Psychiatric and Mental Health Nursing Commons^™

Peer Support For Addiction In The Inpatient Setting, Rebecca Sweeney

DNP Scholarly Projects

Background: In 2006 the Institute of Medicine reported that combined mental illness and substance use disorder was the second leading cause of disability and death in women and the highest cause in men. More recent data obtained from the 2016 National Survey on Drug Use and Health (Ahrnsbratz et al 2016) indicates in 2016 only one in ten of the people who need treatment, receive it. At Cambridge Health Alliance’s Everett Hospital, the site of this pilot project, opioid overdose and acute alcohol intoxication comprise one in every ten visits in the Emergency Department. In January of 2018, CHA partnered …

The Effects Of Compassion Fatigue On Burnout Among Inpatient Psychiatric And Intensive Care Unit Nurses, Amita Madan Neidlinger

DNP Projects

PURPOSE: This DNP project is relevant to nurses of the psychiatric and Intensive Care Unit (ICU) setting, as high stress environments may produce higher rates of compassion fatigue and burnout. Investigation of these areas may help illuminate unnecessary healthcare costs that are associated with these phenomena. This DNP project is important to the University of Kentucky’s healthcare system, its patients, and nurses. Increased absenteeism and increased medication errors are positively associated with the prevalence of compassion fatigue and burnout in nurses. Outcomes from this project will allow identification of unnecessary healthcare costs and encourage administrators to focus on reducing nurse …

The Efficacy Of Meditation-Based Treatments In Relapse Prevention For Persons With Substance Use Disorders, Florence C. Bates

Honors Undergraduate Theses

Substance abuse is a global problem that has contributed to a variety of societal, financial, health, and familial strains. An increasing prevalence of illicit drug, prescription opioids, and alcohol abuse has created a need for re-evaluation of recovery and relapse treatments. This literature review examines the efficacy of meditation-based treatments for relapse prevention in persons recovering from Substance Use Disorders (SUDs). A comparative analysis of Mindfulness Based Relapse Programs (MBRP), an adapted MBRP-W program, and a Transcendental Meditation (TM) intervention was used to examine the success of meditation-based interventions. Research supports improvements associated with the meditation-based interventions including significant reductions …

Depression Screening At A Mental Health Outpatient Clinic: A Quality Improvement Project, Renee Licorish

Doctor of Nursing Practice

Project Background: Depression is one of the most common mental health problems in the United States. Many individuals may seek treatment but go undiagnosed due to the lack of recognition by clinicians. Clinical guidelines recommend the use of a standardized depression screening tool within a clinician’s evaluation process. The Patient Health Questionnaire 9 (PHQ-9) is such a tool and recommended for use in the outpatient care setting. Aims of the Project: To increase depression screening of clients at a hospital-based outpatient behavioral health clinic. Purpose and Objectives: Implementation of the PHQ-9 into the clinic’s mental health assessment process to increase …

Barriers To Providing Psychiatric Care Within Cook County Public Health System: An Integrative Literature Review, Elizabeth Ann Reuter

Grace Peterson Nursing Research Colloquium

Abstract

Background: Cook County Public Health Systems located in Cook County, Illinois, are responsible for providing free and low cost psychiatric care to thousands of residents despite continuing state and federal budget cuts and inadequate Medicaid reimbursements. This not only financially strains county taxpayers, but it also limits treatment options, negatively impacts patients, and places an extreme burden on the public service workforce.

Objectives: The purpose of this integrative literature review was to identify the major barriers of providing psychiatric care within Cook County Public Health Systems.

