DiversityNursing Blog

By LAWRENCE K. ALTMAN

A British-American scientist and a pair of Norwegian researchers were awarded this year’s Nobel Prize in Physiology or Medicine on Monday for discovering “an inner GPS, in the brain,” that makes navigation possible for virtually all creatures.

John O’Keefe, 75, a British-American scientist, will share half of the prize of 8 million kronor, or $1.1 million, in what is considered the most prestigious scientific award. May-Britt Moser, 51, and Edvard I. Moser, 52, who are married, will share the other half, said the Karolinska Institute in Sweden, which chooses the laureates.

The three scientists’ discoveries “have solved a problem that has occupied philosophers and scientists for centuries — how does the brain create a map of the space surrounding us and how can we navigate our way through a complex environment,” the institute said in a news release.

The positioning system in the brain that they discovered helps us know where we are, find our way from place to place and store the information for the next time, said Goran K. Hansson, secretary of the Karolinska’s Nobel Committee, in announcing the laureates.

The researchers documented that certain cells are responsible for higher cognitive function that steers the navigational system, the committee said.

Dr. O’Keefe began using neurophysiological methods in the late 1960s to study how the brain controls behavior. In 1971 he discovered the first component of the inner navigational system in rats. He identified nerve cells in the hippocampus region of the brain that were always activated when a rat was at a certain location. He called them “place cells” and showed that the cells registered not only what they saw, but also what they did not see, by building up inner maps in different environments.

Dr. O’Keefe was born in New York City and graduated from the City College of New York. He earned a Ph.D. in physiological psychology at McGill University in Montreal, in 1967, and moved for postdoctoral training to University College London, where he remains. He is a professor of cognitive neuroscience.

In 2005, the Mosers discovered a second crucial component of the brain’s positioning system by identifying another type of nerve cell that permits coordination and positioning. The scientists, who work at the Norwegian University of Science and Technology in Trondheim, called the cells grid cells. While mapping connections to the hippocampus in rats moving about a room in a laboratory, “they discovered an astonishing pattern of activity in a nearby part of the brain called the entorhinal cortex,” the Nobel committee said.

When the rat passed multiple locations, the cells formed a hexagonal grid. Each cell activated in unique spatial patterns. Their research showed “how both ‘place’ and ‘grid’ cells make it possible to determine position and to navigate,” the committee said.

The Mosers grew up in rural Norway and came from nonacademic families. May-Britt was born in Fosnavag and Edvard in Alesund. Although they went to the same high school, they did not know each other well until they were undergraduates at the University of Oslo. They married while they were college students and have two daughters. Both are professors at the university in Trondheim.

At one point they were visiting scientists at University College London, studying under Dr. O’Keefe.

The three also won Columbia University’s Louisa Gross Horwitz Prize last year for their discoveries.

Only a handful of married couples have shared a Nobel Prize, and the Mosers are only the second in the medicine category, which has been awarded since 1901. Fewer than a dozen women have been named laureates in medicine.

Evidence that place and grid cells exist in humans comes from recent studies using brain imaging techniques and from patients who have undergone neurosurgery.

The laureates’ findings may eventually lead to a better understanding of the spatial losses that occur in Alzheimer’s and other neurological diseases. The hippocampus and entorhinal cortex are often damaged in early stages of Alzheimer’s, with affected individuals’ losing their way and failing to recognize the environment. The findings also open new avenues for understanding cognitive processes like memory, thinking and planning, the Nobel Committee said.

According to The Associated Press, May-Britt Moser said the couple was elated. “This is such a great honor for all of us and all the people who have worked with us and supported us,” she said in a telephone interview with The A.P. “We are going to continue and hopefully do even more groundbreaking work in the future.”

Her husband was flying when the prize was announced, she said, and he later told the Norwegian news agency NTB that he learned about it when he landed and turned on his cellphone, to a barrage of messages and calls. “I didn’t know anything. When I got off the plane there was a representative there with a bouquet of flowers who said ‘congratulations on the prize,’   ” The Associated Press reported.

