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3011: The Table-top Simulation as an Engaging and Inexpensive Approach to Teaching Psychiatric Nursing
Joan C. Masters, EdD, MBA, APRN, PMHNP-BC
The challenges with using simulation in teaching psychiatric nursing are well-known, for example, mannequins do not move and actors can be expensive. Table-top simulations, typically used in disaster scenarios, are an engaging and inexpensive alternative to standard simulations. However, no publications were found reporting their use in teaching psychiatric nursing. In this presentation the development of a psychiatric nursing table-top simulation will be discussed. At the start, students read a Joint Commission report on inpatient suicide risk and an article by a psychiatrist criticizing unreasonably punitive restrictions on patients. Working in pairs and following hospital policy, students log–in a "patient's" belongings using faculty-prepared suitcases. Checking-in a patient is not something they are allowed to do in clinical and they enjoy this new activity as well as the challenge of finding more contraband than their classmates. Suitcases are packed with belongings patients would typically be allowed to have as well as more ambiguous items and contraband. In the debriefing, discussion centers on what are reasonable standards of safety in recovery-centered care, identifying risk factors for self-harm, and whether policies should be modified for different patients. Practical suggestions on assembling the suitcases as well as facilitating discussion will also be presented.
3011: Using Simulation Activities to Enhance Psychiatric Nursing Skills
Carole Bomba, MSN, RN, CNE
Therapeutic communication is a necessary skill for nursing students to learn early in the journey to becoming a registered nurse. Patient-actor scripted simulation scenarios with role-play are one method to provide beginning nursing students an opportunity to practice this skill in a non-threatening, safe environment while also assisting clinical faculty in the evaluation of skill acquisition. Students rotate through three different patient role-play situations with faculty observing the exchange between the beginning student and upper classman. One scenario utilizes a high fidelity mannequin that is programmed to have an alcohol withdrawal seizure. Students are required to interact with the patient as well as care for the patient during the seizure. The other two scenarios are role-play for a severely depressed client and a moderate to severely anxious client. A simple check list, completed by the observing instructor for each student regarding satisfactory or unsatisfactory (requires more practice), was developed to evaluate performance and determine areas for didactic enhancement. Student debriefing after each scenario provides qualitative information about the experience, which is also used to determine future revisions.
3012: CareIndicator, a Self-Management E-tool for Early Signaling and Intervention in Bipolar Disorder
Peter Goossens, PhD, MANP, RN, FEANS
IntroductionIn bipolar disorder, both patients, and caregivers experience the consequences of the illness and the burden is high. For patients, the risk of worsening of symptoms is increased when early warning signs for recurrence are not communicated effectively between patient, caregiver and professional. A lack of early intervention strategies increases the risk for recurrence to an episode of acute mania or depression. CareIndicator is an internet based tool that helps both patient and caregiver to monitor patient specific prodromes and symptoms.ObjectiveDeveloping and testing an E-tool for patients, caregivers and professionals that enables monitoring of early signals, based on an individual action plan composed by patient, caregiver and professional. MethodsDevelopment: focus group interviews with patients, caregivers, professionals and software engineers. After consensus in the focus group the software program was built and tested in an pilot.Pilot: 10 patients, 19 caregivers and 3 professionals have used the system over a period of 6 months. Evaluation pilot: a 24-item questionnaire on satisfaction, user friendliness and effects on self-management was administered.ResultsPilot: Preliminary results show that users find it easy to use and helpful to manage the illness symptoms. Full results will be presented during the APNA conference.
3012: Using a Web-based Patient-Provider Messaging System to Enhance Patient Satisfaction Among Active Duty Sailors and Marines Seen in the Psychiatric Outpatient Clinic: A Pilot Study
LCDR Jane Abanes, MSN/Ed, PMHCNS, PMHNP-BC
Problem: This paper will investigate the use of a web-based messaging system to increase patient satisfaction in a psychiatric outpatient clinic. Literature Review: Patient satisfaction is vital to the practice of psychiatry and remains as one of the key indicators of the quality of mental health care. One of the ways to measure the outcome of healthcare services is by determining the patient's satisfaction with the care received. Patients and providers are embracing the use of online communication as a way to communicate about their health status and treatment strategies. Theoretical Framework: The Transactional Theory of Stress and Coping (TTSC) by Richard Lazarus posits that stress is not measured by a single element but instead is a culmination of the interactions between the person and the environment. Lazarus underscores the influence of the person's self-appraisal or evaluation of the event in how the person will feel and respond to the situation. Implications: Maximizing technological advancements to improve patient satisfaction is imperative in the 21st century; and nurses are at the forefront of embracing this opportunity. However, to lead change and advance mental health, future efforts to integrate these innovations are needed in psychiatric mental health settings.
3013: Feminist Theory: Exploration and Application to an 82 Year Old Anxious Female Therapy Patient
Beverly Reeves-Dudley, MSN, MA, RN, APRN, PMHNP-BC
Elderly female populations presenting for psychotherapy need exploration of a variety of useful theoretical approaches with respect to their developmental needs as well as with situational problems. The literature base for application of Feminist theory needs to be documented more extensively. Additionally, literature review shows some effects of ageism on elderly females as they interact with health care communities highlighting the need to explore how to normalize this population. Generativity set-point is reviewed in a longitudinal prospective study which found that it was achieved when combined with optimism even in declining health in that study of aging women. Feminist theory's compatibility with the concept of generativity set-point as evidenced by improved self efficacy in elderly women is hypothesized. The basic tenets of Feminist theory are reviewed and applied to a therapy patient in an original case study of an elderly female with anxiety exacerbation after an interaction with a health care community. Results for this therapy patient using feminist therapy resulted in improvement in self efficacy. A scale quantifying psychological well-being is discussed as a possible measure of generativity set-point in future research.
3013: Need for Resourcefulness Training for Women Caregivers of Elders with Dementia
Jaclene A. Zauszniewski, PhD, RN-BC, FAAN
Nearly 10 million American women provide care to elders with dementia and may experience overwhelming stress that adversely affects their health. Interventions to teach them to be resourceful in managing their stress may promote their optimal health and facilitate continued caregiving. However, before examining the effectiveness of resourcefulness training (RT), the need for it must be established. Purpose: This pilot intervention trial examined the need for RT in women dementia caregivers. Theoretical Framework. Zauszniewski's mid-range theory of resourcefulness identified the personal and social resourcefulness skills constituting RT. Methods. A convenience sample of 138 women caregivers supplied data on resourcefulness, stress, and depressive symptoms before and after RT. The analysis focused on baseline resourcefulness scores, correlations among resourcefulness, stress, and depressive symptoms, and caregiver post-RT evaluation of need for self and others. Findings: Only 4% of the baseline resourcefulness scores indicated a low need for RT. Lower resourcefulness was associated greater stress and depressive symptoms (r's=-.37, -.53). After RT, 82% of the caregivers reported they needed RT; 93% believed other caregivers need RT. Implications: The results suggest a substantial need for RT in women dementia caregivers and support moving forward with testing RT effectiveness for reducing caregiver stress and depressive symptoms.
3014: Crisis Intervention Training with a Twist: National Staff Training to Develop Self-care Skills and Integrate Chaos Theory for Safer Work Environments
Angela C. Schmidt, BS, BSN, RN-C
Research has shown psychiatric nurse burnout is associated with violence, unsupportive management, lack of formal orientation programs or continuing education programs for staff, high risk and acutely ill patients, too much paperwork and inadequate numbers of staff and/or unsupportive staff communication. Organizational strategies must be developed to break through the silence around PTSD in nurses. Nursing leaders have a duty to inform nurses their work has the possibility for the development of PTSD. Administrative nursing leaders need to attend workshops on how to detect PTSD symptoms in nurses. Occupational stress for nurses can lead to compassion fatigue, burnout, and secondary traumatic stress syndrome. It is necessary for all nurses to be taught the applications of change and chaos theory to allow for daily transitions in the workplace. The ability of nurses to adjust to new evidence-based practice, new leadership models, the essentials of the Magnet hospitals along with nursing informatics have caused new levels of stress never experienced on this multitude of levels simultaneously. For nurses to survive and thrive in the 21st century healthcare model, the APNA must become a leading stakeholder in development and adoption of mandated staff development programs to create healthy work environments.
3014: Demographics, Clinical Characteristics, and Pharmacological Treatment of Aggressive Patients Admitted to an Acute Inpatient Behavioral Health Unit of a Community General Hospital
Cynthia Reade, MS, RN-BC, NE-BC
Introduction:The aggressive patient is a common presence upon the acute inpatient behavioral health units of general hospitals. Previous research has focused upon certain areas to examine regarding predictors or contributors to aggressive or violent behavior during patients' hospitalizations: demographics, clinical characteristics which includes diagnosis and symptoms, unit environment, and staff's interpersonal communication. These factors are all discussed in this research. Method: Forty behavioral health patients participated in this naturalistic observational study and met inclusion/exclusion criteria. Tools utilized were the CGI-S, MOAS with repeated measures statistical analysis and ANOVA. Demographics and clinical characteristics data were also obtained and medications utilized for stabilization at patient discharge. Results: Males of a younger age with a previous history of violence and psychotic symptoms with dominant interpersonal personality characteristics displayed more aggressive behavior. Detailed statistics will be presented at conference. Conclusion: Younger male patients who present with psychotic symptoms, agitation, paranoia, and have co-morbid substance use and a history of violence, particularly within 24-48 hours prior to admit are at risk for violent inpatient behavior during hospitalization with higher risk occurring during the first week of hospitalization.
3015: African American Males Diagnosed with Schizophrenia: Strategies for Treatment
Lorraine B. Anderson, PhD, MPA, RN
AbstractOf the 2.4 million persons diagnosed annually with schizophrenia, African American males comprise a disproportionate cohort. Little, however, is published concerning how these men view themselves within the context of their recovery. This research explores and analyzes aspects of the recovery process that can inform treatment strategies applied by nurses. In the study, five men ranging in age from 21 to 57, living in an urban setting, described their lives in the context of existing with the diagnosis of schizophrenia. Their reports on how they see themselves and others in connection to their diagnosis of schizophrenia have distinct implications for treatment and further research. Based on the findings of this qualitative study, themes potentially impacting therapeutic relationships include ; a desire for authenticity and validation of how the men see themselves are important components of their sense of self; a determination to maintain the boundaries and integrity of their personhood fueled their dialog; by coming to terms with their diagnosis, the participants had achieved an intimate knowledge of themselves and they used this knowledge to improve themselves and advocate for others with schizophrenia. Specific recommendations for treatment planning are proposed in this presentation.
3015: Physical Violence, Emotional Support, Depression, and Suicidal Ideation Among Thai Women
Barbara L. Drew, PhD, PMHCNS-BC
Problem: Over one million people die by suicide worldwide annually. Suicidal ideation (SI) is a known risk factor for suicide and other negative sequelae of depression. Predictors of SI have not been thoroughly examined in women in Thailand. Purpose: To examine predictors (physical violence, emotional support, and depression) of SI among Thai women.Methodology & Analysis: Quantitative data pertinent to physical violence, emotional support, depression, and SI were retrieved from an embedded mixed methods study of 284 OB/GYN Thai patients. Well-established questionnaires (Severity of Violence Against Women Scale; Thai Depression Inventory; and Multidimensional Scale of Perceived Social Support) measured physical violence, emotional support, depression, and suicidality. Alphas of instruments ranged from .88 to .96. Amos Graphics version 21 was used to perform multiple regression analysis. Findings: Approximately 8% of participants had suicidal thoughts. Physical violence and depression were significant predictors of SI. The more the participants experienced physical violence (ß = .12) and depression (ß = .31), the more thoughts they had about committing suicide. Emotional support did not predict SI. The whole model yielded 11.4% of the explained variance in suicidal thoughts. Implications for nursing: Routine screening for physical violence, depression, and SI in Thai OB/GYN patients is warranted.
3016: Recovery Oriented Approach to Milieu Management in a Community Hospital
Jason Melegari, BSN; Brittany Chabak, LSW, MPH
The Tidal Model is a mental health recovery and reclamation model of nursing care specifically designed for acute inpatient psychiatric facilities. Rooted in existential phenomenological psychology and informed by chaos theory, this model provides a pragmatic approach to empowering patients by emphasizing the centrality of one's lived experience, which is discovered and explored through an egalitarian patient-nurse relationship. The Tidal Model has been in use in over 100 facilities worldwide, but there has yet to be a documented implementation of this model in the US. A 32-bed inpatient adult psychiatric unit in Western Pennsylvania recently designated an interdisciplinary committee of 15 key employees to spearhead the creation of the first US inpatient program influenced by the Tidal Model. Utilizing Tidal Model components, this committee will develop a concrete recovery-oriented methodology to restructure the milieu on the inpatient unit and alter the staff's philosophical approach to patient care. Based on research conducted at other institutions employing the Tidal Model, it is anticipated that successful implementation of the adapted Tidal Model at this inpatient adult psychiatric unit will result in fewer instances of patient aggression, a decreased need for restraint procedures, and improved patient satisfaction.
3016: Relationship Between Emotional Intelligence and Leadership Behaviors of Mental Health Nurses
Traci T. Sims, APRN-BC, MS
Emotional Intelligence (EI) is a growing field in both nursing practice and nursing education. Studies have shown that there is a positive relationship between EI and nursing performance. While there are gaps in the literature examining EI among mental health nurses, there is evidence to suggest that mental health nurses who use EI skills are more likely to promote high quality person centered care. Evidence also points toward a correlation between EI and leadership skills. Mental health nurses are agents of change, and research has shown that mental health nurses' leadership and management skills are associated with patient outcomes and organizational effectiveness. The Mayer-Salovey-Caruso Emotional Intelligence model was used to guide this study. Two instruments were used to collect EI and Leadership scores: Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), and Leader Behavior Description Questionnaire - Self (LBDQ). The sample was drawn from mental health nurses at one facility in North Georgia. Results provide evidence of EI among mental health nurse participants and identify the relationship of EI scores to leadership skills. The study has implications for mental health nurse practice, nursing management, and nursing school curriculum.
3021: Intensive Outpatient Behavioral Health Program in a Military Facility
JoEllen Fielden, DNP, PMHNP-BC, ANP-BC
There is a great deal of evidence that psychosocial stressors may be etiological factors for depressive, anxiety, and adjustment disorders in the military. Difficulty coping with stressors was a contributing factor in 82% of active duty military suicidal deaths in the past few years. Behavioral health disorder costs are high, not only with lives lost to suicide; but with military readiness, poor work performance, social problems, and high rates of unhealthy behaviors. This presentation describes a three-week behavioral health intensive outpatient program design implemented at the San Antonio Military Medical Center. The program's overarching philosophy was to develop and institute a holistic behavioral health fitness program for Service Members in order to decrease symptoms, enhance performance and build resistance. The program is specifically aimed at decreasing symptoms associated with depression, anxiety, and hyper-arousal while increasing the ability to self-regulate, and restoring a sense of self-efficacy through provision of coping skills. After completing the program, Service Members will have acquired knowledge and skills to assist them in their transition back to their units or into civilian life. Future implications include modeling readiness focused behavioral health treatment, utilizing alternative treatments, and improving continuity of care (between inpatient and outpatient services).
3022: Boy: TDTM Girl: CD9--Decoding the Dangers of Teen Sexting
Erin Ellington, DNP, RN, PMHNP-BC
Recently, a cultural phenomenon referred to as "sexting" has spurred media and parental attention. Sexting, a portmanteau of sex and texting, is the exchange of sexually explicit images between two people via cell phone or similar device. The prevalence among adolescents has been captured by popular press surveys and more recently by peer reviewed articles; involvement rates vary, but the numbers are alarming. Cell phone communication creates unique issues including development of digital artifacts, potential for widespread circulation, and permanency of the content. Teen vulnerabilities to sexting include volatility of teen relationships, normative increase in sexual energy, and neurodevelopmental influences. Sexual exploration without having sex and sexualization of youth are implicated in teen sexting; peer pressure and other social influences also play a role. Psychological, social, sexual, and legal consequences of sexting are unexpected to many teens during the impulsive act. Preexisting and subsequent mental health sequelae are of special concern. This presentation will equip mental health nurses with tools needed to improve their personal media literacy, incorporate media history taking into their assessments, support and educate teens and parents regarding sexting, and become involved in other activities to prevent or minimize the devastating effects of teen sexting.
3023: Lessons from the Front: Psychiatric Nurse Practitioners Providing Health Care Integration
Aaron M. Miller, RN, MS, PMHNP-BC; Sherri A. Borden, ANP-BC, CNS; Matt Tierney, MSN, CNS, ANP-BC, PMHNP-BC; Bethany Phoenix, PhD, RN, CNS
Despite well-documented high comorbidity of psychiatric and physical disorders and widespread recognition of the need for integrated behavioral health and primary care, stubborn barriers to integration persist. These include differing clinical cultures, a fragmented delivery system and varying reimbursement mechanisms. Psychiatric-mental health APRNs have a key role in bridging existing gaps in the health care delivery system and providing leadership to develop new systems to provide effective integrated care. This panel presentation will begin with an overview of integrated care initiatives and models for use of PMH-APRNs to provide integrated care. Panel members will provide exemplars of Psychiatric-Mental Health NP roles facilitating integrated care in three different settings: 1) a faculty practice offering on-site integrated health services in a community-based organization that delivers residential mental health treatment; 2) a federally qualified health center that provides on-site mental health services; and 3) an office-based buprenorphine induction clinic. Panelists will discuss 1) how health problems that otherwise "fall between the cracks" of our fragmented health care delivery system can be addressed using an integrated nursing model; 2) contradictions or areas of tension that must be resolved in order to provide comprehensive, coordinated, continuous and person-centered care.
3024: Recovery Goals: Identifying a Patient's Passion
Chris Walker, MSN, RN, MHA
