welcome to the 25 annual premier phiin i epsychiatric...

Welcome to the 25th Annual Premier P hi i N i EPsychiatric Nursing Event


(Referenced Slides Not Available)

How to Win How to Win OUROUR Match Race: Match Race: Advocacy Advocacy

……for Psychiatric Nurses for Psychiatric Nurses …for Those We are Called To Serve…for Those We are Called To Serve…for the Profession of PMH Nursing…for the Profession of PMH Nursing

Keynote AddressKeynote AddressAmerican Psychiatric Nurses AssociationAmerican Psychiatric Nurses AssociationAmerican Psychiatric Nurses AssociationAmerican Psychiatric Nurses Association

Annual ConferenceAnnual ConferenceLouisville KYLouisville KYLouisville, KYLouisville, KY

October 13, 2010October 13, 2010

ObjectivesObjectivesjjAt the completion of this At the completion of this presentation the participant willpresentation the participant will::

1.1.Define the term advocacy in Define the term advocacy in yyrelationship to nursingrelationship to nursing

22 Identify opportunities for advocacy inIdentify opportunities for advocacy in2.2.Identify opportunities for advocacy in Identify opportunities for advocacy in psychiatric nursing for the patient and psychiatric nursing for the patient and family the nurse and the professionfamily the nurse and the professionfamily, the nurse, and the professionfamily, the nurse, and the profession

3.3.Develop a personal advocacy goalDevelop a personal advocacy goal

What is a Match Race?What is a Match Race?What is a Match Race?What is a Match Race?A race between two competitorsA race between two competitors

going head to head

Who is the Competitor Who is the Competitor inin the Psychiatric Nursingthe Psychiatric Nursingin in the Psychiatric Nursing the Psychiatric Nursing

Match Race?Match Race?

StigmaStigmaStigmaStigma

Stigma Toward Psychiatry as a Profession

Stigma Toward Psychiatric Nurses

Stigma Toward Those We Serve and Th i F iliTheir Families

Seabiscuit As a Metaphor topView Advocacy for Psychiatric Nurses, Those We Serve, and our ProfessionThose We Serve, and our Profession

(Referenced Video Not Available)

SeabiscuitSeabiscuit and Psychiatric Nursingand Psychiatric Nursing•• SeabiscuitSeabiscuit:: Psychiatric NursesPsychiatric Nurses•• Jockey:Jockey: Needs of our Patients andNeeds of our Patients andJockey:Jockey: Needs of our Patients and Needs of our Patients and

Family MembersFamily Members•• Trainer:Trainer: Wisdom of Our ExperienceWisdom of Our Experience•• Trainer:Trainer: Wisdom of Our Experience, Wisdom of Our Experience,

Our Research, Our Our Research, Our Administrators Our FacultyAdministrators Our FacultyAdministrators, Our FacultyAdministrators, Our Faculty

•• MrMr Howard:Howard: American Psychiatric Nurses American Psychiatric Nurses A i tiA i tiAssociationAssociation

•• War Admiral: Stigma War Admiral: Stigma


What We Are Up AgainstWhat We Are Up Against“Our horse is too little, our jockey is too “Our horse is too little, our jockey is too big, our trainer is too old, and I’m toobig, our trainer is too old, and I’m toobig, our trainer is too old, and I m too big, our trainer is too old, and I m too dumb to know the difference!”dumb to know the difference!”

Charles HowardCharles HowardCharles HowardCharles Howard

Psychiatric NursesPsychiatric NursesI O H T Littl ???I O H T Littl ???…Is Our Horse Too Little???…Is Our Horse Too Little???

300 000 000300 000 000 l li i th USl li i th US••300,000,000300,000,000 people live in the USpeople live in the US••954,000 954,000 physiciansphysicians••3,100,0003,100,000 registered nurses in USAregistered nurses in USA

–– 260,000260,000 are APRNs (8.4%)are APRNs (8.4%)–– 180,000 belong to the ANA (5.8%)180,000 belong to the ANA (5.8%)

••93,00093,000 are psychiatric nurses= are psychiatric nurses= 3.0%3.0%,, p yp y– 12,000 are certified PMH-APRNs (13%)

7 000 belong to the APNA= (7 5%)– 7,000 belong to the APNA= (7.5%)

