Experiences of transmasculine spectrum people who report nonsuicidal self-injury: A qualitative investigation.

Transgender populations experience mental and physical health disparities compared to nontransgender populations, including nonsuicidal self-injury (NSSI). Guided by the minority stress theory and Nock's model of NSSI, this study explored perspectives of transmasculine spectrum people (i.e., people with a gender identity that is man, male, transgender man, genderqueer, or nonbinary and who were assigned female at birth) who engage in NSSI. Qualitative interviews were conducted with transmasculine spectrum people (N = 18) who reported a history of NSSI. Their mean age was 24.9 years old (SD = 5.43, range = 17-38). Participants reported that NSSI was influenced by a variety of factors including stress from gender nonconformity in childhood and adolescence. Stigma related to minority status and identity as well as proximal minority stress processes of concealment and expectations of rejection were identified as contributing to NSSI. Transgender identity development tasks such as coming out and identity exploration also appeared to affect NSSI. Finding a community of peers who engage in NSSI was helpful in mitigating social isolation, but at times reinforced NSSI. We discuss clinical implications at the individual and family levels. Interventions to reduce NSSI among transmasculine-spectrum people should include facilitating connections with gender minority peers and providing individual support and family interventions to facilitate transgender identity development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations: an integrative review.

AIMS AND OBJECTIVES: To conduct an integrative review of nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations to better understand the prevalence; to identify the lesbian, gay, bisexual and transgender subgroups at increased risk for nonsuicidal self-injury; and to examine the risk factors associated with nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations. BACKGROUND: Nonsuicidal self-injury, defined as intentional injury to the body's surface without intent to die, is a significant mental health concern among adolescents and adults. Mental health disparities in lesbian, gay, bisexual and transgender populations, including anxiety, depression and suicidality, have been documented in the scientific literature with little focus on findings about nonsuicidal self-injury. DESIGN: Integrative literature review of published quantitative and qualitative empirical research. METHODS: A literature search of 11 on-line databases was conducted of articles published through April 2015. Keywords were used to identify articles about lesbian, gay, bisexual and transgender populations and nonsuicidal self-injury. RESULTS: After screening by title, abstract and full text, 26 articles were included in this review. The literature synthesised demonstrates a consistent pattern of increased prevalence of nonsuicidal self-injury among sexual and gender minority populations compared with heterosexual peers. This body of literature indicates which subgroups of the lesbian, gay, bisexual and transgender populations appear to be at increased risk for nonsuicidal self-injury and which specific factors contributing to vulnerability to nonsuicidal self-injury among these populations. CONCLUSIONS: Lesbian, gay, bisexual and transgender populations are at higher risk for nonsuicidal self-injury compared with the general population. Lesbian, gay, bisexual and transgender-specific and general risk factors appear to contribute to this heightened vulnerability. RELEVANCE TO CLINICAL PRACTICE: Clinical nurses should screen for nonsuicidal self-injury and for sexual and gender minority identity in all of their patients. Comprehensive assessment of lesbian, gay, bisexual and transgender patients presenting with nonsuicidal self-injury may lead to identification of risk factors that can be addressed through nursing interventions. Nurse researchers and clinicians should take an active role in developing and implementing evidenced-based tailored interventions to reduce the higher vulnerability to nonsuicidal self-injury among lesbian, gay, bisexual and transgender populations.

Using social network analysis to examine collaborative relationships among PhD and DNP students and faculty in a research-intensive university school of nursing.

The nursing profession has seen a dramatic rise in the number of schools offering both DNP and PhD nursing programs. Information is limited on the impact of this parallel approach in doctoral education on the quality and scope of scholarly interactions or institutional culture.The authors studied collaboration characteristics across the DNP and PhD programs of a research-intensive university school of nursing, before and after programmatic enhancements. An IRB-approved online survey was delivered to faculty and students of both programs at baseline and one year after curricular changes. Response rates were 70% and 74%, respectively. The responses were analyzed by using social network analysis and descriptive statistics to characterize the number and strength of connections between and within student groups, and between students and faculty. At baseline, the flow of communication was centralized primarily through faculty. At Time 2, density of links between students increased and network centralization decreased, suggesting more distributed communication. This nonlinear quantitative approach may be a useful addition to the evaluation strategies for doctoral education initiatives.

