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Psychiatric Nursing Workforce Survey: Results and Implications. 精神科护理人员队伍调查:结果和影响。
IF 2 4区 医学 Q3 NURSING Pub Date : 2024-05-01 Epub Date: 2022-12-29 DOI: 10.1177/10783903221146190
Angela M Gerolamo, Kathleen R Delaney, Bethany Phoenix, Patricia Black, Amy Rushton, Janette Stallings

Objective: The last national survey of psychiatric-mental health (PMH) nurses was conducted in 2016 and was limited to advanced practice registered nurses (APRNs). Data on the demographic and employment characteristics of the PMH workforce could inform how to optimize the PMH nursing workforce to address increasing demands for mental health services. The objective was to conduct a national survey of PMH registered nurses (RNs) and PMH-APRNs to gather data on their demographic, educational, and practice characteristics.

Methods: An email survey was administered between October 2020 and February 2021 to all members of the American Psychiatric Nurses Association and to all PMH-APRNs certified by the American Nurses Credentialing Center. Separate surveys included 51 questions (RN) and 52 questions (APRN). Survey questions were informed by several sources including the Minimum Data Set for the Behavioral Health Workforce.

Results: Surveys were completed by 4,088 PMH-RNs and 5,158 PMH-APRNs, with a combined response rate of 12.1%. Findings suggest that the workforce is aging but has increased slightly in diversity. In all, 62.4% of RNs reported a hospital as their primary employment setting, while the majority of APRNs (70.4%) practice in outpatient settings. Forty-four percent of the PMH-APRN respondents indicated that most of their patients receive federal insurance.

Conclusions: Nursing must plan for significant retirements in the PMH workforce in next 5 years. Hospital-based practice continues to dominate PMH-RN roles but might be expanded to community-based settings teaming with PMH-APRNs in outpatient sites. Increasing the diversity of the workforce should be prioritized.

