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DNP Residency/DNP Project Hourly LogStudent Name:___Emlyne St. Helen____________________ DNP Project Advisor:_____________Dr.Debra Shockey___________________Name and Number:________________________ Content Expert/Site:__________Riveside LLHealth __________________DateHours (#)Cumulative HoursDescription of Scholarly Activities: Record all activities taken to meet course objectives and analysis of progress toward goalsIdentify the DNP Essential(s) that applies to your scholarly activity8/20/1911Presentation on leadership in a new light. The presenter focus on leadership strategies to get people to change. II8/21/1933Residency 4- discussed project implementation and evaluation. Poster development and presentation. II,VIII8/27/1911Meet with unit manages, discuss education program and need to encourage staff members to participate in education program. II,VI9/11/1911Meet with educator, discuss project to include education session, set up tentative dates for education classes. Discuss what will be needed to include posting fliers and printing out handouts. Also discuss how many sessions will that is needed to facilitate participation from staff. II,VI9/15/1966Worked on project- power point presentation, downloading and uploading videos into power point. Send information to nurse educator and unit manager to review. Review per test survey, send out survey to staff participants III,VIII9/16/1911Met with DNP advisor. Provide update on project and steps to implementation. Discuss power point and review survey. Also discussed printing out pre-test survey for staff in the event that they did not complete survey on line. III9/20/1922Finalize date and time with nurse educator, ensure that fliers were on unit. Ensure that unit managers encourage their staff to attend sessions. VI, II9/25/1922Preparation for education program: ensure that handouts were printed, PowerPoint was finalized, ensure pre-test survey was printed out. Education coordinator handled most that. She also ensure that there was a log in sheet for staff. VI9//26/1966Education session with staff at Nursing facility: two sessions were presented, Session one presented at 6-7 am. Session two presented 2-3 pm Staff had to complete pretest survey if it was not completed online I, II, III, VI9/27/1966Day two of education training for staff members: two sessions were presented, session one presented 6-7 am, session two presented 2-3 pm. Staff had to complete pre-test survey, if not completed on online. I, II, III, VI10/2/191313At APRN 2019 conference New Orleans.Pre-conference sessionThe central autonomic memory network: A theoretical model for understanding the neurobiological basis of trauma and suicide behaviors.Persons who have experienced trauma e.g childhood abuse, sexual abuse, PTSD have higher rate of suicide attempt and death by suicide. About 10-20% of people in the general population experience chronic trauma-based disorders. US suicide rate has increased approximately 33% in 2017 as compared to 1999. Suicide is the 10th leading cause of death in the US since 2017. Highest rate of Suicide in 2017 were adults 45-54 years of age. Second highest those age 65 years or older.Suicide Risk factors- Suicidal behaviors to completion result from interactions between distal and proximal factors. Distal factors – biological, contextual, and interpersonal vulnerabilities. (heritable or familial phenotype, epigenetic changes, psychopathology, childhood maltreatment, chronic medical comorbidities, substance use)Proximal factors- stressors or precipitating conditions that could immediately induce or precede suicidal behavior.( peer victimization , physical, emotional, sexual abuse, social dysregulation, acute illness, intoxication, anxiety, agitation, impulsivity, feelings of worthlessness, hopelessness, sleep disruptions. Common Trauma based symptoms-Depression, somatization and anxiety, Chronic medical comorbiditiesAlterations in arousal and activityIrritability, reactivity or impulsivityRe-experiencing Trauma or intrusive thoughts. Emotional numbness and avoidance Impaired cognitive, emotional and social processing Substance abuse. While distal and proximal risk integration provides clinical direction, our ability to predict suicidal behaviors to death by suicide remain severely limited. The central autonomic memory network model provides an innovative approach to understanding, identifying ad treating suicidal- related behaviors from a neurointegrative standpoint. Still up behavior Change River without any OARS? Advancing your motivational interviewing skills for challenging clinical problems. Purpose of this presentation is to learn to demonstrate Motivational interview consistent communication skills. Incorporating the spirit of motivational interview and reflective listening. Be able to use case scenarios and role-plays geared to support health behavior change. There are four processes of MI – Engaging, Focusing, Evoking and Planning. Engaging is the primary task. Lean towards guiding, following and filling. Lean away from righting reflex, directing, fact gathering.Focusing- clarify one or more goals, develop shared goals. Evoke motivation- don’t try to install it, focus and engagement are required Planning- clear plan- make it SMART. When less is more: Deprescribing in PMHNP Practice- focus was more on outpatient practice. Introduced three concepts that can be utilized in psych to