Testing the Effectiveness of a Mindfulness- and Acceptance-Based Smartphone App for Nurses Traumatized by the COVID-19 Pandemic: A Pilot Study.

A significant proportion of frontline nurses developed post-traumatic stress disorder (PTSD) symptoms as a result of working during the COVID-19 pandemic. This study aimed to determine the efficacy of a mindfulness- and acceptance-based smartphone app intervention among nurses traumatized by the COVID-19 pandemic. This was a two-arm, randomized controlled trial. We randomly assigned 60 frontline nurses working in various clinical settings in the United States during the pandemic to either the intervention group (i.e. participants used the mindfulness app for 6 wk) or the wait-list control group. We assessed the app's efficacy through outcome measures of PTSD symptom severity, experiential avoidance, rumination, mindfulness, and resilience, measured at pre-, mid-, and post-intervention periods and a 1-month follow-up. Intervention satisfaction and perceived usability of the app were assessed within the intervention group. There was strong evidence of within-between interaction for PTSD, experiential avoidance, and rumination, implying significant improvement of these outcomes for the intervention group as compared to the control group. We only found a within-group interaction effect for mindfulness, indicating significant improvement of mindfulness within the intervention group only. Participants in the intervention group reported high satisfaction levels and perceived usability with the app. Findings highlight that mindfulness- and acceptance-based smartphone apps can improve PTSD symptoms of nurses traumatized by the pandemic. Healthcare organizations should provide nurses with accessible interventions (e.g. mindfulness apps) to treat and prevent secondary behavioral consequences of the pandemic, such as PTSD.

Using the Socioecological Model to Explore Barriers to Health Care Provision in Underserved Communities in the Philippines: Qualitative Study.

BACKGROUND: The Philippines' primary care is delivered via local health centers called barangay health centers (BHCs). Barangays are the most local government units in the Philippines. Designed to promote and prevent disease via basic health care, these BHCs are staffed mainly by barangay health workers (BHWs). However, there has been limited research on the social and environmental factors affecting underserved communities' access to health care in underserved areas of the Philippines. Given the importance of BHCs in disease prevention and health promotion, it is necessary to identify obstacles to providing their services and initiatives. OBJECTIVE: This study aimed to explore multilevel barriers to accessing and providing basic health care in BHCs. METHODS: We used a qualitative approach and the socioecological model as a framework to investigate the multilevel barriers affecting basic health care provision. A total of 18 BHWs from 6 BHCs nationwide participated in focus group interviews. Traditional thematic content analysis was used to analyze the focus group data. After that, we conducted individual semistructured interviews with 4 public health nurses who supervised the BHWs to confirm findings from focus groups as a data source triangulation. The final stage of thematic analysis was conducted using the socioecological model as the framework. RESULTS: Findings revealed various barriers at the individual (lack of staff motivation and misperceptions of health care needs), interpersonal (lack of training, unprofessional behaviors, and lack of communication), institutional (lack of human resources for health, lack of accountability of staff, unrealistic expectations, and lack of physical space or supplies), community (lack of community support, lack of availability of appropriate resources, and belief in traditional healers), and policy (lack of uniformity in policies and resources and lack of a functional infrastructure) levels. CONCLUSIONS: Examining individual-, interpersonal-, institutional-, community-, and policy-level determinants that affect BHCs can inform community-based health promotion interventions for the country's underserved communities. Given the multidimensional barriers identified, a comprehensive program must be developed and implemented in collaboration with health care providers, community leaders, local and regional health care department representatives, and policy makers.

Correlates of Psychological Distress Among Filipino Americans and Filipinos Living in Urban Areas in the United States and the Philippines.