Problem: Historically patients on a locked mental health unit do not find their stay to be effective to help them cope with life issues in the real world. The patient's plan of care typically involves the staff defining what goals the patient needs to accomplish in order to be discharged. Summary of findings from literature search: Reviewed 40 randomized controlled studies of illness management programs and identified five effective components of successful programs. Theoretical framework: Illness Management and Recovery (IM & R) is a step-by-step program that helps people set meaningful goals for themselves, acquire information and skills to develop more sense of mastery over their psychiatric illness, and make progress towards their own personal recovery. Effective components of IM & R programs include psychoeducation, behavioral tailoring for medication adherence, relapse prevention training, coping skills training and social skills training. Brief description of practice: Staff were taught how to connect everything to patient recovery goals, involving significant others, and tracking the patient's progress towards goals. Staff uses motivational, educational, and cognitive behavioral techniques. Future implications: IM & R gives our patients the improved ability to manage their illness which helps to avoid relapses and hospitalizations.
3025: And the Oscar Goes to… Mental Health Therapeutic Communication Simulation: Enhancing Student Learning
Leslie Miles, DNP, PMHNP-BC; Linda Mabey, DNP, APRN-BC; Katie Stansfield, BSN Student; Sarah Leggett, BSN Student
Mental health nursing does not lend itself well for nursing faculty observation of student- patient therapeutic communication. There is limited literature about how to bridge the gap between didactic and clinical experiences that would guide students towards the highest levels of therapeutic communication competency. Brigham Young University faculty created an innovative simulation approach to enhance the learning of students in communication skills to promote change and growth in patients. First semester and senior nursing students participate in recorded patient interaction simulations. Standardized patients were developed to provide consistency. No expensive mannequins, paid actors or volunteer faculty are needed. Previous semester volunteer nursing students portray the standardized patient and provide immediate feedback about the therapeutic factors in the simulated interactions. To integrate the learning experience, students complete a written assignment where they identify the effective and non-effective communication skills and therapeutic techniques utilized, identify areas of personal strengths and weaknesses, and address the therapeutic factors of genuineness, empathy, and positive regard. A recording of each interaction provides the venue to assess essential verbal and nonverbal skills that faculty members were hoping to measure and provide formative feedback across the curriculum. Student evaluations have been positive about these unique learning activities.
3026: The Experiences and Needs of Family Members of Adolescents with Disruptive Behavior Disorders
Ukamaka M. Oruche, PhD, RN, PMHCNS-BC; Claire Draucker, PhD, RN, FAAN; Halima Al-Khattab, RN, PhD Student; Hillary Cravens, MSN, RN; Brittany Lowry, MSW; Laura Lindsey, RN
Purpose and Background: Adolescents with Disruptive Behavior Disorders (DBDs), which include Oppositional Defiant Disorder and Conduct Disorder, present unique challenges for their families. Most studies of these families have focused on the experiences of mothers, and little is known about the experiences of fathers, siblings, and other family members. To inform family-focused interventions, problems and perceived needs of all family members need to be better understood. This study aims to describe the functioning of families of adolescents with DBDs, levels of emotional distress of adult family members, and experiences and perceived needs for support and/or treatment of all family members. Methods: Multiple family members (e.g., parents/caretakers, siblings, and other significant family members) from 15 families of adolescents with DBDs are being recruited from a public mental health clinic. Data are gathered with self-report questionnaires and in-depth interviews. Survey data are being analysed with descriptive statistics and interview data are being analysed by standard content analytic procedures.Results: Preliminary results from eight families indicate difficult family functioning and above average levels of distress in adult family members. Content analyses of experiences and perceived needs for support and/or treatment are on-going.Conclusions: Implications for intervention development will be discussed.
3031: Moral Injury in Returning Veterans: Concept and Emerging Treatments
Doris C Vallone, PhD, PMHCNS, BC
Over two million service members have been deployed to Afghanistan and Iraq since 2001. Recent government reports have identified posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) as the signature mental illnesses among Veterans of these conflicts. Vast treatment resources have been marshaled in both the Veterans Health Administration and the Department of Defense. During the past few years, clinicians working with recently deployed service members observed that there were symptoms unique to those who witnessed or engaged in perceived unnecessary acts of violence. They identified the phenomenon as "moral injury". Moral injury results when there is an internal conflict resulting from a perceived transgression of a personal moral code. It is evidenced by shame, guilt, anxiety and self-condemnation. There is high risk for suicide. The treatment strategy combines education, elements of traditional exposure, self-forgiveness and restitution acts. The attitude and introspection of the therapist is also a key component. Nurse therapists will encounter returning Veterans in many treatment settings outside of the VA. Recognizing the manifestations of moral injury will enable them to offer these Veterans a compassionate connection.
3032: Turning the Tides of Trauma and Addiction Through Group Therapy
Joan Parker-Dias, RN-BC, MSN, PMHCNS; Tina M. Truncellito, RN, BS, CNIV
Turning the Tides of Trauma and Addiction through Group TherapyPurpose/Description of ProblemUp to 59% of adolescents with post-traumatic stress disorder (PTSD) subsequently develop substance abuse. These co-morbid conditions are associated with increased symptom severity and worse treatment outcomes. Youth in the inpatient setting face a lack of integrated services. This project seeks to identify an effective evidenced-based group therapy for treating trauma and substance abuse within the adolescent population. Model/PlanThe Iowa model of Evidenced-based Practice guided this clinical innovation project.Background/MethodsThe trigger for this project was a lack of standardized therapeutic approaches for treating trauma and substance abuse disorders in a residential behavioral health unit. A team met monthly to critique and synthesizes twenty-one articles. Expert opinion was solicited from substance abuse treatment centers. Outcomes/ResultsBy March 2013 it is anticipated that a group therapy program will be implemented. Expected evaluation measures include: trends in incidence of adverse events (seclusion/restraints, self-injurious behaviors, PRN medications); prevalence of PTSD symptoms (via patient self-report tool); recidivism rates; patient adherence with substance abuse relapse prevention plans.Recommendations/Implications for NursingAnticipated implications for psychiatric nursing include the delivery of safe, quality patient care as evidenced by positive improvement in patient outcomes.
3033: Integrating Behavioral Health in a Primary Care Clinic
Kathy E. Brotzge, MSN, PMHNP-BC
Psychiatric treatment is not available to everyone. Many seek treatment thru primary care. Advanced practice psychiatric nurses can help by working as prescribing/treating psychiatric consultants in the primary care setting. Integrating care can improve quality of life and health. A review of literature provided studies on the increase in quality of life for persons receiving care in an integrative system. Research supported improvement in medical and mental illnesses in co-located primary care and mental healthcare clinics. Eight hours a week I work in a community health primary care clinic as a psychiatric nurse practitioner. I am a consultant to the primary care prescribers. This position is supported by an LCSW, behavioral health support associates and a case manager. I evaluate persons who have failed on multiple treatments, gotten lost in the mental health system and provide education to prescribers.The primary care clinic provides a great opportunity for behavioral health care. It can also help persons with severe comorbid medical conditions maintain better health. This model is one that improves quality of life. The advanced practice psychiatric nurse can improve care and collaboration with primary care.
3034: Promoting Recovery with Trauma Informed Practice
Diane H. Esposito, ARNP, MSN, PMHCNS-BC
The incorporation of a recovery model in the treatment of mental health disorders has been cited as one of the most important goals for the mental health care delivery system. Another key focus in transforming the mental health care system is the concept of 'trauma-informed care'. These concepts go hand in hand, and research has already identified that incorporation of trauma specific interventions has enhanced the recovery and decreased relapse rates when used in chemical dependency treatment programs (McHugo et al, 2005). This presentation will review the fundamental components of 'recovery' and 'trauma informed care' as they relate to behavioral health care. This presentation will also review several theoretical frameworks regarding trauma, and discuss the standardized assessment tools available to screen for the experience of trauma, and present several treatment strategies for trauma related behavioral health conditions.
3035: Creating and Evaluating "The Mental Health Ward": An International Collaborative Evidence Based Simulation
Jeanette Rossetti, EdD, MS, RN; Trish J. Bendel, MS, RN
There is a need for significant enhancement of psychiatric mental health nursing education that incorporates recovery principles into the undergraduate curriculum. Educational models and innovative teaching strategies that are evidence-based are needed to better prepare nursing graduates entering the specialty of psychiatric mental health nursing. This presentation will discuss the development and evaluation of a new curriculum "The Mental Health Ward" offered at a Midwestern University. This innovative, simulated hospital environment (situated at a collaborating behavioral health hospital) includes the use of standardized patients and scenarios resulting in a full mission simulation. The collaborative effort between faculty, students, nurses, service users, and international colleagues in the development and success of the Mental Health Ward will be highlighted. In this simulated hospital environment, students learn a variety of psychiatric diagnoses and practice a variety of skills while incorporating recovery principles in their care. The developed infrastructure of the Mental Health Ward and results of research utilizing the CAE© Simulation Effectiveness Scale will be reviewed. Learning Outcomes related to self-efficacy and communication techniques utilized by nursing students in the simulated experience will be highlighted.
3036: The Effects of Aroma Therapy on Falls in a Geropsychiatric Population.
Suzanne Lee, BSN, RN; Erin Ritter, MSN, RN, CNL
Background: Geriatric populations are at risks for falls. Purpose: Use aroma therapy to decrease agitation and decrease the use of sedating medication in geriatric patients in the hospital. Theory: there is some evidence that essential oils have an effect on GABA pathways and have anxiolytic effect on patients. Method: each month director collects fall information and adds the number of falls to the matrix. Data has been collected for the past year on the geriatric unit and compared to previous year falls. Findings: Falls have reduced 50% over previous year since the introduction of aroma therapy. The number of medications given for agitation has also decreased over the past year. As an unintended consequence, staff report feeling calmer and more relaxed during aroma therapy use. Implications: Agitation in geriatric patients can be relieved by the use of aromatherapy. Aromatherapy has been proven to relieve agitation, reduce sensory stimulation, enhance memory, and improve sleep. In addition, it provides an alternative to sedating medications which can pose a risk for falls in geriatric patients.
3041: Roadmap to Recovery along the VA Way : A Guide to Applying the Recovery Model to Nursing Practice Across the Continuum of Care
Joan Strenio, MSN,PMHCNS-BC
During the 26th Annual APNA conference, the Recovery Council confessed that psychiatric nurses as a discipline were behind their professional peers in incorporating recovery principles into their practice. Despite research findings which support the belief that many individuals with serious mental illness can achieve high levels of social, educational, and occupational functioning despite experiencing relatively severe symptoms, traditional paternalistic models of psychiatric care persist in many settings. This session will describe how the Cleveland VA's Psychosocial Rehabilitation and Recovery Center (PRRC) achieved award winning recovery model fidelity status by offering evidence-based programming and processes,community integration activities, and individualized goal planning and coaching to help participants achieve greater life satisfaction. In particular,classes in CBT, Social Skills Training, WRAP, Illness Management and Recovery, Health and Wellness and Dual Diagnosis are offered to address learning and rehabilitation needs. Collaboration with intensive case management, supportive employment, primary care and other VA and community based services are used to provide holistic,integrated care. The model supports the concepts of mutual respect, strengths focus, trauma informed and choice driven care. Case study examples will be provided during the discussion to illustrate success stories.Implications for nursing practice across the continuum of care will be provided.
3042: Promoting the Therapeutic Alliance by Defining Effective Engagement Between Adolescents and Their Mental Health Clinicians
Jennifer S. Schneider, RN, MA
Client engagement in mental healthcare is critically important to facilitate effective therapeutic change and is vital to the psychiatric nurse-patient relationship. Engagement is especially critical with adolescents, as this is a time period of enormous identity development. Adolescent engagement is a common construct in both the research and clinical literature although definitions are inconsistent. In the research literature, engagement is often defined in terms of behavioral measures such as attrition rates, while the clinical literature focuses on the therapeutic alliance between client and clinician. Using Morse's Pragmatic Utility Method of concept analysis, the depth and breadth of "adolescent engagement" will be explored across literature contexts and mental health practice disciplines. A definition of adolescent engagement in mental health services will be presented using cognitive behavioral change theory to organize components of engagement into three discreet and exemplar categories: behavioral, affective, and cognitive. Having a richer definition of engagement will allow for better measurement of this concept and can improve understanding of its role in the therapeutic relationship and in mental health outcomes for adolescents. Presentation participants will be introduced to new strategies of engaging with their adolescent clients based on this emerging theoretical model.
3043: Development of a Behavioral Health Medical Home: Nurses Filling the Gap
Paula Bolton, MS, APRN-BC; Margaret Knight, PhD, PMHCNS-BC
Obesity, metabolic syndrome and cardiovascular disease are major health issues. Persons with serious mental illness are at higher risk for these conditions than the general population. Psychiatric nurses encounter patients with these conditions as well as risks for developing severe complications.Addressing the medical needs of the acutely ill psychiatric patient is challenging and complicated. As patients move toward self-care, chronic medical issues may not be fully addressed by the psychiatric team, yet patients have difficulty negotiating the complexities of the health care system to get medical needs met. This presentation will highlight risks and discuss evidence-based nursing measures to integrate psychiatric, medical, lifestyle and behavioral issues across inpatient, residential, and outpatient settings.The concept of the behavioral health medical home will be explored along with the integral role nursing must play to develop these ventures. This presentation will include a description of a pilot study underway to implement a behavioral health-medical home within a psychotic disorders program at a major free-standing psychiatric institution.
3044: Advancing Mental Health Recovery: Lessons Learned from the Transformation of an Inpatient Unit
MaryBeth Cassidy, MSN, APRN-BC; Sandra Jensen, BSN, RN
The 2011-2014 SAMHSA initiatives of recovery support and health reform along with increasing recidivism in the psychiatric population provided the vision for the transformation of a 20-bed inpatient psychiatric unit. This presentation will explore the catalysts for change, planning, implementation and evaluation processes associated with the collaborative, interdisciplinary initiative to launch a recovery based treatment program on a psychiatric unit where the previous treatment delivery model was inconsistent with recovery oriented principles. Participants will learn about the critical psychiatric nursing roles required in transforming the delivery of inpatient care. This will include discussion about the leadership role of the nurse manager in gaining staff buy-in, instilling motivation, providing education, and ensuring nursing accountability in the implementation of a recovery paradigm. It will also focus on the refinement of the nurse practitioner's role as hospitalist in managing all aspects of patient care and providing clinical leadership to target outcomes for this redesigned inpatient program.
3045: Hearing Voices: Evaluation of a Six Second Simulation
Brenda Marshall, EdD, PMHNP-BC; Julie Bliss, EdD, RN
Background: Simulation teaches nurses about urgent situations without posing any threat to the patient during the learning session. Psychiatric hi tech simulations provide opportunities to interview a bipolar patient or "see", using special eyeglasses, visual hallucinations. Evaluating the educational worthiness of these experiences on educational impact have not been well documented in the literature. Purpose: This study evaluates the educational impact of a six second in-class simulation of "hearing voices". Theoretical Framework: Meizirow's (1981) transformational learning focusing on experience, critical reflection and rational discussion in education. Method: Over a three year period (2010-2013) over 200 undergraduate nursing students engaged in the six second "hearing voices" simulation during a mental health class. Sixty randomly chosen, anonymous self-reflective papers were analyzed using ATLAS ti7 software to identify common recurring themes. Findings: Preliminary results demonstrate that students report increased empathy for the schizophrenic patient, a deeper understanding of the stress and anxiety a schizophrenic patient experiences and a professional determination to engage in therapeutic communication techniques to support the clients road to recovery. Future Implications: Developing short, effective experiential learning simulations for psychiatric mental health education would transformational learning experiences that can increase understanding of the importance of developing strategies for therapeutic communication.
3046: What You Really Need to Know About Menopause, Prescribing & Depression for Advanced
Margit B. Gerardi, PhD, RN, WHNP
It is well established that rates of depression for women peak from 45 to 64 years of age. What remains more elusive is the role of estradiol in the aging brain as the many activities of estradiol in the human brain have only recently been explored. It has been suggested that estrogen has a role as a trimonoamine modulator for depression and vasomotor symptoms especially in the beginning of menopause. Estradiol influences regionally specific apoptosis, synaptogenesis, and the form of neurons and astrocytes with additional non-estrogen receptor effects influencing ion channels and G protein-coupled receptors. These and other factors need to be considered when prescribing antidepressants for women experiencing peri-menopause and menopause. With regard to prescribing, estrogen has been found to decrease oxidation of some tricyclic antidepressants such as imipramine. Concurrent use of medications and regimens known to induce cytochrome P450 enzymes may increase the metabolism of estrogens and progestogens. Researchers have suggested that certain antidepressant classifications work better in the presence of hormone replacement therapy than other classes (SSRI versus SNRI). APRN's need to use this information to individualize pharmacotherapy and address important health concerns and related nursing interventions for care of the peri-menopausal and menopausal woman experiencing depression.
3051: APNA's Institute for Mental Health Advocacy: What's New on the Advocacy Scene for 2013
Margaret Halter, PhD, APRN; Christine Tebaldi, MSN, PMHNP-BC
The Institute for Mental Health Advocacy Interactive Panel focuses on advocacy initiatives for the past year. We will describe the initiatives that APNA signed onto and exciting events where APNA took its place at the table. APNA members will share health policy issues happening in their states and solicit feedback. Attendees will be encouraged to interact and share their ideas for APNA's advocacy work.
3052: Child and Adolescent Council Interactive Panel
Sue Odegarden, MA, MS, BSN; Vanessa Genung, PhD, RN, PMHNP-BC, LCSW-ACP, LMFT, LCDC
This panel meeting is an opportunity to address advances in mental health recovery for child/adolescent practice. Share your success stories, recovery principles, and methods to minimize mental health problems for children/adolescents/ families. Go to the APNA website discussion board-post a topic for discussion-describe care that was successful.
3053: Tobacco Dependence Interactive Panel
Daryl Sharp, PhD, PMHCNS-BC, NPP; Susan Blaakman, PhD, PMHNP-BC
The interactive panel will update participants on our progress in implementing APNA's national strategic plan for addressing tobacco dependence with a particular focus on nursing education.
3054: Forensic Psychiatric Nurses Council Interactive Panel
Carrie M. Carretta, PhD, APN, AHN-BC, FPMHNP
Violence and crime are major issues facing practicing psychiatric nurses. Forensic psychiatric nurses are poised to deal with these issues in a variety of settings. The purpose of the Interactive panel is to focus on key issues through interactive case studies involving homicide, suicide, and combined homicide/suicide.


