A new study has found much higher rates of dementia in retired NFL players. Here is the link to the NY Times report on it: http://www.nytimes.com/2009/09/30/sports/football/30dementia.html?_r=1&th&emc=th
Evidence has been accumulating on this issue for several years, it will be interesting to see how it is handled by the NFL. Prior studies have also linked concussion to depression. This study was done by a pretty reputable group (Univ of Mich Institute for Social Research).
Of course this has implications for many children and adults who are injured in sports and other activities. I've heard from many school nurses who find that injuries on the field are being taken much more seriously than they had been previously.
Unfortunately I've also heard stories of children being knocked out (and not responsive) on the field who go back in to play after injury rather than going to be evaluated medically. It seems coaches, athletes, and parents need better education about the risks of 'playing through' an injury. Particularly given this new evidence.
The idea that football which already has a host of protective gear in use including helmets, has this problem is troublesome. How will we protect children and adult athletes from these injuries?
Wednesday, September 30, 2009
Evening event: Thursday Oct 1, 2009
We are hoping the word has gotten out to Psych APRN's in the area to join us for an evening of discussion related to the future of our profession (both Nationally and in CT) and networking. Hope to see you there!
Friday, September 25, 2009
LACE and the Advanced Practice Psychiatric Nurse (APRN)
There is a lot happening nationally in Advanced Practice Nursing. It is unsettling at times because it is unclear whether the voices of all Master’s prepared psych nurses are being heard. Given that whatever happens with LACE (which stands for Licensure, Accreditation, Certification and Education) recommendations will affect the ability of nurses to practice (and find work) in the future. I hate to think that a small group of nurses are chosen to decide the future of our profession without all members of the profession having input. This is an issue affecting our livelihoods and careers, and for this reason all the professionals involved should be represented.
The current proposal, approved by APNA (the American Psychiatric Nurses Association), involves APRN's in psych being considered a ‘population’ rather than a ‘role’. Examples of roles in Advanced Practice nursing are Nurse Midwife, Nurse Anesthetist, Nurse Practitioner, etc. Examples of populations, as currently defined are gender, pediatric, psychiatric/mental health (see the links below for further info). My view is that Psych-Mental Health APRN’s should be considered a role. Unfortunately this was decided by a small subgroup working on the model, and to my knowledge did not involve input from all involved. There are several problems with this decision:
1. We should have autonomy in defining the future of Psych Advanced Practice Nursing. We remain tied to NP and CNS group regulation. This is despite our clear differences in focus and role. These other groups do not understand or know what the Psych APRN role is, yet they define competencies and other standards that guide education, practice and certification.
2. We are not able to define the specific aspects of role unique to psych that are not applicable to any other specialty group.
3. We remain stuck with two kinds of psych APRN’s: NP and CNS despite the fact that these roles have been shown to be nearly completely alike. This means we also have 2 kinds of certification again despite the redundancy in role.
The other aspect of the models being considered are that our educational programs must provide a lifespan approach to education. I think this is fine, however I think we may be taking this a step too far in relegating that in the future all Psych APRN’s will be Family Psych NP’s. While it is an interesting population level solution for providing care to children/adolescents in rural areas, I think it will produce a very generic graduate without much skill in any population (this is expected to require 200 clinical hours for each student in each population group: child, adult, geri). We are all very aware of the differences in skills required to treat children and adolescents vs. adults and elders. I do not think this is the best plan for the entire profession. Graduates will have little focused experience with psychotherapy and medication management in any population group. In addition, I rarely see clinicians or students entering our program who are interested in working with all population groups.
Finally, I would like to see that planning is in place for articulation of all Master’s prepared psych nurses with the new requirements. For example,
· What will current child or adult CNS’s and NP’s do? Will they be allowed to practice as a ‘Family Psych NP’?
· What will Master’s prepared psych nurses do who have completed their educational preparation but are not currently CNS or NP certified or licensed as an APRN? This happens due to family obligations, practicing in a clinical or work site where certification is not required, and in some states due to lack of definition of roles related to APRN billing or prescriptive authority.
· Who will teach the new ‘Family Psych NP’? As we change certification and educational requirements we have not been vigilant about articulation for those with the most experience who have actually developed psych Advanced Practice roles. Will Psych CNS’s remain eligible to teach in Psych NP programs? Will the Adult CNS or NP be able to teach the Family Psych NP student? We have a shortage not only of direct care providers but of nursing faculty as well. What plans are being made for role articulation from the many current levels nurses practice from now?