INTRODUCTION: Many Asian immigrants, including Filipino Americans (FilAms), experience psychological distress (PD) due to the challenges in adjusting to their new country and culture. This descriptive comparative study aimed to compare FilAms and Filipinos concerning their levels of PD, sources of stress, and use of health-promotion strategies. METHODS: Data from 89 FilAms and 95 Filipinos living in urban cities, obtained from the I-HELP-FILIPINOS database, measuring cardiometabolic risks, mental health, and environmental stressors in 2017, including PD, were examined. RESULTS: The mean age of all participants (N = 184) was 44.2 ± 22.8 years old. Both groups rated their health as good to excellent, although Filipinos were significantly more likely to be distressed (p < .001). Filipinos were also more likely to ascribe stress to employment (48.3% vs. 68.2%, p =.006) and finances (28.1% vs. 52.6%, p <.001) than FilAms. DISCUSSION: While both groups shared comparative perspectives on health, FilAms reported lower PD than Filipinos. The most significant source of stress was the country of residence. We recommend tailoring interventions to each local context's unique social and environmental circumstances.

Relationships Among Rumination, Resilience, Mindfulness, and Perceived PTSD Symptoms in Military Veterans Returning to College: A Cross-Sectional Study.

The influx of military Veterans with posttraumatic stress disorder (PTSD) returning to college following active military service presents an unmanageable trend for many secondary educational institutions in the United States. The current study aimed to determine relationships among rumination, resilience, mindfulness, and perceived PTSD symptoms in college student Veterans. To this end, 133 college student military Veterans registered in a U.S. university responded to an online survey. Results revealed that rumination has a direct effect on perceived PTSD symptoms and mediates the relationship between mindfulness and perceived PTSD symptoms, and that resilience moderates the relationship between mindfulness and perceived PTSD symptoms through rumination as the mediator. These findings imply that designing and developing mindfulness-based interventions for college student Veterans with PTSD requires concerted efforts targeted at improving ruminative thinking and enhancing resilience. [Journal of Psychosocial Nursing and Mental Health Services, 61(6), 43-50.].

The Moderating Role of Resilience on Mindfulness, Experiential Avoidance, and Posttraumatic Stress Disorder (PTSD) Symptoms of College Student Veterans: A Cross-Sectional Study.

The purpose of the study was to investigate the moderating effect of resilience on the relationship between mindfulness, experiential avoidance, and posttraumatic stress disorder (PTSD) symptom severity. A cross-sectional study design was used on a sample of 133 college student military veterans. We found a direct effect of mindfulness on PTSD and a significant mediating effect of experiential avoidance on the relationship between mindfulness and PTSD. Resilience also had a significant moderating effect on the relationship between mindfulness and PTSD. This study provides preliminary evidence on the usefulness of integrating resilience development in mindfulness-based interventions for trauma-related disorders.

The Process of Learning Mindfulness and Acceptance through the Use of a Mobile App Based on Acceptance and Commitment Therapy: A Grounded Theory Analysis.

This study aimed to explore the process of how college student military veterans with posttraumatic stress disorder (PTSD) symptoms learn mindfulness and acceptance through the use of a mobile app based on acceptance and commitment therapy (ACT). Twenty-three college student veterans with PTSD symptoms participated in the 4-week ACT mobile app-based intervention and took part in three weekly semi-structured interviews. Results of the grounded theory data analysis reveal the core category of Mindful Scaffolding, a process indicating how student veterans cope with the interruptions and intrusions associated with learning mindfulness and acceptance through the use of the ACT-based app. The grounded theory provides a foundational theoretical framework for increasing adherence with using mindfulness- and acceptance-based mobile app interventions for PTSD.

Medication Decision Making Among African American Caregivers of Children With ADHD: A Review of the Literature.

Background: Significant pharmacotherapy disparities exist among children from ethnic minorities with ADHD. Objective: The purpose of this review is to synthesize existing evidence on African American caregiver medication decision making (MDM) for children with ADHD. Method: Databases queried for this review included the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsychINFO, PubMed, and Education Resources Information Center (ERIC). Information regarding the unique culturally specific barriers and supports to MDM were examined through the relevant literature search. Results: Fourteen articles were included in this review (seven observational studies, four qualitative studies, three mixed methods studies). Three main themes were identified which include (a) fundamental perspectives of ADHD, and cultural norms for child behavior; (b) the impact of fundamental perspectives on MDM in ADHD; and (c) ADHD diagnosis and treatment as forms of social control. Conclusion: Evidence-based recommendations for clinicians are provided, along with direction for future research.