Age Distribution of RNs http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-http://www.iom.edu/Reports/2010/The Future of Nursing LeadingChange-Advancing-Health.aspx

Distribution of RNs and US Racial/Ethnic Background Distribution of RNs and US Racial/Ethnic Background http://www.iom.edu/Reports/2010/Thehttp://www.iom.edu/Reports/2010/The--FutureFuture--ofof--NursingNursing--LeadingLeading--ChangeChange--AdvancingAdvancing--Health aspxHealth aspxAdvancingAdvancing Health.aspxHealth.aspx

All Registered Nurses By EducationAll Registered Nurses By Education--20082008•• ADNADN 36% 36% •• DiplomaDiploma 14%14%•• BSNBSN 37%37%•• PostPost--BSNBSN 13%13%

–– MastersMasters 370,000370,000–– PhDPhD 28,000 (116 programs)28,000 (116 programs), ( p g ), ( p g )

(551 graduates in 2008)(551 graduates in 2008)–– DNPDNP 92 programs92 programsp gp g

(361 graduates in 2008)(361 graduates in 2008)–– Enrolled Doctoral (PHD)Enrolled Doctoral (PHD) 3,9763,976( )( )–– Enrolled Doctoral (DNP)Enrolled Doctoral (DNP) 3,4163,416

www.aacn.nche.edu/

The Needs of Patients and FamiliesIs our Jockey Too Big?…Is our Jockey Too Big?

• Persons with mental illness in the world– 450,000,000 with mental health diagnoses-over450,000,000 with mental health diagnoses over

80% do not receive treatment– 95,000,000 with depression– 873,000 people commit suicide every year (WHO:

http://www.who.int/mental_health/en/)

• Persons with mental illness in the USPersons with mental illness in the US (http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml)

– 78,000,000 (approx 26% of those 18 and over)78,000,000 (approx 26% of those 18 and over)– 5,500,000 (approx 7 % with serious and

persistent mental illness)• 2,200,000 suffer from schizophrenia • 2,300,000 suffer with bi-polar disorder

The Needs of Patients and Families• On any given day, 1.8 million of those with

schizophrenia and bipolar go without p p gtreatment.

• More than two-out-of-five of our most severely mentally ill people go untreated – places the people who need treatment the

most, and the whole nation, at risk.– the failure to treat mental illness takes its toll

(e g Virginia Tech Texas Arizona)(e.g. Virginia Tech, Texas, Arizona)• Approximate number of Americans with

untreated severe mental illness who areuntreated severe mental illness who are homeless: 200,000

Faculty, Researchers, Administrators Is Our Trainer too Old?… Is Our Trainer too Old?

• 60% of faculty are over age 45y g– 20% are over age 60– Average age of retirement-62.5g g– Nearly 7% faculty shortage across the US

• Only 13 2% (409 200)of all RNs (hold• Only 13.2% (409,200)of all RNs (hold Master’s or Higher degrees

www.aacn.nche.edu/

Age Distribution of Faculty (IOM, 2010)

American Psychiatric Nurses Association…is the ‘owner’ looking out for us?g

• 7,000 members strong-up 50% in 4 years– 1733 new members in 2010!

• Equity in excess of $1,200,000 • 35 chapters representing 41 states• Recipient of the $350,000 5 year nursing

award from SAMHSA for Recovery to Practice GrantPractice Grant

• JAPNA• Counseling PointsCounseling Points• Clinical Psychopharmacology Institute• Annual Conferenceua Co e e ce• Janssen Scholar Program

APNA (Cont’)

• www.apna.org• Member Bridge: 2 500 eGroup posts in• Member Bridge: 2,500 eGroup posts in

over 95 communities last year• Our finger is on the pulse of the nation• Our finger is on the pulse of the nation

– 8 Councils2 Institutes– 2 Institutes

– 2 Task Forces16 Committees– 16 Committees

• We are present at all key tablesWe have started setting the table in• We have started setting the table in our own house!

STIGMA…Can we beat War Admiral?• Since 1960, more than 90 percent of state

psychiatric hospital beds have been eliminatedeliminated.