facilitate deprescribing in outpatient population. Deprescribing means to decrease number of dosage of psychotropic medications that a patient is on. This approach was used in geriatric patients to decrease risk of poly pharmacy. An overview of Emotionally Focused Therapy: Application to Individuals, Couples and Families. This presentation focused on emotionally focused therapy which is based on the theory of attachment. There are 3 stages of therapy (De-escalation, Reconstructing the bond and consolidation of change) which recognizes the important role of emotions within the human experience. The skills acquired promote the expertise of advanced practice nurses who provide counseling services. Lunch- drug Conference kick off and awards presentation- welcome remarks, few words from APNA leadership and meet the award recipients.I, II, VI, VII, VIII10/3/191515Breakfast – Product theater breakfast- Spravato – the frist NMDA receptor antagonist approved in conjunction with an oral antidepressant for adults with treatment resistant depression. President’s address- PMHN: The whole health connection- This explore the elements of connection that PMHN use to create healing relationships. Examples of healing connections presented. An understanding of the science that backs up the importance of these connections to not only relieve suffering but create recovery and whole health. Expand your conceptual framework for the role of connections in our work and in our own lives. Participants are challenged to think about how to innovate and advance methods to create and support connections for whole health. Permutations of the silver tsunami: empowering psych APRNs to lead the change for integrated care in long term care.Integrated care for long term care residents is associated with improved outcomes and reduced mortality. Increased admissions to LTCs of residents with severe mental illness combined with the traditional nursing home population mix which psych APRNs are distinctively positioned to treat and lead integrated care. Use of Measurement- based care to inform clinical decision making during psychiatric client encounters. Presentation focused on promoting the use of measurement based tools that are quick and easy to use in psychiatric client encounters. They can be used to improve client outcomes, include clients in their own care, reduce disability from psychiatric disorders, improve continuity of care and improve life expectancy of psychiatric clients. Graduate education: Teaching and assessing PMHNP student clinical competencies using two types of simulations- This presentation focused on stimulated exercises developed to enable graduate PMHNP students to build advanced practice competencies at a distance using available text-based and telehealth technology. Students incurred no additional costs and faculty were able to directly observed student performance and provide meaningful feedback. Product theater Lunch- Bipolar Depression in Adults: presentation, diagnosis and treatment- the pervasive impact on patient’s lives. Exhibits – network with different agencies, schools and other health professionals in Exhibit hallEngaging PMHNP students through an integrated team based stimulation experience. Experiential learning opportunities occur throughout nursing program with interprofessional students joining together to simulate health care delivery experiences. Faculty must have the skills for determining solutions to challenges in developing, implementing and evaluating interprofessional simulations for student engagement during integrated simulation experiences that address that whole health of clients.Countertransference in Geriatric Psychiatry: what is Beneath the Stigma and how to Address it- This presentation examines sensitive topics that trigger providers when caring for geropsychiatric population, including grief and loss, dependency and suicide. These issues are not addressed in nursing education yet they impact potential providers negatively and deter pursuit as a subspecialty. TMS for OCD: New Hope for SufferingTranscranial magnetic stimulation is a new treatment for patients with treatment resistant OCD. Pre-treatment provocation of symptoms and monitoring of anxiety levels is part of the treatment and presents challenges for clinicians. This treatment modality was explained at length in this presentation and cases were reviewed. The role of TMS was clearly defined. Standup comedy and Mardi Gras receptionThe role of humor in forging connections. – Humor and laughter explored as an essential and therapeutic connector to whole health. I, II, III, IV VI, VII, VIII10/4/191515Product theater breakfast- understanding a medication assisted treatment option for opioid and alcohol dependenceChanneling the power of human connection toward whole health-In this presentation the presenter discuss the healing power of caring that flows exclusively through human connection. We learn four specific strategies for increasing human connection ( talk less, judge less, listen more, appreciate more). We also discuss connection between practicing good self- care and practicing good nursing care. Complementary and alternative treatments-Evaluation of a mind-body-spirit yoga intervention for rural dwelling adults who are in outpatient treatment for opioid addiction group. – this presentation illustrates the use of a novel group physiological yoga approach in reducing depression, anxiety and stress symptoms