Janet York

Addressing Gaps in Mental Health Needs of Diverse, At-Risk, Underserved, and Disenfranchised Populations: A Call for Nursing Action

Psychiatric nurses have an essential role in meeting the mental health needs of diverse, at-risk, underserved, and disenfranchised populations across the lifespan. This paper summarizes the needs of individuals especially at-risk for mental health disorders, acknowledging that such vulnerability is contextual, age-specific, and influenced by biological, behavioral, socio-demographic and cultural factors. With its longstanding commitment to cultural sensitivity and social justice, its pivotal role in healthcare, and its broad educational base, psychiatric nursing is well-positioned for leadership in addressing the gaps in mental health prevention and treatment services for vulnerable and underserved populations. This paper describes these issues, presents psychiatric nursing exemplars that address the problems, and makes strong recommendations to psychiatric nurse leaders, policy makers and mental health advocates to help achieve change.

Implementation of Online Suicide-Specific Training for VA Providers

ObjectiveDue to the gap in suicide-specific intervention training for mental health students and professionals, e-learning is one solution to improving provider skills in the Veterans Affairs (VA) health system. This study focused on the development and evaluation of an equivalent e-learning alternative to the Collaborative Assessment and Management of Suicidality (CAMS) in-person training approach at a Veteran Health Affairs medical center.MethodsThe study used a multicenter, randomized, cluster, and three group design. the development of e-CAMS was an iterative process and included pilot testing. Eligible and consenting mental health providers, who completed a CAMS pre-survey, were randomized. Provider satisfaction was assessed using the standard VA evaluation of training consisting of 20 items. Two post training focus groups, divided by learning conditions, were conducted to assess practice adoption using a protocol focused on experiences with training and delivery of CAMS.ResultsA total of 215 providers in five sites were randomized to three conditions: 69 to e-learning, 70 to in-person, 76 to the control. The providers were primarily female, Caucasian, midlife providers. Based on frequency scores of satisfaction items, both learning groups rated the trainings positively. In focus groups representing divided by learning conditions, participants described positive reactions to CAMS training and similar individual and institutional barriers to full implementation of CAMS.ConclusionsThis is the first evaluation study of a suicide-specific e-learning training within the VA. The e-CAMS appears equivalent to the in-person CAMS in terms of provider satisfaction with training and practice adoption, consistent with other comparisons of training deliveries across specialty areas. Additional evaluation of provider confidence and adoption and patient outcomes is in progress. The e-CAMS has the potential to provide ongoing training for VA and military mental health providers and serve as a tutorial for psychiatrists in preparation for specialty boards.

Veteran-specific suicide prevention

Suicide rates have been increasing in some subgroups of Veteran populations, such as those who have experienced combat. Several initiatives are addressing this critical need and the Department of Veterans Affairs (VA) has been recognized for its leadership. This integrative review adopts the Research Impact Framework (RIM) to address suicide-specific prevention activities targeting Veterans. The RIM is a standardized approach for developing issue narratives using four broad areas: societal-related impacts, research-related impacts, policy-related impacts, and service-related impacts. The questions addressed in this review are: (1) What are the major initiatives in Veteran-specific suicide prevention in four areas of impact—society, research, policy, and services? (2) Are there gaps related in each impact area? and (3) What are the implications of this narrative for other strategies to address suicide prevention targeting Veterans? Systematic application of the RIM identifies exemplars, milestones, gaps, and health disparity issues.

Technology-enhanced suicide prevention interventions: A systematic review of the current state of the science.

Objective Suicide prevention is a high priority. Scalable and sustainable interventions for suicide prevention are needed to set the stage for population-level impact. This systematic review explores how technology-enhanced interventions target suicide risk and protective factors, using the Centers for Disease Control and Prevention (CDC, 2015) Risk and Protective Factors Ecological Model. Methods Information databases (PsycINFO, PubMed and CINAHL) were systematically searched and records including technology-enhanced interventions for suicide prevention (n = 3764) were reviewed. Records with varying technologies and diverse methodologies were integrated into the search. Results Review of the records resulted in the inclusion of 16 studies that utilized technology-enhanced interventions to address determinants of suicidal behaviour. This includes the use of standalone or, in most cases, adjunct technology-enhanced interventions for suicide prevention delivered by mobile phone application, text message, telephone, computer, web, CD-ROM and video. Conclusion Intervention effectiveness was variable, but several technology-enhanced interventions have demonstrated effectiveness in reducing suicidal ideation and mental health co-morbidities. Large-scale research and evaluation initiatives are needed to evaluate the costs and long-term population-level impact of these interventions.

Suicide-specific Safety in the Inpatient Psychiatric Unit

In total, 75% of suicides reported to the Joint Commission as sentinel events since 1995, have occurred in psychiatric settings. Ensuring patient safety is one of the primary tasks of inpatient psychiatric units. A review of inpatient suicide-specific safety components, inclusive of incidence and risk; guidelines for evidence-based care; environmental safety; suicide risk assessment; milieu observation and monitoring; psychotherapeutic interventions; and documentation is provided. The Veterans Health Administration (VA) has been recognized as an exemplar system in suicide prevention. A VA inpatient psychiatric unit is used to illustrate the operationalization of a culture of suicide-specific safety. We conclude by describing preliminary unit outcomes and acknowledging limitations of suicide-specific inpatient care and gaps in the current inpatient practices and research on psychotherapeutic interventions, observation, and monitoring.