An Innovative Academic Practice Model for Clinical Nursing Education During the COVID-19 Pandemic.

In March of 2020, Columbia University School of Nursing (CUSON) Masters Direct Entry (MDE) program and New York Presbyterian Hospital (NYPH) created an innovative academic partnership to address the clinical needs of students and to help alleviate the burden of surging COVID-19 cases on nurses and the health care system. Through this partnership, students were hired as nurse technicians to assist with patient care during the first wave of the COVID-19 pandemic. As a result of this enhanced relationship, a pipeline of well-qualified graduate nurses with unique skills to adapt to a rapidly changing practice environment was created. Student participants in this opportunity developed an understanding of the organizational and leadership structures of the health care institution. The understanding of organizational and leadership structures will help transform the delivery of care.

Preparing Teaching Assistants in Nursing: A Mixed-Methods Evaluation.

BACKGROUND: Teaching assistants (TAs) serve an important role in schools of nursing, but their educational needs are poorly understood. PURPOSE: To better prepare TAs, our School of Nursing identified and evaluated current TA practices to create tailored educational materials. METHODS: A 16-item survey captured how faculty used TAs. Focus groups with current faculty and former TAs explored the TA role and identified areas to target for future training. Focus groups were analyzed using thematic content analysis. RESULTS: Survey response rate was high (88%). Most faculty meet with TAs before the semester, and typical TA duties included attending lecture (71%) and facilitating examination review sessions (64%). Qualitative themes focused on faculty/TA communication, faculty guidance, knowing the policies, and TA/student boundary negotiation. CONCLUSIONS: Findings demonstrate the importance of preparing TAs. Since this study, the university and school of nursing have each developed educational materials to better prepare TAs and faculty.

Exploration of advanced practice nurses' competencies necessary for achievement of universal health coverage in Jordan.

BACKGROUND: Given the global shortage of the health workforce and the nature of diseases, strengthening and improving health care systems become a necessity. One of the solutions that is recommended by the literature is to utilize advanced practice nurses (APNs) to accelerate the progress toward the Sustainable Development Goals and universal health coverage (UHC). PURPOSE: To delineate APN practice and competencies in relation to UHC and primary care in Jordan from the perspective of nurse administrators, clinical nurse specialist, academics, and policymakers. PROCEDURE: A descriptive exploratory survey design was utilized to identify APN competencies that are important in achieving UHC. The survey developed by one of the authors (JH) at a PAHO Collaborating Center to delineate APN practice and APN competencies was adapted and utilized. A convenience sample of 94 nurse leaders was recruited from the education sector, nursing associations, councils, and hospitals. RESULTS: The results showed that all four competencies (clinical care; interdisciplinary and patient-centered communication; systems of care; and using evidence for best practice) were rated as agree/strongly agree across all four domains. There was a consensus of participates on dimensions of all competency domains. CONCLUSION: The current study confirms that the role of APNs is still in its infancy in Jordan. The current study provides nurse educators with baseline information that can be utilized as a framework for APN education programs. The faculty readiness to start new competency-based APN programs or revise the current graduate programs needs to be assessed.

A snapshot of clinical educational experiences for advanced practice nurses worldwide.

Using a convenience sampling, nurse educators representing 10 countries were surveyed to describe required clinical education for advanced practice beyond basic traditional nursing education. This article explores the many factors currently influencing the structure and diversity of these clinical experiences worldwide.

Moving towards universal health coverage: advanced practice nurse competencies. / Avançando na direção de cobertura universal de saúde: competências de enfermeiros de práticas avançadas.

OBJECTIVE: this paper aims to describe the first phase of a project whose general goal was to develop a consensus-based set of advanced practice nurse competencies applicable to Latin American countries and, based on these competencies, produce an advanced practice nurse curricular prototype adapted to Latin American countries. The project was framed in a competency-based approach to advanced practice nursing education. The specific aims of the first phase of the project described in this paper were: 1) to identify a set of potential advanced practice nurse competencies that would serve as the template for Core Advanced Practice Nurse Competencies in Latin American countries and 2) to establish consensus for Core Advanced Practice Nurse Competencies in Latin American countries. METHOD: advanced practice nurse competencies were derived from a comprehensive review of published competencies and informed the development of a survey designed to assess the relevance of advanced practice nurse competencies in Latin American countries. The survey was distributed to nurse leaders and nurse educators. Data were analyzed using descriptive statistics. RESULTS: consensus for Core Competencies was established. CONCLUSION: the Core Advanced Practice Nurse Competencies presented can provide a structured framework to build educational programs aligned to the needs of the regional environment.

