Mary D Moller
Pacific Lutheran University, Nursing, Faculty Member
Expert Consensus Guidelines for Schizophrenia 1999
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A course entitled "How to Enter the World of Schizophrenia ... a Family Educational Perspective" was developed to simultaneously educate individuals with schizophrenia and their families regarding the psychiatric diagnosis, treatment, and... more
A course entitled "How to Enter the World of Schizophrenia ... a Family Educational Perspective" was developed to simultaneously educate individuals with schizophrenia and their families regarding the psychiatric diagnosis, treatment, and management of schizophrenia. The course was developed and implemented by psychiatric-mental health nursing clinical specialists utilizing an eclectic approach. The complexity of this endeavor required the incorporation of five theoretical models to effect the delivery of health education in a multigeneration family situation complicated with a serious mental illness. It was essential that the leaders possess working knowledge of the aforementioned theories as well as advanced knowledge of the medical diagnosis and treatment of schizophrenia to include neuroanatomy, physiology, and biochemistry; therapeutic nutrition; and psychopharmacology. Equally important were the leaders' abilities to conduct groups using the style of coleadership, as each class averaged 30 to 50 people, including individuals with schizophrenia, siblings, parents, and grandparents, which represented segments of families or the entire family. The leaders must display open, honest communication techniques while developing self-esteem and self-worth among the family members. Use of here-and-now material facilitates self-disclosure of emotionally painful material and leaders role-model problem-solving techniques, which aid families in coping with problems occurring with serious mental illness. The class has been taught 12 times since 1985 to over 500 persons.
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Primary-care practitioners confront myriad issue in managing their patients with depression and/or anxiety. Understanding the scope and epidemiology of these disorders is essential to understanding their shared characteristics. Do we... more
Primary-care practitioners confront myriad issue in managing their patients with depression and/or anxiety. Understanding the scope and epidemiology of these disorders is essential to understanding their shared characteristics. Do we always recognize these patients in practice? What are the barriers to diagnosis and treatment, and how can they overcome? What are the treatment options of these sometimes life-altering conditions, and how do we choose from among the many that exist?
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The number of psychiatric prescribes per capita is at one of the lowest levels in history. (1) Approximately 43.4 million persons (17.9%) in the United States have a diagnosable mental illness (2); 9.8 million (4%) are diagnosed with a... more
The number of psychiatric prescribes per capita is at one of the lowest levels in history. (1) Approximately 43.4 million persons (17.9%) in the United States have a diagnosable mental illness (2); 9.8 million (4%) are diagnosed with a serious and persistent mental illness, such as schizophrenia, bipolar disorder, and major depressive disorder (these figures do not include substance use disorders). (3) Of the 45,000 licensed psychiatrists, approximately 25,000 are in active practice. (4) By comparison, there are approximately 19,000 practicing licensed psychiatric advanced practice registered nurses (APRNs). (5) Annually, approximately 1,300 physicians graduate from psychiatric residency programs (6) and 700 APRNs from master's or Doctor of Nursing Practice programs. (7) Combining the 2 prescribing workforces (44,000) yields a ratio of 986 patients per licensed prescriben Seeing each patient only once every 2 months would equate to 25 patients daily considering a 5-day work week. Recognizing that some patients need much more frequent follow-up, this is an impossible task even if these providers and patients were dispersed uniformly across the United States. Currently, ratios are calculated based on the number of psychiatrists per 100,000 individuals, which in the United States is 16. (8) Most psychiatrists practice in urban areas, (9) whereas psychiatric nurse practitioners are found primarily in rural and less populated urban areas. (10) Who can provide care? Although the growing number of psychiatric APRNs is encouraging for the mental health workforce, their limited role and function remain a battle in the 27 states that do not grant full practice authority. This dispute has become so contentious that the Federal Trade Commission (FTC) has stated that the debate over scope of practice represents federal restraint of trade, (11) while patients and their families suffer from lack of access to care. Recognizing that 9 million patients age Who are APRNs? The first master's degree in nursing was created by Hildegard Peplau, EdD, at Rutgers University in 1954, using the title Clinical Specialist in Psychiatric Mental Health Nursing (PMH-CNS). As a master's prepared clinician, the PMH-CNS could function independently, and many chose to open private practices. Other universities began to create clinical specialty programs in a variety of disciplines. In 1996, 41 states granted prescriptive authority to the PMH-CNS. Psychiatric nurse practitioners were first certified in 2000 to meet the statutory requirements for prescriptive authority of the other 9 states. However this created 4 PMH-APRN roles: Adult and Child/Adolescent CNS and Adult and Family PMHNPs. Clinical specialists in most areas of health care--except for psychiatry--were primarily working in institutional settings, whereas nurse practitioners were hired principally in primary care community-based settings. The public grew familiar with the term "nurse practitioner," but these professionals functioned primarily under institutional protocols, while the PMH-CNS had the ability to practice independently. In the mid-1990s, the 4 advanced practice nursing roles of nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist were encompassed under 1 title: APRN. In 2010 the American Psychiatric Nurses Association endorsed one title for the psychiatric mental health advanced practice registered nurse (PMH-APRN), the psychiatric nurse practitioner, to be educated across the lifespan. …
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... may also be explained by the fact that many psychiatric CNSs have identified themselves aspsychoanalysts, psychotherapists, family therapists ... health nursing care, including choices about prescriptive authority, moves the specialty... more
... may also be explained by the fact that many psychiatric CNSs have identified themselves aspsychoanalysts, psychotherapists, family therapists ... health nursing care, including choices about prescriptive authority, moves the specialty forward as the twenty first century approaches ...
