APNA 30th Annual Conference Session 4032: October 22, 2016 Integrating Mental Health Topics into a FNP Curriculum Shonda Phelon DNP, FNP ‐ BC, APMHNP ‐ BC, GNP ‐ BC Sueanne Davidson DNP, FNP ‐ BC www.muw.edu THE SPEAKERS HAVE NO CONFLICTS OF INTEREST TO DISCLOSE. Learning Objectives • Explain how mental health topics are integrated throughout a Family Nurse Practitioner Curriculum. • Identify conditions that are treated by both Psychiatric and Family Nurse Practitioners. • Examine methods of collaboration used when formulating the curriculum. Phelon 1
APNA 30th Annual Conference Session 4032: October 22, 2016 Purpose • Identify and explain how mental health topics were integrated into the FNP Curriculum. The Problem • About 50% of all primary care visits involve a mental health complaint. • Only about 50% of those treated in primary care receive appropriate treatment. • Shortage of Mental Health Providers • FNP’s are often the ONLY provider for patients Why do patients choose PCP for tx? • FNP’s often a first point of access for Mental Health Treatment. • Patients are often very comfortable in discussing mental health issues. • Established relationship with primary care provider • “I am not crazy.” • Less stigma walking into primary care setting then mental health setting. Phelon 2
APNA 30th Annual Conference Session 4032: October 22, 2016 Problems in Primary Care • Unrecognized • Undertreated • Depression and Anxiety often treated with inadequate dose of medication or therapy alone • Screening often done with little follow through. Morbidity and Mortality in People with Serious Mental Illness • Die 25 years earlier than the general population • Suicide and injury account for 30 ‐ 40% of excess mortality • 60% of premature deaths—due to medical conditions such as cardiovascular, pulmonary and infectious diseases. • Imperative that FNP’s understand these risks 8 8 Background • Mississippi University for Women • First NP program started 1976 • Only totally Face to Face Program in the State • Past tracks Family, Gerontology, Pediatrics • Consortium with other schools Phelon 3
APNA 30th Annual Conference Session 4032: October 22, 2016 Conditions routinely treated by both FNP’s and PMHNP’s in MS • Depression • Anxiety Disorders • ADD/ADHD • Delirium • Dementia • Substance Abuse Curriculum Integration 1. First Semester a. NU 503 Advanced Health Assessment b. NU 521 Science of Diagnostic Reasoning c. NU 508 Advanced Nursing Theory d. NU 508 Advanced Nursing Research and Evidenced Based Strategies 2. Second Semester a. Nu 501 Advanced Pharmacology b. NU 503 Family Practice Management c. NU 503 Lab Family Practice Clinical Practicum/Case Studies 3. Third Semester a. NU 506/506 Lab Family Practice Management and Clinical Practicum b. NU 516 Population Health for Advanced Practice c. NU 570 Advanced Health Policy and Politics d. NU 597 Research Presentations e. Final Clinical Exam and Case Study Health Assessment Diagnostic Reasoning • Holistic Approach • Therapeutic Communication • Health Interview focusing on health promotion and determination of risk factors • Basic overview of Psychiatric Disorders • Labs and testing to rule out/in mental disorders Phelon 4
APNA 30th Annual Conference Session 4032: October 22, 2016 Mental Health Screening and Assessment Patient Identifiers • Medically unexplained physical symptoms • High symptom count • High severity of the presenting somatic complaint • Chronic pain • Symptoms more than 6 weeks • Rated as a “difficult encounter” • Recent stress • Low self rating of worth • High use of health care • Substance Abuse Advanced Nursing Theory/Research • Psychosocial Theories: Erickson, Roy’s Adaptation Model, Peplau, Johnson’s Behavioral System Model, Family Theory, Comfort Theory, Bandura’s Self Efficacy Theory • Research and Evidence Based Practice Advanced Pharmacology • Antidepressants • Antipsychotics • Stimulants • Mood Stabilizers • Anxiety Medication • Agents for Dementia • Choosing the appropriate agent • Medications causing psychiatric symptoms • Geriatric Considerations Phelon 5