• More psychiatric patients are now in jails/prisons than in hospitalsjails/prisons than in hospitals– 280,000 in jails– 70,000 in hospitals

• San Francisco – a City of “Open-Air Asylums” “The homeless mentally ill in the city of San Francisco have been so visible for so longFrancisco have been so visible for so long they've become almost part of the landscape to us city dwellers--essentially invisible people who for all intents and purposes havewho, for all intents and purposes, have disappeared,” (ER physician and author Paul R. Linde—TreatmentAdvocacyCenter.org, 2010)

Getting Seabiscuit ReadyGetting Seabiscuit Ready to Run the Match Race


What Can Psychiatric Nurses Do To Win?

ADVOC ACY!!!!!!!ADVOC ACY!!!!!!!

Key Nursing Advocacy Roles• Teaching• Informingg• Supporting patients and family members• Protecting patients• Attending to the whole person• Being a voice for patients

P i h d• Preserving personhood• Building a caring relationship through carrying out a

commitmentcommitment• Empowering patients• Being a risk taker and moral agent• Guardian of the patient’s rights to autonomy and free

choice

Virginia Henderson—an advocacy pioneeran advocacy pioneer

“ helping people do what they would….helping people do what they would ordinarily do for themselves to maintain health recover from illness or die ahealth, recover from illness, or die a peaceful death when persons lack the strength will or knowledge to care forstrength, will, or knowledge to care for themselves” (Henderson, 1961, p. 41).

Patient Advocacy Started…

• As a result of the Employee RetirementAs a result of the Employee Retirement Income Security Act of 1974 (ERISA), enrollees in employer-sponsored healthenrollees in employer sponsored health plans are generally unable to pursue legal remedies for injuries resulting fromlegal remedies for injuries resulting from actions or decisions of their health plans under state lawunder state law.

• The first iteration of the Patient’s Bill of Rights quickly emergedRights quickly emerged

Nursing Advocacy Followed…g y

• 1976-the patient advocacy role described1976 the patient advocacy role described in the ANA Code for Nurses with Interpretive Statements:Interpretive Statements:– “the nurse acts to safeguard the client and

the public when health care and safety arethe public when health care and safety are affected by the incompetent, unethical, or illegal practice of any person”. (p. 2)

• ICN-2000 nursing advocacy is a key role

Concept Analysis Based on the Four Advocacy ModelsAdvocacy Models

• Patient advocacy includes– Safeguarding patients’ autonomy– Acting on behalf of patients– Championing social justice in the provision

of health care• A parallel process exists for the

psychiatric nurses and our professionp y p

(Bu & Jezewsky, 2006)

Patient Care Advocate: Communication Role CategoriesCommunication Role Categories

1. Liaison1. Liaison2. Feedback-remediation provider3 Counseling and support provider3. Counseling and support provider4. System monitor5 Troubleshooter5. Troubleshooter6. Investigator7 Group facilitator7. Group facilitator

Martin & Tipton, 2007p ,

Barriers to Individual Advocacy

• Conflict of interest between the nurse’s responsibility to the patient and nurse’s duty to theresponsibility to the patient and nurse s duty to the institution where employed

• Lack of institutional supportLack of institutional support• Lack of power• Lack of education• Lack of time• Threats of punishment• Being feminine

Hanks 2007Hanks, 2007

What Will Change in the Next 5 Years?

National health reform legislation—serving more people MH/SU parity legislation-Medicare copayment parityMH/SU parity legislation Medicare copayment parity Integrated healthcare delivery-Medical/healthcare homes—

tremendous opportunities for the RN Changes in reimbursement approaches/incentives Changes in reimbursement approaches/incentives Health information technology-electronic health records Changing consumer & workforce demographics Greater emphasis on recovery & reduction of disparities Enhanced focus on quality improvement & use of evidence based

practices New patterns of leadership & collaboration Care coordination Interprofessional educationInterprofessional education

Professional Associations!!!!

• It is only through the expression ofIt is only through the expression of advocacy as a collective responsibility that nursing can advocate for thethat nursing can advocate for the necessary social and political reforms.

• Associations must depend on nurses to• Associations must depend on nurses to report advocacy needsTh A i ti t d d• The Association must respond and ours HAS

Mahlin, 2010

HOW WILL YOU ADVOCATE?

I Don’t Know How

I’m Too Busy

I’m Scared

Get a Seat at the Table

If t t thIf you are not at the table YOU are ontable…..YOU are on the menu!!!!the menu!!!!

