Why Depression Screenings Are an Important Tool

Why Depression Screenings Are an Important Tool

Despite the increased focus on mental health over the pandemic, it’s not always easy to diagnose or recognize depression. When it’s something you are experiencing, it can be even tougher to see the bigger picture.

October 6 is National Depression Screening Day and offers an excellent opportunity to assess your own mental health by taking an online depression screening and learning more about depression. Depression can happen at any time and to any person regardless of their race, ethnicity, social status, income, lifestyle, location, family history, or previous mental health status. Sometimes depression is triggered by an event–a death, a divorce, a diagnosis, a job loss, a trauma. Sometimes depressive symptoms coincide with the changing seasons. Depression can also be brought on by genetics or by hormonal changes in pregnancy, menopause, or puberty. It can be fleeting, lasting less than a year, or it can be something a person manages throughout their lifespan.

Why do people need a depression screening? Because depression can look like a lot of other things. This condition can appear as individual bothersome symptoms that are easy to overlook or brush off. When seen collectively, it becomes more obvious that there’s something more serious going on. A depression screening gives that broader scope and opens the path for treatment options.

Many people recognize some of the more obvious symptoms of depression including feeling sad, having crying spells, or a lack of interest in many things they once loved. But other symptoms of depression are more difficult for people to recognize.

Less obvious symptoms of depression include

  • irritability and anger
  • generalized, persistent feelings of fatigue or being tired that are unrelated to amount of sleep
  • lack of focus
  • feelings of being unwell like stomach pains, muscle aches, headaches
  • trouble sleeping or sleeping too much
  • changes in eating–eating too much or not enough

What do these look like in real life? It can be as simple as noticing you are raising your voice at your kids or your partner. You might find yourself getting unusually frustrated at work when a colleague is late or a patient is challenging. It could be that the daily walks that used to give you energy and a sense of calm, have dropped off your activity list because you just can’t get motivated. Or you seem to have a pounding headache by the time your day ends–on most days. Taken individually, these might not seem to be anything but an unusual blip in life. But when any of these happen repeatedly or happen collectively, it’s a signal that something else is going on.

A depression screening is an excellent tool for nurses to apply to themselves or to patients or loved ones. Nurses can look more into depression assessments to see what kind of assessment is used in particular circumstances in the industry too. But simple depression screenings can help you recognize when you might need help to manage your symptoms.

Depression treatment can include talk therapy and medications for milder cases and more intensive treatments for moderate to severe depression. If you notice that you’re experiencing symptoms of depression or that someone you  love or someone you care for is, seeking additional help should be the next step.

Meeting Mental Health Needs

Meeting Mental Health Needs

In the press of caring for patients, family nurse practitioners (FNPs) must tend to a patients physical well-being and mental health. Caring for a patients mental status can be vital to meeting healthcare needs.meeting-mental-health-needs

As primary care providers, FNPS play a significant role in tending to mental health concerns. The American Association of Nurse Practitioners (AANP) reflected that 88% of the nations NP workforce are certified in an area of primary care, with over 70% delivering primary care services, notes LaMicha M. Hogan, PhD, APRN, FNP-BC, associate dean/department chair for APRN Programs for the Texas Tech University Health Sciences Center School of Nursing-Graduate Program.

In this article, we’ll offer ways to ensure you’re attending to your patient’s mental health needs and touch on how FNP programs should educate students about mental health.

Great Impact

Though stigmatizing societal attitudes regarding mental healthcare have improved, a patients initial encounter with a healthcare provider will likely have the most significant impact on self-perception of a mental health complaint as well as willingness to seek continued treatment, notes Hogan.

Early detection and intervention lead to the best outcomes, in conjunction with a trusting, collaborative rapport between the patient and FNP to reduce stigma present with having a mental health condition, according to Hogan. FNPs must be aware that a patient’s mental health status has a greater impact on chronic physical health conditions if undiagnosed or left untreated, she notes.

Its imperative for FNPs, especially those in primary care settings, to prioritize the screening of conditions such as depression and anxiety, notes Amanda Ringold, DNP, FNP-BC, CRNP, SANE-A, assistant professor at the University of Pittsburgh School of Nursing. “To ensure effective mental health assessments, FNPs must address and overcome organizational barriers, including time constraints, a lack of a universal screening policy, and providers’ feelings of inadequacy in conducting mental health screenings. FNPs are poised to take on leadership roles within clinical settings to address and mitigate these challenges,” she explains.

Screening Strategies

Various strategies exist for dealing with mental health during patient care visits. For instance, 

Ringold notes that not every screening needs to be done face-to-face with the FNP. Instead, screenings can be conducted with pen and paper in the waiting room or via an app before the appointment. She notes that other team members, including nurses or medical assistants, can be trained in administering the screenings.