Method: An integrative literature review was conductedusing the databases of Academic Search …

Nurses Role In Health Home Mixed Methods Study, Jacqueline S. Prokop

Nursing Theses and Dissertations

Managing individuals with chronic health conditions in the primary care setting continues to be a significant challenge in the U.S. health care system. This issue is further compounded for low-income individuals with both mental health and physical health chronic conditions. With the enactment of the Affordable Care Act (ACA), new chronic disease health home opportunities have emerged to address the existing structural and process gaps found in primary healthcare. The nurse’s role is integral to health homes as they empower nurses to play a greater role in improving patient experiences, population health, and lowering healthcare costs. Three research manuscripts presented …

Evaluation Of A Youth Emergency Room Enhancement Program For Behavioral Health, Anne Thatcher

Dissertations

Problem. Pediatric mental health complaints and subsequent hospitalizations have been steadily increasing. The Behavioral Health Network (BHN) developed an intensive outreach case management program aimed at reducing youth mental health emergency department (ED) visits and inpatient psychiatric admissions. The Youth Emergency Room Enhancement (YERE) program was a process improvement initiative to provide immediate case management to youth and caregivers for mental health care.

Methods. A Plan-Do-Study-Act (PDSA) method utilizing a retrospective case record review occurred over a six-month period. A convenience sample of youth aged 6-20 years presenting to one of eight healthcare facilities for either ED or inpatient hospitalization …

Metabolic Syndrome Screening Among Inpatient Psychiatric Patients, Susan Magorno

Doctor of Nursing Practice Final Manuscripts

Background: More than 50% of patients with severe mental illness carry undiagnosed Metabolic Syndrome (MetS) comorbidities of hypertension, hyperlipidemia, or diabetes. These patients are three times more likely to die of cardiovascular-related causes; however, this population is not routinely assessed for MetS and frequently lack appropriate treatment.

Objective: The objective is to implement a screening tool designed to identify risk for MetS and trigger appropriate treatment.

Design: The screening tool triggers the provider to address positive criteria through interventions such as further evaluation, medical and/or diabetes educator consultation.

Results: Although overall rates of screening improved significantly, follow-up interventions were …

Individualizing Care For Pediatric Patients With Autism Spectrum Disorder In Perioperative Services, Erin Scheller

Master's Theses

This research explores solutions for individualizing and improving care for pediatric patients with Autism Spectrum Disorder in the Perioperative Setting of an Outpatient Surgery Center. Specifically, it seeks to determine if providing parent and staff resources on Autism Spectrum Disorder is significantly helpful in increasing confidence in the staff by the parents and the staff themselves. Participants included thirty-five surveyed families who had pediatric patients visiting perioperative services and staff who work on the unit. Methods used include information dissemination with the use of printable and online evidence-based resources, an in-person education event for staff, and a pilot study of …

Primary Care Provider Attitudes Towards Adoption Of Evidence Based Practice: Indicators Of Acceptance Towards Bibliotherapy, Shannon Scott

Doctor of Nursing Practice Scholarly Projects

The rising prevalence of depression is straining the skeletal mental health systems in rural communities, resulting in a majority of patients receiving management for their depression solely by their primary care providers. However, providers need to be empowered with evidence-based resources to provide adequate care beyond pharmacotherapy exclusively. Bibliotherapy, or the prescription of books for the treatment of disease, is readily used by psychologists but less incorporated into the traditional medical model of patient care. This small pilot study provided primary care providers in a rural area complimentary copies of the self-help text Feeling Good (Burns, 2009) to incorporate into …

Pornography As A Public Health Issue: Promoting Violence And Exploitation Of Children, Youth, And Adults, Elisabeth Taylor

Dignity: A Journal of Analysis of Exploitation and Violence

The pornography industry is expanding exponentially as a result of ongoing technological advances. The ability to stream videos over the internet and the ubiquity of the smart phone have meant that pornography producers are able to use algorithms to target potential consumers, to cultivate new sexual tastes and to deliver content to a more diverse audience over mobile devices. The advent of virtual reality pornography with interactive sex toys and sex robots imbued with artificial intelligence promises to unleash a further step-change in the extent to which pornography influences ‘real-world’ sexual culture. The critical analysis of pornography undertaken over decades …

Effects Of A Phase Ii Cardiac Rehabilitation Program On Patient Depression, Michael R. Legal, Dnp, Msn-Ed, Rn, Ccrn-K

Doctor of Nursing Practice Projects

Background: Screening for depression upon intake and completion of a Phase II cardiac rehabilitation (CR) program may influence the type of interventions implemented by CR staff and reduce depression.

