Digital Commons Network^™

Designing And Implementing A De-Escalation Toolkit To Improve Staff Education And Competency On De-Escalation Within A Mental Health Outpatient Setting, Balraj Bajwa

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this study is to develop and implement a de-escalation toolkit to help improve memory, retention, and utility of de-escalation techniques within an outpatient mental health crisis stabilization unit.

Problem: The aforementioned crisis stabilization unit has elevated rates of patient aggression/violence and staff present with difficulty recalling de-escalation techniques due to the lapse in memory and/or retention.

Methods: The project was introduced to the stakeholders of the crisis stabilization unit and input was obtained on the design and components of the toolkit. Various analyses were conducted to ensure the appropriate implementation of the project.

Intervention: A de-escalation …

Assessment Of Conduct Disorder In Primary Care: Integrative Review, Chantel M. Kilford

DNP Qualifying Manuscripts

Conduct disorder and behavioral problems in children are the 6^th most prominent childhood health disorder within the United States of America. Early recognition and interventions have shown to improve outcomes and reduce lifelong adult sequela. Evidence suggests that primary care providers are not confident or knowledgeable about identification and assessment of the disorder. The manuscript examines the prevalence, co-morbidities, trajectories, mortality risk and outcomes of conduct disorder. Health disparities and diagnostic stigma are also addressed. Additionally, the manuscript provides primary care providers with evidence-based research and recommendations for prompt identification and screening. Conduct disorder has devasting individual, social, and …

Providing Resources To Caregivers Of Pediatric Mentally Ill Clients And Assessing For Caregiver Burden, Stacy Dee

Doctor of Nursing Practice

Background. Provision of educational and supportive resources to the caregivers of children with mental illness can help create an environment of advocacy and understanding between the child, caregiver, and provider. In depth and comprehensive learning about their child’s mental illness cannot be accomplished in a one-hour new patient appointment or established patient appointment of 20 minutes. Purpose. The purpose of this practice improvement project was to facilitate educational and community support for caregivers of pediatric clients with mental illness and evaluate if caregivers require additional support due to burden. Objectives. (a) 100% of caregivers of pediatric clients who have appointments …

Evaluation Of Depression, Anxiety And Stress In Graduate Nursing Students, Rachel Dunston

Dissertations

Mental health issues are growing in the United States. Postgraduate school is widely known to increase the level of psychological difficulties (Dyrbye et al., 2006) experienced by students. There is a need to address mental health care in graduate nursing students. This project was a descriptive observational comparison pre-post-intervention design used to see if online modes of delivery would aid in decreasing mental health issues for nursing graduate students. Participants were provided with access to three podcasts and encouraged to use the Sanvello mobile application provided to all students at this university. The first podcast focused on using the Sanvello …

Mental Health Concerns Of Frontline Registered Nurses Associated With The Covid-19 Pandemic, Julie Ingle

Dissertations

Problem

COVID-19 caused local healthcare facilities to admit patients with COVID-19 at increasing rates, critically overloading healthcare system resources. Caregiver-related stress associated with the COVID-19 pandemic placed frontline registered nurses (RNs) at risk for mental health consequences (Havlioglu & Demir, 2020; Shechter et al.,2020).

Methods

This quality improvement project used a descriptive design to administer a collection of validated instruments assessing anxiety, depression, posttraumatic stress disorder (PTSD), and demographics. A purposive sample of RNs were recruited from the COVID-19 units in a local hospital, and the survey was distributed via email.

Results

During the implementation period (April 4, 2021-May 15, …

Mental Health Effects Of The Covid-19 Pandemic On Older Adults, Elizabeth Kerr

Dissertations

Problem: Significant psychological effects such as anxiety, depression, stress, and loneliness are shown to affect the older adult population, aged 65 years and older. The social isolation and disconnectedness related to the COVID-19 pandemic potentially worsens anxious and depressive feelings, increasing the risk for adverse outcomes in the high-risk older adult population. This project aimed to identify older adults at risk for acute, situational mental health issues associated with the pandemic.