Key Messages

• Behavioral health is an essential part of healthhealth Improves health status Lowers costs for families businesses and Lowers costs for families, businesses and

governments

• Prevention worksPrevention works• Treatment is effective

P l• People recover

43

8 Strategic Initiatives1. Prevention of Substance Abuse and

Mental IllnessMental Illness2. Trauma and Justice3 Military Families3. Military Families 4. Health Reform5. Housing and Homelessness 6. Health Information Technology for gy

Behavioral Health Providers7. Data, Outcomes, and Quality

44

ata, Outco es, a d Qua ty8. Public Awareness and Support

Partnership:Partnership:Cannot do it aloneCannot do it aloneService Agency Service Agency Cannot do it aloneCannot do it alone

St tSt tAd tAd t

Administrators Administrators

Medical Medical States, States, Territories & Territories &

TribesTribes

ResearchersResearchersAdvocatesAdvocates

MilitMilit

CommunityCommunity

TribesTribesSubstance Substance

Use Use Individuals, Individuals, Families &Families & EducatorsEducators

Military Military Consumers

and Recovery

F ith &F ith &

Treatment Treatment ProvidersProviders

Families & Families & CommunitiesCommunities

EducatorsEducators

MediaMedia

Recovery Community

Faith & Faith & CommunityCommunity

basedbased

Mental Mental Health Health

Criminal Criminal Justice Justice

PractitionersPractitioners

4545

--based based ProvidersProviders Treatment Treatment

ProvidersProvidersCommunity Community Policy Policy

Makers Makers

Your APNA

Pick Just One and Go For It!

S bi it’ Fi l RSeabiscuit’s Final Race


Donna Riemer, RN, BC

• The healing power of empathyThe healing power of empathy

Psychiatric Nursing Will Win Through Advocacy

To be what we are,To be what we are, and to become what

bl fwe are capable of becoming is the onlybecoming is the only

end of life.

Robert Louis StevensonRobert Louis Stevenson

Psychiatric Nurses

Never be afraid to raise your voice for Never be afraid to raise your voice for Never be afraid to raise your voice for Never be afraid to raise your voice for f y ff y fhonesty, truth, and compassion.honesty, truth, and compassion.

f y ff y fhonesty, truth, and compassion.honesty, truth, and compassion.

If people all over the world in thousands If people all over the world in thousands If people all over the world in thousands If people all over the world in thousands of rooms like this one, would do this.of rooms like this one, would do this.of rooms like this one, would do this.of rooms like this one, would do this.

It would change the earth.It would change the earth.It would change the earth.It would change the earth.William FaulknerWilliam FaulknerWilliam FaulknerWilliam Faulkner

WHO AREWHO AREWHO ARE WHO ARE WE???????WE???????WE???????WE???????

THANK YOU AND HAVE A THANK YOU AND HAVE A WONDERFUL CONFERENCEWONDERFUL CONFERENCE

References• Bu, X. & Wu, Y. B. (2008). Development and psychometric evaluation of

the instrument: attitude toward patient advocacy. Research in Nursing and Health 31 63 75and Health, 31, 63-75.

• Bu, X & Jezewski, M.A. (2006). Developing a mid-range theory of patient advocacy through concept analysis. Journal of Advanced Nursing, 57 (1), 101-110.

• Curtin, L. L. (1979). The nurse as advocate: a philosophical foundation for nursing. Advances in Nursing Science 1 (3), 1-10.

• Drought, T. (2007). Parrhesia as a conceptual metaphor for nursing advocacy. Nursing Ethics, 14 (2), 127-128.

• Fowler, M.D. (1989). Ethical issues in critical care. Heart and Lunch, 18 (1), 97-99. G d S (1980) E i t ti l Ad Phil hi l F d ti f• Gadow, S. (1980). Existential Advocacy: Philosophical Foundation of Nursing. New York: Springer Publishing Co.

• Gaylord, N. & Grace, P. (1995). Nursing advocacy: An ethic of practice. Nursing Ethics 2 (1) 11-18Nursing Ethics, 2 (1), 11-18.

