APNA 29th Annual Conference Session 4034: October 31, 2015 Identify - - PDF document

APNA 29th Annual Conference Session 4034: October 31, 2015 Milstein 1

RE DUCING ST IGMA AMONG NP ST UDE NT S OF VARYING DISCIPL INE S WIT H T HE USE OF ST ANDARDIZE D PAT IE NT SIMUL AT ION

 Dr . Ruth Milste in, DNP, PMHNP- BC, L MHC  Dr. Cla re Conne r, DNP, PMHNP- BC  Dr. T yke Ha nisc h, DNP, APRN, F NP- C  She rwin Impe rio, RN

 With sta tistic a l he lp fr

• m: Dr

. Don Bie sse l T he spe a ke r s ha ve no c onflic t of inte r e st to disc lose

OBJE CT I VE S

 Identify benefits of using an interdisciplinary approach to

educating NP students utilizing scenarios in a nonthreatening, safe environment

 Discuss ways to reduce stigma and raise awareness

among NP students treating those with mental illness.

 Evaluate the information presented and formulate their

• pinion on the use of standardized patient psychiatric

simulations

T HE PROBL E M

 Pe ople with me nta l illne ss e xist in a ll a re a s of he a lthc a r e a nd ye t ma ny nursing stude nts a nd NP stude nts still sta te – “I don’t wa nt to work in psyc h”.  Me nta l illne ss, inc luding substa nc e use disorde rs, is quic kly be c oming the le a ding c a use of disa bility worldwide .  Stude nts still be lie ve tha t those with me nta l illne ss a re only found in psyc h fa c ilitie s a nd not in se tting s whe re the y work

RE COMME NDAT IONS F OR IMPROVE ME NT

 2001: Institute of Me dic ine re port on how he a lth syste ms in the 21st Ce ntury ne e d to func tion  In 2006, a se c ond re port by IOM a ddre sse d me nta l he a lth issue s spe c ific a lly

Physic a l a nd Me nta l he a lth must

ha ve pa r ity

Coor

dina tion / c olla bor a tion with our c olle a g ue s is a n e xpe c ta tion ST IGMA ST IL L E XIST S

We still strug g le to provide sa fe , c ost e ffe c tive c a re a c ross of he a lth c a re de live ry syste ms We still strug g le to ha ve our pa tie nts unde rstood a nd c a re d for We still strug g le to ha ve our pa tie nts fe e l c onside re d a nd tre a te d with inc lusion

T HE IMPE T US

 L a c k of site s for our stude nts  Othe r spe c ia ltie s don’t g e t e xposure  Cla re ’s proje c t ma de us a ll ta ke a look a t wha t we c ould do to he lp  Othe r stude nts we re a lso inte re ste d in working on stig ma re duc tion for the ir Clinic a l Sc hola rly Proje c ts  We we re a lre a dy using a c tors for our simula tions in the psyc h prog ra m  Othe r spe c ia lty instruc tors a ske d us to do some thing for the ir stude nts  Othe r instruc tors showe d some stig ma towa rds

• ur stude nts a nd e ve n us

 Sta rte d with a pre se nta tion without a c tors on working with those with me nta l illne ss in othe r se tting s.

APNA 29th Annual Conference Session 4034: October 31, 2015 Milstein 2

BE HAVIORAL HE AL T HCARE IS COMING OUT OF T HE CL OSE T !

T he disc ussion of c a r e for the me nta lly ill ha s fina lly move d into the ma instre a m of public a ffa irs a nd ne w polic y is c ha lle ng ing soc ie ty to look a t this popula tion a s one with e qua l rig hts for c a re (Goldma n, Glie d, & Ale g r ia , 2009) T his popula tion ha s long be e n pushe d a side but ma ny org a niza tions a re now looking a t how we c a n he lp by de ve loping public polic y tha t inc lude s me nta l illne ss whe n le g isla tur e is disc ussing he a lthc a re issue s, pa rity, a nd re form.

BOT T OM L INE You don’t ha ve to be a psyc h nur se to e nc ounte r pa tie nts e xpe r ie nc ing psyc hia tr ic e me rg e nc ie s. T ha t’s why a ll nur se s should ha ve a ba sic knowle dg e of psyc hia tric nur sing , r e g a r dle ss of the se tting the y wor k in.

CL ARE ’S PROJE CT

Cla re will ta lk a bit a bout he r proje c t whic h be c a me the be g inning of our de c ision to introduc e the othe r spe c ia ltie s to stig ma re duc tion

RE DUCING ST IGMA BY E DUCAT ING NURSE S T O CARE F OR PE RSONS WIT H ME NT AL IL L NE SS IN GE NE RAL SE T T INGS Cla Clare M.