College student veterans' experience with a mindfulness- and acceptance-based mobile app intervention for PTSD: A qualitative study.

This study aimed to explore college student military veterans' experience with a mindfulness- and acceptance-based smartphone app intervention. Upon the 4-week participation in the intervention, 23 student veterans took part in semi-structured interviews. In the thematic analysis of the interview transcripts, three main themes emerged: (1) generating momentum of app use; (2) optimizing the functions and benefits of the app; and (3) resolving to deepen the practice of mindfulness and acceptance. Considering the low engagement rates of several previous app-based studies, our results provide a useful framework for incorporating human feedback and support in enhancing users' engagement with the app.

Cardiovascular disease knowledge, risk factors, and resilience among US veterans with and without post-traumatic stress disorder.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the United States and the leading cause of hospitalization and disability among the US veterans. Information about CVD knowledge and risk factors, and connection between psychological health and CVD among veterans transitioning from the military are limited. PURPOSE: We examined the existing knowledge of CVD and its risk factors among the US veterans with and without post-traumatic stress disorder (PTSD), and the relationship between knowledge, risk factors, resilience, and PTSD. METHODS: A total of 104 veterans participated in our study by responding to the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Heart Disease Fact Questionnaire (HDFQ) knowledge scale, and Connor-Davidson Resilience Scale 10. Data were extracted from the online Qualtrics survey software into SPSS (v. 25) for analysis. RESULTS: Mean age was 52.3 years, mostly males (85.6%), married (72.1%), employed (54.8%), and with college education. Most were in the Navy or Air Force (72.1%) and served in a war (68.0%). Hypertension, high cholesterol, and obesity were the most common CVD risk factors reported. Average CVD knowledge score was 85%. Marines scored higher on resilience than other branches of the military. Seventeen percent reported having PTSD. The Connor-Davidson Resilience Scale 10 was significantly correlated with the HDFQ in the probable PTSD group (r = .589, p = .013). IMPLICATIONS FOR PRACTICE: Our study provides information about the knowledge and risk factors of CVD among veterans and insights about interventions needed to improve CV health. Nurse practitioners should assess the CV and psychological health of veterans and screen for PTSD to provide appropriate care and referral.

Resilience, Trauma, and Cultural Norms Regarding Disclosure of Mental Health Problems among Foreign-Born and US-Born Filipino American Women.

Resilience refers to a set of personal qualities and abilities that allow an individual to confront challenges, risks, or traumatic experiences in an integrated manner and to thrive in the face of significant adversities. This cross-sectional study explores resilience, posttraumatic stress disorder (PTSD), and family norms with disclosure of mental health problems (FNAD) in a sample of 182 Filipino American women (FAW). Participants completed survey measures of resilience, PTSD, and FNAD and open-ended questions about beliefs and reasons for (not) disclosing mental health problems outside the family. Previous research found that the rates of psychological trauma and depression among FAW are higher than those in other Asian ethnic groups, which makes it necessary to investigate the protective characteristic of resilience among FAW. According to our results, foreign-born FAW had a significantly lower PTSD and greater resilience as compared to their US-born counterparts. A significant negative relationship between PTSD and resilience was observed only among foreign-born FAW. We also found a conditional moderating effect of FNAD on the negative relationship between resilience and PTSD. The results of our qualitative analysis of the participants' responses to the open-ended questions of the survey showed that FAW's family norms of nondisclosure are related to the cultural value of "saving face," a salient cultural construct among Asian family members. Results suggest that protective properties of resilience against PTSD are influenced by cultural factors, such as FNAD. Taken together, our findings underscore the importance of considering the impact of collectivistic cultural values (e.g., FNAD) in future research on resilience among Asian Americans.

Testing the acceptability and initial efficacy of a smartphone-app mindfulness intervention for college student veterans with PTSD.