Methods: A descriptive study design was used. Telephone interviews were conducted to explore effects of the COVID-19 pandemic on mental health responses in older adults. A convenience sample …

Identifying Adverse Childhood Experiences (Aces) In A Federally Qualified Health Center Using The Pediatric Aces And Related Life Events Screener, Melody Albarran-Slovin, Bsn, Rn

Doctor of Nursing Practice Final Manuscripts

Background: Evidence links adverse childhood experiences (ACEs) to health issues later in life. Most research has been conducted in adults but there is a lack of recent research on the impact of ACEs in the pediatric population particularly in relation to mental health conditions. Utilizing the Pediatric ACEs Screener (PEARLS) health care providers can screen for ACEs at earlier ages.

Purpose: The aim of this evidence-based project is to determine if there is an increase of newly diagnosed mental health related disorders when using PEARLS compared to not using PEARLS in the previous months before implementation.

Methods: ACEs were identified …

Balancing Provider Stress And Resilience In The Time Of Covid, Zachary Love

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project is to improve secondary traumatic stress (STS), compassion satisfaction, and burnout amongst providers—physicians, residents, and nurse practitioners—within the acute psychiatry units of the La Jolla Veterans Health Administration (VHA) through a one-time educational training session.

Background: Mental health providers at the VHA acute psychiatry units experience one of the highest risks for the development of STS, CF, and burnout amongst all professions due to a number of individual and institutional factors. STS is characterized by secondhand traumatization with symptoms similar to that of Post-Traumatic Stress Disorder—difficulty sleeping, mood changes, upsetting images appearing …

Developing A Culturally Relevant Mental Health Assessment For Persons Of African Descent, Roberta Iyamu

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Persons of African descent have lower access to mental health care, are less likely to receive needed care, and are more likely to be misdiagnosed, experience severe disease, and to receive mental health care through primary care than non-Hispanic Whites. Context: Cultural norms related to mental health as well as the lack of culturally congruent health care delivery contribute to lower mental health care access and uptake among persons of African descent. Interventions: Campinha-Bacote’s cultural competence model and the BATHE technique provided the theoretical framework for the development and implementation of a nurse practitioner (NP) (n = 4) …

Identifying Barriers To Keeping Appointments In Mental Health, Shontel Ray

Doctor of Nursing Practice Projects

Abstract

Accessing healthcare for mental illness is important but has been challenging to resolve. Due to barriers, individuals are missing appointments leading to long-term negative effects of poor patient outcomes, such as homelessness and suicide. Understanding why individuals cancel or do not show up to their appointments is crucial to resolve this nationwide problem. Further investigation is needed to identify what barriers cause individuals to miss appointments so interventions can be created to resolve it and improve patient care. For this study, those who did not attend their first or second appointments were called and given an eight-question survey. The …

Implementation Of A Mental Health Screening In A Gastroenterology Office, Kayla Craig

Doctor of Nursing Practice Projects

The growing prevalence of depression in gastrointestinal patients is the reason why outpatient offices, gastrointestinal offices included, need to screen for mental health problems in their appointments. Many outpatient settings don't have a standard tool to screen for depression in patients, and therefore many patients are not being treated or diagnosed with depression in the process. The PHQ-9 has been shown to have strong validity and specificity in diagnosing depression in the outpatient setting.

Screening For Resilience In Pediatric Primary Care, Kaitlin Phelan, Martha Grant Fuller

Doctor of Nursing Practice Final Manuscripts

Introduction: Adversity in childhood increases risk for physical and mental health problems. Children who undergo adverse events can still flourish, due to the concept of resilience. Literature shows that resilience influences health more than adversity, and screening for resilience may improve practice.

Method: A valid screening tool for resilience, The CD-RISC, was given to children twelve and above during their well visit during February 2021 at a clinic in Oceanside, CA. Scores were categorized into four quartiles. Children responding in the lowest two quartiles received provider follow up.

Results: 97 surveys were scored: 39 scoring in the lowest quartile, 19 …

Covid-19’S Psychological Influences: How Have University Students Been Affected?, Julaby Dalman

Nursing | Senior Theses

Undergraduate students are well-known as a vulnerable population prone to stress, anxiety, depression and various other psychological problems during their academic time at university or college. With the introduction and sudden integration of the COVID-19 pandemic into the daily lives of these high-risk students, globally, many people are concerned with how the mental health of this population will be affected, given the presence of the pandemic in addition to the multiple safety measures put in place in an attempt to contain the virus. This includes students having been subjected to prolonged implementation of shelter-in-place mandates and requirements of social-distancing across …

The Effects Of Losing A Parent On Teenagers Mental Health, Emily O'Keefe

Nursing | Senior Theses

Losing a parent is one of the hardest losses we experience. For many, the loss of a parent comes too early. Losing a parent as a teenager has lasting effects. This thesis examines the research literature review and proposes a study for further investigation about this important healthcare matter.