The laureates traditionally receive their awards at a banquet in Stockholm on Dec. 10, the anniversary of the death in 1896 of the prize’s creator, Alfred Nobel, an industrialist and inventor of dynamite.

Source: http://www.nytimes.com

By MNT

"People tend to think that happiness in schizophrenia is an oxymoron," says senior author Dr. Dilip V. Jeste, distinguished professor of Psychiatry and Neurosciences at the University of California, San Diego School of Medicine.

"Without discounting the suffering this disease inflicts on people, our study shows that happiness is an attainable goal for at least some schizophrenia patients," he adds. "This means we can help make these individuals' lives happier."

Dr. Jeste's team surveyed 72 schizophrenia outpatients in the San Diego area - all but nine of whom were taking at least one anti-psychotic medication. Just over half of the respondents were residents in assisted-living facilities.

A comparison group was comprised of 64 healthy men and women who did not currently use alcohol or illegal drugs and who had not been diagnosed with dementia or other neurological illnesses.

The mean age for both groups was 50 years.

In the survey, the respondents answered questions on their happiness over the previous week. They were asked to rate statements such as "I was happy" and "I enjoyed life" on a scale from "never or rarely" to "all or most of the time."

The results reveal that about 37% of the schizophrenia patients were happy most or all of the time, compared with about 83% of respondents in the comparison group.

However, about 15% of people in the schizophrenia group reported being rarely or never happy, but no one in the comparison group reported such a low level of happiness.

'Patients' happiness was unrelated to the severity or duration of their illness'

The researchers compared the self-reported happiness of the respondents with other factors including age, gender, education, living situation, medication status, mental health, physical health, cognitive function, stress, attitude toward aging, spirituality, optimism, resilience and personal mastery.

The study - which is published in the journal Schizophrenia Research - suggests that the patients' levels of happiness were unrelated to the severity or duration of their illness, cognitive or physical function, age or education. This is clinically significant because, among healthy adults, all of these factors are associated with a greater sense of well-being.

Lead author Barton W. Palmer, PhD, professor in the UC San Diego Department of Psychiatry summarizes the study's findings:

"People with schizophrenia are clearly less happy than those in the general population at large, but this is not surprising.

What is impressive is that almost 40% of these patients are reporting happiness and that their happiness is associated with positive psychosocial attributes that can be potentially enhanced."

Source: http://www.medicalnewstoday.com

By GILLIAN MOHNEY

For all the impressive advancements in medical technology, researchers and scientists still face a daunting challenge when they study the habits of the adorable but uncommunicative subjects called human infants.

In order to study infants without overwhelming them, scientists often try to mask the massive machines needed to view brain activity either by having the child sleep through it or by covering it in kid-friendly decorations. Other researchers have devised decidedly low-tech ways of reading an infant’s interest in a subject, even when they can’t say a single word.

In a study released Monday in the Proceedings of National Academy of Sciences, doctors used a special machine to examine infant brain activity as they start to learn language skills.

Patricia Kuhl, a professor of speech and hearing sciences at University of Washington and the lead author of the study, said the research indicated the area of the infants’ brain that controlled motor skills lit up when they heard certain words. The activity indicated that the infants are trying to mimic adults and speak much earlier before they say their first word.

However, Kuhl said, the study was important because of both the surprising findings and the way researchers were able to get them. To “read” the infant’s brain activity, they used the cutting-edge device called a magnetoencephalograph, that was quiet and nimble enough to read the chaotic world of infants’ brain activity.

Kuhl said unlike an MRI machine, which is extremely loud and requires a patient to be totally still, the magnetoencephalograph is nearly silent. However the infants still had to be strapped into a chair, so to keep them entertained the researchers were tasked with making silly faces and holding up toys all in the name of science.