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Research Interests: Psychology, Interpersonal Communication, Schizophrenia, Cognition, Cognitive Dissonance, and 12 moreMedicine, Emotions, Humans, Male, Young Adult, Interpersonal Relations, Adult, Psychotic Disorders, Antipsychotic agents, Psychology and Cognitive Sciences, Interviews as topic, and Medical and Health Sciences
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The American Psychiatric Nurses Association and the American Nurses Credentialing Center conducted a logical job analysis based on three recent role-delineation studies (RDSs) to determine whether there was enough commonality in the... more
The American Psychiatric Nurses Association and the American Nurses Credentialing Center conducted a logical job analysis based on three recent role-delineation studies (RDSs) to determine whether there was enough commonality in the practice of psychiatric and mental health nursing by clinical nurse specialists (PMH-CS) and nurse practitioners (PMH-NP) to support the development of a single certification examination. Three hundred seventy-one work tasks gleaned from the three RDSs were presented for systematic review and discussion by the logical job analysis committee of 28 nurses certified in the specialty. Of the 371 work tasks, 332 (90%) were considered important enough to test for both the PMH-CS and PMH-NP. The results of the logical job analysis indicated that there was enough commonality in the practices of the PMH-CS and PMH-NP in psychiatric mental health nursing to warrant the development of one advanced practice examination for both roles. J Am Psychiatr Nurses Assoc, 2007; 13(3), 153-159.
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ABSTRACT In 2009, the seminal integrative literature review on vitamin D and the occurrence of depression included 17 studies on older adults and determined the relationship between vitamin D and depression to be largely circumstantial.... more
ABSTRACT In 2009, the seminal integrative literature review on vitamin D and the occurrence of depression included 17 studies on older adults and determined the relationship between vitamin D and depression to be largely circumstantial. Since this publication, 10 studies have assessed the relationship of vitamin D status/supplementation to depression in elders. Six studies indicated a link between vitamin D deficiency, depressive symptoms, and overall psychological health, and 4 studies highlight vitamin D supplementation and the effect on depressive symptoms. More studies are needed to confirm a definitive relationship between vitamin D status, supplementation, and effect on depression in geriatric populations.
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Background: Cortisol secretions serve as the barometer of the hypothalamic–pituitary–adrenal (HPA) axis, which regulates and controls responses to stress. Studies of cortisol secretions in patients with posttraumatic stress disorder... more
Background: Cortisol secretions serve as the barometer of the hypothalamic–pituitary–adrenal (HPA) axis, which regulates and controls responses to stress. Studies of cortisol secretions in patients with posttraumatic stress disorder (PTSD) reveal inconsistent results. Purpose: Current research on HPA axis functioning in PTSD is examined to elucidate the neuroendocrine contributions in the disorder, identify current treatment’s impact on the HPA axis, and consider implications for nursing care and areas for future research. Findings: There is evidence for HPA dysregulation in PTSD, which contributes to widespread impairment in functions such as memory and stress reactivity and to physical morbidity via processes such as allostatic load. There is limited, but building, evidence that dehydroepiandrosterone (DHEA), which is released simultaneously with cortisol, may provide anti-glucocorticoid and neuroprotective effects. Conclusion: Current treatments such as selective serotonin reuptake inhibitors and psychotherapy may have a beneficial impact on the HPA axis in PTSD populations. Somatic approaches to treating PTSD have not yet been studied in relation to their impact on HPA axis parameters in PTSD patients. Treatment studies of DHEA or glucocorticoids have not yet used HPA axis endpoints. PTSD treatment studies that include measures of HPA axis target mechanisms and consider HPA axis regulation as an additional treatment outcome are warranted.
