Integrating a professional apprenticeship model with psychiatric clinical simulation

In this article, we present a theory-based application of clinical simulation in psychiatric-mental health nursing education. As described by Benner, Sutphen, Leonard, and Day, a three-pronged apprenticeship that integrates intellectual, practical, and ethical aspects of the professional role is critical in the development of practical reasoning in nursing education and training. Clinical encounters are often fraught with ambiguity and uncertainty. Therefore, educating for a practice discipline requires experiential and situated learning. Using the three-pronged experiential model in simulated psychiatric-mental health nursing practice supports the development of critical nursing skills, ethics, and theoretical concepts. A clinical scenario is presented that demonstrates the application of this model of professional apprenticeship in psychiatric-mental health education. Applications of the concept presented may be used in training nurses new to the practice of psychiatric-mental health nursing.     

Providing psychiatric-mental health care for Native Americans: lessons learned by a non-Native American PMHNP

Providing culturally sensitive psychiatric-mental health nursing care to Native Americans requires a unique set of understandings. Traditional tribal customs and beliefs, historical events of the past 500 years, and acculturation and enculturation have affected Native Americans' health and well-being. In 2004, I had the opportunity to practice as a psychiatric-mental health nurse practitioner with a Native American tribe in the southwestern United States. This article describes the lessons I learned while practicing on the reservation and suggests ways other non-Native American practitioners can best serve this population.     

The Influence of Agency Staffing on Quality of Care in Nursing Homes

ABSTRACT

Data from a large sample of nursing homes were used to examine the cross-sectional association between use of agency staff, regular staff, and quality. Agency use data came from a survey conducted in 2003 (N?=?1071 nursing homes). The agency and regular staff measures were for nurse aides, licensed practical nurses, and registered nurses. We used a single quality factor constructed from the 14 quality measures in Nursing Home Compare. More agency nurse aides resulted in a smaller increase in quality, compared to the use of an equivalent number of regular nurse aides. Agency registered nurse staff were associated with better quality factor scores, especially in the presence of high levels of regular licensed practical nurses. Our results have policy and practice implications, the most significant of which is that agency registered nurses may be beneficial in a wide variety of circumstances, whereas agency nurse aides and licensed practical nurses should be used with caution.     

Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

Empowering part-time nurses in the treatment of depressed inpatients.

1. With the consistent number of part-time nurses in the workforce, hospitals would benefit by more actively integrating them into professional nursing practice. 2. Empowering part-time nurses by affording them the opportunity to provide primary care has the potential to effectively use part-time personnel, decrease the workload for full-time staff, offer more flexibility in scheduling, and result in savings for hospitals in terms of nursing recruitment and retention. 3. This program has successfully developed and implemented a model of primary nursing that places three part-time nurses on a team capable of handling two to three primary patients. The success of this model has been attributed to excellent communication, trust in one another's professional skills, and nursing expertise.     

Depression in school-aged children: assessment & early intervention

A careful assessment of all of these factors will help nurse therapists who are also primary care providers develop a more holistic approach to treatment and, thus, increase treatment effectiveness. The three-pronged assessment approach discussed above is cost effective, safe, and indicated as a frontline measure to assess the risk for depression in children and their parents (particularly mothers), which can begin the process of "true" early intervention. I say "true" early intervention because in my role as an early intervention specialist, my first meeting with families usually occurs after a crucial incident requiring hospitalization of the child or the parent, or school failure, or both. My programs of intervention are hardly "early," although treatment is started relatively early in the life of the child. In the past few years, I have noticed that psychiatric-mental health advanced practice nurses, including myself, are increasingly working in some capacity in primary health centers, such as school-based clinics, churches, collaborative practices, and community health centers. It would be wonderful if we used these settings to identify risk for depression in children and begin preventive treatment (starting with teaching good sleep hygiene, a treatment in itself) to truly make early intervention a reality.     

Learning opportunities through camping for mental health nursing

1. To equip nurses with the skills necessary for working with disturbed people, nurse educators need to be mindful of not watering down the essential skills necessary for nurses to deal with difficult behaviour in all branches of nursing. 2. These components of a mental health clinical experience should equip the graduate to deal with the pressures of dealing with disturbed people in any environment, as the skills learned generalize to any branch of nursing. 3. Universities can combine with traditional hospital services and community mental health services to provide services to clients with mental illness. An additional benefit is in providing students with an intensive clinical learning experience that reinforces the theory taught in the classroom.     

