Nursing leadership and influence in practice domains at a Veterans Affairs Health Care System.

BACKGROUND: Studies in Veteran populations have examined disparities in health service use, care quality, outcomes and increased demands for behavioral health. PURPOSE: The purpose is to describe the development of nursing leadership roles that influenced practice improvements and demonstrated outcomes related to health disparities in a Veterans Affairs (VA) population over a 12-year period. METHODS: The Sundean and colleagues' concept analysis of nurse leadership influence was applied to frame the initiative process and impacts. DISCUSSION: Antecedents and processes that facilitated leadership development included mentorship, disparities expertise, partnerships, consultation, scholarship, dissemination, advocacy, education, and strong coauthor collaboration. Improvements and outcomes included access to services, improved health indicators, tools, workforce, funding, innovations, and nurse investigator studies, consistent with VA priorities and policy related to disparities and equity. Limitations and barriers were addressed. CONCLUSION: This initiative models' strategies to increase nurse leadership in health equity and care transformation in health systems and community practices.

Increase Adherence to Psychotropic Medication Through Motivational Adherence Therapy: A Quality Improvement Project.

BACKGROUND: Non-adherence to psychiatric mediations is a nationwide problem for people diagnosed with severe mental illness (SMI). National non-adherence rates for psychotropic medications are estimated to range from 50% to as high as 75%. The project site data is reflective of the national data. AIMS: The aim of this manuscript is to report the impact of Motivational Interviewing Style Adherence Therapy (MISAT) on adherence to psychotropic medication in veterans living with SMI. METHOD: Implementation of evidence-based MISAT through a quality improvement project in a Veterans Affairs Mental Health Clinic. RESULTS: MISAT was found to be clinically significant in improving adherence to psychotropic medication. Average refill history for participants increased from 82% to 85%. MISAT also unified how non-adherence to psychotropic is addressed by mental health providers. DISCUSSION: MISAT should be considered in other settings where patients diagnosed with SMI are faced with non-adherence to psychotropic medication, but the sessions' format should be structured to fit the patients' needs.