Primary Care Advanced Practice Registered Nurses Knowledge of Posttraumatic Stress Disorder and Screening

Transcription

1 Primary Care Advanced Practice Registered Nurses Knowledge of Posttraumatic Stress Disorder and Screening KIM LINK, DNP, APRN LYNETTE SMITH, PHD, APRN WESTERN KENTUCKY UNIVERSITY

2 Disclosure & Learning Objectives Kim Link & Lynette Smith (Western Kentucky University) have no conflict of interest to disclose & no funding or sponsorship was received. Learning objectives: The learner will be able to describe primary care advanced practice registered nurses (APRNs ) knowledge of posttraumatic stress disorder (PTSD) & screening practices. The learner will be able to describe primary care APRNs self-efficacy, subjective norms, & attitudes toward PTSD screening.

3 Posttraumatic Stress Disorder (PTSD) Exposure to or witnessing a traumatic event Lifetime prevalence rates: United States-6.8% China-0.3% New Zealand-6.1% APA, 2013; Gradus, 2014; Ivanova et al.,2011

4 Posttraumatic Stress Disorder (PTSD) Signs & Symptoms: Intrusive, recurrent thoughts or images Negative alterations in cognition and mood Increased arousal & reactivity Difficulty with daily functioning APA, 2013

5 PTSD in Primary Care More individuals are seeking treatment in primary care settings PTSD often goes undiagnosed in primary care Colon-Gonzalez et al., 2013; Graves et al., 2011; Kulesza, Pedersen, Corrigan, & Marshall, 2015; Sonis, 2013

6 Problem Statement Often present to primary care with somatic complaints & medical comorbidities Utilize healthcare resources at high rates Higher rates of disability & unemployment Lower quality of life Graves et al., 2011; Freedy et al., 2010; Spoont et al., 2013

7 Increased Demand for APRN Services in Primary Care Shortage of primary care physicians 30% more APRNs providing primary care services by 2020 Primary care APRNs may play an important role in identifying PTSD Iglehart, 2014; DHHS, 2013

8 Literature Review Knowledge & screening practices Boscarino, Larson, Ladd, Hill, & Paolucci, 2010; Brown & Weisler, 2011; Freedy & Brock, 2010; VA/DoD, 2010

9 Literature Review Perceived pressure to screen (subjective norms) VA, 2016; VA/DoD, 2010

10 Literature Review Confidence in screening (self-efficacy) APA, 2013; Boscarino et al., 2010; Brown & Weisler, 2011; Green et al., 2011; Samuelson et al., 2014; VA/DoD, 2010

11 Literature Review Attitudes regarding screening Brown & Weisler, 2011; Green et al., 2011; Freedy & Brock, 2010; Samuelson, et al., 2014

12 Theoretical Framework & Purpose of Study Extended Theory of Planned Behavior Knowledge influences self-efficacy, subjective norms, & attitudes, which has indirect effect on intentional behavior Purpose of Study Polonsky, Renzaho, Ferdous, & McQuilten, 2013

13 Study Design & Methods Descriptive cross-sectional study design Electronic educational needs assessment survey Subjects recruited through membership of a midsouthern statewide nursing organization Survey tool contained 4 patient vignettes & 30 items Brown & Weisler, 2011; Byrnes, 2006

14 Study Design & Methods Content validity established (CVI=1.00) Reliability (Cronbach s alpha) Self-efficacy items: 0.83 Attitude items: 0.79 Subjective norm items: 0.51

15 Data analysis Frequency data Mean scores & standard deviations analyzed for each variable

16 Sample Characteristics 128 total participants 69 eligible (61 family, 8 adult) Years of practice: 1-4 years (34.3%), 5 to 10 years (32.8%), 11 years or more (32.8%)

17 Sample Characteristics Patient population 98.5% family or adult Practice location Urban: 44.9% Rural: 55.1%

18 Sample Characteristics Screening rates: 6 months (53% had not);12 months (48.5% had not) EHR alerts: 76.8% did not receive alerts to screen 0% had received training in previous 4 weeks

19 Knowledge of PTSD Screening Subjects incorrectly listed the following as symptoms of PTSD: psychosis (27) hyperactivity (26) grandiosity (14)

20 Knowledge of PTSD Screening Knowledge of PTSD screening tools 32.4% were able to identify primary care screening tools 10.8% knew the Primary Care PTSD Screening tool takes less than 2 minutes to administer

21 Knowledge of PTSD Screening Scores Range: 0-7 (higher score = increased knowledge) Mean: 3.87 (SD = 1.24) Minimum: 2 Maximum: 7

22 Screening Practices: Patient Vignettes Military: 68.1% would screen 46.4% identified + screen Natural disaster: 98.6% would screen Sexual trauma: 78.3% would screen 58% identified + screen Automobile accident: 80.9% would screen

23 Screening Practices Scores Range: 0-10 (higher score = correct screening practices) Mean: 5.07 (SD = 1.83) Minimum: 0 Maximum: 9

24 Subjective Norms 80% 70% 60% 50% Strongly disagree Somewhat disagree Agree Strongly agree 40% 30% 20% 10% 0% Screening is within my scope of practice Responsible for identifying patients to screen Standardized screening tool should be used Screening is a component of my practice

25 Subjective Norms Scores Range: 4-16 (higher score = more pressure to screen) Mean: (SD = 1.84) Minimum: 6 Maximum: 16

26 Self-Efficacy 60% 50% 40% 30% Not at all confident Somewhat confident Confident Very confident 20% 10% 0% Abillity to screen for PTSD Distinguising between ASD & PTSD