• M. Con

Conner, DN DNP , APR APRN PMH PMHNP-BC

Projec

• ject C

t Chair: K Kathleen M thleen McCoy, D DNSc, , APR APRN-B

• BC, F

FAANP IMPE T US F OR PROJE CT

 Witne ss to wha t wa s pe rc e ive d a s ina de qua te or ina ppropria te tre a tme nt  L a c k of unde rsta nding a nd e mpa thy on the pa rt of c a re sta ff in g e ne ra l se tting s  Inte r e st in:  E nha nc ing nursing knowle dg e  Improving pa tie nt c a re  Improving outc ome s

L IT E RAT URE RE VIE W RE SUL T S

Ability to provide a ppropria te

c a re to pe rsons with me nta l illne ss (PWMI) in g e ne ra l se tting s wa s a ffe c te d by nurse s’ se lf- pe rc e ptions of

Knowle dg e de fic its Skill de fic its Comfort in working with PWMI

APNA 29th Annual Conference Session 4034: October 31, 2015 Milstein 3

PROJE CT IMPL E ME NT AT ION

 Goa l: improving knowle dg e , skill a nd c omfort will le a d to improve d c a re a nd be tte r

• utc ome s

 Pre te st/ postte st de sig n with inte rve ntion  Inte rve ntion wa s a 55 minute vide o  Re sults indic ate d de c re ase d stigma  92% found informa tion he lpful  78% thoug ht it would improve the ir pra c tic e

E ND OF T HE ST ORY

 Bra ndma n Unive rsity ha s inc orpora te d a spe c ts of this proje c t into the ir e duc a tion for all nurse pra c titione r stude nts  You, too, c a n be one who stig matize s!  Re mind yourse lve s a nd your c olle a g ue s tha t our pa tie nts c a n do be tte r a nd have be tte r outc ome s whe n we a re a wa re of our own fe e ling s a nd a ttitude s towa rd our pa tie nts

HT T P:/ / DNPWE L L NE SSADVOCAT E .WE E BL Y.COM/

SO T HE N WE DID… ..

 T

• ok Cla re ’s proje c t a nd our powe r point

pre se nta tion a nd built on the m be c a use we wa nte d to bring this to our stude nts  How c ould we do this?  Use of sta nda rdize d pa tie nts se e me d like the way to go  Worke d with She rwin Impe rio, RN – a c urre nt stude nt who is working on a simila r proje c t for his Clinic a l Sc hola rly Proje c t to write up simulations

WHY ST ANDARDIZE D PAT IE NT S?

 Ava ila ble to us  Sta nd up c ome dia ns tha t a re tra ine d in improv who ha ve prove d suc c e ssful for

• ur PMHNP stude nts

 L it Re vie w showe d promising re sults with the use of SP’s.  Ability of “the pa tie nt” to the n te ll how the y fe lt

WHAT DID WE WANT T O T E ACH?

 T ha t pa tie nts with me nta l illne ss a nd substa nc e use disorde rs a re pe ople too!  T he se pa tie nts a re not only in psyc h units  T

• dispe l the myths a bout me nta l illne ss

 De monstra tion of be tte r me thods of c ommunic a tion  How the pa tie nt fe e ls – the ir point of vie w  How to not inc orre c tly c a use a n involunta ry c ommitme nt  Diffe re nc e be twe e n a c tive a nd pa ssive  T he y wa nt to be he a rd  T he y ne e d to be he a rd  T he importa nc e of… …

APNA 29th Annual Conference Session 4034: October 31, 2015 Milstein 4

UNCONDIT IONAL POSIT IVE RE GARD

 No one in the ir life ha s provide d this  T re at the m as you would want your mom, your c hild, your family me mbe r tre ate d  Don’t misinte rpre t the ir words, a c tions, re a c tions  Wa tc h your fa c ia l re a c tions  E mploy T he ra pe utic Use of Se lf  Don’t ta lk in the hallway, nurse s station, e le va tor

DON’T

JUDGE !

HOW WE DID IT

 One pe rsona in diffe re nt se tting s  Pa tie nt wa s in ICU  Pa tie nt wa s the mom of a c hild in the hospita l  Pa tie nt wa s a t the Prima ry Ca re offic e post hospita liza tion  Pa tie nt wa s in Psyc h Provide rs offic e

Ac tre ss only ha d to le a rn one c ha ra c te r

DE PRE SSION:ANXIE T Y:MANIA

We c hose a simple diagnosis whic h we the n c omplic a te d a bit with a little substa nc e use disorde r Our ac tre ss e xpre sse d:  Sha me  Guilt  F e a r  Importa nc e of fe e ling a c c e pte d  Wa nting re spe c t of he r fe e ling s