The mental health of teenagers who lose a parent experience worsened mental health than those who have two living parents. Bereaved teenagers experience worsened mental health, increased aggression, and an increased risk for self-harm. The research in this literature reviews, supports this, and further emphasizes the negative impact of losing a …

Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos

Electronic Theses, Projects, and Dissertations

In 2018, of 1.3 million Latinx adults in the United States facing concurrent issues with substance use disorders (SUD) and mental health disorders (MHD) 93% remained untreated for either diagnosis. This is concerning since Substance Abuse and Mental Health Services Administration (SAMHSA) data reveals that this population is at greater risk for suicidal thoughts, plans, and attempts. They also face structural barriers such as employment, housing, legal involvement, and insurability that further impede access to treatment.

This study’s purpose was to examine barriers to accessing treatment for Latinx populations confronting co-occurring SUDs and MHDs. This study used a qualitative design …

Improving Therapeutic Communication In Mental Health Nursing: A Quality Improvement Project, Patricia A. Nill

UNLV Theses, Dissertations, Professional Papers, and Capstones

Over 46 million adults in the United States (U.S.) live with a mental illness. Locally in Nevada, the psychiatrist to patient ratio is approximately 700:1, and patients are seen primarily in the inpatient setting, if seen at all, due to the wait average of 85 hours in the hospital emergency rooms for access into mental health hospitals or specialty units of a general hospital. Moreover, costs for mental health mood disorders alone are estimated at over seven million dollars annually. The Institute of Medicine (IOM) opined the need for change in healthcare to redesign practice and clinical communication with patients …

Scholarly Manuscript: Deficiencies In Memory And Effective Education Of De-Escalation Techniques In Mental Health Settings, Balraj Bajwa

DNP Qualifying Manuscripts

Objective: To appraise and evaluate evidence recognizing the lack of effective staff education on de-escalation techniques, the impact that this creates on nursing practice, and staff perceptions on de-escalation methods and techniques in acute care inpatient and/or outpatient mental health settings.

Methods: Three databases were searched (CINAHL, PubMed, and PsycINFO) to identify articles/reviews which focused on de-escalation techniques and training. Additionally, five journals were also reviewed to help with the search process. Specific inclusion criteria were used to streamline the search process and to help identify articles/reviews which were primarily focused on the desired objective. Five different articles …

Examining Health Disparities Among Lesbian, Gay, Bisexual, Transgender, And Queer/Questioning Adults In Davidson County, Tennessee, Samantha Anticuar

DNP Scholarly Projects

Background: Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) individuals experience increased risks for health disparities and discrimination compared to non-LGBTQ individuals, yet there is limited research in southern populations. Purpose: The purpose of this scholarly project was to examine if LGBTQ individuals had increased health disparities compared to non-LGBTQ individuals in Davidson County, Tennessee (TN). Methods: A quasi-experimental design (N = 1,704) used the 2019 Nashville Community Health and Well-being Survey for analysis. Results: Findings suggested LGBTQ individuals had increased odds of not having health insurance (p = .009, adjusted odds: 6.84), poor mental health (p …

Increasing Mental Health Competency In School Nurses, Jennifer M. Walsh Msn, Cpnp, Cne

Doctor of Nursing Practice Projects

Background: Mental health concerns in the pediatric population have increased over recent years, even more so due to the COVID-19 pandemic. Time from onset of symptoms to treatment is over eight years, leaving less than 25% receiving care. Virginia ranks 47th for pediatric mental health care. School nurses spend a significant amount of workload on MH issues but often report being untrained to deal with these issues. Aims: Implement a quality improvement pilot program for school nurses designed to increase competency of identification, management, and referrals for students with mental health concerns. Outcomes measured domains of knowledge, attitude, and competency …

Rural Young Adult Health: Drivers And Barriers To Accessing Care, Maggie Thompson

DNP Qualifying Manuscripts

Adolescents and young adults are developmentally inclined to seek autonomy and take risks. This propensity for risk and challenging boundaries is essential for personal identity formation and belief systems development. During the transition to adulthood, adolescents and young adults often place a high value on peer group acceptance and adhering to perceived social norms. As a result, adolescents and young adults are more likely to engage in pleasure-seeking behaviors despite the associated risks.