“You want them to like the lab,” said Kuhl. “It’s decorated with fish and it’s got little stickies [on it.] It’s ... very baby friendly. We wave toys and we’re very aware and of their curiosity and of their desire to play. We do everything to make them comfortable.”

In a 2013 study published in Psychological Science, researchers used MRI machines to examine baby’s brain activity in response to different stimuli. However, to get the infants into a machine where they could not move, the researchers had the babies go in after they fell asleep naturally. They also used ear coverings so the loud MRI machine didn’t wake the infants.

MRI machines can be so distressing for patients because of claustrophobia or other fears about being in the hospital that a New York Hospital installed a pirate-themed scanner to put children (and some parents) more at ease.

“The genius is in this machine. ... There’s no noise and the baby can listen and can move,” said Kuhl of the magnetoencephalograph. “The ability for the first time to do this kind of recording in this kind of technical advanced machine ... [it’s like] we’re putting [on] a stethoscope.”

Aside from technological advancements, researchers rely on some decidedly low-tech approaches when studying infants.

Fei Xue, a professor of psychology at the University of California Berkeley, has done numerous studies examining how infants learn and react to new toys or information. She said researchers have plenty of tricks to keep babies focused on the tasks at hand.

Xue said most studies only last between 5-10 minutes because the infants will get bored if they're longer. If they want a baby to focus on an object, they darken the room and light up the object to draw the baby's attention.

“In a way, it’s easy to work with infants,” said Xue. “They’re very curious and they’re interested in the world.”

To measure if babies are interested in an object or scene without getting verbal confirmation, Xue and her fellow researchers simply follow the infant’s eye movement. While there are special computer programs, Xue said often it just comes down to a researcher holding a stopwatch and watching the infant through a monitor.

In spite of the infants’ inability to speak, Xue said, understanding their thought process can reveal how they learn, which could eventually help shape education programs.

“When they go to preschool and elementary school ... they will help us to know how to structure the school system,” said Xue of her young subjects. “Understanding these really young humans is important.”

Source: http://abcnews.go.com

By Cornell University

In a forthcoming Cornell study published in the journal Health Environments Research and Design, Rana Zadeh, assistant professor of design and environmental analysis, discovered nurses who had access to natural light enjoyed significantly lower blood pressure, communicated more often with their colleagues, laughed more and served their patients in better moods than nurses who settled for large doses of artificial light.

Letting natural light into the nurses’ workstations offered improved alertness and mood restoration effects. “The increase in positive sociability, as measured by the occurrence of frequent laughter, was … significant,” noted Zadeh in the paper.

Nurses work long shifts, during non-standardized hours. They work on demanding and sensitive tasks and their alertness is connected to both staff and patient safety. Past evidence indicates natural light and views have restorative effects on people both physiologically and psychologically. Maximizing access to natural daylight and providing quality lighting design in nursing areas may be an opportunity to improve safety though environmental design and enable staff to manage sleepiness, work in a better mood and stay alert, according to Zadeh.

“Nurses save lives and deal with complications every day. It can be a very intense and stressful work environment, which is why humor and a good mood are integral to the nursing profession,” Zadeh said. “As a nurse, it’s an art to keep your smile – which helps ensure an excellent connection to patients. A smart and affordable way to bring positive mood – and laughter – into the workplace, is designing the right workspace for it.”

Access to natural daylight, and a nice view to outside, should be provided for clinical workspace design, said Zadeh. In situations where natural light is not possible, she suggests optimizing electric lighting in terms of spectrum, intensity and variability to support circadian rhythms and work performance.

“The physical environment in which the caregivers work on critical tasks should be designed to support a high-performing and healthy clinical staff,” she said “ improving the physiological and psychological wellbeing of healthcare staff, by designing the right workspace, can directly benefit the organization’s outcomes”.

In addition to Zadeh, this study, “The Impact of Windows and Daylight on Acute-Care Nurses’ Physiological, Psychological, and Behavioral Health,” was authored by Mardelle Shepley, Texas A&M University; Cornell doctoral candidate Susan Sung Eun Chung; and Gary Williams, MSN, RN. The research was supported by the Center for Health Design Research Coalition’s New Investigator Award.

