The Challenge. Psychiatric Mental Health Nursing. Shortage of nurses choosing Psychiatric Mental Health Nursing as a specialization

Transcription

1 American Psychiatric Nurses Association 25th Annual National Conference October 19 22, 2011 Anaheim, California The Pathways Project: A Community Partnership Approach to Enhancing Psychiatric Nursing Education Sheila Harvin, RN, CNS, MSN Assistant Professor, Prairie View A&M University Charlzetta McMurray Horton, RN BC, NEA BC, MS Director of Nursing Psychiatry, Ben Taub General Hospital Shana Westerfield, RN, PMHNP BC, MBA, MS, PhD Professor, Houston Community College The above speakers have no conflicts of interest to disclose The Pathways Project is a collaborative initiative of the Network of Behavioral Health Providers, Houston, Texas and the Greater Houston Area Health Education Center (AHEC) 1 Psychiatric Mental Health Nursing The Challenge Shortage of nurses choosing Psychiatric Mental Health Nursing as a specialization 2 Durkin (2002) Educators must work with providers in the creation of high quality psychiatric nursing education programs to provide students with a satisfying psychiatric nursing experience. Through a combination of effective, intellectually stimulating classroom instruction and positive, welcoming clinical experiences, educators and clinical nursing staff may increase the number of nursing graduates who pursue this rewarding specialty 3 McMurray-Horton, Harvin, Westerfield 1

2 Hanrahan (2009) Undergraduate curriculum needs reform Average age of PMHN is By 2018, over an half of the PMHN will retire In Texas, 12.7 PMH RNs per 100,000 population Higgins & McCarthy (2005) Preceptors Key role models Help students adjust and integrate into clinical settings. 4 Puskar et al (2003) student focus group input no scientific or technical focus boring days no skills or hands on nursing awkward communication behavioral change does not work frustrating field patients noncompliant patients don t improve difficult to intervene with language skills versus technique little knowledge of the role of the psychiatric nurse 5 Faculty concluded three types of barriers Technical/task focus Acute/chronic framework Few role models 6 McMurray-Horton, Harvin, Westerfield 2

3 Pathways goal: To grow the number of nurses choosing psychiatric nursing as their career choice and/or to provide a clinical experience that results in nurses (regardless of their ultimate specialization) who understand the overarching interrelatedness of physical and mental health and the critical need to treat the whole patient 7 Pathways objectives: To have providers and educators work together to develop a py psychiatric nursing clinical experience that can address the shortfalls identified by students and faculty. 8 The experience would: Call upon clinical sites to provide students ample opportunities for technical and task experience Combat the acute/chronic framework by reconceptualizing the clinical experience Charge preceptors with providing intensive, interactive instruction allowing for more in depth understanding of their roles provide exposure to no less than 6 preceptors in a variety of settings 9 McMurray-Horton, Harvin, Westerfield 3

4 Pathways response Unique opportunity to bring educators and providers together with existence of Network of Behavioral Health and their decision to work collaboratively on behavioral health workforce development 10 Implementation Advisory Committee composed of providers, faculty, and network staff developed model Began with ADN program Piloted model Evaluated results Replicated at second school (BSN program) Revised model Implemented model Evaluated results 11 The Pathways Model Parallels the journey of the mental health client from crisis stabilization through inpatient treatment on to outpatient community clinic long term care Each hospital/facility partner identifies and highlights unique qualities of their specific entity s services/role 2/1 Student Preceptor ratio is primary working unit of rotation 12 McMurray-Horton, Harvin, Westerfield 4

5 The Pathways Model Preceptors understand the qualitative difference of the Pathways rotation in contrast to regular rotation Competitive process with small number of participants (8) ensures participation of those most serious about psychiatric mental health nursing and with the highest probability of success 13 Crisis Acute Maintenance / Recovery The Journey Houston Community Coleman College of Nursing Ben Taub Emergency Center Psychiatry Psychiatric Emergency Service 48 hours (6 weeks) Harris County Psychiatric Center St Joseph s Medical Center Outpatient Services Prairie View A & M University College of Nursing Ben Taub Emergency Center Psychiatry Psychiatric Emergency Service 64 hours (4 weeks) Harris County Psychiatric Center Methodist Hospital Outpatient Services 14 Student outcomes Outcomes High degree of satisfaction with experience Increase in likelihood of choosing specialization Higher grades in didactic than regular rotation students 15 McMurray-Horton, Harvin, Westerfield 5

6 Outcomes Preceptor/facility outcomes Preceptor survey findings Commitment of all hospitals/facilities l to continue and participate in expansion Reenergized staff 16 Challenges Can only provide to a small number of students (but the goal is not to impact everyone) Is extra burden on hospital staff and faculty (but all Pathways participants state they don t mind because they see the difference) 17 Conclusions Improved understanding of the importance of the psychiatric continuum of care Healthier perceptions of mental illness and its relevance to integrated health care Greater respect for psychiatric mental health nursing skills and their application in today's diverse clinical settings 18 McMurray-Horton, Harvin, Westerfield 6

7 Future Plans Finalize psychiatric nursing rotation model Continue rotation at HCC and PVAMU Expand rotation to at least two other (BSN) schools of nursing Create post graduation six week residency program Create mid career retooling educational program for career nurses 19 McMurray-Horton, Harvin, Westerfield 7