Professional Nursing Advancement Program Recognizes Nurses’ Achievements

May 17, 2023

Five nurses were honored through the Professional Nursing Advancement Program (PNAP) at December’s Nursing Day Conference.

PNAP encourages nurses to advance in their profession, rewarding education and certification, clinical skills, research, and leadership—among other accomplishments. It’s a tiered system: tier 4 is the highest level a nurse can attain. Awardees were recognized in the tier 1 and 3 categories this winter.

Congratulations to the PNAP honorees! Read more about them below.

  • Laura Crupi, RN, BSN, ECT Service: Tier 3
  • Sheridan Armstrong, ADN, RN, Dissociative Disorders and Trauma Inpatient Program: Tier 1
  • Alex Dunham, BSN, Dissociative Disorders and Trauma Inpatient Program: Tier 1
  • Victoria Maxwell, BSN, Short Term Unit South: Tier 1
  • Megan Sly, BSN, RN, Short Term Unit: Tier 1

Laura Crupi

Nursing Philosophy

Crupi said her philosophy of nursing has evolved over her 33 years of practice, but a core tenet has remained constant: that care must be centered around “compassion, empathy, and clinical expertise.”

As a young teenager, she worked as a receptionist in her psychiatrist father’s office and learned a lot from witnessing how he interacted with his patients.

“They trusted him and relied on him for reassurance and guidance. I saw their facial expressions change after their session as compared to when they walked in,” she wrote.

Crupi believes that in order to provide top-quality care, nurses must consider every aspect of a patient’s life. And clinical expertise is critical. “Oftentimes it is the nurse’s role to provide education to both patients and their families, and it is therefore crucial that nurses remain up to date in their specialty.”

Clinical Exemplar

T is a childhood friend of Crupi’s, who had her first psychotic episode at age 13. Her parents sought care at McLean, where she spent the next year. T eventually found a medication regimen that stabilized her, and she graduated from high school and then college. Crupi stayed in touch with her over the years.

Fast forward 40 years. Crupi received a call from T’s sister saying that T was hospitalized with severe psychosis and catatonia. Crupi helped get her transferred to McLean’s psychotic disorders program, where she received excellent care. T eventually began receiving ECT at McLean and Crupi had the opportunity to care for her.

“When she came to the clinic escorted by staff, she, although quite psychotic, would ask for me,” Crupi wrote. “When she saw me, she smiled, her fear and anxiety lifted. I held her hand and reassured her that she was safe. She trusted me.”

“It has been nothing short of an honor to have had the opportunity to take care of her in her time of need.”

Sheriden Armstrong

Nursing Philosophy

For Armstrong, providing quality patient care requires having a deep devotion to helping others and viewing patients in a holistic way—taking into account their emotional, mental, and physical well-being—since psychiatric illnesses often co-occur with physical symptoms and disorders.

“Therapeutic communication and building rapport are fundamental pieces in caring for others,” wrote Armstrong. She added that taking into account patients’ race, ethnicity, cultural background, and religion and personal beliefs is necessary in order to provide culturally competent care.

It’s also the nurse’s job to help patients “regain a sense of self, autonomy, and hope for the future,” she wrote.

Finally, life-long learning assures that nurses are up to date on the latest evidence-based treatment. “No one is ever finished learning,” wrote Armstrong.

Patient Exemplar

The patient had a history of trauma, including sex trafficking, and had made multiple suicidal gestures on the unit. That day, she had pulled her blanket over her neck and head so it was impossible for staff to ensure she was safe.

Simply pulling the blanket off would have been re-traumatizing, given the patient’s troubled history with sleeping and being in bed.

“As the charge nurse, I had to make the decision to remove the blanket and decide how to do so without causing unnecessary distress,” wrote Armstrong. She asked the male staff member to step away, then asked the patient why she was struggling to show her neck and face. She replied that she was experiencing migraines and flashbacks. Armstrong offered her pain medication for the migraine and another medication to help her with the flashbacks.