Source: www.sciencedaily.com

By Robert Preidt

Surviving a life-threatening illness or injury may be more likely if you're treated at a busy emergency department instead of one that handles fewer patients, a new study finds.

Researchers analyzed data on 17.5 million emergency patients treated at nearly 3,000 hospitals across the United States. The overall risk of death in the hospital was 10 percent lower among those who initially went to the busiest emergency departments rather than to the least busy ones, the study found.

"It's too early to say that based on these results, patients and first responders should change their decision about which hospital to choose in an emergency," said the study's lead author, Dr. Keith Kocher, an assistant professor of emergency medicine at the University of Michigan Medical School.

"But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care and they matter," he added.

The survival difference was even greater for patients with serious, time-sensitive conditions. Death rates were 26 percent lower for sepsis patients and 22 percent lower for lung failure patients who went to the busiest emergency departments, compared to those who went to the least busy ones.

Heart attack patients were also more likely to survive if they went to the busiest emergency departments, according to the study published July 17 in the journal Annals of Emergency Medicine.

If all emergency patients received the kind of care provided at the busiest emergency departments, 24,000 fewer patients would die each year, the researchers said.

The finding held even when the researchers accounted for differences in the patients' health, income level, hospital location and technology, they said.

But the study wasn't designed to look into the reasons for the finding; it only found an association between better survival rates and busier ERs.

"The take-home message for patients is that you should still call 911 or seek the closest emergency care, because you don't know exactly what you're experiencing. What makes one hospital better than another is still a black box, and emergency medicine is still in its infancy in terms of figuring that out," Kocher said in a university news release.

"For those who study and want to improve emergency care and post-emergency care, we hope these findings will inform the way we identify conditions in the pre-hospital setting, where we send patients, and what we do once they arrive at the emergency department and we admit them to an inpatient bed," he added.

Source: http://www.medicinenet.com

By Honor Whiteman

For women going through menopause, hot flashes can be one of the most uncomfortable symptoms. But a new study suggests that acupuncture may help to reduce the severity and frequency of hot flashes among menopausal women.

Hot flashes, also known as hot flushes, are a sudden feeling of heat over all or parts of the body. They may also cause redness on the face and neck, red blotches on the arms, back and chest, and heavy sweating or cold shivers. Many health conditions can cause hot flashes, but they are most common among women going through menopause.

The most effective treatment for hot flashes is hormone therapy - the use of medication that contains estrogen or progesterone. However, such treatment can increase the risk of other health conditions, including stroke, heart disease and cancer.

In this latest study, recently published in the journalMenopause, researchers wanted to see how acupuncture affected the regularity and severity of hot flashes a woman experienced while going through natural menopause.

Acupuncture is a form of alternative medicine that is more than 2,500 years old. It incorporates a number of procedures that stimulate anatomical points on the body as a form of healing. The most common form of acupuncture involves the use of thin, metallic needles that penetrate the skin.

The technique is most commonly used to help treat chronic pain, but past research has indicated it can help reduce inflammation and may even boost weight loss.

Acupuncture 'reduced severity and frequency of hot flashes for up to 3 months'

The research team analyzed 104 studies that assessed the effectiveness of acupuncture. The team included 12 of these studies in their research, involving 869 women between the ages of 40-60 who were going through natural menopause.

The women included in the study underwent various forms of acupuncture, including acupressure, electroacupuncture, laser acupuncture, ear acupuncture and traditional Chinese medicine acupuncture.

The investigators found that women who underwent acupuncture experienced a reduction in the severity and frequency of hot flashes for up to 3 months. Furthermore, the treatment appeared to have a beneficial effect on hot flashes regardless of the number of doses, sessions or duration of treatment received.

However, the researchers note that sham acupuncture reduced the frequency of hot flashes as much as true acupuncture.