Stigma, gender dysphoria, and nonsuicidal self-injury in a community sample of transgender individuals.

We investigated rates of nonsuicidal self-injury (NSSI) and correlates of past-year NSSI among transgender people to better understand factors contributing to this health disparity. A community-based sample of 332 transgender people participated in quantitative in-person interviews. The mean age of participants was 34.56 years (SD = 13.78, range = 16-87). The sample was evenly divided between transfeminine spectrum (50.3%) and transmasculine spectrum identities (49.7%) and was diverse in race/ethnicity. We evaluated associations between sociodemographic characteristics, stigma, hypothesized resilience factors, and identity variables with past-year NSSI. 53.3% of participants reported ever having self-injured in their lifetime. Past-year NSSI was reported by 22.3% of the sample and did not significantly differ based on gender identity. In logistic regression models, past-year NSSI was associated with younger age and felt stigma (perceived or anticipated rejection), but not enacted stigma (actual experiences of discrimination), and with gender dysphoria. Efforts to address the high rates of NSSI among transgender people should aim to reduce felt stigma and gender dysphoria, and promote transgender congruence. Future research using a developmental approach to assess variations in NSSI across the life course and in relation to transgender identity development may illuminate additional processes that affect NSSI in this population.

Transforming nursing curricula for a global community.

With nurses and midwives providing the majority of health care globally, nursing education in all countries must prepare students for broader responsibilities to move the agenda forward for equitable care and universal health coverage. Columbia University School of Nursing developed and implemented a vibrant approach to curriculum transformation that included a new didactic course followed by a program of global clinical experiences to expand students' learning environments in global health. Program planning included defining learning objectives, mobilizing support within the school, establishing new sites, recruiting and preparing students, overseeing of students with host institutions, and evaluating the program. A total of twenty-four students were placed over five sites for a six-week credit-bearing global clinical experience. Students had varied clinical experiences with new understandings of the reality of health disparities. Host sites expressed a commitment to have students return in the next year, and all students stated that they would chose a global experience again. This innovation provides a transformative addition to nursing education with a deepened understanding of health disparities and nursing roles in different health systems. It strengthens the school's network of nursing and midwifery educators and opens doors for new exchanges.

Development and evaluation of a PDA-based decision support system for pediatric depression screening.

Depression is under recognized in a variety of pediatric settings. The purpose of this paper is to describe the development and initial evaluation of a personal digital assistant (PDA)-based decision support system (DSS) for pediatric depression screening in ages 8 to 18 years of age by pediatric advanced practice nurse (APN) students. Three aspects are described: selection of depression screening instrument; integration of the instrument into the PDA; and quantitative (usage) and qualitative (focus group) evaluation. Only one third of eligible patients were screened. Twenty percent of those screened were identified as at risk for mood disorder. The barriers to screening identified through focus groups included a lack of time, knowledge, intervention protocol, referral resources, PDA usability issues, preceptor motivation and comfort, as well as perceived or real cultural barriers. Suggestions for educational, research, and interventions to integrate clinical based PDA-based screening are discussed.

Health-related quality of life of HIV-infected children on complex antiretroviral therapy at home.

The study describes quality of life as perceived by parents and measured by the Child Health Questionnaire (CHQ-28) for a convenience sample of 33 HIV-infected children age 5 to 18 years cared for at home on complex antiretroviral drug regimens. When compared with normative data on healthy U.S. children, parent reports for the HIV-infected children did not differ significantly on the following CHQ concepts: role/social related to emotional, behavioral or physical problems; bodily pain; behavior; mental health; self-esteem; impact on parental time; family activities; and family cohesion. Parents perceived their children to be functioning at a level significantly lower than the norm in general health (t -6.47, p = .000), physical functioning (t -2.37, p = .024), and physical summary (t -3.80, p = .001). Parental impact-emotional was impressively higher than the norm (t -3.74, p = .001). Differences were independent of gender, primary language, ethnicity, and Centers for Disease Control and Prevention clinical classifications for pediatric HIV disease.