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At SeaWorld, everything we do is for the young or young at heart. Here are a few highlights of experiences your kids will love!
A Sesame Street® Breakfast
Limited time offer during Just for Kids! weekends only. Now through May 18, kids eat FREE at Sesame Street Breakfast! When you purchase 1 adult reservation, you can get 1 FREE reservation for your child. So start your day with a delicious buffet and great big hugs from Elmo and his Sesame Street friends. Hurry, space is limited! Book now >
Family Adventure Tour
Enjoy an exclusive, early morning SeaWorld® experience before the park gates even open. Get an up-close look at our animals and a chance to feed seals, sea lions and Atlantic bottlenose dolphins a bite of breakfast. Later on, enjoy reserved seats for our One Ocean® show and a Quick Queue® ticket for front-of-line entrance throughout the park. Book now >
Sefari Tour
During the Seafari Tour, guests have the opportunity to feed Atlantic bottlenose dolphins at Dolphin Cove®, seals and California sea lions at the Seal and Sea Lion Community Pool, and visit Sharks/The Coral Reef and Penguin Encounter®. Book now >
Sesame Street® Bay of Play
Sesame Street Bay of Play is an attraction for families featuring Elmo, Big Bird and all their friends. Sesame Street Bay of Play includes 3 acres of exciting rides, shows and play areas. Explore more >
Reserve a private cabana for a space that's exclusively yours and includes extras like towels and lunch! Book now >
Dolphin Cove®
This spacious lagoon is home to a pod of playful Atlantic bottlenose dolphins whose intelligence is matched only by their appetite for fun. Whether they're showing off their jumping skills or catching the fish tossed out at feeding time, see why humans have been crazy about dolphins for centuries. Explore more >