调查目的上一次全国精神科-心理健康(PMH)护士调查于 2016 年进行,调查对象仅限于高级执业注册护士(APRN)。有关精神心理健康(PMH)护士队伍的人口和就业特征的数据可为如何优化精神心理健康(PMH)护士队伍提供信息,以应对日益增长的精神健康服务需求。我们的目标是对 PMH 注册护士(RNs)和 PMH-APRNs 进行一次全国性调查,以收集有关他们的人口、教育和实践特征的数据:在 2020 年 10 月至 2021 年 2 月期间,通过电子邮件向美国精神科护士协会的所有会员和美国护士资格认证中心认证的所有 PMH-APRNs 进行了调查。单独的调查包括 51 个问题(RN)和 52 个问题(APRN)。调查问题参考了多个资料来源,包括《行为健康工作者最低数据集》(Minimum Data Set for the Behavioral Health Workforce):共有 4088 名 PMH-RN 和 5158 名 PMH-APRN 完成了调查,总回复率为 12.1%。调查结果显示,医务人员队伍正在老龄化,但多样性略有增加。总的来说,62.4%的护士称医院为其主要工作场所,而大多数全科护士(70.4%)在门诊工作。44%的 PMH-APRN 受访者表示,他们的大多数病人都享受联邦保险:结论:护理人员必须为未来5年 PMH 工作队伍的大量退休做好计划。以医院为基础的实践继续主导 PMH-RN 的角色,但可能会扩展到以社区为基础的环境,在门诊场所与 PMH-APRNs 组成团队。应优先考虑增加员工队伍的多样性。
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引用次数: 0
Evaluating the Psychometric Properties of the Sexual and Gender Minority Adverse Childhood Experiences Scale Among Sexual Minority Men and Women 评估少数性取向男性和女性童年不良经历量表的心理测量特性
IF 2 4区 医学 Q3 NURSING Pub Date : 2024-04-20 DOI: 10.1177/10783903241246562
Marvin A. Solberg, Julie A. M. J. Kurzer
BACKGROUND:Adverse childhood experiences (ACEs) are known determinants of negative health outcomes. Sexual and gender minority (SGM) individuals have higher ACE scores than non-SGM individuals. The SGM-ACE scale was developed to better assess this population but is not yet validated in SGM subgroups.AIMS:This study aims to validate the sexual and gender minority adverse childhood experiences (SGM-ACE) scale among sexual minority men (SMM) and sexual minority women (SMW), while testing measurement invariance across both groups.METHODS:A cross-sectional survey included 530 sexual minority adults (265 men, 265 women) in the United States. Cronbach’s alpha established internal consistency reliability. Validity was assessed via confirmatory factor analysis (CFA) for the SGM-ACE’s theoretical structure and Pearson’s correlations for concurrent validity with substance use outcomes (alcohol, cannabis, and drugs). Multigroup structural equation modeling (SEM) determined measurement invariance between SMM and SMW.RESULTS:The CFA of the original model exhibited good fit. Fit was improved after removing the institutionalization item, chi-square ( χ2) = 14.26, degrees of freedom ( df) = 9, p = 0.113, minimum discrepancy (CMIN/ df) = 1.59, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.03, 90% confidence interval (CI): (0.00–0.06), and standardized root mean square residual (SRMR) = 0.02. Internal consistency reliability was established (α = 0.78). SGM-ACE exhibited weak, yet significant relationships with each substance use outcome. Multigroup SEM indicated measurement invariance between SMM and SMW.CONCLUSION:This study provides psychometric validation of the SGM-ACE, establishing measurement invariance between SMM and SMW. Future research should explore its utility in diverse SGM minority subgroups.
背景:众所周知,童年不良经历(ACE)是导致不良健康后果的决定因素。性与性别少数群体(SGM)的 ACE 分数高于非 SGM 群体。目的:本研究旨在在性少数群体男性(SMM)和性少数群体女性(SMW)中验证性少数群体和性别少数群体童年不良经历量表(SGM-ACE),同时测试这两个群体的测量不变性。方法:横断面调查包括美国的 530 名性少数群体成年人(265 名男性,265 名女性)。Cronbach's alpha 确定了内部一致性可靠性。通过确认性因子分析(CFA)评估了 SGM-ACE 的理论结构的有效性,并通过皮尔逊相关性评估了与药物使用结果(酒精、大麻和毒品)的并发有效性。多组结构方程模型(SEM)确定了 SMM 和 SMW 之间的测量不变性。去掉机构化项目后,拟合度有所提高,秩方(χ2)= 14.26,自由度(df)= 9,p= 0.113,最小差异(CMIN/ df)= 1.59,比较拟合指数(CFI)= 0.99,均方根近似误差(RMSEA)= 0.03,90%置信区间(CI):(0.00-0.06),标准化均方根残差(SRMR)= 0.02。内部一致性信度确定(α = 0.78)。SGM-ACE 与每种药物使用结果之间的关系微弱但显著。结论:本研究对 SGM-ACE 进行了心理测量验证,确定了 SMM 和 SMW 之间的测量不变性。未来的研究应探索其在不同的 SGM 少数群体亚群中的实用性。
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引用次数: 0
Artificial Intelligence and Publication Ethics 人工智能与出版伦理
IF 2 4区 医学 Q3 NURSING Pub Date : 2024-04-15 DOI: 10.1177/10783903241245423
Geraldine S. Pearson
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引用次数: 0
Social Support Is Protective Against the Effects of Discrimination on Parental Mental Health Outcomes 社会支持可抵御歧视对父母心理健康结果的影响