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Two focus groups were held with patients who had experienced inpatient hospitalization and their families, to discuss spiritual needs during psychosis. Spirituality was described in terms of relationship and religion in terms of rules.... more
Two focus groups were held with patients who had experienced inpatient hospitalization and their families, to discuss spiritual needs during psychosis. Spirituality was described in terms of relationship and religion in terms of rules. Four themes emerged to describe spiritual needs during an inpatient hospitalization: comfort, companionship, conversation, and consolation. Eleven succinct interventions were identified within these themes. The number one need expressed by consumers of all denominations and religions who belonged to a church/temple/spiritual group was for their pastor/rabbi/spiritual advisor to not abandon them. For those who did not belong to a religious/spiritual group their number one need was to at least be asked for some type of religious/spiritual preference and for the nurse to somehow contact the person mentioned.
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Research Interests: Psychology, Clinical Psychology, Interpersonal Communication, Mental Health, Spirituality, and 14 moreHealth Education, Medicine, Humans, Female, Psychoeducation, Male, Attitude, Health Status, Aged, Middle Aged, Questionnaires, Adult, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Psychology, Nursing, Psychiatry, Community-Based Mental Health Services, Quality of life, and 12 moreForecasting, Medicine, Philosophy of Nursing, Humans, United States, Psychiatric Nursing, Mental Disorders, Patient Centered Care, Deinstitutionalization, Community Based Mental Health Services, Clinical Nursing Research, and Community integration
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Schizophrenia is a heterogeneous disorder with characteristic symptoms, including cognitive impairments that are associated with the illness and its outcome. Cognitive impairments include deficits in processing speed and working memory,... more
Schizophrenia is a heterogeneous disorder with characteristic symptoms, including cognitive impairments that are associated with the illness and its outcome. Cognitive impairments include deficits in processing speed and working memory, inattention, and impaired problem-solving ability. These cognitive insufficiencies are considered to reflect the core of the disorder and to worsen as the disorder progresses, further impairing functioning. Novel approaches to treat cognitive impairments are greatly needed and transcranial Direct Current Stimulation (tDCS) is a promising modality that may address these cognitive impairments. TDCS is a noninvasive, non-pharmacological neuromodulation technique that has demonstrated efficacy in improving attention processing in normal controls and in persons with diverse pathologies. By modulating cortical excitability, anodal (excitatory) tDCS to the Prefrontal Cortex (PFC) may facilitate access to existing PFC neural reserves in people with schizophr...
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Primary-care practitioners confront myriad issue in managing their patients with depression and/or anxiety. Understanding the scope and epidemiology of these disorders is essential to understanding their shared characteristics. Do we... more
Primary-care practitioners confront myriad issue in managing their patients with depression and/or anxiety. Understanding the scope and epidemiology of these disorders is essential to understanding their shared characteristics. Do we always recognize these patients in practice? What are the barriers to diagnosis and treatment, and how can they overcome? What are the treatment options of these sometimes life-altering conditions, and how do we choose from among the many that exist?
Research Interests:
... may also be explained by the fact that many psychiatric CNSs have identified themselves aspsychoanalysts, psychotherapists, family therapists ... health nursing care, including choices about prescriptive authority, moves the specialty... more
... may also be explained by the fact that many psychiatric CNSs have identified themselves aspsychoanalysts, psychotherapists, family therapists ... health nursing care, including choices about prescriptive authority, moves the specialty forward as the twenty first century approaches ...