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Favorite to fool and, therefore, overall favorite: Local mottleds top my list by getting wise shortly after the shooting starts and compounding that frustration by piloting migrators to safe waters. It's almost a grudge match between us requiring skill and innovation to draw them to known spreads or to blend into spots they deem safe.
Favorite to shoot: I find the greenwings' aerobatics make them the most fun to shoot.
Favorite to eat: Neither blackbellied or fulvous whistling ducks fly as far or hard as other wild ducks, so neither shares their oxygenated blood demands, meaning they've lighter, milder, more domestic duck-like meat.
Favorite from a guiding standpoint: Has to be the mallard. No other bird is as responsive to decent calling and makes me look so much like I know what I'm doing. And few other ducks are as easy for young, old and the most casual of hunters to hit.


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Peace, Love, and UnderstandingWhat's so funny about protesters camping in lower Manhattan? More scenes from #OccupyWallStreet.
Photographer Jacob Blickenstaff is covering the #OccupyWallStreet protests in New York City for Mother Jones.
Don't miss the rest of MoJo's coverage: Follow reporter Josh Harkinson inside Zuccotti Park; meet the activists who created "We Are the 99 Percent"; check out the former Obama blogger who joined the protesters after scorning them; explore our interactive map of protest hot spots nationwide; and much more.


