Journal of the American Psychiatric Nurses Association

Treatment-resistant depression (TRD) exists when patient depression continues without remission or reduction despite treatment. There are no standardized guidelines for identifying TRD, but one failed antidepressant treatment at an adequate dose and duration can constitute TRD, especially in cases of severe depression or suicidality. TRD rates for depressed patients average approximately 50% to 60% of the general population. These numbers are higher in the military population and are often complicated by comorbidities.

Chart audits revealed 68% of psychiatric clinic outpatient veterans met criteria for TRD. Only 25% of patients were being treated adequately for TRD, and 0% were offered other options for treatment. This project aimed to improve patient-centered TRD care at a veteran’s hospital to 80% within 90 days.

This quality improvement project was implemented using plan-do-study-act (PDSA) cycles. Interventions were tested over four rapid-cycle phases with improvements for screening, handouts, surveys, and team meetings over 8 weeks. Four core interventions were followed throughout the project: screening for TRD, right-care case management tracking, patient engagement with shared decision-making (SDM), and team engagement.

Starting from a baseline right-care score of 25%, the project attained an overall mean of 99.6% representing improved patient-centered TRD care and surpassing the 80% goal defined in the aim.

Overall TRD care was improved using SDM options and inter-clinic teamwork and communication.

There is an increasing need for millennial psychiatric nurses in health care. Nurses’ levels of satisfaction with their manager’s leadership styles are critical to their remaining in the profession.

To explore the relationship between the roles of nursing leadership and their influence on the millennial psychiatric nurse’s level of job satisfaction and intent to leave.

Eighty-three psychiatric registered nurses between the ages of 22 and 37 with 6 months or more experience completed a Managerial Skills and Job Satisfaction Survey questionnaire.

The millennial psychiatric nurse who perceived their managers to display the roles in being a mentor (M = 24.95, SD = 2.81), director (M = 23.08, SD = 2.55), and monitor (M = 22.71, SD = 2.51) had higher job satisfaction and would be less likely to leave the specialty, current position, and organization.

The study revealed that nursing leaders need to focus on strengthening the monitor and mentor roles and work on changing from having a coordinator role to the director role.

Food insecurity affects 15 million households in the United States and is associated with negative physical and mental health outcomes including Major Depressive Disorder. Governmental public assistance or food benefit programs including the Supplemental Nutrition Assistance Program (SNAP) and Women, Infants, and Children (WIC) are social intervention services that attempt to minimize food insecurity for low-income households. There is little consensus regarding the effects of food benefit participation on reducing risk of depressive symptoms.

This study aims to explore the association between household food insecurity and food benefit participation (SNAP or WIC) on risk for depressive symptoms using nationally representative samples from the Center for Disease and Control and Prevention Nutritional Health and Nutrition Examination Survey 2013-2014 and 2015-2016 cohorts. We hypothesize that food insecurity is associated with increased risk of depressive symptoms and food benefit participation with reduced risk.

Cross-sectional analyses were conducted using survey-weighted logistic regression to explore the relationship between food insecurity, food benefit participation, and the risk of depressive symptoms controlling for relevant income and sociodemographic variables.

When controlling for sociodemographic variables, food benefit participation did not reduce the risk of depressive symptoms, while high levels of food insecurity were associated with elevated risk.

High levels of food insecurity are associated with elevated risk of depressive symptoms. Nurses and public health professionals can address food security needs through increased knowledge of referral and eligibility requirements. Implications on clinical practice, policy, and future directions for research are discussed.

The most crucial discussion in psychiatric hospitals is the safety of patients, especially during incidents that have the potential to cause physical harm such as those where mechanical restraints are used.

The goal of the project was to reduce the use of mechanical restraints by 25% within 10 weeks in two piloted medical–surgical units.

A total of 60 articles were examined for relevance; out of these, the author used 30 studies that were based on observational, literature review, quantitative analysis, or clinical trial methodologies to conduct a comprehensive literature review. The author used a retrospective and descriptive design of chart review data collection to implement the project. The six core strategies framework, coupled with the creation of mental health championship role, was implemented to mitigate the problem.

This study shows that the implementation of the six core strategies and the role of a mental health champion helped reduce the use of mechanical restraints by 100%.

A total of 3,072 patients’ charts were reviewed in which there were three PERT (Psychiatric Emergency Response Team) activation and no mechanical restraint events, which showed a considerable quality improvement compared to the pre-implementation data collection of 37 PERT and 14 mechanical restraint events. The implications for practice and further study in the field are the involvement of more authors with similar expertise, the use of a control group for comparison, and a longer length of study duration.

