Okoli CTC, Almogheer Z, Seng S
… +5 more, Wang T, Abufarsakh B, Koyagi E, Stith H, Makowski A
J Am Psychiatr Nurses Assoc
· 2025 Aug · PMID 40808487
·
Publisher ↗
BACKGROUND: Telehealth offers a flexible and effective alternative to in-person behavioral health services, with users generally reporting high satisfaction. However, several barriers can limit equitable access among Med...BACKGROUND: Telehealth offers a flexible and effective alternative to in-person behavioral health services, with users generally reporting high satisfaction. However, several barriers can limit equitable access among Medicaid beneficiaries. AIM: This study aimed to examine factors associated with Telehealth Utilization Questionnaire (TUQ) scores among Medicaid beneficiaries and providers. METHODS: A cross-sectional research design was employed to collect data from beneficiaries and providers at five community mental health centers and managed care organizations. Descriptive statistics, chi-square analyses, and hierarchical regression analyses were used to analyze the data. RESULTS: Most Medicaid beneficiaries ( = 181) were 36 years or older, female, White non-Hispanic, and resided in urban locations. Among them, 46.4% used telehealth 50.0% or more of the time and reported moderate to high trust in providers' scores (TPS) and TUQ scores. There were no significant differences in telehealth usage based on residence or diagnosis. Regression analysis revealed that TPS was significantly associated with telehealth use frequency. Most Medicaid providers ( = 188) were 36 years or older, female, White non-Hispanic, and practiced in rural locations. There were no significant differences in the proportion endorsing providing care via telehealth to 50.0% or more of their patients based on practice location or job role. Regression analyses identified that practicing in urban locations and providing care via telehealth to 50% or more of their patients were significantly associated with telehealth use frequency. CONCLUSION: Trust in providers is a key driver of perspectives on telehealth usability among Medicaid beneficiaries, while practice location and utilization frequency significantly influence providers' perspectives on telehealth usability for delivering mental and behavioral healthcare. These findings suggest the importance of fostering trust among beneficiaries and addressing location-based barriers for providers to optimize telehealth usage.
Kearney K, Owen CP, Kobeissi MM
… +1 more, Djukic M
J Am Psychiatr Nurses Assoc
· 2025 Aug · PMID 40808476
·
Publisher ↗
BACKGROUND: Chronic shortages of mental health providers restrict access for 51 million people in the United States with mental illness. Psychiatric-mental health nurse practitioners (PMHNPs) can help expand access using...BACKGROUND: Chronic shortages of mental health providers restrict access for 51 million people in the United States with mental illness. Psychiatric-mental health nurse practitioners (PMHNPs) can help expand access using technology and team-based care. AIMS: The aim of this study was to analyze education and practice trends of PMHNPs in team-based care and telehealth models using a national sample of PMHNPs. METHODS: A secondary analysis of publicly available data from the 2022 National Sample Survey of Registered Nurses examined responses from 1,753 employed, certified PMHNPs. The descriptive study used means and frequencies to assess demographic, education, and work characteristics, along with 4 items on team-based care and 10 on telehealth. RESULTS: Most respondents report receiving training on team-based care through formal education, work, or professional development (83.2%), with 73.6% reporting their training was sufficient. Those participating in team-based care comprised 46.3%, and only 5.6% reported no participation. Over 82% report their workplace uses telehealth, and 77.6% report personal use of telehealth. The most used telehealth methods included live videoconferencing (72.8%) and telephone calls without video (53.2%). CONCLUSION: With the increasing reliance on team-based care and telehealth as strategies to improve accessibility and efficiency in patient care, nursing programs should consider incorporating telehealth frameworks, competency-based education, and digital literacy into the preparation of PMHNPs to meet the demands of modern health care.
ObjectivesThis paper describes the different modalities of Coordinated Specialty Care (CSC) in first-episode psychosis and illustrates how psychiatric nurse practitioners can fulfill important roles in the team-based eff...ObjectivesThis paper describes the different modalities of Coordinated Specialty Care (CSC) in first-episode psychosis and illustrates how psychiatric nurse practitioners can fulfill important roles in the team-based effort of individualized treatment and therefore increase access to specialized care for those suffering from early serious mental illness.MethodsReview of published literature and other online resources on first-episode psychosis (FEP) and CSC, shortage of psychiatric providers, and the role of the Psychiatric Mental Health Nurse Practitioner.ResultsResults are extracted from published literature on young persons experiencing FEP within current CSC models, as well as other online resources evaluating the increasing psychiatrist shortage throughout the United States.ConclusionThis article explores the potential roles and benefits of integrating psychiatric nurse practitioners into first-episode care and advocates that their involvement improves access to timely and effective interventions for young persons experiencing new-onset psychosis.