in adults who live in poverty, are addicted to opioids, and participates in a medication- assisted outpatient program. The SKY program is a standardized instruction manual- based intervention. Trauma-Sensitive yoga for women veterans with PTSD who experienced Military Sexual Trauma: Theoretical psycho-physiologic mechanisms and demonstrated effectiveness for PTSD symptoms- This presentation was research based and it presented a theoretical psychophysiological mechanisms of action of yoga for PTSD and the results of a randomized controlled trial of trauma- sensitive yoga for PTSD in women veterans who experienced military sexual trauma. Product theater Lunch- Tardive Dyskinesia: from screening through treatment.Substance use Opioids- Do nurses’ alcohol and other drug- personal experiences and education impact their willingness to provide care to patients with opioid use-related problems? The presentation explores the impact of nurses’ AOD-personal experiences and education having on shaping their opioid use-related perceptions and consequently their willingness to provide care to patients with opioid use-related problems. Exploring these personal and educational experiences can promote the development of interventions that target nurses’ willingness to provide opioid- related care. A community collaboration of HOPE- Heroin and Opioid prevention and education- Presentation introduces a new concept to fight the ongoing opioid epidemic within our communities by discussing best practices for PMH nurses in the hospital and community setting. It presents alternative options to incarceration, hospital recidivism and chronic overdoses by implementing a community based collaboration that supports access to treatment. An Examination of the quality of Evidence on Emotional support Animals. The presentation analyzed the sparse literature based on emotional support animals. It highlights the gap in knowledge and allows participants to think critically about the ethics of an emerging area in which generally recognized standards for preparatory training do not yet exist. Igniting Early Adopters: Implementing collaborative care for depression. In this presentation the presenters described a project to improve access to mental health care by implementing collaborative care for depression in primary care in an integrated health care system. Research shows that the process of innovation is complex. They used concepts form diffusion of innovation and quality improvement to implement the program.Crisis? Escalation or innovation, it is your choice. The use of innovative DBT- Informed nursing care techniques and their impact on crisis management in a child and adolescent psychiatric inpatient setting. The presentation shows how DBT- informed model of care served to address staff educational needs, improve patient safety and reduced seclusion and restraint events. By assisting patients and staff to recognize vulnerabilities that can lead to emotional dysregulation a proactive rather than reactive milieu can ensue. Symposium Dinner Practical Strategies for patient follow up and long term VMAT2 inhibitor treatmentI, II, VI, VII, VIII,V10/3/1955Creating holistic environment for the inpatient setting. This presentation shows the journey of an inpatient unit to expand their holistic framework by adding groups that model both Holistic nursing and concepts of recovery including: drumming, aromatherapy. Ideas discussed on how to begin your own journey melding mental health and a holistic framework. ADHD or Bipolar Mania? Using neuroscience to inform diagnosis and treatment in children and adolescents. The presentation helps the APRN to differentiate between ADHD and bipolar mania in children and adolescents through a review of neuroscience mechanisms associated with each disorder. It also address evidence-based treatment strategies for each disorder as well as treatment of complicating comorbid disorders. Nurses in Recovery : A healthcare provider treatment program: This presentation will review professional development themes common to nurses, how those themes are distorted in active addiction and resolved in recovery. A healthcare professional treatment program was described, focusing on the unique treatment approaches developed to effectively work with nurses who have been diagnosed with substance use disorder. VII, VIII, III, I10/4/1933Collect data from unit and surveys- start to review data obtained. Review, charts of patients who are on antipsychotic medications. Diagnosis and why they are currently on antipsychotic medications. II,III,V, VI, VII10/7/1944Work on project, analyze data. Review information obtained from Unit Manager and “ Pointright”II, III, V, VI, VII10/8/1911Attend unit Hurdle- discuss survey and implementation of DOS tool on unit. II10/11/1922Dementia Training video for care givers- Brief definition of dementia- interesting to know that there are 130 different causes of dementia. Dementia is the 3rd leading cause of death in the world. It is important to consider your approach in managing the care of the person with dementia. Speak to them in simple terms, use simple short phrases. Speak to them at eye level. Watch you tone of voice when talking to them. Do not discuss their condition in front of them this may appear disrespectful. VII, 10/14/1944Discuss with class, view Video on end of life care. View video, review article. Meet with class have discussion. This was very interesting discuss