Journal of the American Psychiatric Nurses Association最新文献

Background: Burnout has been shown to negatively affect the physical and emotional health of staff; contribute to rising costs; negatively impact patient satisfaction, worsen patient outcomes, and increase rates of safety events as well as mortality. Some research suggests that the practice of mindfulness could help nurses with burnout, but attrition rates are high due to the time commitment. In recent studies, the use of a 3-min mindfulness practice showed positive results.

Aims: This research aimed to determine if a 3-min mindfulness-based intervention can decrease burnout and improve overall well-being in psychiatric nurses.

Methods: An online 3-min mindfulness breathing space was used as the intervention. Burnout and well-being were measured prior to the intervention and at 2 weeks post-intervention.

Results: The total sample included 46 psychiatric nurses; for the 16 who completed the pre- and post-well-being instrument, overall well-being increased. There was no difference in burnout scores from pre- to post-intervention.

Conclusions: This is a promising intervention for psychiatric nurses that increases overall feelings of well-being.

Objective: Residents of long-term care facilities have reduced access to mental health care due to the availability of providers, transportation, and staff or family members who must accompany the resident. As a result, many residents wait up to 6 months for a first appointment with a psychiatric provider or utilize their primary care provider to meet their mental health care needs.

Methods: To increase access to mental health care, tablets were placed in long-term care facilities to access telehealth visits with mental health providers. Psychiatric visits were conducted via telehealth to assess, diagnose, and treat residents of the facilities. Psychiatric Mental Health Nurse Practitioners also worked to ensure the correct diagnosis and treatment were applied to each resident. In addition, there was a focus on prescribing psychotropic medications such as antipsychotics and benzodiazepines only when clinically indicated and at the lowest effective doses and ensuring gradual dose reduction efforts were being conducted safely.

Results: Results of this project showed a decrease in time to first appointment from 6 months to 20 days, an increase in the application of clinical criteria to determine diagnoses, improvement in initiating gradual dose reduction requirements when clinically indicated, and resident, staff, and family satisfaction with care.

Conclusions: The results of this project show that it is feasible and safe to provide mental health visits to residents of long-term care facilities through telehealth and should be considered to improve access to mental health care services for this population.

AimExamine methods of suicide among nurses cross-nationally.MethodsThe literature was searched to identify epidemiological and cohort studies that analyzed suicide mortality among nurses cross-nationally. Studies were included if nurse suicide mortality was analyzed, and if methods of suicide among nurses were concurrently examined. In total, 22 studies were included, 16 of which were epidemiological and 6 of which were cohort.ResultsAcross all studies, nurse suicide decedents from 11 countries were represented. Across most global studies, self-poisoning and hanging were two frequently utilized methods of suicide among nurses. However, in the United States, two common suicide methods included self-poisoning and firearms. While there was likely overlap with respect to public reporting of global cases, in China and India, leading methods included jumping from a building and hanging, respectively. Taken together, despite some inconsistencies, self-poisoning was one of the most frequently reported suicide methods among nurses across studies.ConclusionAdditional research is important in building the evidence base, particularly with respect to ranking methods of suicide, and further differentiating between suicide methods used by female and male nurses cross-nationally. Additional cross-national research regarding specific substances utilized in suicide self-poisoning deaths is also needed. Because means restriction represents a key suicide prevention strategy, these data are needed to inform means restriction interventions among nurses.

Objective: Restrictive laws still impede nurse practitioners (NPs) from realizing the full scope of their training and education in too many states. While practice laws vary from state to state, working in states with restricted practice policies creates a multitude of barriers for patients seeking accessible, high-quality mental health care, especially in rural areas.

Methods: One psychiatric mental health NP describes the multiple obstacles she faced in attempting to provide much-needed care to the perinatal mental health community in her state.

Results: This review highlights evidence that supports full practice authority, showing improved patient access to high-quality care combined with anecdotal support describing the barriers faced by one clinician.

Conclusions: Her journey directly speaks to harsh realities imposed by collaborative physician mandates and the urgent need for nurse practitioner independent practice.

Background: Workplace violence is an urgent issue for psychiatric mental health nurses. While physical workplace violence is overt, microaggressions are covert. Microaggressions are brief, daily offenses that communicate negativity. An estimated 90% of healthcare providers report experiencing microaggressions. However, evidence-based strategies and interventions for mitigating microaggressions in healthcare settings are not well established.

Aims: The purpose of the review was to identify strategies and interventions for addressing microaggressions that are applicable to nurses.

Method: The evidence-based literature review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases included Web of Science, Embase, CINAHL, and PubMed. Published articles from 2010 to 2024 were included if they: (a) discussed strategies or interventions for reducing microaggressions and (b) included health professions students, educators, healthcare workers, or first responders in the sample. After a preliminary review, deduplication and eligibility criteria screening of 102 articles, 17 articles were included in the review.

Results: Of the 17 articles, seven reported on communication strategies and eight on interventions. Four articles highlighted microinterventions as a strategy to address microaggressions. Seven of the eight intervention studies used a descriptive, pre/post-test design. All intervention studies targeted medicine professionals and none nurses. Most interventions effectively raised awareness and the ability to recognize microaggressions, but the effectiveness to reduce microaggressions was not measured.

Conclusions: Findings suggest further research is needed on strategies and interventions addressing microaggressions, particularly for nurses.

Introduction: Actions of physical violence, harassment, or other threatening and intimidating behavior characterize workplace violence, often subsequently followed by seclusion to maintain safety in emergency department (ED) and psychiatric settings. Though there is no universally identified benchmark of acceptable rates of seclusion, April to September 2023 preintervention rate of seclusion hours on a psychiatric ED unit at a public state hospital in the southeast was 5.57/1,000 patient care hours, exceeding current comparison data from Centers for Medicare and Medicaid Services (CMS) for calendar year 2022 with a state average, 0.26/1,000 patient care hours and national average, 0.35/1,000 patient care hours.

Aim: This project aimed to reduce seclusion rates through the implementation of a violence risk identification and management protocol.

Methods: Interventions included brief training and implementation of a violence risk protocol using the Violence Assessment Tool (VAT) and seclusion debriefing.

Results: Reports of workplace violence decreased by 25% in the psychiatric ED and 17% across the adult psychiatric inpatient units, and there was a cumulative decrease in Inpatient Psychiatric Facility Quality Reporting seclusion rates by 5% across the adult psychiatric inpatient units where the components of the VAT were communicated in report from the psychiatric ED.

Conclusion: Early identification of violence risk, patient-specific agitation factors, and de-escalation preferences in the ED setting may have the potential to improve safety through reduced seclusion and workplace violence events. Future research could study patient perspectives of the VAT as a patient-centered tool in de-escalation to reduce seclusion.