Objectives: We examined patients before and after a Phase II CR program who self-reported as depressed using the CES-D score and also assessed scores by procedure, gender and age. We further identified the types of interventions used for those who were depressed.

Methods: We conducted a pre-post intervention study. Using a convenience sample, data were collected on CES-D scores before and after the program and by type of procedure, gender, and …

The Effects Of A Structured Teaching Session On Perceived Self-Efficacy Among Mental Health Nursing Supervisors, Pamela Fess, Dnp, Msn

Doctor of Nursing Practice Projects

Background: Specific factors that contribute to nursing supervisors perceived self-efficacy remains unclear. Although several studies have examined the relationship between self-efficacy and mental health nursing supervision most have focused on the impact of client care. To date, there is a dearth of studies to assess the impact of a leadership focused teaching session on the perceived self-efficacy of mental health nursing supervisors. Equipping nurses who are responsible for the supervision of others with the skills needed to fulfill their role responsibilities has the potential to improve their job performance, the work satisfaction, and well-being of staff nurses they supervise as …

Pilot Study Of Anxiety, Depression, And Quality Of Life In Patients With The Diagnosis Of Metastatic Uveal Melanoma, Regine Nshimiyimana, Dnp, Bpharm, Fnp-Bc, Agacnp-Bc, Ocn, Aocnp

Doctor of Nursing Practice Projects

Background: Awareness of a patient’s anxiety, depression, and quality of life (QOL) in those with metastatic uveal melanoma (MUM) can influence care that meets patients’ bio-psychosocial-spiritual needs.

Objectives: To measure the level of anxiety, depression, and QOL in patients with MUM and explore differences by gender, age range, time to metastatic disease, and duration of illness since metastasis.

Methods: We used a descriptive-comparative survey design. Over three months, a convenience sample of 70 patients with MUM aged ≥ 18 years, treated at a Mid-Atlantic hospital were invited to complete a combined survey of the Hospital Anxiety and Depression Scale and …

Maternal Psychological Distress And Cortsiol, Jenna Schroeder

Grace Peterson Nursing Research Colloquium

Abstract

Background: Previous studies have reported associations between prenatal maternal distress and negative health outcomes for the unborn. There are gaps within this body of knowledge and inconsistencies in the research which make the relevant relationships unclear. If changes in maternal cortisol cause alterations in fetal development, it is important to gain an adequate understanding of how, and if, maternal psychological distress predicts maternal cortisol levels. This study is an integrative literature review that looks at the research investigating a connection between maternal psychological distress and maternal cortisol levels during pregnancy. Lazarus and Folkman’s (1984) Transactional Model of Stress and …

Conversion Disorder, Ann Summar

Nursing Posters

Conversion Disorder:

• Neurologic symptoms that are inconsistent with a neurologic disease
• Symptoms cause distress and/or impairment
• No radiological or laboratory findings for symptoms
• May have poor outcomes without proper treatment

The Impact Of Schizophrenia On Copd Readmission Rate Among Hospitalized South Carolinians, Emilienne Y. Watonsi

DNP Research Projects

Due to elevated readmission costs, the Affordable Care Act established the Hospital Readmission Reduction Program in 2012 to curb the 30-day readmission rates. COPD and schizophrenia are two very expensive diseases, COPD national medical costs is projected to be $49.0 billion in 2020; the cost of schizophrenia was 155.7 billion in 2013. The main objective of this study was to determine if schizophrenia is a significant predictor of 30-day readmission following hospitalization for acute exacerbation of COPD after adjusting for age, gender, anxiety, smoking status, T2DM, chronic ischemic heart disease, and GERD. Methods: A retrospective cohort design was used to …

The Lived Experiences Of Opioid Withdrawal: A Phenomenological Study, Eliza Mall

DNP Research Projects

The United States is in the midst of an opioid overdose epidemic resulting to 40,000 accidental drug overdose deaths. In 2016, the number of deaths related to opioid overdose increased to 116 people per day resulting to $504 billion in economic costs. This research study explored the lived experiences of drug addicts having experienced opioid withdrawal symptoms. Phenomenology is useful in discovering the narrative lived experiences that cannot be obtained in quantitative approach. Six themes emerged to describe the lived experiences of opioid addicts who have undergone withdrawal: (a) Increasing desires that are hard to resist (b) Helplessness and hopelessness …