This is an issue affecting all of our livelihoods, I think the voices of psych APRN's need to be heard by our national leaders. We cannot accept a group of 7 or 12 individuals deciding the fate of an entire professional group. Not when it affects whether you or I will be able to practice and make a living. I encourage all Psych APRN’s to be vocal about this. In addition Psych RN’s should also be vocal. This is their future as well, they may decide to take the next steps and further their nursing education.
The other side of this is that we can’t afford to complain about the resulting plans if we haven’t taken the time to learn about the issues and told our representatives what our wishes are.
Here is a link to the APNA website where you can begin to see some of the plans that are being made. I’d love to hear your thoughts!
http://www.apna.org/i4a/pages/index.cfm?pageid=3498 (on LACE)
http://www.apna.org/i4a/pages/index.cfm?pageid=3707 (on APRN Consensus Model)
http://www.apna.org/i4a/pages/Index.cfm?pageID=3717 (presentation on options for Psych APRN’s
If any of you are going to be in or around New Haven, CT in the next week, our APNA Executive Director, Nick Croce will be part of an evening event where we will hear the latest on Psych APRN issues. Consider joining us for the evening!
The current proposal, approved by APNA (the American Psychiatric Nurses Association), involves APRN's in psych being considered a ‘population’ rather than a ‘role’. Examples of roles in Advanced Practice nursing are Nurse Midwife, Nurse Anesthetist, Nurse Practitioner, etc. Examples of populations, as currently defined are gender, pediatric, psychiatric/mental health (see the links below for further info). My view is that Psych-Mental Health APRN’s should be considered a role. Unfortunately this was decided by a small subgroup working on the model, and to my knowledge did not involve input from all involved. There are several problems with this decision:
1. We should have autonomy in defining the future of Psych Advanced Practice Nursing. We remain tied to NP and CNS group regulation. This is despite our clear differences in focus and role. These other groups do not understand or know what the Psych APRN role is, yet they define competencies and other standards that guide education, practice and certification.
2. We are not able to define the specific aspects of role unique to psych that are not applicable to any other specialty group.
3. We remain stuck with two kinds of psych APRN’s: NP and CNS despite the fact that these roles have been shown to be nearly completely alike. This means we also have 2 kinds of certification again despite the redundancy in role.
The other aspect of the models being considered are that our educational programs must provide a lifespan approach to education. I think this is fine, however I think we may be taking this a step too far in relegating that in the future all Psych APRN’s will be Family Psych NP’s. While it is an interesting population level solution for providing care to children/adolescents in rural areas, I think it will produce a very generic graduate without much skill in any population (this is expected to require 200 clinical hours for each student in each population group: child, adult, geri). We are all very aware of the differences in skills required to treat children and adolescents vs. adults and elders. I do not think this is the best plan for the entire profession. Graduates will have little focused experience with psychotherapy and medication management in any population group. In addition, I rarely see clinicians or students entering our program who are interested in working with all population groups.
Finally, I would like to see that planning is in place for articulation of all Master’s prepared psych nurses with the new requirements. For example,
· What will current child or adult CNS’s and NP’s do? Will they be allowed to practice as a ‘Family Psych NP’?
· What will Master’s prepared psych nurses do who have completed their educational preparation but are not currently CNS or NP certified or licensed as an APRN? This happens due to family obligations, practicing in a clinical or work site where certification is not required, and in some states due to lack of definition of roles related to APRN billing or prescriptive authority.
· Who will teach the new ‘Family Psych NP’? As we change certification and educational requirements we have not been vigilant about articulation for those with the most experience who have actually developed psych Advanced Practice roles. Will Psych CNS’s remain eligible to teach in Psych NP programs? Will the Adult CNS or NP be able to teach the Family Psych NP student? We have a shortage not only of direct care providers but of nursing faculty as well. What plans are being made for role articulation from the many current levels nurses practice from now?
This is an issue affecting all of our livelihoods, I think the voices of psych APRN's need to be heard by our national leaders. We cannot accept a group of 7 or 12 individuals deciding the fate of an entire professional group. Not when it affects whether you or I will be able to practice and make a living. I encourage all Psych APRN’s to be vocal about this. In addition Psych RN’s should also be vocal. This is their future as well, they may decide to take the next steps and further their nursing education.
The other side of this is that we can’t afford to complain about the resulting plans if we haven’t taken the time to learn about the issues and told our representatives what our wishes are.
