About One DNP

I earned my "terminal practice" degree in nursing from the University of Tennessee Health Sciences Center in a journey of excitement and challenge. It inspired me to advocate for an all encompassing clinical credential rather than continuing the hodgepodge of nonsensical initials. I hope these entries will provide entertainment and insight into the Doctor of Nursing Practice experience, which will soon be the entry standard for all advanced practice nurses.

Sunday, April 19, 2015

Sneak Peek: Low Milk Supply AANP15

Presentation submitted and accepted for CEUs for the American Association of Nurse Practitioner's annual conference in New Orleans June 2015. I have to admit, I do think my working title "When Liquid Gold Goes Bust" was a smidge catchier. Here is a sneak-peak for those of you coming to AANP15 and for those of you who will be there in spirit.

Sunday, November 23, 2014

AANP Abstract Accepted!

When I submitted my abstract, Counting Every Drop: Navigating Low Milk Supply, for consideration for the American Association of Nurse Practitioners 2015 national conference in New Orleans, I did not expect it to be accepted. Not only was this my first submission to AANP,  but the conference presenters are the top of their field, and this topic is very much out of my daily professional expertise. I am surprised and honored to be selected as a podium presenter and to share the knowledge that I researched out of my personal struggles dealing with low-milk supply. Here is a look at my abstract submission:

Brief Bio 
Dr. Jaclyn Engelsher is a Psychiatric Mental Health and Family Nurse Practitioner, and is nationally certified in Oriental Medicine. She has over a decade of experience blending allopathic and complementary evidence-based therapies for physical and emotional wellness.

Summarize why the topic is important 
Current guidelines recommend exclusive breastfeeding for the first six-months of life, however many women are unable to produce adequate milk to meet this goal. Unlike initial difficulties or short-term factors that impact full supply, those suffering with chronic low-milk supply require a higher level of education, management, and support to increase or maintain production. The purpose of this presentation is to describe genetic, social, and emotional factors that contribute to low milk supply, and provide the practitioner with a summary of evidence-based allopathic and complementary interventions.

Summarize the literature on the subject
A review of the literature demonstrates up to 15% of women experience insufficient lactation, and 4-5% have chronic-low supply. The contributing factors can be categorized into issues of either production or extraction. Breast structure, previous breast surgery, certain medications, and pregnancy or postpartum complications contribute to production issues. Extraction issues may be related to feeding length and frequency, insufficient milk transfer, and incomplete breast emptying. Early detection and intervention with galactagogues, latch correction, and feeding or pumping optimization increase the likelihood of reaching full supply.

Summarize the focus of the presentation, such as management of condition, etc. 
This presentation will provide evaluation strategies and review causes of low milk supply, including insufficient glandular tissue, infant lip and posterior tongue tie, postpartum difficulties, hormonal imbalances, diet, and emotional factors. Pharmaceutical, herbal, and food-based galactagogues, and lifestyle interventions such as feeding and pumping regimens, will be presented to help the practitioner identify appropriate management strategies. A list of patient education and peer-support references will be provided.

Describe the implications for practice, policy, education, and/or research 
Low-milk supply evaluation and intervention has practice implications for the nurse practitioner specializing in pediatric, women’s-health, family, and mental health care. Differentiating transient from chronic supply issues, and early identification and management are key in choosing the appropriate intervention for the physical and emotional health of mother and baby.

Sunday, October 26, 2014

APNA14: You Can't Learn Mindfulness in a Weekend Workshop

Conferencing with an infant is certainly a unique experience! I had a blast reconnecting with many of my teachers and mentors while getting an infusion of professional and EBP goodness, though I must admit I missed my UT-DNP peeps.  Every year I get to add to my list of memorable interpretive quotes and insights from the APNA conference, and APNA 14 was no exception. I am going to forgo an in-depth recap of this year's events and share some of my favorite gems. If you were there, you know who and where they came from!

  • We don't give enough credit to how difficult it is to be fully present

  • Mindfulness is the antidote to mind wandering and time travel

  • Nurses feel they have to be twice as good to be any good

  • Perfect is the enemy of good

  • Negotiation of difference is what we all have in common

  • Assessment tools without the patient narrative assess very little

  • In nursing, you can have a mid-life crisis every 7-years

  • If you can't squeeze water out of a rock, don't blame the rock

  • Nursing as a fall-back position is not exactly what you would call a career path

  • I hope to have at least two more disclosures by the end of the month

I am already looking forward to APNA15 in Disney World - if it isn't the happiest place on earth when the psych nurses get there, believe it will be by the time we leave!

Wednesday, July 16, 2014

Trashing the CAPA-NS!