Effectiveness Of An Open Access Scheduling System In A Community Mental Health Center, Callie Crockett

Doctoral Projects

Abstract

Open Access Schedule (OAS) systems are a new way to schedule patient appointment in an outpatient medical setting. In theory these systems will provide many benefits that are not seen in a traditional scheduling model, such as decreased wait times to see a provider and more provider flexibility. However, little research has been done to examine how effective these systems are once they are put into practice, particularly in the mental health setting. The purpose of this project was to examine a recently implemented open access scheduling system in a community mental health center in rural Northeast Tennessee and …

Increasing Depression Screenings In Adults With Advanced Non-Surgical Heart Failure Using 2013 Accf/Aha Recommendations And Healthy People 2020 Target Goals, Valerie Valencia

Doctor of Nursing Practice

The purpose of this evidence-based practice project was to increase depression screenings in adults with non-surgical advanced heart failure using reliable and valid tools, 2013 American College of Cardiology Foundation/American Heart Association recommendations, and Healthy People 2020 Target Goals as a method to identify and facilitate appropriate mental health referral, patient education, and follow-up for depressive symptoms. Interventions took place June 5, 2017, through August 10, 2017. This intervention project involving 246 adults with advanced heart failure demonstrated that an evidence-based intervention for depression screenings increased the number of patients screened from 5% to 44%. At project completion, 65% of …

Grace Peterson Research Colloquium, Emma Pfeiffer

Grace Peterson Nursing Research Colloquium

Mental illness is commonly under-diagnosed, misdiagnosed, or untreated, particularly in the elderly population. An expected population increase for those 65 years and older, increased in health care expenses coupled with the moral and ethical obligation of health care providers to promote quality of life at all ages makes investigation to alternative treatments in this population is worth investigating. The purpose of this literature review is to synthesize existing studies to clarify the following questions: What are the effects of pet therapy on those experiencing signs and symptoms of depression and anxiety? Why is pet therapy still lagging in validated studies, …

College Students, Experiences On Smart Phone Technology Usage: A Qualitative Content Analysis Study, Fatemeh Jafarzadeh-Kenarsari, Parand Pourghane

The Qualitative Report

Besides many benefits of the cell phone technology, numerous arguments are raised on the different and important negative effects of such a technology. This qualitative content analysis study explored the common usages of smart phone technology, its challenges, and benefits among Iranian college students. Participants were 32 bachelor degree students who were recruited using purposive sampling method with maximum variation. Data were collected through 11 individual semi-structured interviews and 3 focus group discussions (5-8 students in each group). Data analysis was done based on a conventional content analysis approach. Data analysis resulted in 3 main themes and 12 sub-themes. The …

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit, P6 Inpatient Geri-Med Psychiatry, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

MaineHealth Maine Medical Center

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted.

The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better …

Barriers To Medication-Assisted Opioid Recovery: An Integrative Review Of Literature, Emily Miller

Grace Peterson Nursing Research Colloquium

Abstract

Background: Opioid addiction has become one of the fastest growing epidemics sweeping the world, but despite the use of opioid agonist medication-assisted treatment (MAT) with methadone or buprenorphine having been found to be one of the most effective methods for treatment of this epidemic, there is still a significant gap between the number of people that need MAT and the number of people that actually receive MAT.

Objective: The purpose of this integrative literature review is to explore the barriers that prevent many addicts from receiving MAT and to identify strategies that may assist in eliminating these barriers in …

The Benefits Of And Barriers To Psychiatric Advance Directive Implementation, Lauren Haindfield

Grace Peterson Nursing Research Colloquium

The Benefits of and Barriers to Psychiatric Advance Directive Implementation

Lauren Haindfield

Faculty Sponsor: Dr. Barbara Harris

Background: Psychiatric advance directives can be beneficial for patients with mental disorders, but their implementation is limited in large part due to a knowledge gap.