This single-arm, pre-post feasibility study evaluated the acceptability and initial efficacy of a mindfulness smartphone-app intervention intended to promote resilience and improve posttraumatic stress disorder (PTSD) symptoms among college student military veterans. The app contained mindfulness exercises and meditations based on the acceptance and commitment therapy. Twenty-three student veterans used the app for four weeks. The results showed high levels of perceived satisfaction and usability of the app. Significant changes in resilience, mindfulness, PTSD, experiential avoidance, and rumination were observed. Future research is needed to test the intervention in a randomized controlled trial.

Promoting Resilience Among College Student Veterans Through an Acceptance-and-Commitment-Therapy App: An Intervention Refinement Study.

Military veterans' stigmatized views on mental disorders and traditional mental health care considerably reduce veterans' access to mental health services. The present study aimed to refine a previously developed non-stigmatizing smartphone-app intervention based on the principles of acceptance and commitment therapy for college student veterans with posttraumatic stress disorder (PTSD). To this end, we tested the acceptability of the developed prototype using a mixed-method study design. A total of nine student veterans participated in the study by using the app intervention and completing pre-post study measures and a post-intervention qualitative interview. The results showed that the intervention was highly acceptable. The results of the qualitative data analysis highlighted relevant themes related to strategies for improving the content, delivery, and structure of the intervention. The results also showed that, despite a decrease in the participants' adherence as the intervention progressed, there was a consistent improvement in the participants' resilience, PTSD, and rumination. Based on the results, the intervention was revised for prospective feasibility and efficacy testing. Our results highlight the need to use a collaborative approach in the early stage of the development of self-management PTSD interventions.

Resilience and psychological trauma among Filipino American women.

AIMS: To explore the types of traumatic exposure, prevalence of posttraumatic stress disorder (PTSD), and level of resilience in a community sample of Filipino American women (FAW), as well as to investigate the relationships between their PTSD symptoms, history of traumatic exposure, and resilience. METHOD: A cross-sectional study with a total of 188 adult FAW. RESULTS: We observed high levels of resilience and low levels of PTSD symptom severity. The most common form of traumatic exposure was non-interpersonal trauma occurring after the age of 18 years old. We also found a significant correlation between history of traumatic exposure and PTSD and between resilience and PTSD. Resilience was found to have a significant moderating effect on the relationship between traumatic exposure and PTSD. CONCLUSIONS: The results provide preliminary evidence on the buffering and protective properties of FAW's resilience to PTSD despite traumatic exposure.

Student Veterans' Coping with Posttraumatic Stress Symptoms: A Glaserian Grounded Theory Study.

The present study investigated the ways in which student military veterans cope with their posttraumatic stress symptoms. The participants were a total of 21 military veterans attending a U.S. university. The results of the grounded theory data analysis reveal the core category of modulating intrusions, a process indicating how student veterans cope with recurrent and unwanted posttraumatic stress experiences. Our findings also demonstrate that veterans cope by either avoiding or allowing themselves to experience the pain associated from their traumatic experiences. The proposed framework can be meaningfully used to facilitate the development of adaptive coping among veterans with posttraumatic stress.

Exploring Pain Management Among Asian Immigrants with Chronic Pain: Self-Management and Resilience.

Asians immigrants (AIs) are one of the fastest growing racial groups in many countries globally. Despite pain prevalence, studies on chronic pain management among AIs is limited in the literature. An integrative review was conducted exploring the current state of science on chronic pain management among AIs. Several databases were used to identify related articles and 15 studies met the inclusion criteria. Two major themes emerged: (a) self-management, pertaining to how AIs take responsibility for their pain, and (b) resilience, their adaptive behaviors indicating low levels of pain-related dysfunction and burden despite chronic pain severity. Resilience plays a significant role in the mechanism by which self-management works in pain among AIs. Chronic pain management is a complex process where challenges to effective treatments exist. Findings have significant implications to healthcare providers and the general pain population. Future research directions include the necessity for increased participation of AIs in studies.