IF 2 4区 医学 Q3 NURSING Pub Date : 2024-04-11 DOI: 10.1177/10783903241243092
Dallis Alvarez, Harry Adynski, Rebeca Harris, Baiming Zou, Jacquelyn Y. Taylor, Hudson P. Santos
BACKGROUND:Discrimination, or unfair treatment based on individual characteristics such as gender, race, skin color, and or sexual orientation, is a pervasive social stressor that perpetuates health disparities by limiting social and economic opportunity and is associated with poor mental and physical health outcomes.AIMS:The purpose of the present study is to (1) examine the association between maternal experiences of discrimination and paternal experiences of discrimination; (2) explore how discrimination relates to parental (maternal and paternal) stress and depressive symptoms; and (3) examine whether social support exerts protective effects.METHODS:The sample was 2,510 mothers and 1,249 fathers from the Child Community Health Network study. Linear regression models were conducted to explore associations between maternal and paternal discrimination. In addition, mediation analyses were conducted to explore if social support functioned as a mediator between discrimination on parental stress and depressive symptoms.RESULTS:Most mothers (40.3%) and fathers (50.7%) identified race as the predominant reason for discrimination. Experiencing discrimination was significantly related to stress and depressive symptoms for both parents, and all forms of social support mediated these relationships. Our findings suggest that social support can act as a protective factor against the negative association between discrimination and both stress and depressive symptoms.CONCLUSIONS:These findings highlight the need to integrate social support into existing interventions and include fathers in mental health screenings in primary-care settings. Finally, we briefly describe the role of nurses and other allied health professionals in addressing discrimination in health care and health policy implications.
背景:歧视,或基于性别、种族、肤色或性取向等个人特征的不公平待遇,是一种普遍存在的社会压力源,它通过限制社会和经济机会来延续健康差异,并与不良的身心健康结果相关联。研究目的:本研究的目的是:(1)研究母亲遭受歧视的经历与父亲遭受歧视的经历之间的关联;(2)探讨歧视与父母(母亲和父亲)的压力和抑郁症状之间的关系;以及(3)研究社会支持是否具有保护作用。采用线性回归模型探讨母亲和父亲歧视之间的关联。结果:大多数母亲(40.3%)和父亲(50.7%)认为种族是歧视的主要原因。经历歧视与父母双方的压力和抑郁症状有明显关系,而所有形式的社会支持都能调节这些关系。我们的研究结果表明,社会支持可以作为一种保护因素,防止歧视与压力和抑郁症状之间的负相关。结论:这些研究结果强调了将社会支持纳入现有干预措施的必要性,并将父亲纳入初级保健机构的心理健康筛查中。最后,我们简要介绍了护士和其他专职医疗人员在解决医疗保健中的歧视问题方面所扮演的角色以及对医疗政策的影响。
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引用次数: 0
“It’s My Secret”: Shame as a Barrier to Care in Individuals With Opioid Use Disorder "这是我的秘密羞耻感是阿片类药物使用障碍患者接受治疗的障碍
IF 2 4区 医学 Q3 NURSING Pub Date : 2024-04-06 DOI: 10.1177/10783903241242748
Monika S. Schuler, Valerie Seney
BACKGROUND:Substance use disorder (SUD) is a chronic illness impacting more than 59 million Americans last year. Opioid use disorder (OUD) is a subset of SUD. The literature supports that healthcare providers frequently stigmatize patients with OUD. Individuals with OUD often feel shame associated with their disorder. Shame has been associated with maladaptive and avoidant behaviors.AIM:The aim of this qualitative descriptive study was to examine and describe the experiences of shame and health-seeking behaviors in individuals with OUD.METHODS:A qualitative exploratory design using focus groups with individuals in treatment for OUD was used to identify the issue of shame and its relationship to health-seeking behaviors.RESULTS:A systematic content analysis of discussions with 11 participants in four focus groups revealed four major themes and associated subthemes: Avoidance of Preventive Care (belief providers are judgmental); the Hidden Disorder (keeping secrets); Constraints of Shame (justification for the continuation of drug usage); and Trust in MOUD (Medication for Opioid Use Disorder) Providers. The feeling of shame leads to a reluctance to engage in health-promoting actions, such as scheduling appointments with primary care providers and dentists.CONCLUSION:Healthcare practitioners must prioritize providing a safe, nonstigmatizing environment for patients with SUD/OUD. This includes establishing trust and rapport, providing education, collaboration with psychiatric mental health specialists and other healthcare providers, and the offering support and resources to help patients manage their condition to achieve optimal health outcomes.
