Nurse Faculty Scholars - Mental Health

Randomized Clinical Trial of the Effectiveness of a Home-Based Advanced practice Psychiatric Nurse Intervention: Outcomes for Individuals with Serious Mental Illness and HIV

kdeming — Tue, 14 Jun 2011 18:53:43 +0000

Published Date:

Wed, 2011-03-09 (All day)

Individuals with serious mental illness have greater risk for contracting HIV, multiple morbidities, and die 25 years younger than the general population. This high need and high cost subgroup face unique barriers to accessing required health care in the current health care system. The effectiveness of an advanced practice nurse model of care management was assessed in a four-year random controlled trial. Results are reported in this paper. In a four-year random controlled trial, a total of 238 community-dwelling individuals with HIV and serious mental illness (SMI) were randomly assigned to an intervention group (n=128) or to a control group (n=110). Over 12 months, the intervention group received care management from advanced practice psychiatric nurse, and the control group received usual care. The intervention group showed significant improvement in depression (P=.012) and the physical component of health-related quality of life (P=.03) from baseline to 12 months. The advanced practice psychiatric nurse intervention is a model of care that holds promise for a higher quality of care and outcomes for this vulnerable population.

Analysis of the psychiatric-mental health nurse workforce in the United States.

lsharp — Mon, 21 Feb 2011 15:54:17 +0000

Published Date:

Fri, 2009-05-01 (All day)

A shortage of RNs is a problem that has reached crisis levels in the United States and many other countries. The inadequate supply of RNs translates into limited access for individuals who need health care. The U.S. psychiatric-mental health RN (PMH RN) workforce is virtually unstudied. The purposes of this article are to present a nationally representative demographic, education, and employment profile of PMH RNs, analyze issues associated with the supply of PMH RNs, and discuss options for building the PMH RN workforce.

Capitalizing on the potential of advanced practice psychiatric nurses

lsharp — Mon, 21 Feb 2011 15:51:20 +0000

Published Date:

Thu, 2011-01-13 (All day)

In the last decade the US federal government proposed a transformation vision of mental health service delivery; patient-centered, evidence-based and recovery oriented treatment models. Health care reform brings additional expectations for innovation in mental/substance use service delivery, particularly the idea of creating systems where physical health, mental health and substance use treatment is fully integrated. Psychiatric nurses, as one of the four core US mental health professions, have the potential to play a significant role in the both the transformation initiative and health care reform vision. However, psychiatric nurses, particularly advanced practice psychiatric nurses, are an untapped resource due in part to significant state regulatory barriers that limit their scope of practice in many states. The purpose of this paper is to document what is currently known about advanced practice psychiatric nurses and discuss policy implications for tapping into the strengths of this workforce. Strategies for facilitating utilization of advanced practice psychiatric nurses discussed

Whatever does not kill us: cumulative lifetime adversity, vulnerability, and resilience

nfs — Fri, 07 Jan 2011 20:36:59 +0000

Published Date:

Wed, 2010-12-01 (All day)

Exposure to adverse life events typically predicts subsequent negative effects on mental health and well-being, such that more adversity predicts worse outcomes. However, adverse experiences may also foster subsequent resilience, with resulting advantages for mental health and well-being. In a multiyear longitudinal study of a national sample, people with a history of some lifetime adversity reported better mental health and well-being outcomes than not only people with a high history of adversity but also than people with no history of adversity. Specifically, U-shaped quadratic relationships indicated that a history of some but nonzero lifetime adversity predicted relatively lower global distress, lower self-rated functional impairment, fewer posttraumatic stress symptoms, and higher life satisfaction over time. Furthermore, people with some prior lifetime adversity were the least affected by recent adverse events. These results suggest that, in moderation, whatever does not kill us may indeed make us stronger.

Employment of Advanced-Practice Psychiatric Nurses to Stem Rural Mental Health Workforce Shortages

lsharp — Tue, 19 Oct 2010 12:19:34 +0000

Published Date:

Tue, 2008-01-01 (All day)

OBJECTIVE: People living in rural areas have the same incidence of mental illness but far less access to mental health services compared with people living in urban areas. This brief report describes the workforce of advanced-practice psychiatric nurses (APPNs) and explores their potential to ease the rural mental health workforce shortage.

METHODS: National certification data were used to describe workforce characteristics and the rural distribution of APPNs. All nationally certified APPNs in 2003 were included (N=8,751).

RESULTS:APPNs were more likely than psychiatrists to live in rural areas. The ratio of APPNs to state rural populations ranged from .06 to 14.9. The mean SD ratio of APPNs per 100,000 in the rural population was 3.0±3.0.

CONCLUSIONS: APPNs have great potential to be a solution to the rural mental health workforce shortage. Even so, the number of APPNs must increase and barriers to their full scope of practice must be removed.