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Hey there fellow anime-lovers! Welcome to my bio, where you can find out about me (maybe a bit more than you wanna know) and find a list of spanking good sites for your anime-purposes!
First my bio:
Ive been watching anime since I could remember; my first ones being Crayon shin-chan, Doraemon, and Dragon ball Z. I started watching anime in a more dedicated otaku fashion around early 2006, starting with Shaman King. Then i stopped watching anime (sacrilegious indeed) for a bout a year, before i discovered the gospel that was Death Note, which truly steered me back into The Path (of Otakudom) Ever since then, I've been in love with anime, manga, visual novel and related 2D goodness ^.^
Since about Spring (in Japan) 2009, I've been watching a lot of the Currently Airing shows, as well as downloading about 80% of everything that airs/gets released. But more on my collection later~ ^^
Finally, if you're bored or got an exam coming up, may I suggest a fine way to procrastinate is to look through my list of Watched Anime and suggest some of your own favourites that I havent yet seen. I'd love to get recommendations from fellow anime-lovers :)
See you all around! <(^.^)>
P.S. One thing I really LOVE about anime are the Opening and Ending songs. I know some friends who are also into anime, but I haven't found many who enjoy the songs as much as I do, so if you like the OSTs as much as I do, do write a comment and we can talk anisongs till the space cows come home~!!!
And just for fun, here's my wn little "Fans of ANIMusic Club" (members in alphabetical order ^^)
alykay93, aritentd, DarkMagicianGirl, DeDaan, Entrility, mentalstatic, PeaceStarM, Phenom2, PhilipAres, sovok, wickedshizuku
If you love anime songs too, LET ME KNOW!!! (>^^)>
Here is my favourite OP of all time, from a series that I never ended up watching because the lol-story of season 1 was already too unbearable for me. It's JOINT from Shakugan no Shana II:
Thanks very very much to Zaig for showing me how to embed it!! (>^.^)>
I'm also a very avid collector of anime (amongst other random things ^o^) and right now my collection is: 915GB + 763GB = 1678GBs of animu, every bit of which i am very proud of~!! (>^.^)>
I also have a few Visual Novels, namely Clannad, Fate-stay Night, Little Busters EX, Planetarian, Utawarerumono, Yume Miru Kusuri. But i've only actually played FSN, LB, and Uta, and no where even near finishing any of them, lol.
Over the years of scouring the internet to download anime songs, the following is a list of my favourite and list of sites to get anime OSTs, they each are good for a specific type of song, or timing, so do read my description of the site ^.^:
http://gendou.com/amusic/ - my personal favourite coz the files are already fully detailed with singers and year and which show its from. Its a community site so you can request songs there too actually :) Also, the Lyrics are uploaded by users as well, which is very very cool as you can now sing along out-of-tune with your favourite anisong.
Be warned that Gendou often has "scheduled maintenance", so the site would be down for 5-10 mins. Gets annoying when you REALLY want that song, so try the following 2 sites too.
Also, as of 2010, the webmaster of Gendou seems to be very busy and doesnt update the songs uploaded by users very often... This is clearly a huge and unfortunate setback to what was and still is, a fantastic site upheld by the community. In this sad circumstance, if the songs you're after arent on Gendou, please try the following sites.
http://www.nyaatorrents.org/?page=torrents&catid=3&subcat=16 - Nyaatorrents' page for OST singles. I use this when i get impatient and want that song REAL bad. They're often (all?) rips from the tv eps, so its good and bad. Good coz its fast as hell. Bad coz sometimes bad rippers do bad quality songs. I use these for my "TV Size" ones, and wait till the proper CD is released in Japan, at which point I grab it from here:
https://nipponsei.minglong.org/tracker/ - The ultimate final destination for my anime song needs. This is where wonderful kind-hearted people who have bought the CD, either in Japan or shipped it, upload the contents to the net to share with the rest of the anime community <3 They even do all the scans of the CD case cover and the CDs' designs. Now THAT's dedication. This site gets updated VERY VERY frequently, eg if the CD gets released in Japan today, it'll most probably be on Nipponsei tomorrow.
BEWARE!!!: These are some BIG files at Nipponsei - "Singles" are around 60mbs whereas Original Sound Tracks are a whooping 100-150mbs!!! DX Oh yeah, and they are torrents only, no direct download.
Also note: Nipponsei has the songs (singles really) uploaded much faster than Gendou, so go to Nipponsei if you're an enthusiast, but go to Gendou if you're "just enthusiastic" about a particular song~ ^.^
http://tenshi.ru/anime-ost/ (got some older songs, incase u cant find it on gendou - prob coz gendou wasnt formed when the song got released or something - otherwise Google helps XD)
http://awesmoe.wordpress.com/ - has lyrics of new albums, in both romaji and kana/kanji. Unfortunately, often not in english trans. :\
http://atashi.wordpress.com/ - also new songs, but this time with eng trans as well as romaji and kana/kanji. These are often not just albums, but also has the Op/Ed song of currently airing shows.
http://www.animelyrics.com/anime/ - Has lots of "older" songs, by that i mean, often series wont be uploaded here until the next season after they've finished. But once it's on Animelyrics, this is probably the best place to look, coz they have both romaji and english trans side by side. Kana/kanji is often linked on a diff page, AND they occasionally have video clips of the Op/Ed sequence. AND AND they have OSTs (songs related to the anime, but not the Op/Ed themselves, eg Insert songs and etc).
And i dont know if im overboard but I usually (read: ALWAYS) get the album cover art as well for my anisongs, to put on my ipod, lol. So if you're crazy like that too, here's a site to grab the cover:
http://www.amazon.co.jp/ref=gno_logo (everyone's favourite site, Amazon, BUT IN JAPANESE! XD)
http://www.cdjapan.co.jp/anime/index.html (another site i used to use, but now i just grab everything from Amazon)
(the ones with *'s are my HIGHLY recommended sites:)
*http://www.anime-planet.com/ (obviously this site comes first ^.^)
*http://myanimelist.net/anime.php (another wonderfully detailed site)
*http://anidb.net/perl-bin/animedb.pl?show=main (yet another great site for info, this one is ESPECIALLY good for fansubbing groups comparison, coz it lists what group has done which eps, and has user-ratings for the groups)
http://www.anime-source.com/banzai/modules.php?name=Anime (great indepth reviews, slightly not so good on the general details/info)
*http://www.animetake.com/recently-updated-episodes/ (a bloody fantastic site thats got all the lastest shows - great site, updated every millisecond - no exageration ;)
*http://www.animea.net/series (its got almost every show there is/ever was, especially good for older shows, or if you want different qualities/formats)
*http://www.bakabt.com/index.php - has very well seeded torrents for completed series. Prob my first stop for grabbing completed shows. But if its not on here, see the sites under the section titled: OMNIPOTENT TOOLS FOR THE CONDEMNED OTAKU
*http://www.anilinkz.com/anime-list/ (Its got pretty much everything i tried to find; be it new or old stuff. Plus it MOSTLY uses VeohPlayer which is easily ripped offstream - good stuff!)
*http://www.animeseason.com/ (its got a sidepane listing all the OngoingSeries, then it shows info about the show, its got rating for the show, then on the ep its got the SubGroup in the files' name, AND it mostly uses VeohPlayer - easily ripped offstream by most ripping-programs~!! PURE AWESOMENESS!!! XD OH BUT its a relatively new site, so it doesnt have much older stuff, so if you want a VERY COMPLETE list of anime to stream, use the next link; Anilinkz!! ^.^)
*http://crazytje.be/ (so far this site has given every and any manga that i needed to download, so i never really bothered to find other sites. But then again, i tend to read most of manga online, so.... But yes, id much appreciate it if anyone has another good manga downing site to suggest, coz i dont like to rely on just one site - might close down any day... Dx)
*http://www.mangafox.com/ - died around 2009-2010 but came springing back to life. Possibly one of the best sites around for reading manga new or old. I know it's my personal favourite :)
*http://manga.animea.net/ - like it's anime counterpart, MangA has a lot of stuff, but is a tiny bit slower to update than MangaFox. But regardless, it's still a fantastic site.
*http://thecartdriver.com/category/season-previews/charts/ - has charts of all the new shows coming out each season. Really awesome that it's got next NEXT season's too. Updates on the 27th of every month.
*http://chartfag.wordpress.com/ - this used to be my (and i think for everyone as well) number place for charts, until the bastardly demon known as RL came to bite the webmaster, so there was a prolonged drought of anime foresight around mid-2010 for half a year. Then Cartdriver (above) valiantly rose up and took the helm of driving anime fans across the globe into the future. So basically, Chartfag is old now; go to Cartdriver. But it's here in honour of its courageous service since 200X.
*http://www.moetron.com/ - i just discovered this site a bit back, and it's very good. It's got news on a lot on and around manga stuff, like what's been recently greenlit for an adaptation etc etc. They've got next-season-charts too as well as links to PV (promotional videos/Previews) which is great. Cant really say who's charts are better, between Cartdriver and Moetron, use both :)
*http://countdown.mandragon.info/index1.html- really cool that it's a live countdown to when the next episode airs. I've default it on the "Sort anime by Day of Week" so i know that Monday = X anime day, and Tuesday = Y anime etc. Adds a pinch of 2D happiness to my daily life. Btw, that's a funny url "mandragon" :)
*http://animecalendar.net/ - shows a calendar of all the shows that are currently airing, as well as the dates that each episode comes out. Kind of outdone by Countdown in some aspects, but AnimeCalendar goes further and tells you whats airing NEXT month and so on and so forth, in a very clear manner. Also tells you when something will have it's last episode, so you have a silent vigil at your computer, waiting for its release.
*http://tokyotosho.info/ - THE Google/torrent for any and all anime/manga/other jap related stuff like dramas and the like. It has everything ever made and ever will be made. Seriously a great omipotent tool. Oh, but it links, so it doesnt ACTUALLY host stuff.
*http://www.nyaatorrents.org/ - Nyaa on the other hand, hosts the torrents that are often linked to by Tokyotosho. So you could actually just come here instead, lol.
*http://www.hongfire.com/ - HF is a bunch of forums and threads, but the community there is very focussed on delivering awesome links to downloading lots of awesome anime/manga/visual novel/etc/etc stuff. Seriously, there's threads for almost everything you could ever need there. In fact, it's so big, i tend to just Google "hongfire" and the name of whatever im looking for. I find that tends to be the quickest way to get something slightly obscure and hard to find on any of the sites I've listed above.
Enjoy, hopefully these sites will help someone ^.^ Pls do let me know if you find any of these sites useful, that'll encourage me to update this list more often (like once a year) ^-^
Well, cya all around~!!! d(^.^)b
last updated: 18.2.2011
Im really lazy and dont update this once a year, so some of the recommended sites may be dead when you click on them, lol
8,832 total episodes
i think Fruits Basket might be good one that your looking for but i'm till trying to remember that one show they you say you want something like school life and. I know a very good one but i can't remember the name i post to you soon i remember enjoy. ^^
to love ru is awesome. i saw the previews for it when i was in Japan. if you like that then you might like Rosario to Vampire and Rosario to Vampire Capu2. it is funny a great comedy and romance anime.
Try watching Negima! and Negima!? they are good show but if you looking for something better just ask me and i try to help you.
Sorry about the late reply!
Thanks for the suggestions!! I'll take those into mind! ^^
Well, it's kinda the same for me, I watched Ai to Yuuki no Pig Girl Tonde Buurin! when I was little...
Regarding Hayate... well I started to watched it about 8 months ago, then the site were I download it run into some dificulties and I just restarted to watch about a month ago, so far I'm in episode 14 because of the lack of time, but seems to be a really funny story