Achieving adherence with antiretroviral medications for pediatric HIV disease.

Factors influencing antiretroviral adherence for 42 HIV-positive children were elicited from primary caregivers, and the perspectives of families and clinicians regarding success with adherence were compared. Interviews in preferred language (Spanish or English), chart reviews, and visual analogue scales (VAS) were used. Adherence was high by traditional markers of prescriptions filled (100%), doses reported taken (97%), and appointments kept (88%). Clinicians estimated slightly but not significantly lower adherence than did families using the VAS. Sixty-four percent of families reported barriers to adherence, and 30% reported strategies that differ from those in the general adherence literature. Adherence strategies devised by families depended heavily on family support and resolution of disclosure issues in the household.

Perceived health status in urban minority young adolescents.

PURPOSE: To describe perceptions of health status among a sample of urban minority adolescents and the contribution of demographics, intrinsic motivation, general self-efficacy, risk taking, and stressful life experiences on the adolescent's perception of health status. METHOD: Correlational design. A total of 71 adolescents were studied using the Adolescent Health Chart for perceived health status, the Health Self-Determinism Index for Children, the Self-Efficacy Scale, the Risk Taking Instrument, and the Life Events Checklist. RESULTS: There were no statistically significant effects of demographics on perceived health status. Scores of Perceived Health Status correlated with scores of self-efficacy (r = 0.56; p <.0001), risk-taking (r = 0.39; p <.001), negative events (r = 0.32; p <.01) and violent events (r = -0.41; p <.001). CLINICAL IMPLICATIONS: The study findings suggest that self-efficacy, risk taking, and life events are predictive of perceived health status in urban minority adolescents. The results contribute to the present body of knowledge about patterns of adolescent health as perceived by the adolescent. In addition to expanding the understanding of the minority adolescent experience in relation to health promotion attributes and health compromising behaviors, the results identify antecedents that are predictive of improved perceived health status for the urban adolescent.

Essential health care: affordable for all?

Access to affordable health care has become a national crisis. The uninsured have many faces and many reasons for being uninsured. The nation cannot afford to sustain this broken system; not in terms of resources, nor in terms of the deteriorating health of the public. Universal coverage could offer a promising opportunity to begin to ameliorate the unsustainable use of expensive illness care now substituting for effective low-cost prevention and early detection. A proposal for essential health care coverage, a balance between cost and choice to maximize use of beneficial care, is presented.

Avançando na direção de cobertura universal de saúde: competências de enfermeiros de práticas avançadas / Moving towards universal health coverage: advanced practice nurse competencies / Avanzando hacia la cobertura universal de salud: competencias de enfermería avanzadas

Objetivo: o objetivo deste artigo é descrever a primeira fase de um projeto que teve como finalidade geral desenvolver um conjunto de competências de práticas avançadas de enfermagem baseadas em consenso aplicáveis em países da América Latina e, usando tais competências, produzir um protótipo curricular de práticas avançadas de enfermagem a serem adaptadas em países da América Latina. O projeto foi enquadrado em uma abordagem baseada em competências para o ensino de práticas avançadas de enfermagem. Os objetivos específicos da primeira fase do projeto descritos neste artigo foram: 1) identificar um conjunto de competências em enfermagem para práticas avançadas que serviriam como modelo para as Competências Essenciais de Enfermeiros de Práticas Avançadas em países da América Latina e 2) estabelecer um consenso sobre Competências Essenciais de Enfermeiros de Práticas Avançadas em países da América Latina. Método: as competências de enfermeiros de práticas avançadas foram derivadas de uma revisão abrangente das competências publicadas e informaram o desenvolvimento de uma pesquisa projetada para avaliar a relevância das competências de enfermeiros de práticas avançadas nos países da América Latina. A pesquisa foi distribuída entre enfermeiros líderes e enfermeiros educadores. Os dados foram analisados por meio de estatística descritiva. Resultados: foi estabelecido um consenso sobre Competências Essenciais. Conclusão: apresentam-se as Competências Essenciais de Enfermeiros de Práticas Avançadas que podem fornecer um quadro estruturado para construir programas educacionais alinhados com as necessidades do ambiente regional.