OBJECTIVE: Mental health intake may be a time of vulnerability for transgender and gender-expansive (T/G-E) people. Here, we describe processes that create a supportive environment where T/G-E people can feel welcome and...OBJECTIVE: Mental health intake may be a time of vulnerability for transgender and gender-expansive (T/G-E) people. Here, we describe processes that create a supportive environment where T/G-E people can feel welcome and safe. METHODS: After reviewing the literature describing the many negative experiences of T/G-E people when encountering health care, we developed a nursing theory-driven, humanistic approach for initiating the therapeutic relationship at intake. Specifically, our approach weaves together Human Caring Theory, trauma-informed care, and therapeutic use of the self during the first encounter with mental health services. Focusing on gathering information needed for the next steps, this process included an examination of every aspect of the intake process to eliminate bias. RESULTS: When properly and holistically employed, these processes may facilitate the initiation of a trauma-informed, therapeutic relationship and rapport that welcomes all, but especially T/G-E people. CONCLUSIONS: Human Caring Theory provides necessary guidance that humanizes mental health intake procedures aligns with holistic outcomes and may be especially helpful when providing mental health services to people who identify as T/G-E.
BackgroundThe Philippines is a significant supplier of nurses worldwide despite facing a considerable nursing shortage of about 127,000 in its healthcare system. Given the challenging socioeconomic conditions that can he...BackgroundThe Philippines is a significant supplier of nurses worldwide despite facing a considerable nursing shortage of about 127,000 in its healthcare system. Given the challenging socioeconomic conditions that can heighten their risk for various mental health issues in the country, it is crucial to explore the rate and factors of depression among Filipino nurses to support them in their roles better.AimsThis systematic review explores the rate and associated factors of depression among Filipino nurses.MethodsAfter screening and assessing 56 studies from three databases, data from three studies were extracted, described, compared, and synthesized.ResultsThe proportion of nurses who self-reported experiencing depressive symptoms among the eligible studies ranged from 19.5% to 45%, with 11.2% to 19.9% of participants indicating mild symptoms, 5.8% to 18.2% reporting moderate symptoms, and 2.5% to 6.8% reporting severe to extremely severe depressive symptoms. Depression rates were higher among nurses intending to migrate (31%) than those not intending to migrate (23%). Depression was positively associated with disengagement, exhaustion, and overall occupational burnout, while it was negatively associated with personal faith, spiritual contentment, and religious practice.ConclusionThese findings highlight the need for community-based and hospital-based mental wellness programs for nurses that enhance their motivation, engagement, self-efficacy, and spirituality. Future research should explore longitudinal studies and broader sampling methods to enhance generalizability. Research can also focus on interventions, such as the different religious and spiritual practices, as well as policies addressing depression and its implications.
BackgroundAdverse childhood experiences (ACEs) are associated with both increased depressive symptomatology and nicotine dependence (ND) in the general population. However, the relationship between ACEs, depressive sympt...BackgroundAdverse childhood experiences (ACEs) are associated with both increased depressive symptomatology and nicotine dependence (ND) in the general population. However, the relationship between ACEs, depressive symptoms, and ND among people with mental illness (MI) remains unexplored.AimsIn this study, we examined (a) depressive symptoms mediating the relationship between ACEs and ND and (b) ND severity mediating the relationship between ACEs and depressive symptoms.MethodA cross-sectional design was used to recruit participants online and from community mental health settings. Data analysis was conducted using IBM SPSS version 29.ResultsResponses from 194 individuals were included in the analysis. ND intensity mediated the relationship between ACEs and depressive symptom severity. The indirect variance of the effects of this mediation was 10.9%, 6.9%, and 10.6% among the total sample, females, and males, respectively. In addition, depressive symptoms mediated the relationship between ACEs and ND intensity, and the indirect variance of the effect of this mediation was 7.9%, 3.6%, and 8.8% in the total sample, females, and males, respectively.ConclusionsAmong people living with MI, ND mediates the impact of ACEs on depression, with varying degrees of influence between genders. In addition, depressive symptoms mediate the effect of ACEs on ND intensity. Further research is needed to investigate effective depressive treatment modalities to be integrated into tobacco treatment plans among people living with MI. In addition, nurse clinicians should assess for childhood adversity and depressive symptoms among tobacco users while treating ND.