背景:药物使用障碍(SUD)是一种慢性疾病,去年影响了 5900 多万美国人。阿片类药物使用障碍(OUD)是药物使用障碍的一个分支。文献资料表明,医疗服务提供者经常羞辱 OUD 患者。OUD 患者经常会因自己的失调而感到羞耻。方法:本研究采用定性探索设计,通过与接受 OUD 治疗的患者进行焦点小组讨论来确定羞耻感问题及其与寻求健康行为之间的关系。结果:通过对四个焦点小组中 11 名参与者的讨论进行系统的内容分析,发现了四个主要的主题和相关的次主题:回避预防性护理(认为提供者是评判性的);隐藏的失调(保守秘密);羞耻感的制约(为继续使用毒品辩护);以及对 MOUD(阿片类药物使用失调)提供者的信任。羞耻感导致患者不愿采取促进健康的行动,如预约初级保健提供者和牙医。这包括建立信任和融洽关系、提供教育、与精神心理健康专家和其他医疗服务提供者合作,以及提供支持和资源以帮助患者控制病情,从而达到最佳的健康效果。
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引用次数: 0
Nurse Practitioner Certification Examination Development: From Reflecting Clinical Practice to Ensuring Lifelong Learning 执业护士认证考试开发:从反映临床实践到确保终身学习
IF 2 4区 医学 Q3 NURSING Pub Date : 2024-04-05 DOI: 10.1177/10783903241240075
Tara Myers, Kathy Chappell, Cherith Godwin, Jeanna Krissel, Jeffery Ramirez, Justin Smith
OBJECTIVE:Certifications in psychiatric-mental health nursing promote safe practice by psychiatric-mental health nurse practitioners (PMHNPs) and nurses (PMHNs) and help protect the public from harm. This protection begins with the development of an examination that meets rigorous national education, practice, and accreditation standards and reflects PMHNPs’ or PMHNs’ clinical practice. Achievement and maintenance of a certification is a journey that involves a commitment to lifelong learning and the improvement of the field of psychiatric-mental health nursing through involvement in the examination process.METHODS:This discussion paper outlines the role nurses can play in the development of certification examinations. It describes the process of developing an effective certification examination, including the role of standards, accrediting bodies, and content experts; determining necessary tasks, knowledge, and skills; surveying practitioners to validate information; writing test questions; and ongoing analysis of examination content. The Psychiatric-Mental Health Nurse Practitioner (across the lifespan) Certification (PMHNP-BC) is presented as an example of the process.RESULTS:This discussion paper raises awareness of how certification exams are developed, PMHNPs participate in certification development, and volunteering promotes career development.CONCLUSION:The PMHNP-BC examination is based on education, practice, and certification accreditation standards and reflects current clinical practice. PMHNPs can (a) point to the rigor of certification as an indication of the quality of care they deliver, (b) volunteer to participate in the examination process to ensure examination rigor, and (c) advance their careers through the development and application of a valuable skill set.
目标:精神心理健康护理认证促进精神心理健康执业护士(PMHNPs)和护士(PMHNs)的安全执业,帮助保护公众免受伤害。这种保护始于考试的开发,考试应符合严格的国家教育、实践和认证标准,并反映精神心理健康执业护士(PMHNPs)或精神心理健康护士(PMHNs)的临床实践。方法:本讨论文件概述了护士在制定认证考试中可以发挥的作用。它描述了开发有效认证考试的过程,包括标准、认证机构和内容专家的作用;确定必要的任务、知识和技能;调查从业人员以验证信息;编写试题;以及对考试内容的持续分析。结果:本讨论文件提高了人们对认证考试如何开发的认识,PMHNP参与了认证开发,志愿服务促进了职业发展。结论:PMHNP-BC考试基于教育、实践和认证认可标准,反映了当前的临床实践。PMHNP 可以:(a)将认证的严格性作为他们所提供护理质量的标志;(b)自愿参与考试过程以确保考试的严格性;(c)通过开发和应用一套有价值的技能来促进他们的职业发展。
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引用次数: 0
Trauma Center Trauma-Sensitive Yoga Versus Cognitive Processing Therapy for Women Veterans With PTSD Who Experienced Military Sexual Trauma: A Feasibility Study. 创伤中心创伤敏感瑜伽与认知处理疗法,适用于患有创伤后应激障碍并经历过军队性创伤的女性退伍军人:可行性研究。
IF 1.5 4区 医学 Q3 NURSING Pub Date : 2024-04-01 Epub Date: 2022-07-14 DOI: 10.1177/10783903221108765
Belle Zaccari, Athena D F Sherman, Melinda Higgins, Ursula Ann Kelly