A balancing act. Continuing education for staff nurses

Basic nursing education programs prepare nurses as generalists. Continuing education programs for psychiatric nurses are needed to provide additional knowledge and expertise in this specialty area. 2. This educational program was developed for psychiatric staff nurses who have completed their orientation but are new to their institution or to the psychiatric clinical area. 3. Content of the program includes an overview of theories, therapeutic relationships, psychiatric terminology, the nursing process as it relates to patients with psychiatric problems, psychotropic medications, electroconvulsive therapy, and DSM-III R. 4. A pretest based on the content of this program can help assess the learning needs of each new nurse. The nurse may then attend the entire program or only specific parts based on individualized needs.     

Addiction Social Work Fellowship Program in Canada

Substance use disorders (SUD) disproportionally contribute to the global social and economic cost of disease; however, their treatment has been inadequate in large part due to an enduring research to practice gap in which competencies for treating and preventing SUDs are often lacking from social work education curricula. Training social workers in managing SUDs has been separated from nurse and physician training, partly due to the long-standing divide between the behavioral health and medical care system. Recently, a new interdisciplinary fellowship in addiction social work, nursing and medicine has been established in Vancouver, Canada. We describe the novel fellowship program and outline initial impact of the training on knowledge and skills in addiction social work from our qualitative evaluation of the fellowship. We conclude that training social workers, and other allied health professionals alongside physicians and nurses may extend the reach of this type of training program even further.     

BEYOND THE CLINIC: IN-HOME THERAPY WITH HEAD START FAMILIES

Social workers and case managers have provided in-home services to families for some time. The field of Marriage and Family Therapy, however, has begun to do in-home work only recently. This paper describes the experiences of MFT interns who worked with families in their homes. Two university graduate MFT training programs conceptualized and practiced in-home therapy with families who had at least one child enrolled in the local Head Start program. This collaborative effort was part of the AAMFT-Head Start Training Partnership Project that had the goal of funding projects that demonstrated successful partnerships between MFT and Head Start. Six interns worked with 27 Head Start families in their homes. A model of the interns' transition from clinic-based to home-based therapy is discussed and applied to working with Head Start families. The framework of in-home therapy is expanded to conceptualizing larger systems and community-based interventions, and recommendations for family therapists in private practice and agency settings are made.     

Top 10 reasons to take your graduate program in psychiatric nursing online

1. Removing barriers to graduate psychiatric nursing education is possible by delivering courses via the Internet. 2. The Internet is full of valuable resources for graduate psychiatric nursing education. 3. Successful online learning environments involve a paradigm shift on the part of faculty from traditional teaching to facilitating the learning of adult students. 4. Increasing the number of advanced practice psychiatric nurses through Web-based education will transform the delivery of mental health care.     

Using a NIATx based local learning collaborative for performance improvement

Local governments play an important role in improving substance abuse and mental health services. The structure of the local learning collaborative requires careful attention to old relationships and challenges local governmental leaders to help move participants from a competitive to collaborative environment. This study describes one county's experience applying the NIATx process improvement model via a local learning collaborative. Local substance abuse and mental health agencies participated in two local learning collaboratives designed to improve client retention in substance abuse treatment and client access to mental health services. Results of changes implemented at the provider level on access and retention are outlined. The process of implementing evidence-based practices by using the Plan-Do-Study-Act rapid-cycle change is a powerful combination for change at the local level. Key lessons include: creating a clear plan and shared vision, recognizing that one size does not fit all, using data can help fuel participant engagement, a long collaborative may benefit from breaking it into smaller segments, and paying providers to offset costs of participation enhances their engagement. The experience gained in Onondaga County, New York, offers insights that serve as a foundation for using the local learning collaborative in other community-based organizations.     

Cognitive therapy: a training model for advanced practice nurses

1. Mental health needs exist in medically underserved areas and can be addressed in nurse-managed, community-based health centers. 2. Cognitive therapy techniques can be used in community-based health centers to intervene and alleviate patients' distress and improve their adherence to treatment. 3. A training program in cognitive therapy can help advanced practice nurses and other health care providers implement the techniques needed to address many behavioral and mental health problems.     

Promoting public/academic linkage.

1. Collaborative linkages between public mental health/mental retardation service systems and academic institutions have evolved in response to several problems: increasing numbers of individuals requiring long-term mental health care; the nursing shortage; and a decline in enrollment and students graduating from psychiatric mental health nursing programs. 2. Evidence suggests that a public/academic linkage in the form of a multidisciplinary training course in the care of seriously mentally ill patients promotes a recruitment of mental health professionals to work with these patients. 3. The establishment of academic/health care system linkages can enhance client care, expand and improve clinical experiences and education for students, and provide opportunities for collaborative research among clinical staff, faculty members, and graduate students.     