ObjectiveThis paper updates the psychiatric mental health (PMH) nursing community regarding the progress of five recommendations for policy and practice to enhance workplace violence (WPV) prevention. This information sh...ObjectiveThis paper updates the psychiatric mental health (PMH) nursing community regarding the progress of five recommendations for policy and practice to enhance workplace violence (WPV) prevention. This information should be useful to nurses in their efforts to advocate for workplace safety.MethodsA comprehensive search of current literature, organizational action, and national policy relevant to the recommendations are reviewed and discussed to enhance WPV prevention and safety.ResultsWorkplace safety is a critical concern for PMH nurses and has far-reaching implications in PMH nursing settings. While there has been implementation of state policy around WPV, federal legislation remains stalled. The national accreditation standards continue to provide individual institutions guidance around WPV data collection, reporting, and analysis, but these data do not inform national efforts particularly around defining requirements for mechanisms to support healthcare workplace protection. However, recent research continues to document both prevalence and associated conditions/quality metrics. While dashboards are now available for public reporting of select WPV data, nationally the public reporting standards remain the same. Organizing a nursing voice in WPV reporting resulted in interesting exemplars. Thus far, no data are available on efforts to include safety in nursing curricula.ConclusionsThe safety of nurses, particularly PMH nurses, is a multi-faceted problem that will require efforts in regulatory, organizational, educational, and personal behavior change.
BackgroundIn the United States, it is estimated that 75% of healthcare workers report encountering workplace violence. Assaults on healthcare workers are associated with increased turnover rates, job dissatisfaction, tra...BackgroundIn the United States, it is estimated that 75% of healthcare workers report encountering workplace violence. Assaults on healthcare workers are associated with increased turnover rates, job dissatisfaction, trauma, and an inability to complete job tasks.AimsThe purpose of this quality improvement project was to evaluate the effectiveness of an education program to increase healthcare workers' knowledge and confidence in managing agitation and violence.MethodsThe project used a single group, pre- and post-test design to evaluate an educational intervention, a modified Awareness, Vigilance, Avoidance, Defense, and Escape/Environment (AVADE) program, using the Confidence in Coping with Patient Aggression Instrument (CCPAI), a 30-day post-intervention follow-up, and a post-violent incident follow-up. Quantitative data were analyzed using descriptive statistics and paired -tests, and qualitative data were analyzed using content analysis of an open-response question on the post-violence and 30-day follow-up surveys.ResultsThackery's CCPAI was completed by 130 participants, across 20 different departments, and 13 job titles. The modified AVADE program was found to increase confidence among healthcare workers when coping with patient aggression.ConclusionAn educational intervention emphasizing de-escalation techniques, situational awareness, self-defense, appropriate restraint use, legal considerations, and case studies increased healthcare workers' confidence in managing patient aggression. According to a 30-day follow-up survey, staff members applied at least one of the strategies taught during the course to handle violent incidents within a month of completing the training.
INTRODUCTION: Workplace violence (WPV) in healthcare is detrimental to staff and institutions. The prevalence of events continues to increase despite efforts to mitigate events. WPV is associated with psychological and p...INTRODUCTION: Workplace violence (WPV) in healthcare is detrimental to staff and institutions. The prevalence of events continues to increase despite efforts to mitigate events. WPV is associated with psychological and physical consequences and has been attributed to healthcare workers leaving the field, further contributing to the shortage of frontline healthcare staff. Healthcare workers often underreport WPV events due to cultures of acceptance, lack of knowledge of resources, and feeling unsupported during or after an event. AIM: This quality improvement project aimed to implement a WPV bundle and evaluate the effectiveness of staff utilization of WPV resources, perceived confidence, knowledge, and support during and after WPV events in a general surgery unit. METHOD: A hybrid education bundle, named the Violet Education Bundle, includes education for nurses on de-escalation techniques, incident reporting, standardization of shift-change huddle reporting, and resources for psychological support. A single-group, pre- and post-test design was utilized, and a paired -test was employed to test for statistical significance. RESULTS: With 23.2% of staff ( = 20) completing both the pre-/post-survey (support, confidence, knowledge, and resource utilization sections) at both time points, no pre- to post-implementation outcome increases were statistically significant. CONCLUSION: Though the 60-day follow-up might have contributed to the null findings, nurses anecdotally expressed that they found the resources valuable and appreciated having them in one place. Future research should include an assessment of effectiveness for improving staff confidence, knowledge, perceived support, and reduced incidence and complications of WPV events over a sustained period of time.
OBJECTIVE: Health care workers are sustaining significant numbers of workplace violence events, and health care organizations are called to respond. Through critical evaluation, comprehensive planning, and thoughtful ste...OBJECTIVE: Health care workers are sustaining significant numbers of workplace violence events, and health care organizations are called to respond. Through critical evaluation, comprehensive planning, and thoughtful steps into action, organizational leaders and direct care staff must work collaboratively to meet the demands of the dynamic health care landscape. Our objective is to identify multidisciplinary, evidence-based practice strategies through the use of tools, innovation, and education to equip health care teams in building a culture of personal and organizational safety. METHODS: A subject-focused review of international research, government, professional, and regulatory guidelines dated 2015 to 2024 was used to identify evidence-based practices and current barriers in workplace violence mitigation. The global nature of workplace violence suggests a need to explore human-centric solutions, and a multidisciplinary framework is ideal to examine the current climate, identify gaps in education and practice, and explore the impact of environmental conditions contributing to workplace violence. Through layered primary, secondary, and tertiary violence prevention strategies, health care systems may engage in continuous quality improvement, elevate interpersonal safety, and mitigate risks associated with workplace violence. RESULTS: Deepening conversations and establishing multi-team engagement around workplace violence expands an organization's capacity to break work silos and build processes that can effectively activate organizational change. CONCLUSIONS: With amplified attention to workplace violence, organizations must be committed to addressing the problem from all sides. Through identifying risk factors and mitigation strategies, targeting education, and empowering health care teams, organizations can navigate a strong path toward a safer future for patients, staff, and communities.