References• Green, A. & Jordan, C. (2004). Common denominators: Shared

governance and work place advocacy—strategies for nurses to i t l th i ti O li J l f I igain control over their practice. Online Journal of Issues in

Nursing, 9 (1), Manuscript 6.• Hamilton, R. (2009). Nursing advocacy in a postgenomic age.

N i Cli i f N th A i 44 435 446Nursing Clinics of North America, 44, 435-446. • Hanks, R.G. (2010). Development and testing of an instrument to

measure protective nursing advocacy. Nursing Ethics, 17 (2), 255-267267.

• Hanks, R.G. (2008). The lived experience of nursing advocacy. Nursing Ethics, 15 (4), 468-477.

• Hanks, R.G. (2007). Barriers to nursing advocacy. Nursing Forum, 42 (4), 171-177.

• Hanks, R.G. (2005). Sphere of nursing advocacy model. Nursing Forum, 40 (3), 75-78.

References• Henderson, V. (1961). Basic principles of nursing care.

International Council of Nurses, London.H l d D (2002) A l ti f th l ti hi b t• Hyland, D. (2002). An exploration of the relationship between patient autonomy and patient advocacy: Implications for nursing practice. Nursing Ethics, 9 (5), 472-482.J T &Il I K (2009) Ad i t l h lth• Jugessur, T. &Iles, I.K. (2009). Advocacy in mental health nursing: an integrative review of the literature. Journal of Psychiatric and Mental Health Nursing, 16, 187-195. K h k M (1982) Ad Ri k d R lit St L i• Kohnke, M. (1982). Advocacy, Risk, and Reality. St. Louis: Mosby.

• Lagan, M., Knights, K., Barton, J., & Boyce, P.M. (2009). Ad f th ith hi t i ill A li i lAdvocacy for mothers with psychiatric illness: A clinical perspective. International Journal of Mental Health Nursing, 18, 53-61. MacDonald H (2006) Relational ethics and ad ocac in n rsing• MacDonald, H. (2006). Relational ethics and advocacy in nursing: literature review. Journal of Advanced Nursing, 57 (2), 119-126.

References• Mahlin, M. (2010). Individual patient advocacy, collective

responsibility and activism within professional nursing i ti N i Ethi 17 (2) 247 254associations. Nursing Ethics, 17 (2), 247-254.

• Mallik, M. (1998). Advocacy in nursing: perceptions and attitudes of the nursing elite in the United Kingdom. Journal of Advanced N i 28 (5) 1001 1011Nursing , 28 (5), 1001-1011.

• Mallik, M. (1997). Advocacy in nursing—a review of the literature. Journal of Advanced Nursing, 25, 130-138.

• Martin, D. R. & Tipton, B.K. (2007). Patient advocacy in the USA: Key communication role functions. Nursing and Health Sciences, 9, 185-191.

• McClure, M. (2005). The nurse leader and nursing education: A case for patient advocacy. Nurse Leader, April, 29-32.

• Rice, M.C. & Wicks, M.N. (2007). The importance of nursing advocacy for the health promotion of female welfare recipients. Nurisng Outlook, 55 (5), 220-223.

References• Spenceley, S. M., Reutter, L., & Allen, M.N. (2006). The road less

traveled: nursing advocacy at the policy level. Policy, Politics & Nursing Practice 7 (3) 180 194Nursing Practice, 7, (3), 180-194.

• Vaartio, H., Leino-Kilpi, H., Salantera, S., & Suominen, T. (2006). Nursing advocacy: how is it defined by patients and nurses, what does it involve and how is it experienced? Scandinavian Journal ofdoes it involve and how is it experienced? Scandinavian Journal of Caring Science, 20, 282-292.

• Welchman, J & Griener G. (2005). Patient advocacy and professional associations: Individual and collective responsibilitiesprofessional associations: Individual and collective responsibilities. Nursing Ethics, 12, (3), 296-304.

• Williams, C. A. & Gossett, M.T. (2001). Nursing communication: Advocacy for the patient or physician? Clinical Nursing ResearchAdvocacy for the patient or physician? Clinical Nursing Research, 10, (3), 332-340.

• Zomorodi, M. & Foley, B.J. (2009). The nature of advocacy vs. paternalism in nursing: clarifying the ‘thin line’ Journal ofpaternalism in nursing: clarifying the thin line . Journal of Advanced Nursing, 65, (8), 1746-1752

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