Effectiveness of a training program for ECT nurses

Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a psychiatrist, a clinical nurse specialist, and recovery nurses. Traditionally, nursing education and training in the context of providing a safe and high standard of care has not been addressed. Ninety-two nurses from 42 different health agencies participated in a training program focusing on defibrillation, electrocardiogram (ECG) and electroencephalogram (EEG) monitoring, intubation, stimulus dosing, setting up the ECT equipment, and caring for the patient. A non-experimental, one-group, pretest-posttest research design was used in this study to evaluate the effectiveness of the training program for nurses working with ECT. Effective training for nurses was hypothesized to make a difference in the standards of practice and clinical effectiveness for patients undergoing ECT. Findings from this study indicated a major knowledge deficit in key components of ECT among nurses who have responsibilities in this area of nursing care. With effective training, nurses' confidence levels increased related to setting up the equipment, administering a double dose, helping with intubation, and using a defibrillator. If nurses are to effectively function as team members in the ECT procedure, they must receive the training necessary to prepare them for this important role. The results of this study support the recommendation of the Royal Australian and New Zealand College of Psychiatrists that ECT nurses should be appropriately trained in anaesthetic and resuscitation techniques and modern ECT practice.     

Consumer Participation: Case Study of the College Health Services Setting

Abstract

Nurses, functioning in expanded roles, have created uneasiness in some circles, particularly medicine. Will these new roles for nurses be competitive or collaborative? It is the thesis of the author that the nurse's new expanded role, which is fast becoming the norm, will be collaborative if there is 1) adequate understanding between the disciplines of nursing and medicine of their respective characteristics and range of activities, and if there is clarification of organizational, financial and certification issues; 2) adequate differentiation between the definitions of health and medical needs; 3) adequate attention and resources are given to prevention of disease and disability and promotion of health in a world dominated by medicine and episodic care; 4) organization and financing of health services that accommodate the utilization of nurses in expanded roles; 5) nurses who prepare themselves scientifically, humanistically, and politically for the type and kind of practitioner that society needs; and if 6) certification of individuals and accreditation of educational programs are controlled by the respective professional group.

However, if the expansion of nursing practice is not recognized, reimbursed, and rewarded appropriately, there will be interprofessional competition for patients or clients, for funds, and for political power.     

Providing nursing leadership in a community residential mental health setting

The worldwide burden of mental illness is increasing. Strong leadership is increasingly emerging as a core component of good mental health nursing. The aim of this article is to demonstrate the ways in which nurses can provide strong and consistent leadership in a values-based practice environment that embodies respect for individuals' dignity and self-determination within a community residential mental health service, which provides a structural foundation for effective action. This is accomplished through the presentation of two vignettes, which highlight how the seemingly impossible becomes possible when an economic paradigm such as agency theory is exchanged for a sociological and psychological paradigm found in leadership as stewardship at the point of service. It is through stronger nursing leadership in mental health that stigma and discrimination can be reduced and better access to treatments and services can be gained by those with mental illness. Nurse leadership in mental health services is not new, but it is still relatively uncommon to see residential services for "high needs" individuals being led by nurses. How nurses meet the challenges faced by mental health services are often at the heart of effective leadership skills and strategies.     

Nursing Intervention on Sexual Health: A Multilevel Behavioral Survey of Senior Nursing Students in Clinical Practice

ABSTRACT. There are many diseases that may impact patients’ sexual health and psychological well-being. Despite the importance of sexual health care (SHC), insufficient SHC occurs across care settings and the patient population. Studies investigating the essential elements of SHC behaviors of nursing students in clinical practice have been scant. The aim of this study was to assess the frequency of senior nursing students’ multilevel interventions for patients’ SHC in primary clinical practice. An anonymous 19-item instrument entitled Nursing Intervention on Sexual Health was distributed among senior nursing students at two central Taiwan nursing schools. We analyzed overall nursing intervention in SHC in clinical practice by levels. The results of this study indicate that the frequency of nursing intervention in sexual health is low. Another important finding is that following the PLISSIT (Permission, Limited Information, Specific Suggestion, Intensive Therapy) model, from permission level to the specific-suggestion level, the behavioral frequency of nursing intervention shows a decrease along with the model. Nursing students omitted each level of SHC in clinical practice, even if they had sufficient time and extensive preceptor resource, in this study. The nursing students’ SHC on different levels would help educators to frame the sexuality education program.