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

The Trouble With Interdisciplinary Studies: Everybody

For those of you contemplating your capstone projects, take heed of the following.

Although social networking is all the rage in health care, I knew when my provider-focused capstone involved a range of mental health disciplines I would have trouble finding a home for it.  The vast majority of responders were nurses, which makes it unsuitable to publish in psychiatry, psychology or social work journals. Not all of the responders were nurses so the nursing journals passed as well.  Many of the social networking journals have gone under, and most of the interdisciplinary ones either make you pay to get published or require you have an MD, PsyD, or LCSW as the primary author. One reviewer mentioned this would be more appropriate for inpatient psych nursing journals, despite the fact most of the responders wee coming from community-based clinics.  In retrospect, I can think of a number of SN topics that would have "sold" better that were patient, disorder, or single-issue focused. I took a risk, it didn't pan out.

While my ego is nursing the bruise of rejection, I have to remind myself that time not only money, it is time. Rather than continue to edit and rework the article to meet the broad ranges of journal editors' criteria for zero-cents-per-word, I am going to do the unthinkable: Share the results on the Internet. This is probably scholarly publication suicide, but suck-it-dry, it is more important to share the findings than wait for the research to go obsolete. This is the PDF proof from one of my submissions:
Social Networking and Mental Health Providers: Practice Trends and Perspectives to Shape Interdisciplinary Guidelines 

Abstract

Background: Social networking activity and media development in health care are advancing rapidly and without a firm understanding of implication for use among mental health providers. Social networking is used to provide education, foster advocacy, promote the profession, and influence policy, but with potential to violate therapeutic boundaries, infringe upon privacy, create liability, and damage professional credibility.  

Objective: This survey was designed to examine current social networking practice trends and perspectives from psychiatric nurses, psychiatrists, psychologists, and therapists. Determining how mental health providers engage in social networking activity and their viewpoints on best practice offers a basis for recommending interdisciplinary guidelines.  

Design: A 20-question online survey was used to gather data from mental health providers recruited through professional member forums, e-mail distribution lists, and social media.  

Results: Key findings demonstrate an extensive use of social networking sites on personal devices for research, continuing education, and peer collaboration; a need to restrict patient communication and access to a provider’s social network; and a desire for specific guidelines to promote prudent, resourceful use of social media that complies with ethical codes, promotes professionalism, and maintains work-life boundaries.  

Conclusions: Results demonstrate the increasing use and evolving nature of social networking requires that clinicians maintain situational awareness of media platforms and technology and a need for further analysis, education, and collaboration to develop a comprehensive consensus model for social networking behavior.


The article is 60 pages with much of it taken up with figures and graphs. If you want to cut to the chase, these are the the proposed guidelines beginning on page 21:

Proposed Guidelines  

The following are proposed key components for foundational interdisciplinary guidelines that each of the professions could expand upon according to their own licensing and regulation requirements.  

• To protect the therapeutic alliance, maintain confidentiality, and prevent dual relationships, providers should refrain from connecting with current patients on their personal social networks.
• To comply with federal regulations, providers should not initiate communication or interact with patients on social networks to discuss health-protected information. 
• Professional profile pages should include a purpose and disclaimer statement with parameters for use on each site (Appendix B). 
• Office or organizational social networking policies should be included as part of informed consent, and discussed with patients as they are updated (Appendix C). 
• To demonstrate respect and trust for the patient, providers should refrain from searching for patient information online unless expressly requested by the patient during formal treatment time.

20 Commandments for MentalHealth workers: 20 Commandments for Mental Health workers

Great guidance from a fellow Dr. Nurse and patient advocate:

20 Commandments for MentalHealth workers: 20 Commandments for Mental Health workers:
Thou shalt respect your client and not judge
Thou shalt increase the well-being, opportunities and happiness of your client
Thou shalt...

My First Task Force!: APNA State Chapter Operations

I had the privilege of being invited to a task force to brainstorm methods of enhancing APNA chapter operations. The room was packed with national board members, current and former state chapter presidents, and colleagues and staff members I had previously only known through email or member forums.  This meeting of the minds began with a few key aphorisms:

“Opinions are not facts until proven” 

“Loud and passionate people can be wrong” (can you say “Facebook?!”)

