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EP-105 - Psychiatric Mental Health Advanced Practices Nurses Using Synchronous Telepsychiatry: A Systematic Review

Monday, April 30
4:05 PM - 4:20 PM
Location: Education Zone, Booth 2416, Screen 1

Background/Significance: Estimates suggest that one in five Americans ages 12 and older are suffering from mental illness, yet less than half receive treatment (1,2). One modality to increase mental health care access and treatment is via telepsychiatry, which has demonstrated clinical effectiveness and satisfaction among providers and patients (3). Among psychiatric mental health advanced practice nurses (PMH APRNs; defined as graduate-prepared, licensed providers who may diagnose, provide psychotherapy, and prescribe medication for mental illness), telepsychiatry use does not have systematic exploration. Thus, this study is the first to systematically review PMH APRN's role and usage of synchronous telepsychiatry.

Methods: The systematic review followed PRISMA guidelines and was registered through Prospero International prospective register of systematic reviews (4). Searched databases included Medline, Embase, Google Scholar, PsychInfo, OpenGrey, and Scopus. Article inclusion criteria comprised the following: PMH APRNs must be represented among telepsychiatry service providers, written in English, telepsychiatry services must be synchronous, real-time, one-on-one treatment, and provide mental health services using visual and auditory teleconferencing technology. Exclusion criteria included the following: Not providing mental health services, not written in English, services provided by registered nurses not holding a graduate degree and/or psychiatric mental health advanced practice license, including only physician providers, non-individual (i.e., group) treatment, and telepsychiatry services that were asynchronous, and did not include both visual and auditory technology. There was no restriction on publication year. The search included syntactic variations and combinations of the following MeSH and commonly used terms: 1) 'advanced practice nursing'/exp OR 'nurse practitioner'/exp OR 'nurse practitioner' OR 'nurse clinician' OR 'advanced practice nurse' OR 'advanced practice nursing' OR aprn OR pmhnp; 2) 'mental health care'/exp OR 'mental disease'/exp OR 'mental patient'/exp OR 'substance abuse'/exp OR 'psychiatric treatment'/exp OR 'mental health'/exp OR stress OR anxiety OR psychosis OR psychotic OR suicide OR suicidal OR 'mental health'; and 3)
'telemedicine'/exp OR 'videoconferencing'/exp OR 'e-counseling'/exp OR 'telenursing'/exp OR 'telehealth'/de OR telepsychiatr* OR telemedicine OR 'tele-mental' OR telesupport OR 'tele-support' OR telemonitoring OR 'tele-monitoring' OR 'tele psych*' OR telepsych* OR 'tele-medicine'. The search was conducted by an associate medical librarian, yielding 277 articles, which were screened by the three nursing researcher authors according to PRISMA guidelines, yielding 100% interrater agreement for inclusion.

Results/Discussion: Only 12 articles met criteria. After, articles were analyzed using The Grades of Recommendation Assessment, Development, and Evaluation (GRADE) Working Group method that holistically evaluates evidence quality and recommendation grading based on risk/benefit ratio (5). Next, results were synthesized using PRISMA guidelines, including narrative descriptions of key features like study characteristics, bias, results, overall integrating findings and summarizing evidence (4). Overall, the vast paucity of the literature andly low methodological quality warrants more telepsychiatry clinical utilization and original scholarly contributions from PMH APRNs, especially across diverse psychiatric clinical settings and geographical locations.

Learning Objectives:

Brooke A. Finley

Dual PhD/DNP Student
University of Arizona College of Nursing

Brooke Finley, BSN, RN-BC, earned her Bachelors of Science in Nursing at The University of Arizona in May 2015 after holding four research positions as an undergraduate. Amidst academic and hands-on exploration, Brooke found her clinical niche in psychiatric nursing and scholarly focus in nursing informatics and is pursuing both a Doctorate of Philosophy in Nursing and Doctorate of Nursing Practice (PMHNP focus). Her research focuses on integrating best practice psychiatrc mental health advanced practice nursing, healthcare informatics, and cognitive science in telepsychiatry applications that will increase access and streamline care delivery, thereby improving patient outcomes among rural and under-served patient populations.

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Roberta K. Maixner

DNP (PMHNP) Student
Arizona State University

My name is Roberta Maixner and I am in the BSN-DNP Family Psychiatric Nurse Practitioner specialty program in the College of Nursing and Health Innovation at Arizona State University. I am also currently a Graduate Writing Consultant for ASU's University Academic Success Programs. ASU Profile: https://isearch.asu.edu/profile/2470709. Extracurricularly, I am currently working on a research team with colleagues and faculty from University of Arizona. Research Gate profile: https://www.researchgate.net/profile/Roberta_Maixner. Our topic is Psychiatric Mental Health Advanced Practices Nurses Using Synchronous Telepsychiatry: A Systematic Review. My practical experiences, after ten years as an RN in psychiatric and critical care, were completed on inpatient adult and adolescent units at Banner Behavioral Health Hospital (BBHH) with several preceptors, a nurse practitioner and psychiatrists. My DNP project is implementing, traininig and role evaluation of SBIRT at BBHH, and may be expanded to other facilities.

I grew up in a rural area of North Dakota. I was an active-duty military spouse for 13 years. I have degrees in Business Administration (National American University, Rapid City, SD), Nursing (California State University, Long Beach, CA) and Law (The George Washington University National Law Center, Washington, DC). I have three children and have lived in SD, MN, DC, VA, CA, AZ and NC. I am interested in writing and research, Nursing Policy, Nursing Education, Nursing Theory, Psychiatric Nursing and changing nursing practice for the betterment of all humans.

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