The team is unable to explain why acupuncture appears to help alleviate hot flashes among menopausal women, but they hypothesize that acupuncture may trigger a reduction in the concentration of beta-endorphin - a neuropeptide found in the cells of the central and peripheral nervous system - in the hypothalamus of the brain. They say lower levels of beta-endorphin may activate the release of calcitonin gene-related peptide (CGRP), which regulates body temperature.

Commenting on the team's findings, Dr. Margery Gass, executive director of The North American Menopause Society (NAMS), says:

"More than anything, this review indicates that there is still much to be learned relative to the causes and treatments of menopausal hot flashes. The review suggests that acupuncture may be an effective alternative for reducing hot flashes, especially for those women seeking non-pharmacologic therapies."

A 2012 study, also published in the journal Menopause, suggested that hypnosis can also minimize the occurrence of hot flashes during menopause by around 75%.

Source: http://www.medicalnewstoday.com

By Serusha Govender and Sara Cheshire

(CNN) -- Do you tend to forget things when you're stressed? Like when you're late for a meeting and can't remember where you left your car keys? Or when you have to give a big presentation and suddenly forget all your talking points seconds before you start?

There's nothing like stress to make your memory go a little spotty. A 2010 study found that chronic stress reduces spatial memory: the memory that helps you recall locations and relate objects.

Hence, your missing car keys.

University of Iowa researchers recently found a connection between the stress hormone cortisol and short-term memory loss in older rats. Their findings, published in the Journal of Neuroscience this week, showed that cortisol reduced synapses -- connections between neurons -- in the animals' pre-frontal cortex, the area of the brain that houses short-term memory.

But there's a difference between how your brain processes long-term job stress, for example, and the stress of getting into a car accident. Research suggests low levels of anxiety can affect your ability to recall memories; acute or high-anxiety situations, on the other hand, can actually reinforce the learning process.

Acute stress increases your brain's ability to encode and recall traumatic events, according to studies. These memories get stored in the part of the brain responsible for survival, and serve as a warning and defense mechanism against future trauma.

If the stress you're experiencing is ongoing, however, there can be devastating effects.

Neuroscientists from the University of California, Berkeley,found that chronic stress can create long-term changes in the brain. Stress increases the development of white matter, which helps send messages across the brain, but decreases the number of neurons that assist with information processing.

The neuroscientists say the resulting imbalance can affect your brain's ability to communicate with itself, and make you more vulnerable to developing a mental illness.

Defects in white matter have been associated with schizophrenia, chronic depression, bipolar disorder, obsessive-compulsive disorder and post-traumatic stress disorder. Research on post-traumatic stress disorder further shows that it can reduce the amount of gray matter in the brain.

The Berkeley researchers believe their findings could explain why young people who are exposed to chronic stress early in life are prone to learning difficulties, anxiety and other mood disorders.

To reduce the effects of stress, the Mayo Clinic recommends identifying and reducing stress triggers. Eating a healthy diet, exercising, getting enough sleep and participating in a stress-reduction activity such as deep breathing, massage or yoga, can also help.

Stress may harm the brain, but it recovers.

Source: www.cnn.com

By Nurse.com

This fall, Duquesne University in Pittsburgh will become the first academic institution in the U.S. and globally to offer a dual degree in nursing and biomedical engineering for undergraduate students, according to a news release.

“Duquesne has pioneered the integration of clinical knowledge and patient care with engineering techniques in a single program, creating the first bachelor’s degree of its kind,” Provost Timothy Austin, PhD, said in the release.

The five-year program will provide students with a foundational body of knowledge that keeps patient care and practical application at the core of studies supporting innovations and technological advances.

The joint degree could prove a tremendous value to employers and patients, said John Viator, PhD, director of Duquesne’s biomedical engineering program. 

By gaining actual clinical experience, students also will develop new perspectives with respect to a patient’s health and functional needs. “Engineers do not always fully appreciate the hospital culture and the clinical needs of patients,” Mary Ellen Glasgow, RN, PhD, FAAN, dean and professor of the School of Nursing, said in the release. “This dual degree gives our students both the engineering and nursing perspectives to solve real world clinical problems.” 