Lisa Johnson, DrNP, CRNP, ACNP-BC, associate professor and DNP/NP Program Coordinator at Gwynedd Mercy University, agrees that patients can complete questionnaires in the waiting room or before the visit. However, we have to be cautious not to fatigue patients with questionnaires and to ascertain their reading level and primary language prior to requesting a mental health assessment be completed by the patient,” she warns.

According to Ringold, the care setting and patient population should dictate the most appropriate screening tools. The most frequently used tools, she notes, include the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder -7 (GAD-7), and the Alcohol Use Disorders Identification Test (AUDIT). When time is limited, notes Ringold, FNPs can use abbreviated versions of screenings such as the PHQ-2, a two-question alternative to the PHQ-9.

In an interview, Irene W. Bean, DNP, FNP/PMHNP-BC, FAAN, FAANP, FNAP, CEO of Serenity Health Care, P.C., and Tennessee State Rep for AANP, says to pay attention to a patient’s body language once in a patient encounter. Watch for poor eye contact or note whether a patient has been crying.

She says to pay attention to slurred speech and be aware of signs such as a patient who typically speaks loudly suddenly speaking in a whisper or a normally talkative patient now being reserved.

FNP Programs

Johnson says NP educational standards emphasize assessing mental health in varied patient populations. Healthcare providers and institutions of higher education need to focus on the cultural considerations of mental health disorders and further emphasize collaborative communication between primary care and mental health providers, she notes.

Hogan says clinical competencies are best attained via a competency-based educational model throughout the FNP curricula. Specialized courses on mental health, simulation training, interprofessional education, and clinical rotations in primary care settings can develop competence. She says that after graduation, FNPs should maintain continuing education specific to FNP’s scope of practice and evidence-based care for mental health concerns.

Ringold notes a growing trend of students at the University of Pittsburgh School of Nursing opting for dual FNP-PMHNP degrees.

Scope of Practice

While FNPs can treat mental health conditions such as basic anxiety and depression, they need to be mindful of their states scope of practice, says Bean. For patients with conditions such as bipolar disorder or schizophrenia, you may be stepping outside your practice scope and may need to refer the patient to a specialist, Bean says

One thing that I would stress, and I stress to my students, is that you want to protect your license. You want to ensure the patient is safe while protecting your license,” Bean says.

Calling on Compassion

When you realize your patient is anxious, depressed, or dealing with a mental health issue, What you don’t want to do is rush that patient from that conversation,” says Bean. You’re going to miss a lot of things when you rush patients who have a mental health crisis through your clinic,” Bean says. 

You have to have compassion for patients dealing with a crisis. Their crisis may not be something you feel is a crisis, but to them, its everything. You cant discount their feelings, and you cant discount what youre seeing in that patient.”

Vanderbilt University School of Nursing Improves Health Equity, Offers Specialized Training with New HRSA Grant

Vanderbilt University School of Nursing Improves Health Equity, Offers Specialized Training with New HRSA Grant

Vanderbilt University School of Nursing has received a four-year, $2.8 million Health Resources and Services Administration (HRSA) Bureau of Health Workforce grant for a primary care nurse practitioner residency program that will recruit, train, and retain primary care providers with a passion for helping rural and underserved communities. Associate Professor Pam Jones, BSN’81, MSN’92, DNP’13, FAAN, is the grant’s project director, with Associate Professor Christian Ketel, DNP’14, FNAP, serving as primary author and evaluator.

The award builds on a $2.4 million HRSA grant the school received four years ago to develop its Community-Based Nurse Practitioner Fellowship, a postgraduate nurse practitioner/nurse-midwife resident training, hiring, and retention plan for community-based health clinics.

The new grant funds five additional advanced practice nurse fellows—three trained in family or adult gerontology primary care, one trained in psychiatric/mental health, and one trained in nurse-midwifery—to work full-time for one year at a participating community-based health clinic.

The fellows benefit from specialized training in behavioral health and psychopharmacology, maternal health, cultural competency, and mitigating issues caused by social determinants of health. They also learn from clinical immersion experiences, mentoring, collaboration with other providers, and providing evidence-based treatments for rural or medically underserved clinics.

Nationally, many new providers based in clinics serving rural or underserved populations become overwhelmed and leave their positions within the first few years. The CBNP Fellows effort is poised to tackle that issue and help new practitioners build confidence and resilience and increase job satisfaction so they continue to practice in communities where they are most needed.

“This program provides, in partnership with our community agencies, a gradual and structured onboarding and an educational program that gives the new provider additional knowledge and ongoing support from the grant team,” Jones explains.

The fellowship will increase access to primary care nurse practitioners for general physical health issues. Behavioral health assistance will be offered as part of holistic primary care and support for people with psychiatric conditions that often aggravate other health conditions. Certified nurse-midwives will promote maternal health through patient education and increased access to providers.

