The Society of Psychiatric Advanced Practice Nurses held it's first quarterly meeting of the year on January 29th at the Woodbridge Hilton. The three hour meeting drew record attendance and high energy discussion. New members were introduced to the Society and future directions of the organization were explored. Member RIchard Pessagno, DNP, RN, PMHNP-BC, presented the LACE recommendations and it's implications for Psychiatric Advanced Practice Nursing. Oliver Lopena, PharmD, Medical Science Liaison for Otsuka America Pharmaceutical, Inc presented the new APA Practice Guidelines for the treatment of depression.
Here is some background and meeting highlights:
Consensus Model and Proposed recommendations for LACE
After meeting for over 4 years, Nursing's leading professional organizations have reached consensus on a model for future advanced practice registered nurse (APRN) regulation. This collaborative work of the APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Committee, establishes clear expectations for licensure, accreditation, certification, and education (LACE) for all APRNs and will shape future practice of Advanced Practice Nursing.
Dr. RIchard Pessagno, presented information on the proposed implementation of the Consensus Model developed by the Joint Task Force of the American Psychiatric Nurses Association and the International Society of Psychiatric Nurses and it's specific implications for Psychiatric Advanced Practice Nurses.
Intended to streamline the process of licensure, accreditation, certification and education for all APNs in the country, the report recommends that there be one educational focus for Psychiatric APRNs in the future: Psychiatric Mental Health Nurse Practitioner. Preparation will be across the lifespan, addressing mental health promotion and mental illness diagnosis and treatment. Curriculum content includes advanced pharmacology, physical assessment pathophysiology and psychotherapy and will address assessment and diagnosis, age specific interventions and the mental health needs and issues of all age groups.
"The process will improve consumer understanding about Advanced Practice Nursing, as well as improve portability and visibility for APN's" stated Dr. Pessagno who also serves on the APNA Board of Directors ."While the Model is for future Psychiatric Advance Practice Nurses, this will not impact the current practicing APN's. The projected plans will create a professional trajectory that will provide the future Psychiatric APN with a life span approach to patient care services, allowing Psychiatric APNs the ability to care for patients of all ages and in multiple settings based on the personal preference and interest."
Treating Depression:
The American Psychiatric Association has revised it's practice guidelines for the treatment of major depression in response to well designed research data such as STAR*D. This federally funded, large-scale, long-term study directly compared different treatment strategies and aimed at defining which subsequent treatment strategies, in what order or sequence, and in what combination(s) are both acceptable to patients and provide the best clinical results with the least side effects. The results point to the urgency of achieving full symptom remission and returning to normal functioning. The sooner symptom remission is achieved, the better the long term prognosis.
"The majority of patients do not achieve adequate depressive symptom resolution after an initial course of monotherapy treatment', said Dr. Oliver Lopena. "after an inadequate or unsatisfactory response to initial antidepressant monotherapy treatment, it is appropriate to either switch to another antidepressant agent or to augment the first agent with psychotherapy or pharmacotherapy" (including the option of atypical antipsychotics). "The guidelines also now acknowledge the role and importance of measurement-based care" he continued. "The implementation of symptom rating scales in conjunction with a deliberate treatment plan can be associated with improved outcomes. Additionally, the use of symptom rating scales can be yet another means for clinicians to help establish a therapeutic alliance with patients."