The potential for harm often grows in young adulthood, as newfound freedoms present more significant opportunities to engage in risk-taking behaviors. Despite some enduring controversy, age-specific, preventative …

Education On My Healthevet To Increase Access To Psychiatric Healthcare For Veterans, Roxann Hackbarth

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Introduction: Access to mental health care can be challenging for many veterans. The Veterans Health Administration (VHA) developed the patient portal My Healthevet (MHV) to increase access to healthcare services. Despite this program, many veterans still do not take advantage of the portal. The goal of this literature review was to gain knowledge on benefits and barriers of using patient portals, identification of patients who use and do not use patient portals, and interventions to increase the use of patient portals.
Evidence Summary: The use of patient portals, including the VHA portal MHV, helps to increase interactions between clinicians and …

Intervention Of Mindfulness With Students To Identify Mental Health Problems And Enhance Coping Strategies, Aileen M. Jones

Doctor of Nursing Practice Projects

When mental health care is delayed, a young person may have more difficulty in academia and social situations. Therefore, it is important to reach young people to provide them with the skills to deal with stressors and mental health issues. The purpose of this project is to use mindfulness techniques to increase mental health literacy (MHL) and strengthen coping skills which can possibly assist students in building resilience to cope with stressors. By utilizing available mental health resources and learning coping skills, there can be a drastic change in the trajectory of a young persons’ life who struggles with stressors …

Using A Psychopharmacology Education Program To Increase Primary Care Provider Comfort With Treating Basic Psychiatric Disorders, Latesha Reed

DNP Scholarly Projects

BACKGROUND: Almost 1 in 5 people have been diagnosed with a mental health illness but the supply of psychiatric providers does not meet patient’s needs. Multiple reasons contribute to this shortage and nurse practitioners are part of the solution. Even with nurse practitioners specializing in psychiatric mental health there is still a shortage. Primary care is where most patients first present their mental health issues.

METHODS: Literature review informed the development of the educational intervention presented to the primary care providers using a digital, asynchronous learning format. A gap analysis of organizational needs and weaknesses was used to determine the …

Social Media And Mental Health In Adolescents And Young Adults: A Systematic Review, Dawn Ritter, Kimberly Ray, Celia Keefe

Williams Honors College, Honors Research Projects

The goal of our project is to increase understanding of the link between social media use and mental illness in teens and young adults. Our objective is to write a systematic review of the literature to answer the PICOT questions: (1) In teens and adults, younger than 25 years, what is the relationship between social media use and mental illness? (2) In teens and adults, younger than 25 years, what is the effect of interventions, such as social media as a resource, on mental health promotion and well-being? The motivation for our project comes from the increased use of social …

Anxiety Screening In Children & Adolescents With Type 1 Diabetes Using The Gad-7 Tool, Allison B. Reynolds

DNP Projects

BACKGROUND: Children and adolescents with type 1 diabetes (T1DM) can encounter a variety of factors that affect proper management of their diabetes, including mental health. Youth with diabetes have significantly higher rates of depression, anxiety, and mental health problems compared to the general population. Anxiety is especially prevalent. PURPOSE: The objective of this project was to evaluate anxiety screening of children and adolescents with T1DM during their routine diabetes visits. Specifically, to assess for any trends in anxiety levels and patient characteristics including demographics, insulin regimen and A1C levels. METHODS: A cross- sectional, retrospective review of ambulatory electronic health records …

The Effects Of Postpartum Depression On Children's Social Development, Delaney Besse, Margaret Williams, Danielle Spencer, Brooke Walters

Williams Honors College, Honors Research Projects

The increased incidence of postpartum depression has had significant effects on children’s social development. The purpose of this systematic review is to bring attention to the growing problem in such a vulnerable population. In addition, it was designed to shed light on the lack of research in this area of healthcare. The methods used to conduct the study include various peer reviewed, scholarly and evidenced based articles from databases such as Academic Search Complete, PsycNet, and Pubmed. Each article has been critically evaluated based on the following guidelines: a population group of children under the age of four, specifically maternal …