Here is a link to the APNA website where you can begin to see some of the plans that are being made. I’d love to hear your thoughts!
http://www.apna.org/i4a/pages/index.cfm?pageid=3498 (on LACE)
http://www.apna.org/i4a/pages/index.cfm?pageid=3707 (on APRN Consensus Model)
http://www.apna.org/i4a/pages/Index.cfm?pageID=3717 (presentation on options for Psych APRN’s
If any of you are going to be in or around New Haven, CT in the next week, our APNA Executive Director, Nick Croce will be part of an evening event where we will hear the latest on Psych APRN issues. Consider joining us for the evening!
Wednesday, September 16, 2009
Signs of suicide
I was reminded by the article written about Finn Casperson’s death, of the signs often present when a person is contemplating suicide (http://www.nytimes.com/2009/09/16/business/16suicide.html?_r=1&th&emc=th). A prominent businessman, Casperson resigned from several boards he worked on as well as put his property up for sale prior to ending his life. While the ‘news’ side of the story relates to speculation that he had hidden his money away to avoid taxes and might soon be caught, this potential which obviously might be very stressful, is second to the fact that he also had kidney cancer. It is unfortunate that this angle was chosen for the story. It appears this businessman and philanthropist will now be dragged down in the desire for a story.
There were some cues to suicide in this story that are good reminders for us: his resignation from several boards, stepping down from civic and private positions that it appears he found quite meaningful and important; and placing his estate up for sale. Those seem to be signals of a person withdrawing from his life. We know that often prior to ending their lives, individuals do try to put things in order and take care of things important to them. Of course in the context of treatment for kidney cancer, it might be perceived that these were a way to limit activity and focus on getting well.
It is always important that clinicians consider stressors as well as actions taken by individuals in trying to determine their safety. Mr. Casperson’s story shows us a good example of this often overlooked sign, which we do try to recognize in those we assess who are depressed or overwhelmed by many stressful events.
We often discuss how difficult it is to really be certain that your assessment of someone’s mental state is accurate. Newer students feel their lack of experience contributes to having a less definitive knowledge of whether someone ‘is safe’. The article does not indicate whether Mr. Casperson’s family, friends, or caregivers had any awareness of the potential for suicide.
Unfortunately Mr. Casperson’s story (at least as told here) is a reminder that there are times we will not know how deeply a person is suffering, and that if intent on ending their life, individuals are quite capable of keeping this hidden from those who know them best. My heart goes out to his family and friends who suffer now with his loss.
There were some cues to suicide in this story that are good reminders for us: his resignation from several boards, stepping down from civic and private positions that it appears he found quite meaningful and important; and placing his estate up for sale. Those seem to be signals of a person withdrawing from his life. We know that often prior to ending their lives, individuals do try to put things in order and take care of things important to them. Of course in the context of treatment for kidney cancer, it might be perceived that these were a way to limit activity and focus on getting well.
It is always important that clinicians consider stressors as well as actions taken by individuals in trying to determine their safety. Mr. Casperson’s story shows us a good example of this often overlooked sign, which we do try to recognize in those we assess who are depressed or overwhelmed by many stressful events.
We often discuss how difficult it is to really be certain that your assessment of someone’s mental state is accurate. Newer students feel their lack of experience contributes to having a less definitive knowledge of whether someone ‘is safe’. The article does not indicate whether Mr. Casperson’s family, friends, or caregivers had any awareness of the potential for suicide.
Unfortunately Mr. Casperson’s story (at least as told here) is a reminder that there are times we will not know how deeply a person is suffering, and that if intent on ending their life, individuals are quite capable of keeping this hidden from those who know them best. My heart goes out to his family and friends who suffer now with his loss.
Wednesday, September 9, 2009
A step in the right direction for those with disabling mental health problems?
I think I am pleased to see the state of New York taking a stand to protect the rights of those needing continued treatment and assistance living in the community. There is a link below to the article reported in the news today. http://www.nytimes.com/2009/09/09/nyregion/09mental.html?_r=1&th&emc=th
The reason I am unsure, is that I think this is one small example of the problems created for those with severe and disabling mental health conditions with deinstitutionalization. It will be interesting to see what the next steps are resulting from this ruling. My hope would be that individuals will get care more tailored to their needs.
Another concern is that there are many individuals in far worse condition who are not even in a housing program and receiving services. So on the priority list, I think I would focus on those who are homeless or end up incarcerated because they have a mental health problem. Hopefully this ruling will not result in addition to the ranks of the homeless or incarcerated.
