Learning Objectives Explain how mental health topics are integrated - - PDF document

APNA 30th Annual Conference Session 4032: October 22, 2016 Phelon 1

www.muw.edu

Integrating Mental Health Topics into a FNP Curriculum

Shonda Phelon DNP, FNP‐BC, APMHNP‐BC, GNP‐BC Sueanne Davidson DNP, FNP‐BC

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.

APNA 30th Annual Conference Session 4032: October 22, 2016 Phelon 2

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.

APNA 30th Annual Conference Session 4032: October 22, 2016 Phelon 3

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.

8

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

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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

APNA 30th Annual Conference Session 4032: October 22, 2016 Phelon 4

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

APNA 30th Annual Conference Session 4032: October 22, 2016 Phelon 5

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

APNA 30th Annual Conference Session 4032: October 22, 2016 Phelon 6

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

APNA 30th Annual Conference Session 4032: October 22, 2016 Phelon 7

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

APNA 30th Annual Conference Session 4032: October 22, 2016 Phelon 8

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.