Objective: this paper aims to describe the first phase of a project whose general goal was to develop a consensus-based set of advanced practice nurse competencies applicable to Latin American countries and, based on these competencies, produce an advanced practice nurse curricular prototype adapted to Latin American countries. The project was framed in a competency-based approach to advanced practice nursing education. The specific aims of the first phase of the project described in this paper were: 1) to identify a set of potential advanced practice nurse competencies that would serve as the template for Core Advanced Practice Nurse Competencies in Latin American countries and 2) to establish consensus for Core Advanced Practice Nurse Competencies in Latin American countries. Method: advanced practice nurse competencies were derived from a comprehensive review of published competencies and informed the development of a survey designed to assess the relevance of advanced practice nurse competencies in Latin American countries. The survey was distributed to nurse leaders and nurse educators. Data were analyzed using descriptive statistics. Results: consensus for Core Competencies was established. Conclusion: the Core Advanced Practice Nurse Competencies presented can provide a structured framework to build educational programs aligned to the needs of the regional environment.

Objetivo: el objetivo de este documento es describir la primera fase de un proyecto, cuyo objetivo general es desarrollar un conjunto basado en consenso de competencias de práctica avanzada de enfermería aplicables en los países de América Latina y utilizando las competencias, producir una enfermera con práctica avanzada de prototipo curricular para la adaptación en países latinoamericanos. El proyecto se encuadró en un enfoque basado en competencias para la educación de enfermería de práctica avanzada. Los objetivos específicos de la primera fase del proyecto descritos en este documento fueron: 1) identificar un conjunto de competencias potenciales de enfermería de práctica avanzada que servirían como un modelo para las Competencias Básicas de Enfermería de Práctica Avanzada en países latinoamericanos y 2) establecer consenso para las Competencias Básicas de Enfermería de Práctica Avanzada en países latinoamericanos. Método: las competencias de práctica avanzada de enfermería se derivaron de una revisión exhaustiva de las competencias publicadas e informaron el desarrollo de una encuesta diseñada para evaluar la relevancia de las competencias de práctica avanzada de la enfermera en los países de América Latina. La encuesta fue distribuida a enfermeras líderes y enfermeras educadoras. Los datos fueron analizados utilizando estadística descriptiva. Resultados: se estableció el consenso para las Competencias Básicas. Conclusión: se presentan las Competencias Básicas de Enfermería de Práctica Avanzada que pueden proporcionar un marco estructurado para construir programas educativos alineados con las necesidades del entorno regional.

Establishing a program of global initiatives for nursing education.

In the global nursing community, schools of nursing are increasingly developing initiatives and networks across national boundaries. This article describes the process undertaken at a school of nursing to determine its global health priorities and develop a program of global initiatives for nursing education. A series of meetings were held to determine faculty global activities and gauge interest in designing a 5-year strategic plan for the program. A volunteer Strategic Planning Work-group was convened to formalize a mission, vision, and strategic plan for the program, which were presented to, refined by, and vetted by an advisory board and the faculty at large. We recommend this process to schools committed to developing or expanding a program dedicated to global initiatives and a global perspective in educational planning. Involving stakeholders, building on current strengths, and aligning with mission and vision are essential elements for developing a meaningful program of global initiatives for nursing education.

Building framework for nursing scholarship: guidelines for appointment and promotion.

As nursing academia responds to shifts in nursing education--the emergence of clinically focused doctoral degrees and an emphasis on evidence-based practice, comparative effectiveness, and translational research, nursing scholarship is undergoing transformation. This article outlines guidelines for appointment and promotion that incorporate the academic tripartite and are relevant for all faculty. A clear and equitable pathway for professorial advancement for the both the clinician and research faculty is delineated. Without such clarity and equity, the unique contributions of clinical and research scholars and the synergy that results from these distinctions will not be garnered. Although there is significant overlap in the criteria, there are also distinguishing scholarly activities and outcomes. For each standard at each rank, unique sample criteria of clinical and research scholarship are outlined and the shared scholarly activities that demonstrate the standard. Using an adaptation of Boyer's model, the guidelines incorporate a broadened view of nursing scholarship and offer a framework for nursing academia that recognizes new ways of knowledge. Although recognizing the coexistence of science and practice, these guidelines offer a clear trajectory for advancement in the professorial role that applies an expanded perspective of and provide a framework for nursing scholarship.