Objectives: The purpose of this integrative literature review was to identify both the benefits of and barriers to psychiatric advance directives.

Methods: This integrative literature review used the databases of CINAHL, PubMEd, and PsychInfo. Search terms included pad implementation, barriers to pad implementation, psychiatric advanced directives, benefits of psychiatric advanced directives, and current pad practices.

Results: PAD implementation …

A Demonstration Project To Address Juvenile Drug Addiction, Mary Ellen Broaddus

Graduate Theses, Dissertations, and Capstones

The rise in adolescent drug use and addiction is becoming a worldwide phenomenon. An eleven year study of youth in European countries found drug use widespread and increasing (Molinaro, Sicilian, & Curzio, 2011). In 2013 there were over 2.8 million new users of illicit drugs, over half of whom were under 18 years of age (‘Drug Facts’, 2015).

Adolescents are at unique risk because biochemical distinctions in their brains, when compared with adults, prompt more risk-taking behaviors (Gallager, 2014). Health risks are considerable and include hypertension, stroke, convulsions and seizures, and liver disease such as cirrhosis and hepatitis. In 2013 …

Mental Illness Stigma, Socially Acceptable Treatment, And Barriers To Health, Frances Renee Gellert

Independent Study Project (ISP) Collection

This paper discusses the topic of mental illness stigma and treatment in Uganda as explored through internship in the Social Work Department at Butabika National Referral Mental Hospital. The objectives of this project were to complete a meaningful internship while exploring causes of mental illness in Uganda, contradictions between traditional and modern approaches to treatment, and the affect of stigma on mental well-being. The internship included a total of 120 hours at Butabika Hospital. Individual research using documentary and literature review methods accompanied the internship. Butabika Hospital did not consent to the completion of formal research at, so any conclusions …

Education Program Using Non-Pharmacologic Support During Benzodiazepine Reduction In Patients With Anxiety Disorders, Kelly D. Kearney Dnp, Rn, Pmhnp-Bc, Diane Wardell Phd, Whnp-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A private mental health clinic developed an initiative to aid patients with anxiety disorders to taper their use of benzodiazepines. Based on best practices, a treatment protocol was developed in which patients attended 4 sessions (1 per month) in which they combined instruction in non-pharmaceutical anti-anxiety techniques (guided imagery, mindfulness meditation, deep breathing, progressive muscle relaxation, exercise, emotional freedom) with cognitive behavioral therapy and use of selective serotonin re uptake inhibitors. Participants experienced a reduction in benzodiazepine use. This small scale initiative showed that the holistic approach to anxiety management was an effective plan to decrease the use of benzodiazepines …

A Clinical Practice Change Initiative To Incorporate Animal Assisted Therapy In Advanced Practice Registered Nurses' Clinical Practice For Children And Adolescents, Donna Rae Cowell

Doctoral Projects

Background: Children and adolescents mental healthcare needs is vital for the future of our nation’s welfare (American Psychology Association, 2014). Research has indicated AAT may be a considerable choice to help with pediatrics mental healthcare and may be utilized as an adjunct to enhance the care within the psychiatric healthcare field (Chandler, 2012). AAT has become popular within the healthcare realm (Friesen, 2009; Uyemura, 2016) and is a unique method for providing “patients” health care, which may improve patient outcomes (Chandler, 2012; Cowell, 2013; McCullough, 2016; McQuarrie & Urichuk, 2008). Research supports that “providers” in the health care field may …

The Effect Of Mindfulness Meditation On Perceived Stress And Total Health Care Cost, Rachel Hale

DNP Projects

Background: Chronic stress can lead to hypertension, tachycardia, and increased inflammatory markers, which put individuals at risk for chronic diseases. Mindful meditation not only decreases perceived stress but also has the potential to decrease the risk of chronic diseases and health care cost. Purpose: The purpose of this mindfulness meditation project is to reaffirm that mindfulness meditation decreases perceived stress scores and to determine whether mindfulness meditation decreases health care cost. Theoretical Model: The relation of mindfulness meditation, lowered stress levels, and chronic diseases can be explained by the social cognitive theory (SCT). Applying SCT, meditation’s goal is to alter …