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This is a lesson about condensation, snow and snowflakes. Learners will investigate how water and ice exist in the atmosphere as they study water vapor condensing, find that clouds are made of tiny droplets of water, and notice that snow forms in... (View More) clouds. Activities include demonstrations by the teacher, small group miming, speaking, drawing, and/or writing. In addition to commonly found classroom materials, dry ice, an aquarium or terrarium container, magnifying glass are needed. This is lesson 6 of 12 in the unit, Exploring Ice in the Solar System. (View Less)
Audience: Pre-kindergarten, Elementary school
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Journalists Killed in 2012
Journalists in Exile, 2007-12
Journalists Killed Since 1992
Imprisoned on December 1, 2012
Unsolved Journalist Murders Since 1992
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Research by CPJ Advocacy Coordinator Mohamed Keita and CPJ's Nairobi-based consultant, Tom Rhodes.
Do you believe the free flow of information must be protected? Sign the #RightToReport petition and demand that President Obama immediately:
1. Issue a presidential policy directive prohibiting the hacking and surveillance of journalists and media organizations.
2. Limit aggressive prosecutions that ensnare journalists and intimidate whistleblowers.
3. Prevent the harassment of journalists at the U.S. border.
Or click here to see the full petition, and join leading journalists like Christiane Amanpour, The Guardian's Alan Rusbridger, Editor of the AP Kathleen Carroll, and Arianna Huffington in signing on.


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The Disability Services Center is the central location on campus for disability-related needs and is committed to providing accommodations for students with disabling conditions and supporting them in achieving their academic goals. As the initial contact point for students with disabilities, the Disability Services Center endeavors to make students aware of the many opportunities and resources available to them. Support services may include classroom and testing accommodations, advisement, referrals, and use of assistive technology. The office not only serves as an advocate for students with disabilities, but also encourages students toward self-advocacy.
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Comment Re:Let's clear up some misinformation. (Score 2) 209
You're forgetting something else: Boot Camp Assistant, the application in the Utilities folder on Macs.
For those who don't know, the Boot Camp Assistant is a Mac OS X application that walks you through starting a Windows installation. It asks you to insert a CD-R or USB drive to copy Windows drivers. It partitions your HD/SSD for you. It asks for you to insert your Windows media, verifies it, sets the system hardware to boot from it, then restarts the hardware.
Later versions of Boot Camp Assistant automatically slipstream the Apple drivers installation into the Windows installer USB drive (using the configuration file interfaces Microsoft provides for OEMs to run their own custom installers at installation time).
I wouldn't say that it's accurate that "the story should be that Bootcamp has been removed from these Macintosh systems," because the Boot Camp Assistant still exists on these systems, and Apple supports the installation of Windows on their hardware when using this application.