27 Self-Efficacy Scores Range: 2-8 (lower score = less confidence) Mean: 3.52 (SD = 1.28) Minimum: 2 Maximum: 8

28 Attitudes Only 39.2% of subjects agreed or strongly agreed PTSD screening was important in practice

29 Attitudes: Patient-Level Barriers 80% 70% 60% 50% Strongly disagree Somewhat disagree Agree Strongly agree 40% 30% 20% 10% 0% Reluctance to discuss symptoms Reluctance to discuss positive results Perceived stigma

30 Attitudes: System-Level Barriers 70% 60% 50% 40% Strongly disagree Somewhat disagree Agree Strongly agree 30% 20% 10% 0% Lack of educational resources Insufficient appointment time Insurance reimbursement issues Lack of referral resources

31 Attitudes Scores Range: 8-32 (higher score = negative attitude) Mean score: (SD = 3.79) Minimum score: 10 Maximum score: 29

32 Discussion Study indicates deficiencies in primary care APRNs knowledge of PTSD and PTSD screening practices

33 Discussion Study indicates discrepancies between primary care APRNs subjective norms and PTSD screening practices

34 Discussion Study indicates primary care APRNs had low selfefficacy, or confidence, in PTSD knowledge and screening

35 Discussion Study indicates the majority of primary care APRNs had a negative attitude towards screening Numerous barriers identified

36 Limitations Small sample size Use of new survey tool

37 Conclusions Education and training may be needed Further research is needed

38 References American Psychiatric Association [APA]. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Boscarino, J. A., Larson, S., Hill, E., Ladd, I., & Paolucci, S. J. (2010). Mental health experiences and needs among primary care providers treating OEF/OIF veterans: Preliminary findings from the Geisinger veterans initiative. International Journal of Emergency Mental Health, 12(3), Retrieved from Brown, J. J., & Weisler, R. H. (2011). Posttraumatic stress disorder screening practices: A 2010 internet assessment of customary care. The Primary Care Companion for CNS Disorders,13(5). doi:10/4088/pcc.11m01171 Byrnes, L. B. (2006). Attitudes, perceived ability, and knowledge about depression screening: A survey of certified nurse-midwives/certified midwives. Journal of Midwifery & Women s Health, 51(5), doi: /j.jmwh Colon-Gonzalez, M. C., McCall-Hosenfeld, J. S., Weisman, C. S., Hillemeier, M. M., Perry, A. N., & Chuang, C. H. (2013). Someone s got to do it - Primary care providers (PCPs) describe caring for rural women with mental health problems. Mental Health and Family Medicine, 10(4), Retrieved from Freedy, J. R., & Brock, C. D. (2010). Spotting and treating PTSD in primary care. The Journal of Family Practice, 59(2), Retrieved from pubmed/ Freedy, J. R., Steenkamp, M. M., Magruder, K. M., Yeager, D. E., Zoller, J. S., Hueston, W. J., & Carek, P. J. (2010). Posttraumatic stress disorder screening test performance in civilian primary care. Family Practice, 27, doi: /fampra/cmq049

39 References Gradus, J. L. (2014). Epidemiology of PTSD. Retrieved from Graves, R. E., Freedy, J. R., Aigbogun, N. U., Lawson, W. B., Mellman, T. A., & Alim, T. N. (2011). PTSD treatment of African American adults in primary care: The gap between current practice and evidence-based treatment guidelines. Journal of the National Medical Association, 103(7), Retrieved from pubmed/ Green, B. L., Kaltman, S., Frank, L., Gleenie, M., Subramamian, A., Fritts-Wilson, M., Chung, J. (2011). Primary care providers experiences with trauma patients: A qualitative study. Psychological Trauma: Theory, Research, Practice, and Policy, 3(1), doi: /a Iglehart, J. K. (2014). Meeting the demand for primary care: Nurse practitioners answer the call. Retrieved from Ivanova, J. I., Birnbaum, H. G., Chen, L., Duhig, A. M., Dayoub, E. J., Kantor, E. S., & Phillips, G. A. (2011). Cost of post-traumatic stress disorder vs. major depressive disorder among individuals covered by Medicaid or private insurance. The American Journal of Managed Care, 17(8), Retrieved from

40 References Kulesza, M., Pedersen, E., Corrigan, P., & Marshall, G. (2015). Help-seeking stigma and mental health treatment seeking among young adult veterans. Military Behavioral Health, 3(4), doi: / Polensky, M. J., Renzaho, A. M., Ferdous, A. S., & McQuilten, Z. (2013). African culturally and linguistically diverse communities blood donation intentions in Australia: Integrating knowledge into the theory of planned behavior. Transfusion, 53(7) doi: /j x Samuelson, K. W., Koenig, C. J., McCamish, N., Choucroun, G., Tarasovsky, G., Bertenthal, D., & Seal, K. H. (2014). Web-based PTSD training for primary care providers: A pilot study. Psychological Services, 11(2), doi: /a Sonis, J. (2013). PTSD in primary care: An update on evidence-based management. Current Psychiatry Reports, 15(7), 373. doi: /s Spoont, M., Arbisi, P., Fu, S., Greer, N., Kehle-Forbes, S., & Meis, L. (2013). Screening for post-traumatic stress disorder (PTSD) in primary care: A systematic review (Project #09-009). Retrieved from U.S. Department of Health and Human Services [DHHS]. (2013). Projecting the supply and demand for primary care practitioners through Retrieved from

41 References U.S. Department of Veterans Affairs, Department of Defense [VA/DoD]. (2010). VA/DoD clinical practice guideline for management of post-traumatic stress. Retrieved from U.S. Department of Veterans Affairs, National Center for PTSD [VA]. (2016). PTSD screening and referral: For healthcare providers. Retrieved from

42 Questions Any questions? Thank you for your time!