We have a big problem in this country with redefining mental health treatment systems of care. There are problems everywhere with this. The adult homes in NYC are just one example of how a ‘good thing’ (deinstitutionalization and even community based adult homes) can go bad…
The reason I am unsure, is that I think this is one small example of the problems created for those with severe and disabling mental health conditions with deinstitutionalization. It will be interesting to see what the next steps are resulting from this ruling. My hope would be that individuals will get care more tailored to their needs.
Another concern is that there are many individuals in far worse condition who are not even in a housing program and receiving services. So on the priority list, I think I would focus on those who are homeless or end up incarcerated because they have a mental health problem. Hopefully this ruling will not result in addition to the ranks of the homeless or incarcerated.
We have a big problem in this country with redefining mental health treatment systems of care. There are problems everywhere with this. The adult homes in NYC are just one example of how a ‘good thing’ (deinstitutionalization and even community based adult homes) can go bad…
Friday, September 4, 2009
Will new pathways and classifications be developed to understand mental health problems?
Genes and Disease… Will genetic links help us discover new ways to understand people with mental health problems? Will these genetic links help in the discovery of new treatments?
Here is a link to an interesting ‘genes & disease’ map to consider…
http://www.nytimes.com/interactive/2008/05/05/science/20080506_DISEASE.html?ref=health#
I can find Schizophrenia and SAD, but I can’t seem to find Bipolar disorder or depression here… can anyone locate it? (psychiatric dx are in green)
Here is the associated article to figure out what the map means. http://www.nytimes.com/2008/05/06/health/research/06dise.html?pagewanted=1
It is interesting to think about the possibilities that arise from studies of these shared links. As the article suggests, there may be drugs used in one disorder that could lead to new discoveries of treatments for genetically linked disorders. This is indeed exciting to consider, particularly in mental health. However the potential for discovery also relates to the mechanisms of action of the drug within the pathway of causality to a particular disorder. So it does depend greatly on how that genetic link cascades out into the actual physiologic abnormality.
There is some discussion of classification of disease in psychiatry in the article as well. One view is that Schizophrenia and Bipolar share some common genetic links. Given this, Dr. Berrettini from Penn suggests we have not correctly categorized disorders. The other view is that even with shared genes the two diseases are distinct. We have all had the experience (or for our newest students will have the experience) of considering whether an individual’s problem is actually schizophrenia or bipolar, and of course there is schizoaffective to consider too.
It is interesting to consider whether the groupings and categorizations we use in psych mental health are helpful (and in what way?).
It is also interesting to brainstorm and open our views to other possibilities of how we might understand and categorize the difficulties of the people we work with and try to help.
What are your thoughts on these categories?
What are your thoughts on the usefulness of considering the genetic links between disorders?
Here is a link to an interesting ‘genes & disease’ map to consider…
http://www.nytimes.com/interactive/2008/05/05/science/20080506_DISEASE.html?ref=health#
I can find Schizophrenia and SAD, but I can’t seem to find Bipolar disorder or depression here… can anyone locate it? (psychiatric dx are in green)
Here is the associated article to figure out what the map means. http://www.nytimes.com/2008/05/06/health/research/06dise.html?pagewanted=1
It is interesting to think about the possibilities that arise from studies of these shared links. As the article suggests, there may be drugs used in one disorder that could lead to new discoveries of treatments for genetically linked disorders. This is indeed exciting to consider, particularly in mental health. However the potential for discovery also relates to the mechanisms of action of the drug within the pathway of causality to a particular disorder. So it does depend greatly on how that genetic link cascades out into the actual physiologic abnormality.
There is some discussion of classification of disease in psychiatry in the article as well. One view is that Schizophrenia and Bipolar share some common genetic links. Given this, Dr. Berrettini from Penn suggests we have not correctly categorized disorders. The other view is that even with shared genes the two diseases are distinct. We have all had the experience (or for our newest students will have the experience) of considering whether an individual’s problem is actually schizophrenia or bipolar, and of course there is schizoaffective to consider too.
It is interesting to consider whether the groupings and categorizations we use in psych mental health are helpful (and in what way?).
It is also interesting to brainstorm and open our views to other possibilities of how we might understand and categorize the difficulties of the people we work with and try to help.
What are your thoughts on these categories?
What are your thoughts on the usefulness of considering the genetic links between disorders?
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