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Grado GR10 In-ear Headphones
" I am lost for words for 2 reasons, 1st: These in ears behave much more like over ears headphones in all the good ways. 2nd: these deserve to be much more popular than they are, I am simply shocked that there is not much more renowned! I currently own the Shure SE535's as well as Sennheiser IE8 and have used and owned many of the 500 and under earphones, such as Monster Turbine Copper Pro..." --Tenor123
Grado GR8 In-Ear Headphones
" I love the full size grado HF2 and older grado's but these do not sound good to my ears. Strident and uneven. These were not lovingly crafted or dialed in. There was no 'man' behind the tuning of these and this is evident in the final product. I'd love to see grado come out with a smooth yet dynamic sounding iem similar to the HF2 but am not holding my breath, especially when I've found..." --thelostMIDrange
Logitech UE 900 Noise-Isolating Earphones
Ultimate Ears 900 Noise-Isolating Earphones deliver sound that's surpassed only by our professional Custom Stage Monitors, thanks to four-armature speakers and a three-way crossover in a universal fit.
Ultimate Ears 100 Noise-Isolating Earphones - Black/Green
" I would personally like flat colors on the design but hey ts just me. Noise Isolation is really great (and I regularly commute home here in Manila, which is really loud at peak hours) Would I recommend it? Well Sure if you really are on a tight budget, but if you can add $10 to $15 dollars more you can get a sweeter pair. " --PLsg08


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Live Telephonic Presentation: Wednesday, June 6, 2012
12:00 p.m. – 2:00 p.m. Eastern Standard Time (Course No. 1410R214)
Part 3 of 3 Part Bundle Series on Trial Preparation and Conducting the Trial
Trial Preparation and Conducting the Trial
Trial Preparation and Conducting The Trial
Co-Chairs: Ron Bornstein, Laura Davis Smith, Julia Wyda
12:00 p.m. - 12:05 p.m.
Welcome/Introduction of Speakers
Julia Wyda, West Palm Beach
12:05 p.m. - 12:40 p.m.
Pretrial Statement, Charts and Summaries, and Exhibits: Framing,
Organizing and Building Your Case
Judge Richard A. Weis, Thirteenth Judicial Circuit
12:40 p.m. - 1:20 p.m.
Opening Statements and Closing Arguments: Winning with Words
Andrew L. Salvage, Ft. Lauderdale
1:20 p.m. - 1:50 p.m.
Preserving the Record: Getting into the Appellate Courts. Drafting
the Proposed Final Judgment: Staying out of the Appellate Courts
Maria Gonzalez, Weston
1:50 p.m. - 2:00 p.m.
Questions, Answers, and Trial Tips
Entire Audio CD Bundled Series: Parts 1 through 3 Bundle Series on Trial Preparation and Presentation (Course No. 1411C)
Parts 1 through 3 Bundle Series on Trial Preparation and Presentation
How do Telephone seminars work?
Registrants will receive dial-in connection instructions two days prior to the scheduled course date via e-mail. If The Florida Bar does not have your e-mail address contact the Order Entry Department at 850-561-5831, two days prior to the event for the instructions. The operator will verify the entry of each call. Only those attorneys registered for this seminar will receive CLE credit. CLE credit will be applied within two weeks after the attendance record has been verified.
[Revised: 06-01-2008]


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Please join Christian Rataj, NAMIC's Western state affairs manager, for Meeting #3 of NAMIC members who write insurance in Utah to discuss ways the industry can influence the state's political environment to promote pro-insurance consumer public policy legislation and offer proactive insurer-sponsored legislation during the 2011 legislative session.
In order to access members-only content, you will need to make sure you that you are a NAMIC member and that you are currently logged into the website.
I am not logged into the website.
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I have never registered for NAMIC.org.
If you are a NAMIC member, but the system did not recognize your email address as a NAMIC member company email, your account will be manually approved. It can take up to 1 business day to process a member access request. You will receive an email when your request has been approved. You will then need to log out of the website and log back in to view member content.
I recently registered for NAMIC.org, but my status is "non-member".
I AM NOT A MEMBER. Why was my access denied?
Unfortunately only NAMIC members are allowed access to this content.
317.875.5250 - Indianapolis | 202.628.1558 - Washington, D.C.


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Web Stories
Forum to feature emerging research, Feb. 27
Posted February 21, 2007; 11:32 p.m.
Princeton's Center for Innovation in Engineering Education will showcase emerging research with strong commercial potential at its second annual Innovation Forum from 5:30 to 7:30 p.m. Tuesday, Feb. 27, in the Friend Center Convocation Room.
At the forum, Princeton scientists and engineers will give short presentations on early-stage entrepreneurial endeavors springing from their laboratories. Among the presenters are:
- Vivek Pai, KyoungSoo Park, Larry Peterson, Marc Fiuczynski and Mark Huang, who have developed a content distribution network called CoBlitz, which can simultaneously handle large data files ranging from 10 kilobyte images to 10 gigabyte movies.
- Michael Hecht, who is researching a new way to screen compounds that could result in treatments for Alzheimer's disease.
- Kale Franz, Anthony Hoffman and Scott Howard of Princeton's Mid-Infrared Technologies for Health and Environment Center, whose company Primis Technologies is developing quantum cascade lasers for medical, environmental and security applications.
- Ivan Glesk and Paul Prucnal, who are working on a secure optical communications network for on-demand applications.
At a reception following the event, forum presenters will be on hand to answer questions about their ventures and display posters that explain their work.
The Innovation Forum is part of EntrepreneurshipWeek USA and is sponsored by the School of Engineering and Applied Science, the JumpStart New Jersey Angel Network and the University's Office of Technology Licensing. It is free and open to the public. To register, contact Stephanie Landers at firstname.lastname@example.com or (609) 258-3979.


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In regards to forgiveness, is there a difference between willful sin and ignorant sin?
Question: "In regards to forgiveness, is there a difference between willful sin and ignorant sin?"
Answer: Though God makes a distinction between those who sin in ignorance and those who sin willfully (Numbers 15:27-31), repentance is always necessary to receive forgiveness (Mark 1:15; Acts 2:38; Acts 26:18). Repentance is literally a change in one's attitude about God and accompanies saving faith in Christ (Acts 3:19; 20:21; 26:20). Without it there can be no forgiveness. Jesus said, "No, I tell you; but unless you repent, you will all likewise perish" (Luke 13:3; cf. 17:3-4; 2 Peter 3:9).
To sin willfully is to go back to trusting oneself rather than the blood of Christ for our forgiveness (Hebrews 10:26; Hebrews 6:4-6). However, sinning in ignorance is not excusable, either: "Now this I say and testify in the Lord, that you must no longer walk as the Gentiles do, in the futility of their minds. They are darkened in their understanding, alienated from the life of God because of the ignorance that is in them, due to their hardness of heart. They have become callous and have given themselves up to sensuality, greedy to practice every kind of impurity" (Ephesians 4:17-19; see also Acts 3:17-19; Acts 17:30-31).
Those who crucified Christ sinned in ignorance, yet they were still held responsible for their actions. Jesus, while hanging on the cross, prayed, "Father, forgive them, for they know not what they do" (Luke 23:34). However, of all those who were present at Christ's crucifixion, only one accepted His forgiveness and, correspondingly, His salvation (Luke 23:43). Jesus had the power to forgive all the evil people gathered around His cross and make them right with God, but the only person who repented was one of the criminals beside Him. All the others, who rejected Christ and His forgiveness, apparently died in their sins. There is no record that they ever repented. Forgiveness is available to all, but we leave it to God's sovereign grace to cause the transgressor to truly repent in order to be pardoned (Ephesians 2:4).
Those who reject Jesus and His gospel in ignorance must accept Him in repentance in order to receive forgiveness of their sins (Luke 17:3). Jesus made this abundantly clear: "I am the way, and the truth, and the life. No one comes to the Father except through me" (John 14:6). It doesn't matter whether someone misses the way because of ignorance or because of willful rebellion—he has still missed the way.
People are not as ignorant as they may claim, however. No one can be utterly ignorant of God, and no one has an excuse to live in disobedience. The apostle Paul said, "For the wrath of God is revealed from heaven against all ungodliness and unrighteousness of men, who by their unrighteousness suppress the truth. For what can be known about God is plain to them, because God has shown it to them. For his invisible attributes, namely, his eternal power and divine nature, have been clearly perceived, ever since the creation of the world, in the things that have been made. So they are without excuse" (Romans 1:18-20).
Though we may at times sin in ignorance, we can always be assured of God's forgiveness. The apostle Paul is a classic example of this truth: "Though formerly I was a blasphemer, persecutor, and insolent opponent. But I received mercy because I had acted ignorantly in unbelief" (1 Timothy 1:13). Yet for those who willfully and habitually sin, Peter makes it clear that "if, after they have escaped the defilements of the world through the knowledge of our Lord and Savior Jesus Christ, they are again entangled in them and overcome, the last state has become worse for them than the first. For it would have been better for them never to have known the way of righteousness than after knowing it to turn back from the holy commandment delivered to them" (2 Peter 2:20-21).
John gives us the bottom line when it comes to forgiveness: "If we say we have no sin, we deceive ourselves, and the truth is not in us. If we confess our sins, He is faithful and just to forgive us our sins and to cleanse us from all unrighteousness" (1 John 1:8-9).
Recommended Resource: Overcoming Sin and Temptation by John Owen
What is original sin?
What is the unpardonable sin / unforgivable sin?
What is the sin nature?
Is there a biblical list of sins?
What is the conviction of sin?
Return to:
Questions about Sin
Return to:
GotQuestions.org Home
In regards to forgiveness, is there a difference between willful sin and ignorant sin?


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Last week we discovered that celebrities like to write novels. But you know what they like to write even more than novels? Children's books! And what better way to introduce your wee ones to the hilarity of celebrity culture than with these 15 kid's books penned by the likes of Ricky Gervais, Julianne Moore, Bob Dylan, and Perez Hilton? Here's what I want to know: When is the Britney Spears children's book about haircare appreciation happening?
Celebrity Reading List: 15 Celeb-Written Children's Books
- 6 years ago by Lucia Peters
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You can reach this post's author, Lucia Peters, on twitter.