Interventions for Posttraumatic Stress with Resilience as Outcome: An Integrative Review.

This integrative review explores the current state of knowledge on trauma-focused interventions with resilience as the outcome. The review synthesized the results of 17 intervention studies. Findings of the review demonstrate the importance of including resilience as an outcome measure for the effectiveness of trauma-focused interventions. Findings also provide preliminary evidence that effective trauma-focused interventions both reduce posttraumatic stress disorder (PTSD) symptoms and improve resilience. Further research should include a focus on developing interventions based on established theoretical frameworks, and using resilience outcome measurement tools appropriate to the interventions and the characteristics of the target population.

Resilience, Acculturative Stress, and Family Norms Against Disclosure of Mental Health Problems Among Foreign-Born Filipino American Women.

The present study explores the relationships between resilience, acculturative stress, and family norms against disclosure of mental health problems among foreign-born Filipino American women. The sample consisted of 159 foreign-born Filipino American women aged 18 years and above and residing in Las Vegas, Nevada, United States. Participants completed paper-and-pencil questionnaires. Results indicated high levels of resilience and moderate levels of acculturative stress. Findings also showed a significant negative correlation between resilience and acculturative stress, and a significant predictive effect of resilience on acculturative stress. We also found a significant negative relationship between resilience and family norms against disclosure of mental health problems but no significant mediating effect of resilience on the relationship between acculturative stress and family norms. This lack of significant findings related to the mediating effect of resilience on the relationship between acculturative stress and family norms against disclosure of mental illness may be due to the absence of theoretical models and research regarding the role of resilience in the context of acculturation among Filipino American women. Our findings imply the need to further explore underlying mechanisms that explain the relationships between resilience, acculturative stress, and family norms. The findings of the study also confirm the need to develop interventions and resources that ameliorate acculturative stress and promote an increase of the disclosure and reporting of mental health problems among Filipino American women.

Exploring Challenges in Conducting E-Mental Health Research Among Asian American Women.

In this discussion paper, we explore the challenges of conducting e-mental health intervention research among Asian American women and propose a model for addressing these barriers. Based on an extensive literature review, we identify two main types of barriers to conducting e-mental health intervention research among Asian American women: recruitment barriers and adherence barriers. Recruitment barriers are further subcategorized into those related to (1) stigmatized cultural beliefs about mental illness and mental health services; (2) lack of awareness about mental health services; and (3) language barrier. As to adherence barriers, the two identified subtypes concern (1) acuity and severity of mental health condition; and (2) lack of time. In order to enhance recruitment and adherence in e-mental health intervention research among the studied population, we formulate the following three main research strategies, namely: (1) considering the cultural and social contexts of Asian American women in the development of e-mental health interventions; (2) determining appropriate program length; and (3) conducting feasibility studies to test e-mental health interventions. We suggest that nurse researchers integrate our proposed model in conducting e-mental health interventions among Asian American women. Our proposed model also implies that nurses play an important role in encouraging Asian American women's acceptance of and adherence to e-mental health interventions. In order to overcome the obstacles to conducting e-mental health research among Asian American women, we recommend that nurses familiarize themselves with credible, relevant, and evidence-based e-mental health resources and integrate online mental health services and information within their nursing practice.

Resilience in Nursing Education: An Integrative Review.

BACKGROUND: Resilience is a phenomenon known to buffer the negative effects of stress. Resilience is important in the lives of nursing students and nurse educators. METHOD: An integrative literature review was conducted to explore the current state of knowledge of resilience in the context of nursing education. Implications from the review findings were deduced for nursing education practice and research. RESULTS: Three theoretical papers and 16 empirical reports were included in the review. Three themes emerged from the analysis: (a) Resilience Is Important in Nursing Education, (b) Resilience Is Conceptualized as Either a Trait or a Process, and (c) Resilience Is Related to Protective Factors. CONCLUSION: The findings provide data to support interventions to enhance the resilience of nursing students and nurse educators and offer a foundation for further research of resilience in nursing education.