“Chronic diseases, including cardiovascular disease, diabetes, arthritis, and depression, contribute significantly to healthcare costs and affect six out of ten adults, with multiple chronic conditions being common,” Ketel says. “Risk factors such as tobacco use, poor nutrition, sedentary lifestyle, and alcohol consumption exacerbate the situation.”

This program is a part of the Vanderbilt School of Nursing’s programs and educational opportunities that focus on community needs and health equity, helping people overcome disparities to live healthy lives.

“VUSN has a long history of developing and managing nurse-managed practices with APRNs and programs that meet the needs of underserved populations,” says Jones, who has seen the good these types of programs can do and how much they are needed. “In my former role as a chief nursing officer, I saw the profound impact of the lack of appropriate primary care in our underserved communities.”

Ketel continued, “Underserved populations often face significant healthcare disparities, including limited access to quality care and higher rates of chronic diseases. By supporting this program, Vanderbilt School of Nursing demonstrates its commitment to addressing healthcare disparities, working towards health equity, and producing culturally sensitive healthcare providers.”

The program seeks new nurse practitioners and nurse-midwives within 18 months of graduation. After a screening process through the Vanderbilt School of Nursing, applicants may be chosen to interview with a partner community-based health clinic, where those hired will become full-time employees for one year under the supervision of a mentor. They will also have access to continuing education opportunities, monthly conferences, and support/coaching from the School of Nursing faculty.

Tennessee Community-Based Health Clinics affiliated with the program include Hardeman County Community Health Center in Bolivar and Neighborhood HealthVanderbilt University Medical Center, Vanderbilt Primary Care West End, and Vanderbilt Midwives Melrose in Nashville.

The School of Nursing team includes Jones, Ketel, Instructor Tonya Elkins, and Associate Professor of Nursing Natasha McClure, DNP, MSN’11. For more information, visit https://nursing.vanderbilt.edu/projects/cbnpf/index.php.

As an innovative program created to collaborate with community partners and support healthcare needs, the Community-Based Nurse Practitioner Fellowship is one way the School of Nursing supports Vanderbilt’s Dare to Grow philosophy, and it supports the passion Vanderbilt nursing faculty and staff have for helping others.

National Black Nurses Association Announces Launch of Two Groundbreaking Campaigns: ‘RETHINK’ and ‘RE:SET’

National Black Nurses Association Announces Launch of Two Groundbreaking Campaigns: ‘RETHINK’ and ‘RE:SET’

NEW YORK, Dec. 8, 2020 /PRNewswire/ — The National Black Nurses Association (NBNA) is excited to announce the launch of two new major campaigns for its members under its new wellness initiative, NBNA Resilient Nurse Resource™. RETHINK, launched yesterday, was created to build awareness around the importance of vaccinations, with a focus on influenza and pneumococcal. The goal of RETHINK is to debunk common myths surrounding vaccines and to inform Black nurses and the Black community on the benefits of vaccinations. The website features an interactive ‘Test Your Flu IQ’ quiz to test participants knowledge and understanding on the flu and vaccines. There is also a flu and pneumococcal vaccination locator to assist with identifying providers in nearby serving areas. Anyone interested in learning more about vaccines can visit www.nbnaRETHINK.com.

On December 15, 2020, the NBNA will also launch its mental wellness campaign, RE:SET. This new initiative offers members FREE counseling services, education webinars, wellness podcasts and more, to aid them in maintaining their mental wellness throughout the current COVID-19 crisis. The free counseling services are only available for existing and new NBNA members, and their families.

Unfortunately, there is a stigma in the Black community surrounding mental health. This, in addition to the lack of providers from diverse racial/ethnic backgrounds and culturally competent providers, contributes to only one-in-three African Americans receiving mental health treatment.

To provide the best patient care, nurses must be able to reset and recharge from the daily pressures and renew their resilience and strength. Creating tools for renewal and increased resilience is especially important as nurses have a high prevalence of anxiety and depression. With this comprehensive resource, NBNA members will receive holistic tools and resources designed to give nurses the boost they need to promote mental wellness and wellbeing.

“We know how difficult this year has been for nurses everywhere, especially Black nurses who are faced with both the pandemic and the current racial uprising,” states Dr. Martha A. Dawson, NBNA President. “It is crucial that we protect our nurses’ physical and mental wellbeing during such an unprecedented time in our country. With RE:SET we are able to provide them with the tools necessary to recover from the daily stresses of exhausting working conditions and challenges. It is essentially PPE for their mental and emotional health, which will help to impact their physical health.”