ME T HOD

 Stude nts a ll sig ne d c onse nts (not a ll wa nte d to pa r tic ipa te )  T

• ok pre -surve y – Use d Ope ning Minds Sc ale

 Atte nde d simula tion with the ir spe c ia lty  We re g ive n the link to Cla re ’s vide o a nd we re re que ste d to wa tc h it tha t e ve ning  Post surve y give n the ne xt morning  Done a t two diffe re nt imme rsions, done two ways  Onc e with me doing the sims  Ne xt imme rsion we ha d a stude nt inte ra c t with the SP

DISCUSSION

 Afte r e a c h sim the g roup disc usse d wha t we nt rig ht, wha t we nt wrong , how c ould it ha ve be e n ha ndle d diffe re ntly  SP spoke to stude nts a bout he r pe rc e ption a s the pa tie nt  Ope n disc ussion a bout how to make the pa tie nt c omforta ble a nd how to he lp the mse lve s be c omforta ble

RE SUL T S

During the July Imme rsion –  T he re we re no sig nific a nt diffe re nc e in pre a nd post surve y re sults e xc e pt for #13 whic h is: He althc ar e pr

• vide r

s do not ne e d to be advoc ate s for pe ople with me ntal illne ss.

 T he se re sults did not matc h Clare ’s re sults whic h we re a bit disa ppointing .

APNA 29th Annual Conference Session 4034: October 31, 2015 Milstein 5

L IMIT AT IONS

 Sims a re not uniform  Ac tors c a n take us in diffe re nt dire c tions  Stude nts c a n take us in diffe re nt dire c tions  Don’t re a lly know if the y wa tc he d the vide o  Disc ussion c a n take us in diffe re nt dire c tions  Not be ing truthful on pre a nd post surve y  F

• r July Imme rsion only 36 matc hing surve y

pa irs we re usa ble – 8 pe ople did not use matc hing c ode s – one e xtra post surve y

T HE F UT URE

T his ha s be e n a dopte d by the sc hool a nd will be done with a ll inc oming c la sse s We will ma ke a diffe r e nc e

• ne stude nt a t a time

T HOUGHT F OR T HE NE W YE AR “CHANGE BE GINS WIT H ME ”

"I ha ve c ome to the frig hte ning c onc lusion tha t I a m the de c isive e le me nt. It is my pe rsona l a pproa c h tha t c re a te s the c limate . It is my daily mood that make s the we athe r. I posse ss tre me ndous powe r to make life mise rable or joyous. I c a n be a tool of torture or a n instrume nt of inspira tion, I c a n humilia te

• r humor, hurt or he a l. In a ll situa tions, it is my re sponse tha t

de c ide s whe the r a c risis is e sc a la te d or de - e sc a la te d, a nd a pe rson is huma nize d or de - huma nize d. If we tre a t pe ople a s the y a re , we make the m worse . If we tre a t pe ople a s the y

• ug ht to be , we he lp the m be c ome wha t the y a re c a pa ble of

be c oming ."

 F rom T e a c he r a nd Child: A Book for Pa re nts a nd T e a c he rs, by Ha im G. Ginott

RE F E RE NCE S

 Cunning ha m, P., Mc K

e nzie , K ., & T a ylo r, E F . (2006). T he Strug g le T

• Pro vide Co mmunity-Ba se d Ca re T
• L
• w-Inc o me Pe o ple With Se rio us

Me nta l I llne sse s He alth Affairs 25:3694-705; do i:10.1377/ hltha ff.25.3.694

 Gino tt, Dr., Ha im (2003). Be twe e n Pare nt and Child: T

he Be stse lling Classic T hat Re vo lutio nize d Pare nt-Child Co mmunic atio n (Re vise d and U pdate d). Ne w Yo rk: T hre e Rive rs Pre ss..

 Go ldma n HH, Glie d SA, Ale g ria M. (2009) Co nc lusio n: me nta l he a lth in

the ma instre a m o f pub lic po lic y. Am J Psyc hiatry 166(11):1215-6. do i: 10.1176/ a ppi.a jp .2008.08040585

 Institute o f Me dic ine Co mmitte e o n Qua lity o f He a lth in Ame ric a :

Cro ssing the Qua lity Cha sm: A Ne w He a lth Syste m fo r the 21st Ce ntury: 1–337. Wa shing to n, DC, Na tio na l Ac a de mie s Pre ss Re po rt, 2001

 Institute o f Me dic ine Co mmitte e o n Qua lity o f He a lth in Ame ric a :

Impro ving the Qua lity o f He a lth Ca re fo r Me nta l a nd Sub sta nc e Use Co nditio ns: 77–139. Wa shing to n, DC, Na tio na l Ac a de mie s Pre ss Re po rt, 2006

CONT ACT INF O

 Ruth Milste in - rmilste i@Bra ndma n.e du  Cla re Conne r – c c onne r@rive rbe ndc mhc .org  T yke Ha nisc h – ha nisc h@Br a ndma n.e du  She rwin Impe rio - impe 1101@ma il.br a ndma n.e du