Psychiatric Nurse Reports on the Quality of Psychiatric Care in General Hospitals

lsharp — Tue, 19 Oct 2010 12:15:50 +0000

Published Date:

Wed, 2009-07-01 (All day)

Although acute inpatient psychiatric care has changed dramatically over the past 2 decades, little is known about how these changes have affected the quality of care, psychiatric nurse staffing, or patient outcomes. The purpose of this report is to explore the quality of care, quality of the practice environment, and adverse events as assessed by psychiatric nurses in the general hospital setting. The study sample consisted of 456 registered nurses permanently assigned to psychiatric units, compared with a larger sample of 11 071 registered nurses who work permanently on medical, surgical, or medical-surgical units. Compared with nonpsychiatric nurses, psychiatric nurse characteristics reveal an older, more experienced workforce, with a higher proportion of male nurses. Nurses rated quality of patient care lower in the psychiatric specialty than in the medical-surgical specialty. Furthermore, psychiatric nurses reported significant concern about the readiness of patients for discharge and higher incidence of adverse events. They also experienced more verbal abuse, physical injuries, and complaints from patients and families. Collectively, the results from this study underscore the organizational problems and quality-of-care issues that cause psychiatric nurses in general hospital settings to evaluate their work environments negatively.

Adverse Events Associated With Organizational Factors of General Hospital Inpatient Psychiatric Care Environments

lsharp — Tue, 19 Oct 2010 12:13:17 +0000

Published Date:

Tue, 2010-06-01 (All day)

OBJECTIVE: Although general hospitals receive nearly 60% of all inpatient psychiatric admissions, little is known about the care environment and related adverse events. The purpose of this study was to determine the occurrence of adverse events and examine the extent to which organizing factors of inpatientpsychiatric care environments were associated with the occurrence of these events. The events examined were wrong medication, patient falls with injuries, complaints from patients and families, work-related staff injuries, and verbal abuse directed toward nurses.

METHODS: This cross-sectional study used data from a1999 nurse survey linked with hospital data. Nurse surveys from 353 psychiatric registered nurses working in 67 Pennsylvania general hospitals provided information on nurse characteristics, organizational factors, and the occurrence of adverse events. Linear regression models and robust clustering methods at thehospital level were used to study the relationship of organizational factors of psychiatric care environments and adverse event outcomes.

RESULTS: Verbal abuse toward registered nurses (79%), complaints (61%), patient falls with injuries (44%), and work-related injuries (39%) were frequent occurrences. Better management skill was associated with fewer patient falls and fewer work-related injuries to staff. In addition, fewer occurrences of staff injuries were associated with better nurse-physician relationship and lower patient-to-nurse staffing ratios.

CONCLUSIONS: Adverse events are frequent for inpatient psychiatric care in general hospitals, and organizational factors of care environments are associated with adverse event outcomes. Further development of evidence-based quality and safety monitoring of inpatient psychiatric care in general hospitals is imperative.

OBJECTIVE: Although general hospitals receive nearly 60% of

Towards Innovation and a Partnership Future for Mental Health Nursing

lsharp — Tue, 19 Oct 2010 11:53:39 +0000

Published Date:

Fri, 2010-01-01 (All day)

This year's announcement of psychiatrist Professor Patrick McGorry as Australian of the Year has brought mental health into the spotlight. In a public sense, the award represents a significant acknowledgement of mental health as a growing national concern. After all, 30 per cent of the Australian population experience a mental health problem at any given time. With this in mind, it is important to realise that as few as one-third of them receive adequate treatment. Those treatment figures drop to 25 per cent for young people and just 12 per cent for young males in rural and remote areas.

Psychosocial stress and social support as mediators of relationships between income, length of residence and depressive symptoms among African American women on Detroit's eastside

nfs — Wed, 29 Sep 2010 11:55:44 +0000

Published Date:

Sat, 2005-01-01 (All day)

Patterns of mental health are clearly associated with life circumstances, including educational and economic opportunities, access to safe and supportive neighborhoods, socially structured exposures to stressors and to supportive relationships. In this article, we examine the social and economic correlates of depressive symptoms among African American women residing within a predominantly African American urban neighborhood in Detroit, USA, with relatively few economic resources. We identify distinct stressors associated with financial strain, neighborhood social disorder (concern about police responsiveness, safety stress), and experiences of discrimination. We test the extent to which each of these stressors mediates relationships between household income, length of residence in the neighborhood, social support and depressive symptoms. Our results suggest that for women in this racially segregated area with a high concentration of poverty, relationships between household income and symptoms of depression are partially mediated by financial stress and social support, but that stressors associated with neighborhood disorder and discrimination influence depressive symptoms independent of household income. Furthermore, we find that length of residence in the neighborhood is negatively associated with financial stress and positively associated with police stress and social support, with no significant net effect on symptoms of depression. We conclude that higher household income may help reduce symptoms of depression by reducing financial stress and strengthening social support even within neighborhoods with high concentrations of poverty. However, increased household income does not protect African American women residing in a high poverty community from distress associated with neighborhood disorder or experiences of discrimination.

Relationship between Psychiatric Nurse Work Environments and Nurse Burnout in Acute Care General Hospitals

nfs — Wed, 19 May 2010 14:08:52 +0000

Published Date:

Mon, 2010-03-01 (All day)

Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses' capacity to sustain safe and effective patient care environments