Background: Posttraumatic stress disorder (PTSD) is a common sequela to military sexual trauma (MST) among women veterans. Yoga has shown promise in research examining its benefit for symptoms and sequela of PTSD.

Aims: The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of Trauma Center Trauma-Sensitive Yoga (TCTSY) for women veterans with PTSD related to MST.

Method: In this feasibility study, the final sample included women veterans (n = 41) with PTSD related to MST accessing health care in a Veterans Affairs Health Care System in the southeast United States; the majority were African American (n = 33; 80.5%). Interventions used established protocols of 10 weekly sessions of group TCTSY versus 12 weekly sessions of group Cognitive Processing Therapy (CPT). PTSD was assessed via clinical interview and participant report. Additional data collection included multiple participant-reported outcomes commonly associated with PTSD and psychophysiological measures. We also collected data regarding participant satisfaction and feasibility-related feedback from participants and providers.

Results: Feasibility and acceptability were evaluated via demand, practicality, fidelity, and acceptability. This was measured by expressed interest, attendance, program completion, barriers to care and satisfaction with treatment, and satisfaction with interventions and data collection.

Conclusions: Results indicate the RCT design and TCTSY implementation were feasible; a full-scale RCT was subsequently conducted to determine efficacy of the experimental intervention. Recommendations for successful research strategies are provided.

背景:创伤后应激障碍(PTSD)是女性退伍军人中常见的军事性创伤(MST)后遗症。目的:本研究的目的是评估创伤中心创伤敏感瑜伽(TCTSY)随机对照试验(RCT)对患有创伤后应激障碍(PTSD)的女性退伍军人的可行性:在这项可行性研究中,最终样本包括在美国东南部退伍军人事务医疗保健系统就医的患有创伤后应激障碍(PTSD)的女性退伍军人(n = 41);其中大多数是非裔美国人(n = 33;80.5%)。干预采用既定方案,即每周 10 次集体 TCTSY 与每周 12 次集体认知处理疗法 (CPT)。创伤后应激障碍通过临床访谈和参与者报告进行评估。其他数据收集包括与创伤后应激障碍和心理生理测量相关的多种参与者报告结果。我们还收集了有关参与者满意度的数据以及参与者和提供者对可行性的反馈:结果:可行性和可接受性通过需求、实用性、忠实性和可接受性进行评估。衡量标准包括表达的兴趣、出席情况、计划完成情况、护理障碍和治疗满意度,以及对干预措施和数据收集的满意度:结果表明,RCT 设计和 TCTSY 的实施是可行的;随后进行了全面的 RCT,以确定实验干预的有效性。为成功的研究策略提供了建议。
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引用次数: 0
The Impact of a Nurse-Led Service on Tobacco Treatment Provision Within a Psychiatric Hospital: A Time Series Study. 精神病院护士主导服务对烟草治疗提供的影响:时间序列研究
IF 2 4区 医学 Q3 NURSING Pub Date : 2024-04-01 Epub Date: 2022-05-12 DOI: 10.1177/10783903221093582
Bassema Abufarsakh, Janet K Otachi, Tianyi Wang, Yazan Al-Mrayat, Chizimuzo T C Okoli

Introduction: Psychiatric hospitalization is an opportunity to provide evidence-based tobacco treatment to optimize cessation efforts among people living with mental illnesses (MI). The purpose of this study was to examine the effectiveness of nurse-driven initiatives to enhance tobacco treatment within an inpatient psychiatric setting.

Aims: We assessed the 4-year impact of implementing a nurse-led tobacco treatment service offered to 11,314 inpatients at admissions in a tobacco-free psychiatric facility in Kentucky.

Method: Through a time-series design, we compared the differences in rates of screening for tobacco use and providing treatment from September to December 2015 (prior to implementing the nurse-led tobacco treatment services) to each subsequent year in a 4-year period (2016-2019).

Results: Approximately 60.0% of inpatients were persons using tobacco during the assessment period. Although there were no changes in tobacco use prevalence over the 4-year evaluation duration, there were significant increases in the provision of practical counseling and Food and Drug Administration-approved nicotine replacement therapies for persons using tobacco.

Conclusions: Our findings support the effectiveness of implementing tobacco treatment programs at the organizational level. Psychiatric hospitalizations provide an opportunity to optimize nurse-driven efforts to deliver tobacco treatment to people with MI. Similar models of nurse-led tobacco treatment services can be adopted within inpatient and other mental and behavioral health settings.