RCT evaluating provider outcomes by suicide prevention training modality: in-person vs. e-learning

Purpose – The purpose of this paper is to evaluate provider outcomes in response to two modes of suicide prevention training (e-learning and in-person) and a control group. The Collaborative Assessment and Management of Suicidality (CAMS) was adapted for e-learning delivery to US Veterans Administration mental health providers. Outcomes include: self-evaluated beliefs, ability, and self-efficacy in managing suicidal patients. Design/methodology/approach – This study used a multicenter, randomized, cluster design to test the effectiveness of e-learning vs in-person conditions CAMS for changes in provider outcomes. Findings – Survey scores showed significant improvements for both the e-learning vs control and the in-person vs control between pre-intervention and post-intervention; however, the e-learning and in-person conditions were not significantly different from each other. Research limitations/implications – Limitations of the study include that there were drop-outs over the study period and the survey questions may not have captured all of the aspects of the CAMS training. Practical implications – Results suggest that e-learning training modules can provide comparable outcomes to in-person training for suicide prevention. Social implications – More providers may have accessible training materials for managing suicidal patients. Originality/value – Currently practicing providers now can choose between two equivalent training modalities for improving the management of suicidality in their patients.

Development of Veteran-Centric Competency Domains for Psychiatric–Mental Health Nurse Practitioner Residents

The mental health needs of military service members, Veterans, and their families are a designated national priority; however, there has been little emphasis on the inclusion of Veteran-centric domains in competency-based nursing education for psychiatric-mental health nurse practitioners (PMHNPs). The current article describes the identification and application of Veteran-centric domains in an innovative pilot residency program for PMHNPs, funded by the Veterans Health Administration Office of Academic Affiliations. Fourteen Veteran-centric competency domains were developed from literature review, including knowledge, attitudes, and skill behaviors. Adoption and application of these domains in curricular components included the resident competency evaluation, baseline assessment of military experience, and evidence-based practice seminars and training. Methods of competency domain evaluation are presented, along with gaps related to the evaluation of competency skills. The delivery of mental health services reflecting these domains is consistent with the VA core values and goal of developing a positive service culture. [Journal of Psychosocial Nursing and Mental Health Services, 54(11), 31-36.].

Feasibility of Motivational Interviewing and Physical Activity Counseling Sessions for Improving Physical Activity Self-Management for Latina Women Either at Risk for or Diagnosed With Type 2 Diabetes Mellitus

Introduction: Latinas have a greater chance of dying from diabetes than non-Latina Whites. As a population group, the literature has shown that Latinas do not meet physical activity (PA) guidelines. Motivational interviewing (MI) is a patient-centered counseling method that promotes self-efficacy for behavior change. The purpose of the study was to examine the feasibility of using MI/PA counseling for self-management of type 2 diabetes mellitus with Latinas. Methods: Latinas (n = 12) were recruited from an occupational program in Southern California. Two MI and PA sessions were conducted over 2 months. Feasibility measures included recruitment, retention, protocol adherence, and attrition. Impact outcomes included PA, PA stage of change, and waist circumference. Results: Participants attended all sessions and completed all questionnaires. Half progressed into a later stage of change for PA. Discussion: Results suggest MI and PA counseling is feasible for improving PA with Latinas at risk/diagnosed with type 2 diabetes mellitus.

Exploring Self-Care and Preferred Supports for Adult Parents in Recovery from Substance Use Disorders: Qualitative Findings from a Feasibility Study

ABSTRACT Very little is known about the self-care behaviors (SCB) that adult parents employ and the preferred supports they utilize to maintain their recovery from substance use disorders (SUD) while also parenting their children. This study used a qualitative descriptive approach to explore perceptions of self-care and parenting to inform future self-care interventions for parents in early recovery. Nineteen mothers and fathers of at least one child between the ages of 6–18 were interviewed by telephone about parental self-care practices while in recovery from SUD, recovery management, and preferred supports in the community. Participants described the experience of parenting as challenging, with variations in the level of support and resources. Self-care included meaningful connection with recovery support and children, taking care of physical health, maintaining spirituality, healthy eating, exercise, journaling, continuing education, staying busy, sponsorship, establishing boundaries, self-monitoring, abstinence, and dealing with destructive emotions. Participants reported SCB as being a critical component of their ongoing recovery and their parenting practices, though differences in SCB by gender and for minorities require further exploration. Parental gains were perceived as benefits of SCB that minimized the negative impact of prior parental drug use on their children.

A prism of excellence: The Charleston Veterans Administration Nursing Academic Partnership

BACKGROUND The Veterans Administration (VA) has been committed to academic affiliate training partnerships for nearly 70 years in efforts to enhance veteran-centric health care. One such effort, the VA Nursing Academy (VANA) program, was developed in 2007 in response to the nationwide nursing shortage and began as a five-year pilot with funding competitively awarded to 15 partnerships between local VA medical centers and schools of nursing. The VANA program evolved into the VA Nursing Academic Partnership (VANAP) program following the initial pilot. PURPOSE This article describes the development and evolution of the Charleston VANAP, which includes the Ralph H Johnson VA Medical Center (RHJ VAMC) and the Medical University of South Carolina College of Nursing (MUSC CON). METHODS The VA Office of Academic Affiliations (OAA) funded a large portion of the initial five years of the Charleston VANAP. Once the national funding source ceased, the RHJ VAMC and the MUSC CON entered into a Memorandum of Understanding (MOU) to offer in-kind contributions to the partnership. DISCUSSION The Charleston VANAP is the only program in the nation to offer three different nurse trainee programs and this article highlights some of the more notable achievements from each program. CONCLUSION The Charleston VANAP is a comprehensive partnership between the RHJ VAMC and the MUSC CON that truly demonstrates a commitment to assure that the very best care be provided to Veterans, our Nations heroes.