ABSTRACT
BACKGROUND: Access to mental health care is a struggle for those with serious mental illness (SMI). About 25% of homeless suffer from SMI, compared with 4.2% of the general population. OBJECTIVE: From 2003 to 2012, St. Paul's Center (SPC) operated a unique model to provide quality care to the homeless and those at risk for homelessness, incarceration, and unnecessary hospitalization because of SMI. Data were available for analysis for the years 2008 to 2010. DESIGN: The SPC was developed, managed, and staffed by board-certified psychiatric/mental health nurse practitioners, offering comprehensive mental health services and coordinated interventions. RESULTS: All clients were housed and none incarcerated. From 2008 to 2010, only 3% of clients were hospitalized, compared with 7.5% of adults with SMI. Clinical, academic, and community partnerships increased value, but Medicaid reimbursement was not available. CONCLUSION: Mental health provisions in the recently passed 21st Century Cures Act support community mental health specialty treatment. The SPC provides a template for similar nurse practitioner-led models.
Subject(s)
Community Mental Health Services/methods , Delivery of Health Care, Integrated/methods , Ill-Housed Persons , Mental Disorders/therapy , Nurse Practitioners , Psychiatric Nursing/methods , Cooperative Behavior , Housing , Humans , New York City , Risk , Severity of Illness IndexABSTRACT
All nurses are prepared to be generalists in palliative care. Within the discipline there are nurses who seek advanced educational preparation and develop clinical expertise in palliative care nursing. These are our leaders in palliative care nursing who can exert influence in all health care settings to support nurses providing palliative care. It is nurses and advanced practice nurses in partnership who are capable of developing and advocating for palliative care across settings. The focus of care is the person, not the diagnosis or the setting. The viewpoint that "all nursing care is palliative care" can transform health care with nurses taking the lead.
Subject(s)
Nurses , Palliative Care , Vulnerable Populations , Cause of Death , Female , Humans , MaleABSTRACT
Depression is under recognized in a variety of pediatric settings. The purpose of this paper is to describe the development and initial evaluation of a personal digital assistant (PDA)-based decision support system (DSS) for pediatric depression screening in ages 8 to 18 years of age by pediatric advanced practice nurse (APN) students. Three aspects are described: selection of depression screening instrument; integration of the instrument into the PDA; and quantitative (usage) and qualitative (focus group) evaluation. Only one third of eligible patients were screened. Twenty percent of those screened were identified as at risk for mood disorder. The barriers to screening identified through focus groups included a lack of time, knowledge, intervention protocol, referral resources, PDA usability issues, preceptor motivation and comfort, as well as perceived or real cultural barriers. Suggestions for educational, research, and interventions to integrate clinical based PDA-based screening are discussed.
