Parental Substance Use Disorder and the Rise in Children Being Raised by Grandparents: Focusing on Children's Needs and Improving Outcomes.

The occurrence of children being raised solely by their grandparents has steadily risen in the past decade prompted by parental substance use disorder (SUD) and associated incarceration and death. These families, especially children, are a vulnerable population with unique needs. Nurses should be cognizant of the needs, risk factors, and protective factors often associated with this population. Meanwhile, the literature to date mostly focuses on grandparents. School and pediatric nurses, specifically, are in an advantageous position to help support these families and help foster better child outcomes. The purpose of the current article is to explore the experiences, needs, and resources for supporting children being raised by grandparents due to parental SUD. Best practices for health care professionals, especially nurses, are discussed as well as future directions for research with this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Emergency Department-Initiated Interventions for Illicit Drug Overdose: An Integrative Review of Best Practices.

More than 20 million people in the United States have a substance use disorder (SUD), increasing their risk for overdose (OD). Patients arriving to emergency departments (EDs) with OD typically require lifesaving interventions, but inconsistencies exist regarding further intervention and discharge instructions. The purpose of the current integrative review was to determine best care practices for patients presenting to EDs with an illicit drug OD. A literature search included the databases PubMed, EBSCO Host, ProQuest Health and Medicine, and Google Scholar. Thirty-five articles outlined interventions for SUD/OD initiated in EDs; most for opioid OD. Best practice intervention components included psychiatric evaluations, SUD screening tools, buprenorphine initiation, naloxone distribution and training, OD prevention education, referrals to medication-assisted treatment, and harm reduction strategies. Barriers to implementation included legislation, insurance/costs, community resource availability, staffing, training, and potential stigma. With myriad approaches, nurses with SUD care experience can advocate for instituting best practices for patients in the ED and upon discharge. [Journal of Psychosocial Nursing and Mental Health Services, 61(6), 18-24.].

Research Priorities in Psychiatric Mental Health Nursing: Funding Availability, Recently Published Work, and Future Directions for Advancing Our Science.

BACKGROUND: Identifying and sharing psychiatric mental health (PMH) research priorities can help identify gaps in the literature, determine training needs for nurses, and assist investigators in locating funding. AIMS: The aims for this project included: (1) identify PMH nursing specialty research priorities from large, public funding entities; (2) compare the identified research priorities and scholarly articles published in 2020; and (3) outline future directions for advancing the science of PMH nursing. METHODS: Strategic plans of funding entities for PMH research were reviewed for research priorities. Summarized priorities were then compared with publications from peer-reviewed PMH nursing journals. Work conducted in the United States was extracted and categorized as original research, evidence-based practice (EBP), or quality improvement (QI), then design and population. RESULTS: Priorities from 13 funding entities comprised three domains (education, research, and practice), with nine areas, 30 topics, and subtopics. Eight journals produced 432 articles with 99 (23%) conducted in the United States. Among these journals, publications fitting research priorities ranged from 1 to 33 articles. Of the 99 articles, 85% were original research and 15% were either EBP or QI. Descriptive articles comprised 64% and 23% tested interventions. Populations studied included workforce; adults; infants, children, and adolescents; and parents. CONCLUSIONS: All published articles by the U.S. PMH nurses matched the funding priorities, but not all funding priorities were addressed by 2020 publications. The majority of work was conducted outside of the United States and most published from the United States was descriptive, contrary to many United States funders' priorities for interventional research.

Parental opioid use disorder: Examining their children's experiences, needs, and road to resilience.

PROBLEM: Over 8 million children in the United States live with a parent with substance use disorder (SUD), inclusive of opioid use disorder (OUD). This is an adverse childhood experience (ACE), that often leads to poor outcomes such as developing SUD or mental illness. Interventions and research have focused more on the parent and not their children. Without emphasis on child's experiences, their needs, and building interventions toward developing resilience, the intergenerational cycle of SUD/OUD will persist. METHODS: Nine children (ages 12-17) in custody of Social Services, who experienced a parent with OUD, participated in this pilot study. The intervention was SAMHSA's Children's Program Kit: Supportive Education for Children of Addicted Parents. Thematic analysis of verbal responses/behaviors, observations, field notes, and any retained materials (i.e., handouts) was conducted over eight sessions. FINDINGS: Findings included three themes regarding participant's experiences: Meaning of a Parent; Others Involved; and Witnessing the Cycle. Two sub-themes also emerged: Ways to Cope and Support from Various Sources. CONCLUSIONS: Results support mental health nurses as forerunners in building, implementing, and evaluating child-focused interventions for children of parents with OUD. Interventions should focus on the needs of the children and use a strength-based approach to promote their resilience.

