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

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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,

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APNA 29th Annual Conference Session 2035.2: October 29, 2015 York 1

Specification of Veteran‐centric Competency Domains in Training VA PMHNP Residents

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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

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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 ____________________________

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Program Funding: VA Office of Academic Affiliations Nursing Leadership: Mary Dougherty, PhD Director, Office of Nursing Services, OAA

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APNA 29th Annual Conference Session 2035.2: October 29, 2015 York 2

Disclosures

None

The co‐authors have been informed

  • f their responsibility to disclose to

the audience if they will be discussing

  • ff‐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

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Presentation Objectives

  • Describe the develop of

Veteran‐centric competencies/domains for PMHNP residency

  • Review the theoretical

underpinnings

  • Describe the application of

the domains

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Presentation Outline

  • Need
  • Theoretical underpinnings
  • Development of domains
  • Application
  • Evaluation
  • Discussion and summary

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APNA 29th Annual Conference Session 2035.2: October 29, 2015 York 3

Creating a Narrative of Veteran‐ specific Competency Domains: Need

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  • 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

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

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APNA 29th Annual Conference Session 2035.2: October 29, 2015 York 4

Domain of Competence

  • Cluster of competencies having

similar intentions, functions & meanings

  • Broad distinquishable area of

competence in which aggregate constitutes a general descriptive framework

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Englander et al., 2012; NONPF, 2013

Cultural Competencies

  • General‐SAMSHA
  • Discipline‐specific‐nursing,

counseling, psychology, PMHNP’s

  • Behavioral health‐specific

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APA, 2014; Delaney et al., 2011; Douglas et al., 2014; Hoge et al., 2014; Koh, Gracia, & Alvarez, 2014; NONPF , 2013; SAMHSA, 2014; Weber, 2014

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

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American Psychological Association [APA], 2008; Strom et al., 2012

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APNA 29th Annual Conference Session 2035.2: October 29, 2015 York 5

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

14 Cozza et al., 2014; Lesieur et al., 2012; SAMSHA, 2011; Strom et al., 2012; Tanielian et al., 2014

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

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APNA 29th Annual Conference Session 2035.2: October 29, 2015 York 6

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

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14 Veteran‐centric Competency Domains

58 knowledge, attitudes and skills Example:

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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

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

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APNA 29th Annual Conference Session 2035.2: October 29, 2015 York 7

Application of the Competencies

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Integration into Core Competency Evaluation Tool

  • Residency Task Force adopted SAMSHA Core

Competencies for Integrated Behavioral and Primary Care

  • Added 10th 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

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Interprofessional Seminars (weekly)

  • Strong trauma‐focused VA

research center and partner university center for prevention

  • f violence
  • Experts presented on PTSD,MST,

ET, combat stress

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APNA 29th Annual Conference Session 2035.2: October 29, 2015 York 8

Self‐Assessment: Veteran Experience

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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

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

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APNA 29th Annual Conference Session 2035.2: October 29, 2015 York 9

Discussion

  • Not inclusive, building block
  • 60% of Veterans receive care
  • utside the VA so the domains

could help increase readiness

  • f nurses outside VA
  • Can contribute to

development of national standards for residencies

  • Authors have chance to

pursue further expert review

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Discussion

  • Not inclusive, building block
  • 60% of Veterans receive care
  • utside the VA so the domains

could help increase readiness of nurses outside VA

  • Can contribute to development
  • f national standards for

residencies

  • Authors have chance to pursue

further expert review

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In Summary

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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).

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APNA 29th Annual Conference Session 2035.2: October 29, 2015 York 10

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Contin.

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Contact Information

Jan York janet.york@va.gov 843‐577‐5011 x5206

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