精神科住院是提供循证烟草治疗以优化精神疾病患者戒烟努力的一个机会。本研究的目的是检验护士推动的举措在住院精神病患者中加强烟草治疗的有效性。目的:我们评估了在肯塔基州一家无烟草精神病院对11,314名住院患者实施护士主导的烟草治疗服务的4年影响。方法通过时间序列设计,比较2015年9月至12月(在实施护士主导的烟草治疗服务之前)与随后4年(2016-2019年)每年烟草使用筛查率和提供治疗率的差异。结果60.0%的住院患者在评估期间为吸烟人群。虽然在4年的评估期间,烟草使用率没有变化,但为吸烟者提供的实用咨询和食品和药物管理局批准的尼古丁替代疗法有显著增加。结论本研究结果支持在组织层面实施烟草治疗方案的有效性。精神科住院治疗为优化护士为心肌梗死患者提供烟草治疗的努力提供了机会。护士主导的烟草治疗服务的类似模式可以在住院病人和其他精神和行为健康机构中采用。
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引用次数: 0
The Use of Standardized Patients as an Educational Strategy in Baccalaureate Psychiatric Nursing Simulation: A Mixed Method Pilot Study. 在精神科护理模拟学士学位课程中使用标准化患者作为教学策略:一项混合方法的试点研究。
IF 2 4区 医学 Q3 NURSING Pub Date : 2024-04-01 Epub Date: 2022-06-08 DOI: 10.1177/10783903221101049
Kimberly A Conway, Robert L Scoloveno

Objective: Prior psychiatric simulation experiences required our nursing students to role-play in an unknown area of nursing. Students confidence, clinical satisfaction, and use of clinical skills were negatively impacted leading to unmet course objectives. The aim of this pilot study was to strengthen our baccalaureate senior nursing students' simulation experience in their psychiatric nursing course with the use of standardized patients (SPs) instead of student role-play and measure the impact of this strategy on students' learning, satisfaction, and confidence in an unfamiliar area of nursing.

Methods: A mixed method explanatory sequential design was used. Participants consisted of a convenience sample of senior nursing students enrolled in their psychiatric nursing course. A quantitative simulation tool and a four-item questionnaire were analyzed after completion of the simulations (n = 47).

Results: Findings of this study identified greater than 80% of students had increased level of learning, confidence, and satisfaction with the SP simulation experience. Nurse faculty were able to overcome simulation barriers, that is, a patient hearing voices, non-verbal signs of depression, and evaluate students meeting course learning outcomes.

Conclusions: Findings from this study highlight students' positive simulation experiences. Using SPs as an educational strategy can be effective for students to reach competency, achieve higher knowledge, and improve confidence. It is believed the use of SPs as a simulation strategy in psychiatric nursing will assist students with clinical judgment and better prepare them to meet the needs of vulnerable persons with psychiatric conditions.

背景先前的精神病学模拟经验要求我们的护理学生在未知的护理领域扮演角色。学生的信心、临床满意度和临床技能的使用受到负面影响,导致课程目标未得到满足。目的:本试点研究的目的是通过使用标准化患者(SP)而不是学生角色扮演来加强我们的护理学士学位高年级学生在精神护理课程中的模拟体验,并衡量这种策略对学生在不熟悉的护理领域的学习、满意度和信心的影响。方法采用SA混合法解释序列设计。参与者包括参加精神护理课程的高级护理学生的方便样本。模拟完成后,对定量模拟工具和四项问卷进行了分析(n=47)。结果本研究的结果表明,超过80%的学生对SP模拟体验的学习水平、信心和满意度有所提高。护士能够克服模拟障碍,即患者听到声音、非语言抑郁迹象,并评估学生是否达到课程学习结果。结论本研究的结论突出了学生积极的模拟体验。将SP作为一种教育策略可以有效地帮助学生达到能力、获得更高的知识和提高信心。据信,在精神病护理中使用SP作为模拟策略将有助于学生进行临床判断,并使他们更好地满足患有精神病的弱势人群的需求。
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引用次数: 0
JAPNA's Diversity, Equity, and Inclusion Statement Is Adopted: Commitment to DEI Action and Measurement. JAPNA 的 "多样性、公平性和包容性声明 "获得通过:承诺采取 DEI 行动并进行衡量。
IF 2 4区 医学 Q3 NURSING Pub Date : 2024-04-01 Epub Date: 2024-02-14 DOI: 10.1177/10783903241230294
Michelle DeCoux Hampton
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引用次数: 0
期刊
Journal of the American Psychiatric Nurses Association
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