Clinical outcomes of depressed clients: a review of current literature

Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey

BACKGROUND

Further exploration of the practice roles of psychiatric mental health (PMH) advanced practice registered nurses (APRNs) is warranted.

OBJECTIVE

In March of 2016, the American Psychiatric Nurses Association (APNA) conducted a national survey to gather data on the demographics, practice roles, and activities of certified PMH APRNs.

DESIGN

The e-mail survey contained 46 questions consistent with minimum data set requirements of the Forum of State Nursing Workforce Centers.

RESULTS

The data indicate that PMH APRNs are a clinically active workforce; the majority deliver a wide variety of mental health services including diagnosis and management of both acute and chronic mental illness, prescribing, and providing psychotherapy.

CONCLUSION

PMH APRNs are delivering care to clients dealing with a range of serious mental illnesses across the life span in a variety of roles. It will be critical to monitor the activities and outcomes of this expanding behavioral health care workforce.

The Patient Protection and Affordable Care Act: impact on mental health services demand and provider availability

The Patient Protection and Affordable Care Act (ACA) will greatly increase the demand for mental health (MH) services, as 62.5 million Americans from relatively high-need populations will be newly eligible for MH benefits. Consequently, the supply of MH care provider services is expected to proportionately decrease by 18% to 21% in 2014. ACA funding does not demonstrate the ability to increase turnout of psychiatrists sufficiently to meet the need. Available data indicate that the numbers of advanced practice psychiatric nurses (APPNs) continue to increase at a much greater rate, but information from either a clinical perspective or a market perspective is complicated by the weak distinctions that are made between nurse practitioners (NPs) and other nonphysician care professionals. The following recommendations are made: (a) some of the ACA funding for research into efficient and effective care delivery systems should be allocated to acquiring data on APPNs in leadership roles or clinical settings in which they are ultimately responsible for management of MH care, as differentiated from settings in which they provide support for psychiatrists; and (b) since the available data indicate nurse practitioners achieve good outcomes and are more economically viable than psychiatrists, placement of psychiatric-mental health nurse practitioners in community settings should be recognized as a realistic solution to the shortfall of MH services.

Evaluation of a brief cognitive behavioral group therapy for psychological distress among female Icelandic University students

A study of a brief cognitive behavioral group therapy intervention for psychologically distressed Icelandic female university students was conducted using a pre-post test quasi-experimental design with intervention and control group conditions. Students were randomly allocated to control and intervention group conditions (n = 30). The intervention group received four sessions of cognitive behavioral group therapy, delivered by two advanced practice psychiatric nurses. Assessment of distress included self-reported depression and anxiety symptoms. Students in the intervention group experienced significantly lower levels of depression and anxiety symptoms compared to the control group post-test providing preliminary evidence concerning intervention effectiveness for Icelandic students.

Advanced practice nurse psychiatric bridging intervention

Depression is a prevalent and treatable condition; however, extensive waiting periods for treatment are associated with high failure to attend initial psychiatric evaluation (IPE) appointments. This article describes the development, implementation, and pilot evaluation of the Advanced Practice Nurse (APN) Psychiatric Bridging Intervention. The project was grounded in Peplau's theory of interpersonal relations and designed to provide supportive psychoeducational counseling and initiation of psychotropic medication for clients with depressive symptoms during the time between intake and IPE. Project development was guided by Roger's Diffusion of Innovations framework used for adopting an evidence-based innovation into an organization. A two-group design allowed comparison of preintervention clients (38 clients who received standard care) and intervention clients (19 clients who participated in the bridging intervention). The difference in IPE appointment attendance rates between the two groups approached statistical significance (p = 0.08). An unanticipated finding was that APN Psychiatric Bridging Intervention clients required only 30-minute IPE appointments compared to the typical 60-minute appointment.

Advanced practice nursing students' knowledge, self-efficacy, and attitudes related to depression in older adults: teaching holistic depression care

The aim of this study was to examine the knowledge, attitudes, and self-efficacy of advanced practice nursing students toward depression in older adults. Findings suggest that advanced practice nursing students are interested in caring for the whole person and desired more information on the physical and emotional-spiritual needs of older patients with depression. Suggestions for holistic nursing depression care education are presented.

Health care reform and the federal transformation initiatives: capitalizing on the potential of advanced practice psychiatric nurses

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.