and information on our perception of end of life care was discussed. VI, II, VIII10/21/1922Discussion of DOS tool, with unit manager, discuss behaviors that we will track VIII, VI, V, II10/23/1922Spend time on memory care unit, observing staff, offering advice and reviewing DOS tool, to assess for treads and patterns. VIII, VI, V, II, VII11/13/1944Plan presentation for Hampton University My role at current health system What I do as a geriatric psychiatric nurse practitioner. Care for special population Presentation on Dementia, and other mental disorders in the aging population. What is normal aging? V, VI, VIII, II11/15/1944Presentation at Hampton university- two presentations for college students.Discussion, questions and answer sessions. V, VI, VIII, II11/15/1911Attend unit hurdle- addressed any concerns they had about (Dementia observation System) DOS tool. VIII, VI, V, II11/17/1922Time spent on presentation preparation – for call- presentation is on implementation of the project and- current status and any data obtained. I, II, III, V, VI, VII, VIII11/18/192.52.5Presentation for class – where I am now with project implementation. I, II, III, V, VI, VII, VIII11/20/1966Journal writing course model 1-5Orientation process to manuscript writing. Review of some of the fears and anxiety that people may have that deters them from writing for publication. Revision of the excuses that people make to avoid writing for journal publications. Various factors to understand in the journal publication process. Various strategies explained to facilitate writers in choosing a topic for publication. VIII, 11/21/1944Spend time on unit, gathering data, reviewing the DOS Tool. Obtain Data from Unit manager. Review where we are now and progress we have made. From implementation there is a 2% reduction in antipsychotic use, Gradual dose reduction has been performed on 6 patients. Other units wants to know what we are doing and how it is possible. Consulted on possible implementation of plan throughout the facility since it appears to be successful on one unit. I, II, III, V, VI, VII, VIII11/24/1922Attend unit hurdle- listen to staff concerns, update on upcoming, posttest to evaluate education retention. Listen to concerns that staff have and review current updates in DOS tool. Discuss limiting DOS tool to specific residents but creating a “hot list” per unit manager. Also all patients who are on antipsychotic with recent dose reduction will be on that list for monitoring. VIII, VI, V, II11/25/1955 Current Psychiatry Volume 18, no 10 October 2019 Practical Evidence based- peer reviewed. Journal.Premature mortality across most psychiatric disorders- psychiatric brain disorders are associated with multiple medical diseases that lead to a shorter life span. The evidence is robust and disheartening. As if the personal suffering and societal stigma of mental illness are not bad enough, psychiatric patients also have a short life span. In the past most studies have focused on early mortality and loss of potential life-years in schizophrenia, but many subsequent reports indicate that premature death occurs in all major psychiatric disorders.Some of the major disorders includes- schizophrenia, Bipolar disorder, Major depressive disorder, Attention Deficit/ hyperactivity disorder, Obsessive- compulsive disorder, Anxiety disorder, oppositional defiant conduct disorder, posttraumatic stress disorder, borderline personality disorder and other personality disorders. Important to note that Psychiatric patients are at high risk for potentially fatal medical conditions that require ongoing collaborative care with primary care clinicians. Invisible encephalopathy- Minimal Hepatic encephalopathy (MHE) or latent hepatic encephalopathy is associated with a reduced quality of life, sleep disturbances, fall risk, impaired ability to work and or drive and a risk of developing overt hepatic encephalopathy. Approximately 22% to 74% of patients with liver dysfunction develop MHE. The prevalence is estimated to vary due to poor standardization of diagnostic criteria and potential underdiagnoses due to a lack of obvious symptoms. The psychometric Hepatic Encephalopathy test is used as a diagnostic test, this is a written test that measures motor speed, and accuracy, concentration, attention, visual perception, visual- spatial orientation, visual construction and memory. Other forms of evaluation includes, CT , EEC and MRI Losing a patient to Suicide: Suicide loss can impact clinician’s professional identities, relationships with colleagues and clinical work.Some studies shows that 1in 2 psychiatrist and 1 in 5 psychologist, clinical social workers and other mental health professionals will lose a patient to suicide in the course of their career. Losing a patient to suicide constitutes a clear occupational hazard. Coping with a patient’s suicide is a neglected topic in residency and general mental health training.Various points were discussed in this article to include, the impact of losing a patient to suicide. Confidentiality- related constraints on the ability to discuss and process the loss. The legal and ethical issues. Colleagues’ reactions and stigma and the effects of a suicide loss on one’s clinical work. The article also covered opportunities for personal growth that can result from experiencing a suicide loss, guidelines for optimal postventions and steps clinicians can take to help support colleagues who have lost a