Promoting resilience for children of parents with opioid use disorder: A pilot study of a directed intervention.

PROBLEM: Having a parent with Opioid Use Disorder (OUD) is a childhood adverse experience (ACE), magnified by other accompanying ACEs. Outcomes for these children tend to include developing mental illness and/or Substance Use Disorders themselves. Few studies address these children's experiences and needs. Without child-focused interventions to foster their resilience, generational ramifications of the OUD crisis will persist. METHODS: Nine children (ages 12-17), in Department of Social Services' custody, participated in this pilot study. The intervention delivered was Substance Abuse and Mental Health Administration's Children's Program Kit (CPK): Supportive Education for Children of Addicted Parents. Measures included OUD knowledge pre/posttests and the Behavioral and Emotional Rating Scale (BERS-2). FINDINGS: Findings from paired-samples t tests showed a significant increase in youth OUD knowledge from pre to posttest. Affective strength on the parent version (foster parent or social worker's perception of participant) and overall strength index on the youth's version BERS-2 increased significantly from pre to posttest. Career strength, a separate strength index, showed significant increased scores on both youth and parent BERS-2 versions pre to posttest. CONCLUSIONS: Results support Psychiatric Mental Health nurses to lead development and implementation of interventions, such as the CPK, with a strength-based approach to promote the knowledge and resilience of these children.

Children of Parents With Opioid Use Disorder.

Substance use disorders (SUDs) have been a priority public health concern for decades, with most recent conversations focusing on the opioid use disorder (OUD) epidemic. Children of parents with OUD have been impacted through poverty, violence, neglect, and emotional and physical abuse. Although treatment programs may address the family and parental role, few focus on the children. Without building resiliency in a child's mental and physical health, the far-reaching impact of the opioid epidemic will continue. The goal of the current literature review was to critique available intervention programs that focus on children of parents with SUD/OUD and provide recommendations for best practice. A literature search found six child-focused intervention programs dated in the 1990s and early 2000s and generalized to parents with SUDs. No intervention was found specific to children of parents with OUD. Nurses and other health professionals can use these findings to determine which evidence-based intervention is most appropriate for the needs of this specific population. [Journal of Psychosocial Nursing and Mental Health Services, 59(3), 28-34.].

Applying ambiguous loss theory to children of parents with an opioid use disorder.

PROBLEM: Opioid use disorder (OUD) has reached epidemic proportions in the United States. Children of parents with OUD are an unrepresented population, who often suffer consequences from their parent's substance abuse disorder. Such children may incur numerous psychosocial and physical losses. Without intervention, they are more likely to be diagnosed with a mental illness and/or substance use disorder (SUD). METHODS: This paper examines the experiences of children of parents with OUD using Boss's theory of ambiguous loss (AL) as a lens. FINDINGS: Children growing up with a parent who has an OUD experience AL through that parent's physical absence and psychological presence (e.g., the parent is out opioid-seeking or in rehab or jail) and psychological absence but physical presence (e.g., the parent is high or in withdrawal, or is preoccupied with obtaining opioids). Evidence supports the fact that OUDs affect parenting, produce changes in the parent-child relationship, and often impact child development. Interventions that are child-focused are lacking. CONCLUSIONS: The application of AL theory to this problem can enhance health professionals' understanding and need for developmentally specific interventions to care for this population. Interventions should focus on diminishing stigma and promoting psychosocial wellness and resiliency for children of parents with an OUD.

An Update on Teen Pregnancy.

After years of high teen birth rates, there is currently a decline in U.S. pregnancy and birth rates among teens. Nevertheless, these rates continue to be higher than those of most global counterparts, and psychosocial and physical adversities still occur for pregnant teens and their children. The declining birth rates may be due to teens making better choices about contraceptive use and sexual behaviors. Psychiatric-mental health nurses are in key positions to enhance pregnancy prevention for teens. [Journal of Psychosocial Nursing and Mental Health Services, 54(2), 25-28.].