BACKGROUND: Serious mental illness (SMI) in pregnancy is a public health concern due to associated poor maternal-child outcomes. There is a gap in the literature about the healthcare experiences of pregnant women with SM...BACKGROUND: Serious mental illness (SMI) in pregnancy is a public health concern due to associated poor maternal-child outcomes. There is a gap in the literature about the healthcare experiences of pregnant women with SMI and the experiences of providers who care for this population. The purpose of this scoping review is to examine the current state of the science regarding the experiences of pregnant women with SMI and the experiences of providers when treating this population. AIMS: The aim of this review was to fill a knowledge gap that is needed to facilitate paradigm shifts in the treatment of pregnant women with SMI. METHODS: We conducted a systematic search for published, peer-reviewed, English-language literature addressing the experiences of pregnant women with SMI receiving care and the experiences of those providing care to the population. The databases searched were OVID MEDLINE, Embase (OVID), CINAHL, PsycINFO (EBSCO), and Sociological Abstracts (ProQuest). RESULTS: Sixteen qualitative and mixed-method articles focused on pregnant women with SMI were included in this review. Key themes emerged regarding patients' desire for specialized providers for treatment, preparedness in pregnancy, access to quality guidance and information, special attention to issues/concerns, guidance in medication, and care integration. Providers reported a desire for better interdisciplinary communication and specialized knowledge and expertise regarding SMI. CONCLUSIONS: This review provides insight into areas where interprofessional collaboration can be vital in helping improve health outcomes; however, more research is needed surrounding the perspectives of providers and their support and resources when treating this population.
OBJECTIVE: To explore an innovative model for nursing administration practice in which a trauma-informed care approach is applied to staff and personnel management. This model is applicable especially for preventing work...OBJECTIVE: To explore an innovative model for nursing administration practice in which a trauma-informed care approach is applied to staff and personnel management. This model is applicable especially for preventing workplace violence and managing its aftermath in psychiatric care facilities. METHODS: This discussion article presents a conceptual model for practice called (Nurses who Experience Workplace violence, Leadership to meet Expectations and NeedS), which is based on the BITTEN trauma-informed care framework. A model case exemplar is used to illustrate current nursing administration practices and to contrast them with a trauma-informed care approach to staff and personnel management. RESULTS: The model case exemplar highlights how the implementation of a trauma-informed care approach for nurses and staff could potentially impact the psychiatric work environment. Additionally, the model case exemplar suggests current administrative approaches may not adequately address the cumulative effects of workplace and personal trauma on staff responses to violence. CONCLUSIONS: There is a need for further research on trauma-informed care in psychiatric nursing. Specifically, systematic exploration is required to understand how trauma-informed care strategies in nursing administration can address the intersection of workplace and personal trauma and improve staff resilience and safety.
BACKGROUND: The COVID-19 pandemic created challenges for nurses and healthcare systems, including mental health concerns and intention to leave job roles. AIMS: The purpose of this mixed-methods study was to evaluate the...BACKGROUND: The COVID-19 pandemic created challenges for nurses and healthcare systems, including mental health concerns and intention to leave job roles. AIMS: The purpose of this mixed-methods study was to evaluate the effectiveness of a midwestern health system's resiliency programming in supporting nurse well-being and decreasing intent to leave roles, the organization, and/or the profession. METHODS: A 25-question survey was deployed among all staff nurses in the system. Key measures considered whether there were differences in well-being and intent to leave between nurses who had an interaction with a "" compared to those who did not, as well as between nurses who worked on high-risk units compared to those who did not. Interviews with about the program were transcribed and coded to assess for consistent themes. RESULTS: The study found that nurses who interacted with a disagreed with intending to leave the system. Nurses who worked on COVID-19 units reported better well-being but also agreed with intending to leave their roles, the system, and the profession. Themes such as , and emerged throughout the study. CONCLUSIONS: The program was effective in supporting nurse well-being in high-risk units and decreasing intent to leave the organization for nurses across the system. Findings add to a growing body of knowledge about nursing resiliency within the workplace. As experts in the field of mental health, psychiatric nurses can aid in the design and implementation of resiliency programming to prepare for future workforce crises.