The patient eventually agreed to remove the blanket and talk to Armstrong in a different room. There they reviewed some dialectical behavior therapy skills to help quell her distress and agitation. The patient thanked Armstrong for her gentleness and her consideration of her history.

“I was glad to have avoided negative outcomes for the patient and to be able to show her that even if she is struggling, she can reach out to staff for help and doesn’t need to struggle alone,” Armstrong wrote. “As a leader, I am constantly looking for ways to improve my therapeutic communication, sharpen my assessment skills, and try to learn the best way to teach my patients.”

Patient talks to clinician

McLean’s nurses are dedicated to delivering compassionate mental health care

Alex Dunham

Nursing Philosophy

When a nursing school professor of Dunham’s described psychiatric nursing as the “therapeutic use of self,” Dunham knew he had found the right path.

“I see it as a way to apply my knowledge and experience to provide safe and effective care as well as work on my own evolution.”

His approach to nursing is both humanistic and practical. He gravitates toward Jean Watson’s Theory of Human Caring, which emphasizes “interpersonal connection, energy, presence, intentionality, transcendence, creativity, and, above all, healing,” he wrote.

“I also am a very pragmatic person, so my practice is informed by the evaluation of the patients’ biopsychosocial health and needs, and identifying what ‘bricks in the wall’ might be missing or need repair.”

He believes one important part of his role is teaching patients coping skills to handle life’s stressors. “I often explain that the three ways to manage a stressor are to avoid the stressor, change the stressor, or change how we think about the stressor,” he said.

Dunham encourages patients to use mindfulness—a critical component of dialectical behavior therapy—to put space between their thoughts and emotions and release stress, and he cultivates his own practice as well.

Clinical Exemplar

Dunham first met D in the fall of 2021. She is a middle-aged woman with a trauma history, multiple psychiatric diagnoses, and chronic pain.

She also struggles with extensive dissociative episodes as well as psychogenic, non-epileptic seizures. In 2022, she was readmitted to the Dissociative Disorders and Trauma Inpatient Program on a Friday of a long weekend, after trying to burn staff on another unit with a lit cigarette. She had found out that a sibling had died suddenly.

Dunham was the charge nurse on a busy Saturday evening with three patients on five-minute checks. He was informed that D had wrapped a headband around her neck in a gesture of self-strangulation. She was put on five-minute checks but then was found in the bathroom, again attempting to harm herself. She asked for a one-on-one monitor, but Dunham said he believed she could keep herself safe with the help of staff.

He sat with her as she expressed her grief, talking about what it meant to lose the only person who understood what they had endured during their childhood. Dunham practiced active listening, encouraged her to eat and drink, and helped her settle into bed. He checked on her regularly and she got through the night safely.

Although the next few days were difficult, she was able to work on a plan for aftercare and looked forward to returning home to her wife. She also created a piece of art about her grief.

Dunham says she was one of the most challenging patients he has cared for.

“Working with her required me to monitor basic needs such as nutrition, rest, and pain control, as well as discussing coping, beliefs, and role change associated with acute loss … I formed an alliance with her by offering acceptance, being available, helping her find meaning, and helping to create a comfortable routine at the hospital. I also had to assess how to help her stabilize safely from acute crisis without causing an unproductive dynamic.”

Victoria Maxwell

Nursing Philosophy

Nurses must take the time to understand the uniqueness of each patient in order to create the most effective treatment plan, according to Maxwell.

“Knowing more about a patient’s strengths and areas for improvement, likes and dislikes, and overall personality traits is key in establishing interventions,” wrote Maxwell.

And when treatment is tailored to the individual, it’s more likely they’ll adhere to the plan post-hospitalization.

Maxwell also believes that while nurses can add to patients’ “toolbox” for coping with challenges, applying those skills while still hospitalized is critical.