American College Students' Views of Depression and Utilization of On-Campus Counseling Services.

BACKGROUND: College students are becoming increasingly depressed; however, many do not attend university counseling to seek help. OBJECTIVES: What is the relationship between young adults' mental health literacy, perceived stigma of depression and treatment, knowledge of treatment benefits and risks, beliefs about alternative therapies, and influence of his or her social network with usage of university counseling? STUDY DESIGN: A survey was administered to N = 107 American undergraduate college students to ascertain the students' understanding of depression and their views of counseling services on campus. RESULTS: Both likelihood of using alternative therapies and perceived discrimination of social network accounted for 18% of the variance for likelihood of participants seeking campus counseling. CONCLUSIONS: When a young adult college student perceives stigma or discrimination of depression from family and friends, then they may be less likely to seek university counseling for depression as well as possible applications with alternative therapies as a favorable option.

Awareness and Knowledge of Child and Adolescent Risky Behaviors: A Parent's Perspective.

PROBLEM: Adolescence is a developmental stage marked by risk-taking and limited comprehension of dangers of risky behaviors. Previous research has focused on adolescents' perspective of risk with little evidence on parents' knowledge regarding risk. METHODS: This qualitative study examined parental knowledge and perspectives of child/teen risk behaviors associated with salvia, sexting, inhalant use/abuse, and self/participant-assisted choking. A sample of 30 parents of children/teens aged 10-17 completed a self-administered survey based on Flanagan's critical incident technique. FINDINGS: Data were analyzed according to Flanagan's guidelines. Two advanced practice nurses determined category reliability with 95% agreement. The survey yielded five categories of parental responses to potential risky behaviors in their child/teen including the following: talking to my children, setting up consequences, confronting the child, seeking help, and talking to others. Although the majority of the parents were aware of newer behaviors, less than one half of the participants reported discussing risks with their child/teen. One third reported that their child knew a friend who was thinking about/tried sexting. One quarter of parents reported that they were not monitoring their child/teen's media use. CONCLUSIONS: Study findings provide important implications for developing an evidence-based education intervention to improve parents' awareness, knowledge, and identification of risk behaviors in their children/teens.

Risky Behaviors and Social Networking Sites: How Is YouTube Influencing Our Youth?

Choking, cutting, and setting oneself on fire are just a few of the risky behaviors that the YouTube video sharing website has allowed youth around the world to view, emulate, and comment on. Some researchers contend that the viewing of videos may normalize these behaviors for youth. Disturbing current trends are explored to illustrate the darker side of YouTube. Psychiatric-mental health nurses (PMHNs) are in key positions to help parents and youth better understand the benefits and risks of social networking sites, including YouTube, and to encourage healthy and safe use of the Internet. Nursing implications are offered for PMHNs, educators, health care providers, and parents who have contact with this population.

E-cigarettes: a rising trend among youth.

Electronic cigarettes, known as "e-cigarettes," were designed as a smoking cessation tool for adults. An unintended audience for the product has been found with adolescents, many of whom have never used conventional cigarettes. Broad consequences of e-cigarettes on adolescent health include nicotine addiction-and later nicotine withdrawal-and potential for nicotine overdose. U.S. Food and Drug Administration regulations are non-existent; empirical evidence regarding e-cigarettes is limited; and studies conducted with adolescent e-cigarette use are even less common. Prevention measures must target the manufacturers and retailers of these devices as well as adolescents, parents, schools, and health care professionals. Psychiatricmental health nurses are well positioned to raise awareness of the dangerous consequences of e-cigarette use in teens.

The choking game: a risky behavior for youth.

Nurses working with children and adolescents should be cognizant of choking games, risky acts in which pressure is applied to the neck and the airway is obstructed to achieve a high. Evidence supports that many children and adolescents do not understand the grave consequences of choking games nor do they view participation as dangerous. Parents, teachers, pediatricians, nurses, and psychiatric-mental health professionals are not always aware that children and adolescents are engaging in choking games. The purpose of this article is to describe the signs, changes over the years, consequences, and educational resources available for addressing this behavior in children and adolescents. Understanding the nomenclature of choking games, how to assess, and how to intervene when participation in this behavior is suspected are also addressed.

