APNA 29th Annual Conference Session 2035.2: October 29, 2015 - PDF document

APNA 29th Annual Conference Session 2035.2: October 29, 2015 Specification of Veteran ‐ centric Competency Domains in Training VA PMHNP Residents 1 Presenter Jan York, PhD, PMHCS ‐ BC, FAAN Director, PMNP Residency & COIN Research Faculty, Ralph H. Johnson VAMC Adjunct Research Professor, College of Nursing, MUSC Charleston, SC 2 Co ‐ authors & Acknowledgements Lisa Marie Sternke, PhD, MSN Chief of Staff’s Office, COIN Researcher, Residency Faculty Hugh Myrick, MD ACS Mental Health, Acting VISN Director Joy Lauerer, DNP, PMHCS ‐ BC Co ‐ director, Associate Professor Carole Hair, PhD Mentor/Consultant, San Diego VA & Office of Academic Affiliations ____________________________ Nursing Leadership: Program Funding: Mary Dougherty, PhD VA Office of Academic Affiliations Director, Office of Nursing Services, OAA 3 York 1

APNA 29th Annual Conference Session 2035.2: October 29, 2015 Disclosures None The co ‐ authors have been informed of their responsibility to disclose to the audience if they will be discussing off ‐ label or investigational use(s) of drugs, products, and/or devices (any use not approved by the U.S. Food and Drug Administration). All images are from clipart or used with permission 4 Presentation Objectives • Describe the develop of Veteran ‐ centric competencies/domains for PMHNP residency • Review the theoretical underpinnings • Describe the application of the domains 5 Presentation Outline • Need • Theoretical underpinnings • Development of domains • Application • Evaluation • Discussion and summary 6 York 2

APNA 29th Annual Conference Session 2035.2: October 29, 2015 Creating a Narrative of Veteran ‐ specific Competency Domains: Need • Increased emphasis on – Cultural competencies – Competency based education • Little emphasis on Veteran ‐ centric domains • SAMHSA priority: Well ‐ being of military service members, Veterans, and their families 7 Related Publications How We Developed Competency Domains • Assessed the need • Reviewed IP cultural competencies/guidelines • Reviewed Veteran ‐ centric literature • • Specification of the domains • Review by Residency Task Force and Veteran nurse researcher/faculty 9 York 3

APNA 29th Annual Conference Session 2035.2: October 29, 2015 Domain of Competence • Cluster of competencies having similar intentions, functions & meanings • Broad distinquishable area of competence in which aggregate constitutes a general descriptive framework Englander et al., 2012; NONPF, 2013 10 Cultural Competencies • General ‐ SAMSHA • Discipline ‐ specific ‐ nursing, counseling, psychology, PMHNP’s • Behavioral health ‐ specific APA, 2014; Delaney et al., 2011; Douglas et al., 2014; Hoge et al., 2014; Koh, Gracia, & Alvarez, 2014; NONPF , 2013; SAMHSA, 2014; Weber, 2014 11 Multicultural Competence • An awareness of personal beliefs and/or attitudes about culturally diverse cultures • Knowledge of diverse cultures • The ability to use skills or technologies which are culturally appropriate American Psychological Association [APA], 2008; Strom et al., 2012 12 York 4

APNA 29th Annual Conference Session 2035.2: October 29, 2015 Veteran/Military as a Population Population health defined by the • IOM: The health status of whole communities or nations Veteran and military population • constitute a distinct subculture of language, norms, & beliefs • VA has focused on health disparities • Readiness of providers for patient ‐ • centered care includes being sensitive to unique needs & relevant issues of Veterans 13 Adler, Bachrach, & Frisco, 2013; Reger, Etherage, Reger, & Gahm, 2008; Strom et al., 2012; Tanielian et al., 2014 Veteran/Military Centric Domains PMHN text chapter • Psychology ‐ cultural & ethical • considerations Military/Veteran text • Strategic plans • SAMSHA ‐ Military/Veterans • IOM ‐ patient centered care • VA ‐ patient centered care • RAND study ‐ target readiness in • community working with Veterans Cozza et al., 2014; Lesieur et al., 2012; SAMSHA, 2011; Strom et al., 2012; Tanielian et al., 2014 14 SAMSHA Strategic Plan 2011 ‐ 2014 Goal 3: Improve quality of behavioral health, prevention, treatment, and recovery support services by helping providers respond to needs within the military family culture 15 York 5