APNA 30th Annual Conference Session 4032: October 22, 2016 Family Practice Management • ADD/ADHD • Common Childhood Psychiatric Illness • Mood Disorders • Anxiety Disorders • Thought Disorders • Suicide • Delirium • Dementia • Geriatric Mental Health Issues Clinical Practicum/Case Studies • Settings ‐ high in mental health disorders • Pediatric Rotation ‐ Exposure to ADD/ADHD management • Clinical Evaluations ‐ mental health issues explored and addressed • 5 case studies Population Health and Health Policy • Substance Abuse and Treatment • Societal Violence Assessment and Prevention • Mental Health Reform • Improving Mental Health Access • Achieving Mental Health Parity • Telehealth • Mississippi Medicaid Expansion • Social Policies for Children • Politics of the Pharmaceutical Industry Phelon 6
APNA 30th Annual Conference Session 4032: October 22, 2016 Clinical Research Projects • Depression Identification in Patients with Chronic Pain ‐ MSN • Suicide Screening in Primary Care Patients Diagnosed with Depression ‐ MSN • Depression Screening in Patients with CAD ‐ MSN • Interpersonal Violence Screening ‐ MSN • Suicide Prevention in Primary Care ‐ DNP • Increasing Parental Self Efficacy through Education ‐ DNP Focus on Collaboration • Interprofessional Collaboration is stressed. • Collaboration is taught as part of holistic patient management. • Students are taught to develop network of mental health resources. • Faculty collaborate with each other in faculty based practice. Outcomes • DNP Suicide Project presented at AANP and NNPS • MSN Suicide Screening Assessment presented at MNA Convention • MSN Depression Screening in CV Disease presented at AANP • Faculty/Student Presentation on Interpersonal Violence Screening at AANP • Faculty Presenting collaboratively on MH topics Phelon 7
APNA 30th Annual Conference Session 4032: October 22, 2016 Future Goals • Faculty/students involved in Addiction Research • Faculty pursing Addiction Counseling Certification • Faculty pursing Mental Health NP certification • CE Program for Preceptors addressing Mental Health Topics • Add a Psychiatric NP Certification option to DNP program References • Alligood, Martha Raile. Nursing theorists and their work . Elsevier Health Sciences, 2014. • American Psychiatric Association. (2013). DSM 5 . American Psychiatric Association. • Bartels, S. J., Dums, A. R., Oxman, T. E., Schneider, L. S., Areán, P. A., Alexopoulos, G. S., & Jeste, D. V. (2014). Evidence ‐ based practices in geriatric mental health care • Bickley, L., & Szilagyi, P. G. (2012). Bates' guide to physical examination and history ‐ taking . Lippincott Williams & Wilkins. • Duffy, E. G. (2015). HEALTH CARE POLICY: IMPLICATIONS FOR ADVANCED NURSING PRACTICE. Advanced Practice Nursing: Core Concepts for Professional Role Development , 167. • Edmunds, M. W., & Mayhew, M. S. (2013). Pharmacology for the primary care provider . Elsevier Health Sciences. • Fitzgerald , M. (2015). Nurse Practitioner Certification Examination and Practice Preparation. FA Davis. • Hollier, A. (2016). Clinical Guidelines in Primary Care . Advanced Practice Education Associates • Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2013). Policy and Politics in Nursing and Healthcare ‐ Revised Reprint . Elsevier Health Sciences. • Polit, D. F., & Beck, C. T. (2013). Essentials of nursing research: Appraising evidence for nursing practice . Lippincott Williams & Wilkins. • Resnick, B., & Pacala, J. T. (2012). 2012 Beers criteria. Journal of the American Geriatrics Society , 60 (4), 612 ‐ 613. • Stahl, S. M. (2013). Stahl's essential psychopharmacology: neuroscientific basis and practical applications . Cambridge university press. • Uphold, C. R., & Graham, M. V. (2013). Clinical guidelines in family practice . Barmarrae Books. Phelon 8
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