Research Interests: Medicine()
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The number of psychiatric prescribes per capita is at one of the lowest levels in history. (1) Approximately 43.4 million persons (17.9%) in the United States have a diagnosable mental illness (2); 9.8 million (4%) are diagnosed with a... more
The number of psychiatric prescribes per capita is at one of the lowest levels in history. (1) Approximately 43.4 million persons (17.9%) in the United States have a diagnosable mental illness (2); 9.8 million (4%) are diagnosed with a serious and persistent mental illness, such as schizophrenia, bipolar disorder, and major depressive disorder (these figures do not include substance use disorders). (3) Of the 45,000 licensed psychiatrists, approximately 25,000 are in active practice. (4) By comparison, there are approximately 19,000 practicing licensed psychiatric advanced practice registered nurses (APRNs). (5) Annually, approximately 1,300 physicians graduate from psychiatric residency programs (6) and 700 APRNs from master's or Doctor of Nursing Practice programs. (7) Combining the 2 prescribing workforces (44,000) yields a ratio of 986 patients per licensed prescriben Seeing each patient only once every 2 months would equate to 25 patients daily considering a 5-day work week...
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This interview is with Jane A. Ryan, RN, MN, CNAA, immediate past president of the American Psychiatric Nurses Association. She began her nursing career in 1959 and spent 27 years in psychiatric nursing at the University of California at... more
This interview is with Jane A. Ryan, RN, MN, CNAA, immediate past president of the American Psychiatric Nurses Association. She began her nursing career in 1959 and spent 27 years in psychiatric nursing at the University of California at Los Angeles (UCLA) Medical Center Neuropsychiatric Institute, and eventually was responsible for nursing systems. Now she consults with the U.S. Justice Department on psychiatric nursing in state psychiatrist hospitals. Lisa Legge, managing editor of Creative Nursing Journal, interviewed Ms. Ryan.
Research Interests: Nursing()
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Primary-care practitioners confront myriad issue in managing their patients with depression and/or anxiety. Understanding the scope and epidemiology of these disorders is essential to understanding their shared characteristics. Do we... more
Primary-care practitioners confront myriad issue in managing their patients with depression and/or anxiety. Understanding the scope and epidemiology of these disorders is essential to understanding their shared characteristics. Do we always recognize these patients in practice? What are the barriers to diagnosis and treatment, and how can they overcome? What are the treatment options of these sometimes life-altering conditions, and how do we choose from among the many that exist?
Research Interests:
Two focus groups were held with patients who had experienced inpatient hospitalization and their families, to discuss spiritual needs during psychosis. Spirituality was described in terms of relationship and religion in terms of rules.... more
Two focus groups were held with patients who had experienced inpatient hospitalization and their families, to discuss spiritual needs during psychosis. Spirituality was described in terms of relationship and religion in terms of rules. Four themes emerged to describe spiritual needs during an inpatient hospitalization: comfort, companionship, conversation, and consolation. Eleven succinct interventions were identified within these themes. The number one need expressed by consumers of all denominations and religions who belonged to a church/temple/spiritual group was for their pastor/rabbi/spiritual advisor to not abandon them. For those who did not belong to a religious/spiritual group their number one need was to at least be asked for some type of religious/spiritual preference and for the nurse to somehow contact the person mentioned.
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Research Interests: Nursing, Psychotherapy, Treatment Outcome, Cortisol, Allostatic Load, and 15 moreHumans, Child, Posttraumatic stress disorder, Female, Animals, Male, HPA axis, Nursing Care, Adult, Dehydroepiandrosterone, Anxiety Disorder, Glucocorticoids, Serotonin Uptake Inhibitors, Selective serotonin reuptake inhibitor, and hydrocortisone
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... may also be explained by the fact that many psychiatric CNSs have identified themselves aspsychoanalysts, psychotherapists, family therapists ... health nursing care, including choices about prescriptive authority, moves the specialty... more
... may also be explained by the fact that many psychiatric CNSs have identified themselves aspsychoanalysts, psychotherapists, family therapists ... health nursing care, including choices about prescriptive authority, moves the specialty forward as the twenty first century approaches ...
Primary-care practitioners confront myriad issue in managing their patients with depression and/or anxiety. Understanding the scope and epidemiology of these disorders is essential to understanding their shared characteristics. Do we... more
Primary-care practitioners confront myriad issue in managing their patients with depression and/or anxiety. Understanding the scope and epidemiology of these disorders is essential to understanding their shared characteristics. Do we always recognize these patients in practice? What are the barriers to diagnosis and treatment, and how can they overcome? What are the treatment options of these sometimes life-altering conditions, and how do we choose from among the many that exist?