“A camel is a horse designed by a committee” 

Following brief introductions was a legal discussion on incorporation status, state and local laws, chapter duties, tax exemptions, 501(c) classifications, lobbying activities, and income categorization. If this sounds dull, guess again. This presentation confirmed my suspicion some of the activities of one of my other professional organizations has been performing “substantial lobbying activities” and clarified the core purpose of APNA:

To be the unified voice of psychiatric-mental health nursing

Well that’s nice, but how does that happen? Through value propositions.  APNA has identified 3 key branding features:

• ·      Community (make me feel good as part of the crew)

• ·      Commitment (don’t screw me over and keep your promises)

• ·      Content (give me something meaningful that I can use)

In order to make the individual state needs merge with the overall mission of the “mother ship.” Given that membership numbers have doubled over the past 6 years and retention rates have risen by 15%, we are doing quite well on the national level. State chapter involvement and operations are more variable, and I am ashamed to admit I have not been as active in Kentucky as I should be. The relationship with state chapters is bidirectional – the national mission trickles down and tailored to apply to local issues, while the individual state matters diffuse upward and are encompassed by the whole. So how do we improve operations and encourage coalescence? Our breakout group came up with 3 areas to focus our efforts and match our core values.

Technology (Advancing Community)

            In addition to our active member bridge, the APNA website offers a number of fantastic tools and social media platforms to aid in chapter operations, however, the technology is not utilized to it’s full potential and there are knowledge gaps among members. Webinars, one-on-one tutorials during national and state conferences, and use of virtual conferencing can bridge these knowledge gaps, further connect the community, and disseminate information faster, more comprehensive manner than previous platforms including mailers and email. There is value in face-to-face networking and interpersonal communication (my tutorial on bourbon with Bud Crouch would not have happened or been nearly as entertaining in Go-to-Meeting) and technology should be used as an enhancement and expansion, not absolute substitution.

ADVANTAGES: The efficient use of communication technologies to disseminate information among members and increase communication among individules, board members, chapters, and APNA national are significant advantages. Platforms are continually developed to be more intuitive for ease of use, which can help decrease generational gaps in knowledge.  APNA has been diligent about keeping costs low and maintaining an in-house staff of tech savvy individuals.

HURDLES:  Maintaining situational awareness of emerging technologies, providing education, and performing outreach to members requires significant time investment. Resistance due to reasons of privacy, lack of proficiency, and lifestyle are barriers for engagement by members.

Standardization (Preserving Commitment)

There are toolkits and staff available to aid in chapter operations, yet there remains significant variability in many processes such as meeting agendas, elections, and communication with APNA national. Clear, concise, consistent guidelines for major chapter operations and functions should be developed, but allow flexibility for local variation to expand on the roles and goals of specific state issues.

ADVANTAGES:  A common ground for operations provides security for board members when they assume a position and for all members to experience a consistent, organized environment that will be familiar when visiting or transferring chapters.  It prevents “reinventing the wheel” every time a new board is elected so that time can be better spent on education, advocacy, and networking.

HURDLES: With standardization change and a real or perceived loss of control, particularly in chapters already active and well organized. Coming to agreement on optimal balance of protocol and individuality is time consuming with potential to be too vague or too rigid.

Recruitment/Retention (Enhancing Content)

The big question for joining any membership with dues is “what’s in it for me?”  This can be anything from personal recognition, CEU and professional development opportunities, networking, discounts, collaboration, or professional updates. APNA is supposed to represent all members, not just advanced practice members or the most active chapters. While not an organization with a primary purpose of political activism, more members input from mental health nurses in every area of practice and all manner of nursing license is essential to provide the most accurate representation of our interests as a whole.

ADVANTAGE: Participants active at the local and national level become more competent, invested providers, which translate to better care and advocacy for our patients.  More members result in increased ideas, greater reach of applicability for national agendas, public awareness, and professional strength.

HURDLE: As an organization, membership and involvement have been on an upward trend and this may not be the most urgent area to focus chapter efforts.  In a down economy, membership dues may not bee viewed as a value-added expense.

Highlights from APNA 25: Psych Nurses Have More Fun

This was my second year attending the American Psychiatric Nurses Association annual conference, and the experience again renewed my enthusiasm for live CEU events. There were plenty of excellent speakers, exhibition (sales) booths, and poster presentations, but that is not what makes this a must-do yearly event. It is the camaraderie within the profession and the fact psych-nurses know the importance of having a good time. Here are a few of my personal highlights.

   

Venue: Disneyland Hotel

An excellent location to blend education and fun. Although the place was under construction and wi-fi was a bit spotty, the staff managed to make it magical. We had an awesome renovated room in adventure tower with a view of the evening fireworks. Since we were not run ragged with sessions and the conference ended early on Saturday, there was plenty of time to explore downtown Disney and the parks without the need for car rental or long monorail/bus rides. There were excellent places to eat (Napa Rose for high-brow, Trader Sam's for sips and apps), wonderful spa (ask for Carlos), and a fine collection on shops with live music until 10 or later every night. There were plenty of pens and pads along with a good selection of breakfast and boxed lunch choices. And Pluto, of course!