RE:SET provides NBNA members and their families with easily accessible options for mental wellness – including:

  • RE:SET Support Line: Available 24 hours a day, 365 days a year, members who need in-the-moment support, are connected with licensed clinicians for no-cost, confidential guidance and resources.
  • Free, Confidential Counseling: The RE:SET program provides up to five free sessions with experienced and licensed clinicians. This service removes the cost, access and privacy hassles of getting professional emotional support when NBNA members face a problem or situation that is difficult to resolve.
  • Text Coach®: Also known as ‘text therapy’ is available to NBNA members via mobile phone or desktop computer to help with non-acute concerns. Licensed clinicians will help nurses and their families boost emotional fitness and wellbeing by exchanging text messages, voice notes, tip sheets, videos and resource links.

To learn more about the RE:SET FREE tools and other resources, visit, www.nbna.org on December 15th.

To become a member of the National Black Nurses Association and to gain access to the FREE counseling services, visit www.nbna.org.

About National Black Nurses Association (NBNA)
Founded in 1971, the National Black Nurses Association (NBNA) is a professional organization representing 308,000 African American registered nurses, licensed vocational/practical nurses, and nursing students in 108 chapters and 34 states. The NBNA mission is “to serve as the voice for Black nurses and diverse populations ensuring equal access to professional development, promoting educational opportunities and improving health.” NBNA chapters offer voluntary hours providing health education and screenings to community residents in collaboration with community-based partners, including faith-based organizations, civic, fraternal, hospitals, and schools of nursing. For more information, visit nbna.org. #NBNAResilient

Contact
Marcy Polanco
202.885.5527
[email protected]

Shemika Harmitt
202.885.5527
[email protected]

Keisha Ricks
NBNA Marketing and Communications Manager
443-790-0156
[email protected]

Risk Recommendations for Medication Management

Risk Recommendations for Medication Management

Prescribing is not a responsibility to be taken lightly. Prescribing a drug to any person – even as a “one-time favor” for a coworker, relative, friend, or neighbor – establishes a patient-practitioner relationship. Prescribe the right drug, for the right patient, in the right dose, by the right route, at the right times, for the right duration, and for the right indications.

As health care delivery has continued to evolve, many Americans are using nurse practitioners for much of their health care needs, making NPs a critical component of the modern system. This growth in demand and responsibility has also increased and evolved the many risks NPs face in their work environments.

The Nurse Practitioner Claim Report: 4th Edition from CNA and Nurses Service Organization (NSO) took a deeper look at those risks by analyzing 287 closed professional liability claims against nurse practitioners (claims that resulted in an indemnity payment of $10,000 or greater) over a 5-year period.

Five allegation categories accounted for 95% of all the closed claims in the analysis: diagnosis, medication prescribing, treatment and care management, assessment, and scope of practice. A detailed view of the allegations related to medication prescribing/management show that within this category, the top three allegations involved improper prescribing or management of controlled drugs (27.7%), improper management of medication (24.7%), and wrong dose (15.4%).

The following strategies can help nurses reduce the likelihood of drug-related errors:

  • Review current allergy information.
  • Learn about medication allergies, side effects and interactions, including how to screen patients for potential allergic or other adverse reactions, recognize an allergic response, and treat serious reactions.
  • Review previous medication orders alongside new orders and care plans, and resolve any discrepancies each time a patient moves from one care setting to another.
  • Use developed standard order sets to minimize incorrect or incomplete prescribing, standardize patient care, and clarify medication orders.
  • Emphasize the importance of keeping follow-up appointments, especially when the patient is discharged on warfarin or direct oral anticoagulation therapy and there is a transition of care process.

Nationwide, the Centers for Disease Control and Prevention (CDC) reports that overdose deaths related to prescription opioids were five times higher in 2016 than 1999. Nurses can play an important role in reducing these deaths, as well as addiction problems, through their assessments and monitoring of patients.

When prescribing opioid drugs:

  • All patients suffering pain should be given a thorough physical and have a history taken, including an assessment of psychosocial factors and family history. Reevaluate the level of pain and the efficacy of the treatment plan at every visit.
  • Conduct an opioid risk assessment and depression scale test before prescribing opioids and perform periodic screening thereafter.
  • Use an appropriate opioid dose based on patient age and opioid tolerance.

These claims and recommendations demonstrate the importance of the responsibility for properly evaluating each patient prior to prescribing, following up, and documenting the results of appropriate tests and consultations in a timely manner. While rare events may be difficult to prevent, nurse practitioners can glean lessens from the experiences of their colleagues to help enhance their own clinical, patient safety, and risk management practices.


Disclaimer: This article is provided for general informational purposes only and is not intended to provide individualized business, risk management or legal advice.  It is not intended to be a substitute for any professional standards, guidelines or workplace policies related to the subject matter.

This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to [email protected] or call 1-800-247-1500. www.nso.com.

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