ACT Implementation on a Mood Disorder Unit

A Quality Improvement Project

Carrie Pike, BSN, RN-BC, Christine Feinstein, BSN, RN-BC, Clifton Moore, PhD, CADC, and Kathleen Delaney, PhD, PMH-NP, FAAN

An interdisciplinary team of nurses, mental health counselors, and occupational therapists on 8 North JRB, an adult inpatient psychiatric unit, recognized an opportunity to improve consistency and structure of therapeutic group sessions.

From the work of this team, a quality improvement project was developed which implemented and evaluated the integration of Acceptance and Commitment Therapy (ACT), an evidence-based therapy that aims to improve psychological inflexibility. The interdisciplinary team formulated the hypothesis that ACT implementation would help standardize group processes, enhance coping skills, and increase the patient’s experience on an adult mood disorder unit.

All inpatient nursing staff members were trained by peer ACT champions, Christine Feinstein and Clifton Moore, to ensure consistency of ACT principles and verbiage. Once training was complete, ACT principles were systematically introduced into the patient groups beginning January 2017 until all sessions were fully integrated.

Patient response to groups was monitored from December 2016 through November 2017. Responses were measured using the Acceptance and Action Questionnaire II (AAQII), a validated tool which assesses psychological flexibility (Bond, Hayes, Baer, Carpenter, Guenole, Orcutt, Waltz, & Zettle, 2011). The patients were assessed on admission and discharge from the unit.

In addition, patients received the Evaluation of Group Experience survey, a staff-designed tool, measuring satisfaction with individual group leaders and group experiences during the months of April through July of 2017. This survey helped gather feedback for individual group leaders in an effort to continue improving and adapting group structure and content.

In comparing patient AAQII scores pre and post ACT implementation, the data showed a 19 percent increase in improved AAQII score and an 11 percent decrease in diminished AAQII scores. This equates to an improvement in the patient populations’ psychological flexibility by 30 percent overall.

These outcomes indicate that the integration of ACT therapy improved patients’ experience and enhanced self-reflection and situational awareness. In addition, the Evaluation of Group Experience responses were positive and the comments provided real time feedback for group facilitators. These results remain encouraging for inpatient behavioral health units as increased psychological flexibility is linked to decreased symptom relapse and readmission (Gaudiano and Herbert, 2006).

ACTI mplementation
Evaluation Group Exp Survey
Carrie Pike, BSN, RN-BC Carrie Pike, BSN, RN-BC
Christine Feinstein, BSN, RN-BC Christine Feinstein, BSN, RN-BC
Clifton Moore, PhD, CADC Clifton Moore, PhD, CADC
Procedural Texting to Improve Communication