Member, Pioneer Valley Chapter, is Director, Institute for Emergency Nursing Research, Emergency Nurses Association, Des Plaines, IL, and Clinical Assistant Professor, University of Massachusetts, Amherst, Amherst, MA. Deborah Henderson, Member, Greater Los Angeles County Chapter, is Associate Professor, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA. Anne Manton, Member, Mayflower Chapter, is Mental Health Nurse Practitioner, Cape Cod Hospital–Cape Psychiatric Center, Hyannis, MA.

Customized Role Play: Strategy for Development of Psychiatric Mental Health Nurse Practitioner Competencies

To discuss the teaching/learning strategy of customized role play to enhance psychiatric mental health nurse practitioner (PMHNP) students' entry level competency. Customized role play facilitates application of new content, understanding of the patient's experience, and assessment of skill deficits. New PMHNP graduates have entry level proficiency across the life span with a range of psychotherapeutic interventions.

Expanding the Scope of Psychiatric Nursing Practice: Devaluing the Essence of Psychiatric Nursing?

Psychiatric Nurse Practitioners are quickly becoming sought after employees, especially in public mental health systems where a shrinking number of psychiatrists necessitate alternate access to prescribers. In addition, new guidelines necessitate greater attention to the follow up and monitoring of the medical problems of psychiatric patients. These events are occurring in the midst of declining reimbursement and rising litigation concerns in psychiatry. At the same time there is an increased focus on a recovery orientation to psychiatry alongside the primacy of psychotropic medicine as the most cost effective treatment, which can become competing aims for practitioners. It is important for psychiatric nurses and psychiatric nurse practitioners to consider how these opportunities might also have a negative impact on the core foundation of psychiatric nursing.