Professional writing in nursing education: creating an academic-community writing center.

Contemporary professional nursing requires competency in both oral and written communication. Outside of writing for publication, instructional methods to teach professional writing in baccalaureate nursing programs are not well documented in the literature. The need for professional writing, coupled with the need to diversify the workforce with students from varying ethnic and educational backgrounds, creates some additional challenges to meet programmatic requirements for scholarly, evidence-based writing outcomes. As two new prelicensure programs were initiated, a comprehensive assessment was conducted that included student focus groups and writing assessment tools to assess writing quality and student support needs. As a result of these data, faculty implemented curricular and instructional revisions and created a writing center that was staffed by older adult volunteers who had careers in writing. The processes, tools, and preliminary outcomes of these faculty-initiated changes to improve student support for writing are presented.

Early assessment for Alzheimer's disease and dementia: comparison of two metamemory diagnostic tests.

Alzheimer's disease (AD) is a growing problem in the United States. Because of the inability of the Mini-Mental State Examination to detect AD in the early stages, other avenues of assessment must be explored. Two subjective assessment tests have been proposed to help evaluate progression from nonclinical to clinical AD: the Feeling-of-Knowing and Judgment-of-Learning tests. Currently, no conclusive evidence exists as to which test is better suited to assess for progression toward AD. These tests, however, have been reliable when used to assess metamemory. A decrease in metamemory can be an indicator of nonclinical AD. This article provides practice implications for mental health nurses in administering either test and calculating scores over time. The hope is that by using these two assessment tests, patients with AD may be diagnosed earlier and subsequently lead longer, better quality lives.

Inhalant abuse: youth at risk.

Inhalant abuse is a significant problem affecting many people, particularly youth. The easy availability of products containing volatile substances (e.g., aerosol sprays, cleaning products, paint) provides opportunity for mind-altering experiences. Unfortunately, serious complications such as brain, cardiovascular, liver, and renal damage or even death may ensue. Adolescents perceive the risk as low, and parents may be unaware of the risks. Health care providers, particularly psychiatric nurses, should undertake strategies of prevention, assessment, and treatment of this challenging problem.

Sexting: serious problems for youth.

Youth engaging in sexting (texting plus sex) includes behaviors such as sending, receiving, or forwarding of nude or partially nude images via cell phones. The true prevalence of tweens and teens engaging in sexting is unclear. This might be because of the general secrecy of the behavior, the rapid advances in technology, and the lack of a clear definition that accounts for the added developmental factors (e.g., peak sexual development, impulsivity). Additionally, there is a lack of recognition of the consequences and increased risks of sexting (e.g., shame and guilt, earlier sexual behavior, bullying, incarceration, substance abuse, depression, suicide) for youth as a vulnerable population. The purpose of this article is to examine sexting behaviors among youth by exploring factors specific to today's adolescent population that may influence the prevalence and outcomes of sexting behavior. Implications for nursing practice, including the assessment, intervention, and evaluation that is needed to treat adolescents affected by sexting, are discussed.

Examining factors that increase and decrease stress in adolescent community college students.

In contrast to adolescents attending traditional universities, adolescents attending community colleges represent a large but relatively unstudied population with respect to stress and mental health issues. The purpose of this study was to determine what factors increase and decrease stress in a sample of adolescent community college students (N = 166). Findings from a self-administered questionnaire indicated that students had moderate levels of stress and resilience. Contrary to predictions, males demonstrated statistically significant higher levels of stress than females, but as expected, resilience had a significant negative effect on stress (p < .05). Practice and research implications are discussed for nurses in pediatric settings.

Psychoactive herb use and youth: a closer look at salvia divinorum.

Salvia divinorum is a psychoactive herb and an increasingly popular recreational drug used by young people in our country and abroad. Much of its increased popularity stems from its easy accessibility and affordability; its effects produce an intense and potent "high" and concomitant disorientation and hallucinations. The risks associated with Salvia are poorly defined due to a lack of scientific evidence, leaving Salvia users with false assurances about its safety. Although its safety profile is ill defined, its intense effects are well known and can put young people at risk for injuries and serious errors in judgment. Psychiatric nurses and health care practitioners are in key positions to influence practice, education, and policy regarding the use and abuse of this drug by youth.