Quality improvement and models of behavioral healthcare integration: Position paper #2 from the International Society of Psychiatric-Mental Health Nurses.

This is the second article in a series written to present and address the position of the International Society of Psychiatric-Mental Health Nurses (ISPN) related to the notion of behavioral healthcare integration and the role of nurses in the 21st century. The first article addressed assumptions, definitions and roles related to the integration of behavioral healthcare. The purpose of this article is to focus on Integrated Care within the context of recent initiatives that endeavor to improve quality, safety and reduce costs in the US healthcare system also known as the "Triple Aim" (or more recently, the Quadruple Aim). This paper specifically focuses on the role of nurses and nursing practice by: (a) connecting the concept of integrated behavioral healthcare to quality improvement (QI) and the Quadruple Aim, and (b) highlighting examples of models of integration currently in use. Discussion of models of integration compares ways various models reinforce and actualize integration of behavioral health within primary care, in various special populations across the continuum of care, and in both inpatient and community settings. This paper also stresses innovative training programs offering nurses the skills for learning behavioral health integration through online modules and participation in Interprofessional Education (IPE) activities often through simulation approaches. This 2nd manuscript is consistent with the ISPN 2016 Position Paper and reinforces the necessity for all nurses to be educated on both the Quadruple Aim and behavioral health integration to improve patient care and subsequent care outcomes.

Coming back normal: the process of self-recovery in those with schizophrenia.

BACKGROUND: Researchers have identified the reestablishment of self-identity as a key part of recovery in individuals with schizophrenia. Previous studies have increased scholars' understanding about how and when identity changes occur in those with schizophrenia; less is understood about the process by which individuals with schizophrenia reconstruct their self-identity. OBJECTIVE: The objective of this study is to describe the process of self-identity reconstruction in people with schizophrenia. STUDY DESIGN: A grounded theory study was conducted with 10 purposively selected participants and 4 significant others; 19 semistructured interviews were completed. RESULTS: Constant comparative analysis led to a theory of a six-stage process of self-recovery in those with schizophrenia. For some participants, the successful struggle to care for a new self led to the refinement and eventual recovery of self-identity. CONCLUSIONS: Individuals with schizophrenia experience a process of distinct changes in self-identity occurring between engulfment by a severe mental illness and emergence of a new self.

Integrating spirituality into undergraduate nursing curricula.

Nursing programs have done a commendable job keeping pace with the rapid advances in disease management. Yet, spirituality has received far less attention in nursing curricula (Keefe, 2005) and nursing students often do not have a strong foundation in this area. The purpose of this project was to integrate spirituality into the undergraduate nursing curricula and measure student outcomes related to spiritual knowledge and attitudes. Nursing faculty participated in a spirituality education program and followed this with sessions focused on integration of spiritual content into individual nursing courses. Student pre and post-tests were administered using a standard instrument to evaluate the effectiveness of the program. Significant differences in spirituality knowledge and attitudes among senior-level nursing students (t = -3.059, p = .004) were revealed. As the healthcare system becomes increasingly complex, providing students with tools to identify and strengthen inner resources is essential to patient care.