In addition to learning engineering and nursing, students will benefit from class and clinical experiences that incorporate the Toyota Production System principles (used to address safety, cost and efficiency) and the American Association of Critical Care Nurses’ Synergy Model. 

Job opportunities for biomedical engineers are expected to grow 27% between 2012 and 2022, and nursing careers are expected to expand by 19% in the same timeframe, according to statistics from the Bureau of Labor Statistics. With the combined knowledge and skills of the two disciplines, opportunities may be limitless for the “nurse engineer,” Viator and Glasgow predict.

“Our students will begin their careers with the preparation, knowledge and worldview usually seen in those with years of experience in the field,” Austin said in the release. “This exciting BME/BSN partnership illustrates Duquesne’s innovative academic programs and the university’s focus on preparing students with the knowledge and skills to serve others.” 

Source: nurse.com

By LAUREN SILVERMAN

In the emergency department at Children's Medical Center in Dallas, pharmacists who specialize in emergency medicine review each medication to make sure it's the right one in the right dose.

It's part of the hospital's efforts to cut down on medication errors and dangerous drug interactions, which contribute to more than 7,000 deaths across the country each year.

At Children's in Dallas, there are 10 full-time emergency pharmacists, more than anywhere else in the country, and they are on call 24 hours a day. The pharmacists provide a vital safety net, according to Dr. Rustin Morse, chief quality officer and a pediatric ER physician.

"Every single order I put in," Morse says, "is reviewed in real time by a pharmacist in the emergency department prior to dispensing and administering the medication."

That may sound obvious, but Morse says doctors like him, are used to jotting down a type and quantity of drugs and moving on. If there's a problem, a pharmacist will hopefully catch it and get in touch later. But later won't work in the emergency room.

The extra review is particularly important at Children's because medication errors are three times more likely to occur with children than with adults. That's because kids are not "just little adults," says Dr. Brenda Darling, the clinical pharmacy manager for Children's Medical Center.

"They have completely different metabolic rates that you have to look at," Darling says, "so you have to know your patients."

On any given week, pharmacists at Children's review nearly 20,000 prescriptions and medication orders, looking at things like the child's weight, allergies, medications and health insurance.

There are also automatic reviews by an electronic medical record system designed to essentially "spell check" orders to prevent errors. You need both, says Dr. James Svenson, associate professor of emergency medicine at the University of Wisconsin, because the electronic medical record doesn't catch all errors.

Svenson co-authored a study in the Annals of Emergency Medicine that found that even with an electronic medical record, 25 percent of children's prescriptions had errors, as did 10 percent of adults'. Now his hospital also has a pharmacist in the emergency department 24 hours a day.

So why doesn't every hospital do this? The main reason, Svenson says, is money.

"If you're in a small ER, it's hard enough just to have adequate staffing for your patients in terms of nursing and techs, let alone to have a pharmacist sitting down. If the volume isn't there, it's hard to justify."

Hiring pharmacists is expensive, but Morse points to research showing prescription review can reduce the number of hospital readmissions, thereby saving money and lives.

"People do make mistakes," Morse says, and you need to make sure "a patient doesn't get a drug that could potentially stop them breathing because it's the wrong dose."

Source: npr.org

By Susan Chapman and Bethany J. Phoenix

Because the Affordable Care Act requires that individual and small-group plans include coverage for mental health care that is comparable to that for general medical care, many analysts expect the demand for mental health services to dramatically increase over the next few years. In California, finding enough mental health providers to meet the demand will be a challenge, as the federal Health Resources and Services Administration has identified 128 Mental Health Professional Shortage Areas in our state.