APNA 29th Annual Conference Session 2035.2: October 29, 2015 Putting the Cultural Competency Puzzle Together • There are IP and discipline specific cultural competencies • Some competency frameworks include a cultural competency • There is descriptive literature on Veteran/military culture • Veteran ‐ centric competency domains is an emerging issue 16 14 Veteran ‐ centric Competency Domains 58 knowledge, attitudes and skills Example: Role of Gender in Help ‐ seeking Veterans  Knowledge Familiar with gender ‐ specific issues related to help ‐ seeking and gender stereotypes concerning patient role  Understand women Veterans’ perception of the VA as male ‐ oriented and its impact on women Veterans’ satisfaction Attitudes  Sensitive to help ‐ seeking issues in women Veterans with trauma exposure Skills  Assess gender ‐ specific experiences  Deliver gender ‐ sensitive care 17 Setting/Program In 2013 VA Office of Academic Affiliations RFP • 4 Residencies funded for 3 year pilot programs • Birmingham, Boston, Charleston, Durham VA’s – Now in third cohort of residents – UAB also funded for Education of PMHNP’s – One year, salaried, mentored residency for new • credentialed graduates Focuses on transition to VA practice and EBP – Standardized curriculum being developed – OAA Office of Nursing Services mentored & • monitored DVA, 2013 18 York 6

APNA 29th Annual Conference Session 2035.2: October 29, 2015 Application of the Competencies 19 Integration into Core Competency Evaluation Tool Residency Task Force adopted SAMSHA Core • Competencies for Integrated Behavioral and Primary Care Added 10 th competency for professionalism • Integrated Veteran ‐ and VA ‐ centric domains • into the integrated care competencies Knowledge ‐ Attitudes ‐ Skills ‐ Critical Thinking • Competencies inform recruitment, inform • job descriptions, shape work force, provide training, and performance assessment ANA et al, 2013; Hoge et al., 2014 20 Interprofessional Seminars (weekly) • Strong trauma ‐ focused VA research center and partner university center for prevention of violence • Experts presented on PTSD,MST, ET, combat stress 21 York 7

APNA 29th Annual Conference Session 2035.2: October 29, 2015 Self ‐ Assessment: Veteran Experience Residents attitudes, biases, & experiences impact practice & learning & outcomes Baseline written assessment: Preconceived notions about military culture Ideas about role of military in our country Beliefs about people who join the military Reactions towards recent conflicts Ability to separate these reactions about those who serve and who wear the military uniforms Diagram of 3 generational family and Veterans 911 experience Loss or disability of Veteran Seminar discussions & evaluate impact of residency Hamaoka et al., 2014, p. 13 22 Collaborative Assessment and Management of Suicidality (CAMS) Veteran version e ‐ CAMS (6 CEU’s) • Performance assessment ‐ post test • Process of clinical assessment, treatment • planning, and management of suicidal risk 6 RCT/CT & feasibility studies, recommended • in systematic reviews & policy reports Core multipurpose risk assessment tool ‐ • Suicide Status Form (SSF) ‐ established psychometrics VA purchased rights for SSF • In process activities to place e ‐ CAMS on • national VA training site (Jobes 2006, 2012; Magruder, York al, 2009 ‐ 2013; Marshall, York, Magruder, et al., 2014; Magruder, York, Knapp et al, manuscript in press) 23 Evaluation • Review by Residency Task Force, some content validity • Preceptors observations of attitudes, biases, rapport, documentation, competency evaluation • Capstone projects (performance improvement • Intent to practice with Veterans/pursuit of VA positions 24 York 8

APNA 29th Annual Conference Session 2035.2: October 29, 2015 Discussion • Not inclusive, building block • 60% of Veterans receive care outside the VA so the domains could help increase readiness of nurses outside VA • Can contribute to development of national standards for residencies • Authors have chance to pursue further expert review 25 Discussion • Not inclusive, building block • 60% of Veterans receive care outside the VA so the domains could help increase readiness of nurses outside VA • Can contribute to development of national standards for residencies • Authors have chance to pursue further expert review 26 In Summary Competencies can shape the direction of curriculum program development, clinical practice evaluation credentialing of PMHNP residencies These domains are consistent with VA priorities and values VA core values of integrity, commitment, advocacy, respect, and excellence (Aschenbrener et al., 2015). 27 York 9