2010 Third National DNP Conference, San Diego

Breakout session T2 Details, Thursday, September 30, 2010, 1:45PM
Capri Room

Cynthia Handrup, DNP, APRN, PMHCNS-BC
Private Practice, Chicago, IL
Measuring Psychotherapy Outcomes: A DNP Initiative

Goal of Presentation:
This study was designed as a quality improvement project to evaluate the practice change of using two very brief instrument-the Session Rating Scale (SRS) and Outcome Rating Scale (ORS)-to monitor change and measure therapeutic alliance in all therapy relationships at a private, multidisciplinary, outpatient mental health practice. This project examines the effect of routine therapist monitoring of the process and outcome of psychotherapy on psychotherapy patients’ attrition. Measuring alliance in the nurse-patient relationship is essential for the nursing profession, as this is one of the ways the profession defines itself in the health care arena. Evaluating the nurse-patient therapeutic alliance in psychotherapy could provide a basis for studying therapeutic alliance in the nurse-patient relationship in non-psychiatric settings.

Objectives:
1. Demonstrate an understanding of the effect positive alliance between the patients and practitioner on compliance and promoting health behavior change.
2. Define therapeutic alliance and discuss its role as a predictor of a patients’ engagement in treatment and outcome.
3. Discuss the implications of using rating scales in therapy to measure alliance and outcome and the greater implication for nursing.

Speaker’s Background:
Cynthia Taylor Handrup, DNP, APRN-BC, PMHCNS graduated from Michael Reese School of Nursing in Chicago, IL with a Diploma in nursing. She graduated with a BS in Nursing from the University of Rhode Island, a MS from the Psychiatric Mental Health Clinical Nurse Specialist program at St. Xavier University, Chicago, IL and a DNP from the University of Colorado Denver. An ANCC Clinical Specialist in Psychiatric Mental Health Nursing since 1979, she has practiced as a psychiatric staff nurse, nurse manager and administrator in psychiatric hospitals, an educator in psychiatric nursing in both undergraduate and graduate programs and as a psychotherapist. Dr. Handrup currently maintains a psychotherapy practice in a multidisciplinary group in Chicago and is the 2010 winner of the Heart and Soul of Change Research Award for the best study addressing client directed outcome informed clinical practice.

Susan Benson, DNP, APRN, FNP, PMHCNS
Eastern Colorado Health Care System Nurse Researcher
Insurance for an Intervention: Testing the Treatment Fidelity of a Behavioral Intervention

Goal of Presentation:
Patient health behavior changes, influenced by practitioner communicative behaviors, are the most desired outcomes in health care today and tomorrow. This was a pilot feasibility study to determine if the behavioral intervention of Motivational Interviewing (MI) could motivate smoking veterans with posttraumatic stress disorder through stages of change into smoking fewer cigarettes or cessation. MI was delivered to the client in their home via telephone landline using a Health Buddy® messaging device, along with weekly MI telephone counseling tailored to the patient’s stage of change. Results showed the MI intervention did meet five treatment fidelity criteria related to treatment design, training, delivery, receipt and enactment. The health behavior change outcome measure of patient enactment showed a significant forward progression in patient stages of change and fewer veterans were smoking > 10 cigarettes at the end of study compared to baseline (r=-0.676, p=0.0316), with two veterans quitting. Thus, this MI communication intervention, with the insurance of treatment fidelity, did result in positive patient health behavior changes.

Objectives:
1. List 3 factors the practitioner/researcher needs to consider when choosing a behavioral intervention.
2. Discuss the importance of measuring treatment fidelity
3. Identify 5 guideline of treatment fidelity as illustrated by pilot study

Speaker’s Background:
Since receiving her BSN (University of Minnesota), has prepared A.D. to graduate level nurses with mental health and communication skills. As a psychiatric/mental health CNS (University of Pennsylvania), she practiced in community, university, and telehealth settings. To further practice holistic nursing and integrative medicine, she became a FNP (University of Minnesota). She contributed to the creation of the HealthSciences Institute’s disease management/chronic care certification. For her DNP (University of Colorado) Capstone project, she had a Denver VA research opportunity to use Motivational Interviewing in creating a pilot study telehealth behavioral smoking cessation intervention for veterans with PTSD who smoke. As you know, health behavior change includes two components; caregivers choosing to make behavior changes to how they practice and patients choosing to make behavioral changes in self-care. In summary, my career has largely focused on these two areas; my teaching or training of students as they design their clinical practice and my direct clinical care of psychiatric, telehealth, and primary care patients. This DNP research study is my first career opportunity to add the statistical tools to evaluate both of these practitioner and patient care dimensions.