The Future Is Now: Psychiatric Mental Health Nursing Graduate Preparation for Integrated Care
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1 The Future Is Now: Psychiatric Mental Health Nursing Graduate Preparation for Integrated Care Beth Phoenix, PhD, RN Health Sciences Clinical Professor UCSF School of Nursing
2 Nursing is the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations. American Nurses Association, 2010 NURSING IS INHERENTLY INTEGRATIV E
3 Nursing Education Pre-licensure Knowledge of full range of health conditions Clinical training across spectrum of HC settings including mental health Graduate PMHNP education 3 P s Dx/mgmt of acute & chronic medical conditions Mental health-specific expertise Clinical training in integrated settings
4 UCSF School of Nursing Faculty Practices CLINICAL TRAINING IN INTEGRATED SERVICES
5 Primary Care Outreach to Mentally Ill Individuals (PCOM) Community-based residential treatment & supported housing NP practice provides services on-site in 11 programs > 250 visits/mo. Traditional medical care can frustrate the ordinary individual. It can totally overwhelm individuals with mental illness.
6 PCOM Integrated Services Assessment, urgent care & chronic disease management Health promotion & psycho-education adapted to risk profile of mentally ill adults Health issues groups Staff education and consultation Programmatic interventions to promote healthy habits
7 Glide Health Services Fully-licensed NP-managed clinic FQHC treating 3000 pts/yr Patients predominantly homeless or low income, racially diverse Population w/ great health disparities who would otherwise go without health care
8 Services Provided Primary Care Chronic Disease Management Urgent Care Nursing Case Management Smoking Cessation Services Health Promotion & Education Acupuncture Individual Therapy Crisis Intervention Psychiatric Treatment Substance Abuse Services HIV Testing Risk Reduction Counseling
9 PMHNP Contribution to Integrated Care Broad-based biopsychosocial approach Comprehensive health & psychosocial assessment Identify medical causes of psychiatric sx Care coordination across systems Speak the language of PCPs Experience in a variety of health care settings Familiar with medical comorbidities Focus on human responses to health problems supportive approach to chronic health problems
10 PMHNP Models for Integrated Care Consultation model: Expert resource to PCP Provide education, evaluation of care, clinical expertise for complex cases Provision model Embedded in PC practice to provide MH services Collaborative model Network of collaborating/referring PCPs Coordination of care supported by mutual referral & communication Integrated model Trained in both mental health & primary care Provide integrated health services Weeks, 2005
11 Barriers to Effective Use & Training of PMHNPs in Integrated Care Limited understanding of NP roles & scope of practice Difference between primary care NP & PMHNP PMHNP positions may be limited to prescribing Regulatory restrictions Billing difficulties Few clinical role models/mentors in integrated settings
12 Future Directions IOM Future of Nursing Report: Practice to full extent of education & training Increase supply of PMHNPs in integrated care Cross-train primary care NPs as PMHNPs Increase nursing participation in interdisciplinary training programs Develop PMHNP residencies & fellowships in integrated care
13 References American Nurses Association. (2010). Nursing: Scope and Standards of Practice. Washington, DC: Nursesbooks.org. Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press. Weeks, S. (2005). Models of Collaboration Between Primary Care Providers & PMH-APRNs. American Psychiatric Nurses Association Annual Meeting, Nashville, TN.
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