“If they are able to practice using a skill independently on the unit with good effect, they are more likely to try this approach while in distress, knowing they have succeeded in this before. It can be difficult to push patients out of their comfort zones, but I feel it is necessary for us to try if we want them to succeed,” she wrote.

“We have not done our jobs if we just tell patients what to do; lasting changes will only occur if the patient practices skills and techniques for themselves.”

Her work as a nurse is guided by the belief that each patient should be viewed not just as another case, but through a humanistic and holistic lens, with their dignity and personhood intact.

Clinical Exemplar

The 21-year-old nonbinary patient was diagnosed with major depressive disorder, post-traumatic stress disorder, and bipolar disorder.

They also had a long-standing history of non-suicidal injurious behaviors and had made multiple suicidal gestures during their stay. Over an 18-month stay, they underwent medication trials, ECT and TMS, and finally, ketamine.

After undergoing ketamine treatment, the patient revealed a history of abuse by a teacher. The ketamine triggered intrusive trauma symptoms, leading to more frequent and severe self-injurious behaviors. Staff then had to restrain the patient for more than two hours on some days. The treatment plan had to be revamped to better accommodate the patient’s more acute needs.

Maxwell became the patient’s regular day nurse, familiarizing herself with their extensive mental health history, spending enough time with them to understand their “patterns, behaviors, and main stressors … The patient was able to open up more to me about their internal struggles, sharing thoughts and feelings with me they had never previously been able to verbalize or address.”

Having a strong therapeutic relationship with the patient enabled Maxwell to better advocate for their needs and to come up with more effective interventions when more standard ones did not work.

“It was oftentimes difficult to motivate the patient to use skills rather than turn to self-harm, but with consistent support and encouragement to take treatment into their own hands, they were eventually able to start identifying small bits of progress.”

That progress prompted them to engage further with treatment and imagine a life outside the hospital “after a year of denying protective factors or plans for the future.” The patient was able to eventually transition to the Gunderson Residence and then home.

“To this day, I still utilize crisis interventions for disassociation/self-harm that I learned from working with this patient,” wrote Maxwell.

“I keep this case in the back of my mind as a reminder of why I do what I do. Seeing someone able to take their life back is a privilege, and I strive to be part of this journey for my patients every day.”

Meghan Sly

Nursing Philosophy

Sly believes that providing holistic, patient-centered care grounded in evidence-based practice is the most effective way to help patients heal.

Professional integrity, honesty, and the equal treatment of every patient regardless of their own moral code are other elements of Sly’s nursing philosophy.

She described being particularly influenced by King’s Theory of Goal Attainment, which is “dependent on the relationship between nurse and patient being a successful transaction. If both work together, it ensures patient success.”

Sly also has incorporated Watson’s Philosophy and Science of Caring into her practice.

“With caring being the foundation of nursing, it leads to better health and a more conducive environment to learning,” she wrote. “Watson views nursing as a human science and focuses on meeting the patient’s needs while staying true to the nursing process.”

Sly added that her nursing philosophy will “continue to evolve over time with practice and experience.”

Clinical Exemplar

The patient had a long history of suicide attempts and hospitalizations, which resulted in a nine-month stay on the Short Term Unit.

They experienced multiple dissociative episodes every day, requiring hours of staff intervention to handle their self-injurious behaviors. They also had a deep mistrust of the medical community after receiving various complex diagnoses over the years.

Sly worked hard to establish a rapport with the patient and over time was able to win their trust. Sly was a constant presence, tailoring her communication to the patient’s needs and challenging their behaviors when appropriate.

With staff support, and the use of sensory techniques, therapeutic communication, and dialectical behavior therapy skills, the patient was eventually able to handle their self-injurious urges on their own.

“At the beginning of their stay, they would frequently engage in self-injurious behaviors … and had zero protective factors,” Sly wrote.

“By the end, they were utilizing DBT skills from their workbook, frequently journaling, and genuinely excited for discharge, knowing they had the skills and dedication to stay safe despite their chronic suicidality.”

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