As of today, nurse practitioners in Kentucky can submit a form to dissolve the collaborative agreement with physicians for non-scheduled medications, provided they have been prescribing for 4 years. This is an exciting change on the road to full practice authority. Next stop, the removing the barriers for scheduled prescribing!

Visit the Kentucky Coalition of Nurse Practitioners and Midwives for the most up-to-date legislation on APRN practice in Kentucky!

Saturday, April 12, 2014

Abstract Accepted!

For the fourth year running, I am honored to have a presentation accepted for the American Psychiatric Nurses Association annual conference. As with most topics, you can tell what is going on personally by what I present professionally. This one is especially meaningful because I am stepping out of my clinical comfort zone to do the research while having the perspective as both provider and patient. In keeping to my roots, references will be available via my social network sites - stay tuned for the pinterest board!

Grieving Though Grateful: Reconciling the Traumatic and Disappointing Birth Experience

When a woman experiences a traumatic or disappointing birth, there often exists an emotional dichotomy between gratefulness for the child and grief toward the the experience.  This presentation describes characteristics that contribute to traumatic birth and resources for the PMH nurse to aid in prevention, diagnosis, treatment, and collaboration.

Summary of evidence*
Though up to 30% of women world-wide experience traumatic birth, a review of the literature reveals a paucity of research, and the DSM-5 lacks discussion in the sections on perinatal mood disorders, trauma and stress-related disorders, or bereavement.


Description of practice or protocol*
Traumatic birth may be missed or mistaken for other postpartum mood disorders by clinicians, and under-reported by mothers due to stigma. Platitudes such as "all that matters is a healthy baby" minimize and invalidate the mother's grief toward the experience and contribute to feelings of guilt, anger, helplessness, or diminished self-esteem.


Validation of Evidence / Method of Evaluation*
Factors including psychiatric history, unplanned or emergent obstetric intervention, pain, loss of control, and lack of interpersonal support contribute to negative birth experiences, and put the mother at risk for ineffective maternal role attainment and mental health disorders.


Relevance to PMH Nursing / Results*
A comprehensive  understanding of traumatic birth provides the PMH nurse a foundation for enhanced assessment, intervention, integrative strategies, and interdisciplinary collaboration to help women at risk for or experienced traumatic birth.


Future implications*
Birth is not a mearly a means to an end, but an experience independent of the outcome.  Understanding the risk factors, characteristics, and resources results in refined diagnosis, effective treatment planning, and the opportunity to build connections with peer obstetric clinicians.

Tuesday, February 11, 2014

SB7 Passed! A Small Step with a Huge Compromise

The fight to eliminate the anachronistic farce of a collaborative agreement in Kentucky has been underway since before I became a nurse practitioner. Though gaining more support every year it has come up in the legislative session, the opposition has found ways to keep nurse practitioners beholden to the dispensation of physicians in a manner that reeks of FTC violation and hinders healthcare delivery to a woefully underserved rural population across the commonwealth. This time, there were no stall-tactics, no tacking on of offensive amendments, no removal of mutually beneficial components, or other means of killing the bill.

Senate Bill 7, the first bill to be passed by the General Assembly this year, eliminates the mandated non-controlled substance collaborative agreement for nurse practitioners provided they have been in a prescriptive practice for 4 years. There are also key language amendments in this new section of KRS Chapter 314 that further clarifies that nurses oversee nursing practice - something that has been a huge area of misunderstanding by our physician colleagues. The bill passed on January 14th 2014 with only one "nay" (see voting record), and will go into effect this summer. The official signing ceremony is set for February 28th and I expect with Governor Steve Beshear, there will be bourbon to celebrate. 

The Kentucky Collation of Nurse Practitioners and Nurse Midwives has worked tirelessly to move us another step closer to achieving the ideals of the Institute of Medicine's vision for the future of nursing. While the ideal is to get to full independent practice to the full scope of our education and training, Kentucky is not a state that embraces change without a lot of time to mull it over. To the bone. Even when the preponderance of evidence recommends action. My only question is whether the next step will focus on the controlled-substance collaborative agreement, or the 4-year mandate.

Patience is a nuisance. 

Sunday, October 6, 2013

APNA 2013 Poster

I have been on a writing hiatus. Between the new position at work and being 28 weeks pregnant, I am out of the habit of blogging. Though I would have really enjoyed doing a podium presentation again, I had a feeling it might have been more than I could tack on to an already packed schedule. . . as evidenced by the fact I just completed and ordered the hardcopy today and am leaving on Wednesday for the conference. This was really a fun one to research over the past few months, and I am looking forward to another great APNA conference. See you there! 

Friday, May 10, 2013

Will the DSM-5 Define Normal?

Or rather, neuro-typical?