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Containment the Goal of Initial Oil Spill Cleanup
Chevron is expected to unveil a cleanup plan this morning, after a day in which the company focused on containing an oil leak that fouled Red Butte Creek and Liberty Park pond, in hopes of keeping the toxic spill from reaching the Great Salt Lake.
An oily sheen could be seen Sunday afternoon on the surface of the Jordan River as it flowed through Rose Park Golf Course. But Utah Division of Water Quality scientists did not visually detect any oil farther downstream at a small dam in the lake's marshlands, almost seven miles from the source of the leak in a Chevron pipeline on Salt Lake City's east bench.
"That's good news that it hasn't reached the Great Salt Lake," DWQ Director Walt Baker said of the critical migratory bird habitat, the ultimate recipient of whatever flows down normally docile Red Butte Creek.
The creek's character changed sometime early in the weekend when a buried, 10-inch diameter Chevron pipeline carrying crude from northwestern Colorado's oil fields sprung a major leak.
An estimated 50 gallons of oil gushed into the stream each minute for an unspecified amount of time before the leak was detected. By the time the flow finally was cut off, Salt Lake City Fire Department officials said as much as 21,000 gallons of oil may have entered the creek, which flows into Liberty Park.
Homeowners in the posh Harvard-Yale-Yalecrest neighborhood traversed by the creek assessed the damage to their yards Sunday as Salt Lake City officials made the rounds, listening to concerns and urging property owners to leave the cleanup to Chevron's expert crews.
"It's best if you allow teams that are trained to do their jobs," said Lisa Harrison-Smith, spokeswoman for Mayor Ralph Becker, who visited the impacted area with city council members J.T. Martin and Jill Remington Love.
"This is one of the most beautiful parts of the city," Becker said as he walked the rainy streets. "They've taken care of the river for years because they know what an amenity it is."
While a team of Chevron-led investigators carefully excavated a trench to gain access to the pipeline and find out why it failed, most of the 70 people the company had on the ground Sunday were dealing with the denser concentration of oil accumulating in Liberty Park pond.
They manipulated plastic booms to confine the oil to small portions of the pond, where it could be vacuumed more easily and deposited in storage containers and mobile oil tankers flanking the shore.
Colleagues along the banks repeatedly honked foghorns to scare sea gulls and other birds away from landing on the pond's filmy surface. Their efforts were mostly successful, but Harrison-Smith said more oil-covered birds were sent Sunday to Hogle Zoo for cleaning, increasing the overall number of treated waterfowl to about 200.
An intense odor arose from the pond, to the chagrin of joggers and walkers who were allowed to return to the park Sunday after Saturday's closure for initial disaster response.
"It smells like the inside of a gas station," said Jack Mayer, an everyday exerciser at the park. "It's just horrible, especially with all the baby ducks out there. You expect these [oil company] people to do better than that. There shouldn't be any chance of this happening."
But it did. And Chevron spokesman Sean Comey reiterated Sunday the company's commitment to clean up the damage and respond appropriately to claims filed by impacted residents.
"We regret this problem that has caused the challenges now facing the community. Chevron takes full responsibility for addressing the situation," he said.
Dan Johnson, another Chevron spokesman, said the company has brought in employees from California, Texas, Colorado and Idaho to supplement efforts of local crews and contractors.
U.S. Environmental Protection Agency and Coast Guard officials also arrived Sunday in Salt Lake City to participate in the investigation of the pipeline rupture, which occurred in a utility corridor near other buried water and natural gas pipelines. EPA also will have a say on the acceptability of the emergency response plan Chevron was putting together Sunday, Johnson said.
"We have to submit it to the [government] agencies to see if it's what they think needs to be done," he said. "I'm sure the cleanup plan will be part of the discussion," at a public meeting at 7 p.m. Monday at Clayton Middle School, he said.
To keep oil from reaching the Great Salt Lake, crews installed booms that absorb oil "like a big roll of socks" around the outlets of two storm drains that carry water underground from Liberty Park pond to the Jordan River.
Additional booms were laid down across the river at several locations as it flows north toward the lake, each group of booms seemingly reducing but not completely eliminating the flow of the oily film.
Kevin Tetreault, 41, a homeless man who has been staying with friends in the brushy area near the storm drain's intersection with the river, thought the spill was worse Sunday than Saturday.
"Not just with the sheen on it, but the stench. I don't like the smell," he said, then chuckling: "There were a bunch of kids here earlier, saying 'There goes the fishing.' "
Along with Salt Lake Valley Health Department officials, state Water Quality inspectors took samples along the length of Red Butte Creek and the lower Jordan River, trying to quantify the extent of toxic elements such as toluene or benzene actually in the water.
Results of those samples should be available today, said Water Quality Director Baker.
Harrison-Smith said the mayor's office has been satisfied with Chevron's response to the spill. "They have worked quickly to resolve the problems," she said. "We hope that continues. We have no reason to believe it won't."


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Earth Island Institute
Urban Biofilter
Website: http://urbanbiofilter.org
Urban Biofilter leverages waste to improve quality of life in inner-cities. A micro-industrial forestry project grown with waste water on brownfields, Urban Biofilter bioremediates water, soil and air while shielding residents from industry and transportation routes. By valuing ecosystem services the project enables a green economy that serves environmental justice.no graphic available
Director: Brent Bucknam
Urban Biofilter
942 Clay Street
Oakland, CA 94607
Phone: (510) 415-2994
contact by email


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Okay I've been busy back at work for the last couple of days. Need to build lots of workstations in the near future.
I've been considering getting a colo box. I think I can afford the running costs for a while if I can get some people to help out. The question is how much can I build a 1U box for. I think I should be able to build something for 300-400GBP. I need to pay for setup costs and I think a month in advanced. Should be doable for 500GBP startup. Hopefully I should be able to provide any service that someone wants given that a) the request is sensible (no telnetd :)) and b) they offer a decent price.


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Find a local Amnesty group and fight for human rights in your community!
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Forced rectal feeding, men hung from the ceiling in diapers, men stripped and dragged and beaten. This is an American torture story – but the Justice Department is apparently refusing to read it.
"I didn't know that I could get pregnant after having sex" -- Support women and girls in Burkina Faso
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Lentil Soup with Sweet Potatoes & Spinach
I was a little nervous the first time I made lentil soup for Josh. It was early on in our marriage and I wasn't sure if Josh even liked lentils. Lentil soup is one of my favorites, so I took a risk and made it for dinner one night. I happily discovered that Josh also loves lentil soup. We now enjoy lentil soup on a regular basis, especially during the cold winter months. I am always mixing up the ingredients to keep our meals interesting. My latest creation is Lentil Soup with Sweet Potatoes & Spinach.
I have been adding sweet potatoes to everything lately-risotto, tostadas, biscuits, so why not add them to soup? I can't get enough! I also threw in fresh spinach because the bunch in our refrigerator was starting to look questionable. I love it when I can put our produce to good use.
This vegetarian lentil soup is packed with flavor, protein, nutrients, and heart-warming goodness. It is a great recipe for January-healthy and comforting. This soup freezes beautifully, another reason I love this soup. Make a large pot and save some for later. And if you aren't sure if your kids or spouse will eat lentil soup, don't ask, just make it. I am sure they will like it!
Lentil Soup with Sweet Potatoes and Spinach
Yield: Serves 8-10
1 tablespoon olive oil
1 onion, chopped
3 cloves garlic, minced
1 carrot, diced
1 celery stalk, diced
2 small sweet potatoes, peeled and cut into 1/2 inch cubes
1 1/2 cups brown lentils
4 (15 ounce) cans vegetable broth
2 cups water
2 cans (15 ounce) diced tomatoes
2 bay leaves
1 teaspoon dried thyme
1 tablespoon chopped fresh rosemary
Salt and pepper, to taste
2 cups chopped fresh spinach
1. In a large pot, heat the olive oil. Add the onion and garlic. Saute until onion is tender and garlic is light brown in color. Add carrot, celery, and sweet potatoes. Cook until vegetables soften, about 5-7 minutes.
2. Stir in the lentils, vegetable broth, and water. Add the diced tomatoes, bay leaves, thyme, and rosemary. Season with salt and pepper and stir. Cook on medium-low heat for about 35-40 minutes or until lentils are cooked.
3. Add the fresh spinach and stir. If necessary, season with salt and pepper. Remove bay leaves and serve warm.
Follow twopeasandpod on Instagram and show us what recipes you are making from our blog! Use the hashtag #twopeasandtheirpod! We want to see what you are making in your kitchen!
If you like this lentil soup, you might also like:
Vegetarian Lentil Soup from Two Peas and Their Pod
Curried Butternut and Red Lentil Soup from Eat, Live, Run
Orange Lentil Soup from Phoo-d
Lentil Soup with Italian Sausage & Spinach from Cookin' Canuck


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AimoAio wrote:Chapter 181:Spoiler :I always knew Akashi was a tad crazy but really, this new chapter proves he's insane. I mean gouging out his own eyes? THE HELL DID THAT COME FROM?
Oh, u scored another goal? Let me help you with another one.
Well, that speech he gave there was really good I'd say... what a way to get their morale back
As for anime