After documenting vacancy rates for mental health professionals in county-operated mental health programs and state hospitals, the California Mental Health Planning Council suggested that one way to address this shortage is to increase the recruitment and preparation of psychiatric/mental health nurse practitioners (PMHNPs) as primary mental health providers. Given the direction of health care service delivery in the US, perhaps the most important advantage PMHNPs offer is that they are educated in an integrative practice model that stresses connections between physical and mental health and emphasizes health promotion. This is especially critical in public mental health settings, where many patients struggle to get to any health care appointment, much less multiple appointments with multiple providers.

Using PMHNPs to address shortages and increase access to care in public mental health settings, however, faces a number of challenges. To help understand and address these challenges, we are collaborating with the California Institute for Mental Health (CiMH) to conduct a Robert Wood Johnson Foundation-funded study that will include case studies in five California counties with a history of using PMHNPs. The aim is to document best practices, identify unnecessary restrictions on NP practice and formulate strategies to remove these restrictions. By the conclusion of the study in 2015, we hope to have evidence-based information for key stakeholders – from public mental health care systems to state policymakers – about how PMHNPs can help increase access to mental health services in the state.

One thing the study will allow us to do is examine in more detail presumed barriers that have emerged both anecdotally and from prior research. To begin with, just as with primary care, there is a need to rapidly fill the pipeline by incentivizing existing and future students to work in public mental health. That’s why beginning in 2009, California’s Mental Health Services Act began funding educational stipends to PMHNP students at three schools of nursing, including UC San Francisco. The stipend requires that students “pay back” their stipend by working in a public mental health setting for the equivalent of a year of service for each year of stipend funding.

That’s a fine start, but many of our colleagues across the state are concerned that scope-of-practice laws and the lack of good practice models for PMHNPs in California appear to undermine the effort to prime the pipeline.

For example, UCSF School of Nursing faculty member Aaron Miller was educated in Oregon and says that the biggest difference between the two states is that, “In Oregon, NPs can practice without a collaborative agreement with a physician…and the scope-of-practice law in Oregon contains an explicit description of the NP’s scope of practice: assessment, diagnosis, creation of plan and treatment.” By contrast, he says, in California NPs must always have a collaborative agreement in place with a supervising physician, and in every setting they have to devise agreed-upon standardized procedures that define what the NP can do – essentially, the scope of practice. Moreover, at present, practice models in the state do not facilitate optimal billing for PMHNP services.

Ebony Anderson, one of our former stipend students, says these limitations have dampened her willingness to strike out into independent practice as a psychiatric mental health nurse practitioner.

Thus, even as many in the state recognize that NPs can provide high-quality care and organizations are starting to utilize NPs’ full scope of practice, a number of factors may be erecting unnecessary obstacles to meeting the mental health needs of many Californians – especially in areas already short on qualified providers. These factors include reimbursement challenges, the effort involved in defining acceptable scope for each setting and finding physicians willing to provide NPs with the mandated level of supervision – and bill for services under their provider numbers, if appropriate.

Our charge, among other things, is to examine how and to what degree these factors affect the state’s ability to meet expected growth in demand for mental health services. Such research is the lifeblood of policy change. Our hope is that the results of our work will enable the state to fully leverage an educational system that is training PMHNPs to deliver outstanding care but, at least at the moment, sending them into a health care system that is not yet taking full advantage of their strengths.

Susan Chapman and Bethany J. Phoenix are leading a study to examine the structural, practice and policy opportunities and barriers that affect psychiatric/mental health nurse practitioners’ ability to most effectively use their skills and expertise in public mental health settings. Chapman directs the Health Policy Nursing specialty in the Department of Social and Behavioral Sciences at UC San Francisco School of Nursing. Phoenix is vice chair of the School’sDepartment of Community Health Systems and coordinates the School’s Psychiatric/Mental Health Nursing specialty. The study is supported by the Robert Wood Johnson Foundation’s Future of Nursing National Research Agenda, which is coordinated by the Interdisciplinary Nursing Quality Research Initiative, a national program of the Robert Wood Johnson Foundation.

Source: Science of Caring