I realize phrases like "I'm not normal" and "Who wants to be normal?" and "I never wanted a normal life" are often a person's way of differentiating themselves from what they believe is mainstream (i.e. boring) living. Yet there are many, many people living quiet little wild lives unbeknownst to their neighbor. What looks like the white-bread nuclear family to the casual observer may be anything but. People get altogether too comfortable in their assumptions of how others live and think. Fact is, most of us are actually normal in that we feel a full range of different emotions, can generally trust our senses, have desires, and respond to the trials and tribulations of life with some balance of primal instinct and societal expectation.

Yeah? Well prove it.

Unfortunately, the one diagnostic reference that tells you all of the ways you are abnormal fails to provide guidelines for what is considered within normal limits.

While physical health is somewhat generically considered absence of disease, there are any number of standardized, objective tests that show clinicians where a patient falls within the range of normal. You know if someone's blood sugar has been in control for a few months by drawing a Hemoglobin A1C. You know if someone has a blockage of their coronary artery by performing a cardiac catheterization. You know if someone has a broken arm by getting an x-ray. With mental health disorders, it is subjective report of symptoms coupled with the observation and interaction skills of the clinician that leads to a diagnosis. There is yet no blood test for depression - though we certainly know that low thyroid or Vitamin D levels can contribute. While we can detect brain injury and atrophy, there is no MRI that can yet detect the difference between hallucinations from schizophrenia, bipolar disorder, depression, or substance use. We know certain lifestyle factors correlate with development of mental health problems, from malnutrition, infection, or drug use while in utero to taking too many blows to the head playing football, however thresholds of these biological factors have not been established.

Perhaps if we had a definition of normal mental health, we could identify high-risk individuals and provide primary mental health prevention with education, screening, and management prior to onset or exacerbation of a disorder. Normal grief, normal sadness, normal anger, normal worry, normal happiness - all emotions are appropriate throughout the lifespan, the issues is helping people get in touch with those emotions and be able to evaluate for themselves individual normal limits.

In the meantime, we have yet another tired update to the Diagnostic and Statistical Manual of Mental Disorders, a book developed by the American Psychiatric Association in collaboration with, well, no one except their own psychiatrists, to let the thousands of non-physician mental health providers (you know, the ones that comprise the bulk of the field - social workers, therapists, psychologists, nurses) know how to consistently label people for the purposes of proper billing and coding. Not treatment. Just billing and coding.

It is unsurprising that the National Institute of Mental Health has come out with harsh criticism and calling for more of a biological base to classifications and thereby increase the validity of diagnosis to guide effective treatment. Though they have not formally entered the competitive ring, it is time the  American Psychiatric Association monopoly on mental health definitions fall into line with what is happening in the treatment room. It’s called collaboration. This includes interdisciplinary input from clinicians as well as the lived-experience of the mental health consumer.

Let’s see if the NIMH can do better: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml

The DSM-5 is scheduled for release on May 27th – will you get yours?

Wednesday, April 17, 2013

APNA27 Abstract Accepted

Wow! Three years running I have been honored to have my work accepted at the American Psychiatric Nurses Association Annual Conference. I have put to rest my social networking research and gone back to my roots of practice and interest.  Check out the summery, and get ready for APNA27 this October in San Antonio!

 Serotonin OTC: The Latest in Mental Health Nutraceuticals 

Abstract:  The U.S. vitamin and supplement industry grosses nearly $30 billion per year with a growing number of products targeted to the prevention and alleviation of mental health related conditions. Although the industry is regulated by the FDA and products must adhere to Good Manufacturing Practices (GMP), broad claims of efficacy for mood, sleep, concentration, and other general psychiatric symptoms are not subject to scientific validation. Popular nutraceuticals including GABA, n-acetylcysteine (NAC), and Ashwagandha are advertised as natural alternatives or augmenters to standard psycho-pharmacy, and while consumers who self-medicate without informing their providers may experience a measurable benefit, they put themselves at risk for deleterious outcomes. Consumer interest, desire to decrease pill burden, and product proliferation in the marketplace have encouraged increased research to substantiate health claims, determine potential interactions with medication, and provide a basis for recommendation. This presentation will provide an overview of the functions of 10 common and novel mental health focused nutraceuticals, evaluate the base of evidence for implementation into practice, and provide strategies for educating patients on appropriate use of OTC supplements.

Presentation Summary:  This presentation provides an overview of the functions of common and novel mental health focused nutraceuticals, evaluates the base of evidence for implementation into practice, and provides strategies for educating patients on appropriate use of OTC supplements.

Objective 1:  Identify the key functions of 10 nutraceuticals supplements frequently used in management of mental health disorders.
Objective 2:  Describe potential interactions between classes of psychiatric medication and OTC mental health nutraceuticals.
Objective 3:  Evaluate the evidence base for use of OTC mental health supplements in PMH practice