patient to suicide. Toward a Better Understanding of the Bipolar Depression Spectrum. Depressive symptoms and episodes of predominant presentation of bipolar disorder and account for much of the morbidity associated with the illness. Mixed features in bipolar disorder are common, associated with a more complex and severe illness presentation linked to suicide and comorbidity e.g obesity and often lead to misdiagnosis. Bipolar disorder is a severe lifelong disorder associated with high rates of nonrecovery, chronicity and premature mortality. The actionable current opportunity for reduction the morbidity and mortality of BD is to address current unmet needs. Some of the current unmet needs in BD includes, suboptimal diagnostic accuracy/ timeliness, insufficient treatments for bipolar depression, anxiety, and cognitive symptoms, the management of comorbidity and treatments capable of improving functional recovery/ integration. Recent Advances in Treatment of Bipolar Depression: Depression accounts for most of the disease burden in BD, hence it must be treated aggressively. The article covered novel strategies for management of depression in BD. BD is characterized by manic and depressive episodes. The treatment of depression is a significant unmet need in the management of BD. Treatment for acute Bipolar depression – Zyprexa, Seroquel, Lurasidone. Augmentation in Bipolar depression - OFC vs Olanzapie , Lamotrigine + Lithium and Agomelatine + mood stabilizer. ECT – Electroconvulsive therapy- effective for treatment of acute bipolar depression in previous studies. Recent study shows that ECT was twice as effective as algorithm-based pharmacological treatment in bipolar depression patients who were resistant to pharmacotherapy.Assessing decisional capacity in patients with substance use disorders. A skilled assessment is required to determine if patients can make decisions about their care. Decisional capacity is defined as a patient’s ability to use information about an illness and he proposed treatment options to make a choice that is congruent with one’s own values and preferences. Determination of decisional capacity in the clinical setting should be specific to an individual decision or set of decisions. Serious cognitive impairment can often be concealed by a superficially jovial or verbally skilled patient. It is critical to perform a cognitive evaluation and mental status examination in a medically compromised patient with substance use disorder. The legal system rarely views patients with SUDs as lacking decisional capacity in the absence of overt psychiatric or cognitive deficits. In cases of potentially reversible impairment, targeted interventions may help restore capacity and allow treatment to proceed. Physician burnout vs depression: Recognize the signsBurnout and depression are distinct but overlapping entities. Burnout can be difficult to recognize it is not a DSM diagnosis, it is important the health care providers learn to identify the signs of burnout with reference to the more familiar features of depression. All health care professionals are at risk for burnout but physicians have especially high rates of self-reported burnout- which is commonly understood as a work- related syndrome of emotional exhaustion, depersonalization and a decreased sense of accomplishment that develops over time. One’s sense of community, fairness, and control in the workplace contribute to vulnerability to burnout. VI, VII, III11/28/1933Review of current literature, articles on management of dementia- review article on Lewy- dementia and impact of Lewy-body dementia on the patient. Review treatment for this disease. Watch Video on Lewy Body Dementia – dealt with the diagnosis and management of dementia with Lewy bodies, a type of dementia that causes a progressive decline in mental abilities due to abnormal microscopic deposits that damage brain cells over time. This neurodegenerative disease is the second most common progressive dementia after Alzheimer’s disease. Interesting Statistics to consider DLB- account to 10-25% cases on Dementia 1 in 25% of dementia diagnosis in the community and 1 in 13% diagnosed in a specialty practice. 10-15% of autopsy cases. III, VII11/29/1944Review, Center of Medicare and Medicaid (CMS) current data for antipsychotic medication use nationwide. Review state average and national average. Review Data of antipsychotic use at current facility, obtain data in point right, and also obtain data from unit manager. Review current list of patients on antipsychotics, update the data. Make rounds on the unit, perform observations of direct care staff and patient care, and provide informal re-education when indicated. VII, V, I12/3/1966Journal writing course – models 6-12Review some of the steps and prepare outline and choose a manuscript format. Secondly some strategies to aide in picking out an appropriate journal for manuscript. Well defined steps in the process of determining the authorship of the manuscript, whether single author or multiple authors. Review when it is necessary to send out a query letter.Importance of making time to write and various steps to prevent or avoid writers block. Make time to write the first draft and submit to editor. Respond in a timely manner to any feedback form editors. Finally steps to review the manuscript then submit for publication. VIII, IITotal hours 138.5 ................
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