A number of variables have been shown to influence whether an individual who experiences an emergency psychiatric assessment is admitted to a psychiatric hospital. This study focused on the theoretical orientation of the assessing clinician as a possibly influential variable. The theoretical orientation being studied was Bowen family systems theory or Bowen theory (Bt). Overall the Bt perspective looks at the family as the primary crucible that generates symptoms but at the same time as the natural unit and the best built-in resource to deal with those symptoms.

This study examined whether the theoretical orientation of the nurse psychiatric assessor would affect her inpatient admission rate of patients seen for psychiatric evaluation in an emergency department (ED).

A clinician/researcher with extensive experience applying Bt in clinical practice worked in a Crisis Management Service providing psychiatric evaluation and disposition in a busy community hospital ED. Given Bt’s emphasis on the system rather than individual pathology, the clinician researcher hypothesized that her psychiatric hospitalization rate would be lower than the other clinical nurse specialists. A retrospective chart review analyzed 1 year of cases from all referrals that might have resulted in psychiatric hospitalizations (n = 1,801).

The clinician/researcher’s psychiatric hospitalization rate was significantly lower (p = .004) than the other clinicians.

An approach to psychiatric assessment in the ED applied a Bt perspective in a way that significantly reduced psychiatric hospitalizations.

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.) identifies key features of binge eating (BE) to include the consumption of a large amount of food and the perception of loss of control (LOC) over eating during a distinct episode. While earlier research has focused on food consumption, findings are now emerging on the role of LOC associated with the BE episodes, particularly in women. However, it is unclear that these findings are applicable to men without knowing how men experience LOC associated with BE.

This study examined how college-age men describe LOC associated with BE.

Previously collected qualitative data from a study examining BE in college age-students were used to examine responses from 53 men (mean age 19.9 ± 1.1 [SD] years). Respondents were asked about their individual experiences of LOC associated with BE episodes. Data were analyzed using content analysis.

Four categories emerged from the data: (1) keep eating, (2) can’t stop, (3) without thinking, and (4) food so good.

Findings extend the current understanding of LOC associated with BE in men and point to potential gender differences, and/or weight influences, based on previous reports. Identified categories may be potentially targeted areas for tailored therapy to enhance awareness and self-regulation of BE behavior.

Measuring patient experience is an essential challenge in the inpatient behavioral health population.

This initiative analyzed the psychometric properties of a revised version of the patient Combined Assessment of Psychiatric Environments (p-CAPE-R) survey.

The p-CAPE was revised to encompass the interdisciplinary treatment team and implemented on five inpatient psychiatric units at an academic medical center. A psychometric analysis was performed on the p-CAPE-R.

Analysis of factor loadings with a large sample (n = 786) revealed a more coherent item structure under the “staff competency and engagement” and “treatment effectiveness” domains than presented in the original instrument development research.

Although the p-CAPE-R reflects a more useful and psychometrically sound instrument than the original p-CAPE, further analysis and revision to reflect the entire interdisciplinary team is warranted.

In 2018, nearly 20% of Americans aged 12 years and older reported using illicit substances, with higher rates in rural areas. Federally Qualified Health Centers (FQHCs) provide health care to one in five rural Americans. However, estimates suggest that only 13.6% of patients in rural FQHCs receive substance use (SU) screening compared with 42.6% of patients in urban FQHCs.

This quality improvement (QI) project aimed to improve patient quality and safety and meet Health Resources and Services Administration reporting requirements. These aims were achieved through the design and implementation of a new SU screening protocol in four FQHCs in rural Indiana.

Deming’s plan–do–study–act model was used to implement QI interventions to increase SU screening rates. A new SU screening tool, the National Institute on Drug Abuse –Modified Alcohol, Smoking, and Substance Involvement Screening Testwas implemented, and staff were trained on its use. the screening, brief intervention, and referral to treatment model was used as a guiding framework. Outcome measures included a comparison of SU screening rates from the first quarter of 2019 to the first quarter of 2020, as well a pretest–posttest designed to measure staff knowledge and attitudes regarding SU.

Baseline SU screening rate in 2019 was 0.87%. This increased to 24.8% by March 2020. Additionally, posttest results demonstrated improvement from staff on all indices, and an approval rating of 77% of the new SU screening practices.

This project demonstrated that a low-cost QI intervention can increase SU screening rates in rural FQHCs, as well as improve staff knowledge and attitudes regarding SU.