    

Inspiration: Jean Watson

Her presentation Caring Science and Psychiatric Nursing: Relationship and Emergence of Human Spirit included a singing bowl meditation and an honest discussion on how PMH nurses can use authenticity, interconnectedness, and belonging as instruments of healing.  While speaking on esoteric topics is commonplace in my CAM conferences, I was delighted her powerful delivery made it into an area that does not like to stray far from evidenced-based practice. "Being" is not a concept easily researched through science!  Jean was referred to often throughout the rest of the conference - I gave her a nod in my presentation on the role social networking plays in world connectedness - and she had a huge line of folks waiting to shake her hand following her talk. I studied her middle-range theory of human caring in my MSN program, but there is nothing like a personal illustration by the creator to bring life to a concept that seems more simple and obvious on paper than it does in clinical practice. Watson Caring Science Institute


Mentorship: Pat Cunningham
My advisor won this year' award for excellence in practice and we whooped it up when they presented her award. What is amazing about Pat from a student perspective is her ability to individually listen to each of us, evoke the best practice and thought out of ourselves, and to use that blunt humor so characteristic of the best psych nurses. I imagine her patients feel the same way!

Trend: Integrative Therapies

Last year there were a few posters that addressed CAM use by nurses and I was excited, but this year saw an explosion! Mindfulness training, supplement and nutrition use, and schools of nursing integrating various CAM certifications as part of their psych-np programs are just some of the new blends of therapies to benefit our patients.  I found out one of my current teachers has been using hypnotherapy with some of her pediatric clients and a former psychiatrist colleague has been instrumental in establishing integrative practices in the Long Beach VA's mental-health program. I am excited that the future may hold a number of niches I fit into without having to carve them out on my own. There may be opportunities to expand NP ability to practice certain CAM therapies as part of their scope of practice similarly to how MDs already have, and I would love to be a part of making that happen.

 
   

Coolest Product: Mindability
This product was cool for 2 reasons. First, all the promo literature was on a flash drive that I was able to use to store my presentation when I could not find mine (it resurfaced in my backpack yesterday). Second, the rep gave me a fun wallet card targeted to control emotional reactions. It included some great phrases such as:

• "If I'm reading this, it means I'm more upset than is good for me."
• "However I'm feeling is exaggerated"
• "Whatever I am thinking is distorted." 
• "Whatever I'm thinking about saying or doing, DON'T, until I calm down."

If reality TV stars had these in their pockets, there would be no reality TV stars! In all seriousness, this brought out a new idea for PTSD group I hope to use during clinical soon.

   

International Perspective: Holland
While a group of use were relaxing by the pool area in between sessions, a fellow nurse from Holland decided to sit and chat with us. I found it interesting that while the US is trying to establish mental health parity, in Holland, they have decided those with mental illness will now have to pay over-and-above the standardized government health insurance rate for supplemental coverage if they want psychiatric services. We also had an interesting conversation about different nursing roles and marijuana bars.

Obligatory Gala: California Dreamin'

Hosted on Adventure lawn, the Friday night reception was included in the conference registration rather than having to purchase separately. An excellent buffet and cash bar (boo!) was well staffed, and the all-dentist band made for a wild evening. The dance floor was defiantly too small for this crew as all-ages crowded it and boogied down. Later we went to my room for a wine tasting wind down that resulted in one of my classmates deciding to commit to the ascot. Pittsburgh better watch out in 2012!

  

APNA Presentation & Resource List

Uploaded to slide share and ready to view! Well, except my cool social-media sun did not transfer over well.Please remember to take the survey: Social Networking and Mental Health Providers

Social Networking for Psychiatric-Mental Health Nurses

View more presentations from Jaclyn Engelsher

Resources
ANA's Social Media Toolkit - What every nurse should know

Health Vault - The possibilities for collaboration and consultation are encouraging

VA Directive 6515 (Social Media Policy)

Healthcare Communications & Social Media #hcsm Sunday's at 9pm EST

People Say I'm Crazy John Cadigan, schizophrenia patient, movie maker, twitter junkie

Google Privacy Center  An excellent primer

Facebook Privacy The place to update your settings

Research for Capstone Research

I am currently developing a survey for my DNP capstone project to examine usage trends and perspectives on social media within a number of psychiatric healthcare disciplines.  I am looking into a number of online survey sites to determine which one provides the most feature with the lowest (free?) cost.  It seems there is not one company that dominates the Doctorate student market, but if anyone has a great experience with a particular company, I would love to hear about it! Here are the links:

QuestionPro

SurveyShare

FluidSurveys

SurveyMonkey

SocialSci

SurveyGizmo

PsychData

LimeSurvey

I hope to have the survey up and distributed via a number of social media platforms and professional organizations by the APNA conference in October.  Check back soon!

Networking Nurse Notice

Just "LinkedIn" with author and fellow FNP Stephen Ferrara from NYC. Check out his awesome blog about the nursing world: A Nurse Practitioner's View