Healing Trauma While Staying at Home: Using Telehealth to Conduct a Brief Treatment Program for Posttraumatic Stress Disorder.

Studies suggest that a three-session brief treatment program (Brief Relaxation, Education, and Trauma Healing [BREATHE]) can help treat posttraumatic stress disorder (PTSD) and symptoms of trauma; however, the program has not been examined via telehealth. Thus, the current study evaluated the feasibility of BREATHE delivered via telehealth. The intervention included breathing retraining and psychoeducation about PTSD and trauma. Thirty participants from the community with confirmed PTSD diagnoses participated in this telehealth program. Treatment retention was high, and participants showed decreased PTSD symptoms, posttraumatic cognitions, depression, anxiety, overall psychiatric symptoms, and internalized stigma and increased resiliency at posttreatment and 3-month follow up. Results suggest that a telehealth brief treatment program for PTSD is feasible and effective for individuals with PTSD. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Positive PTSD Screening and Its Health Correlates in Patients With HIV in Urban Primary Care Settings.

Posttraumatic stress disorder (PTSD) is underdiagnosed and undertreated in primary care, especially among African American individuals. The current study assessed documentation rates of PTSD and clinical health correlates among 135 predominantly African American patients with HIV and positive PTSD screens in a primary care unit. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and a retrospective chart review of 135 patients with HIV were conducted. On the PCPTSD-5 (cut point of 3), approximately one half of patients (49.6%; n = 67) had probable PTSD; however, only 11.9% of patients (n = 16) had a chart diagnosis of PTSD. A positive PTSD screen was associated with higher rates of depression and insomnia, but not anxiety, alcohol use, drug use, or pain in patients with HIV. Multi-morbidity of HIV, major depression, and positive PTSD screens was associated with increased risk for asthma, number of medical diagnoses, depression, insomnia, and anxiety. Findings highlight the need for trauma-informed care in primary care settings for people with PTSD and HIV. Larger samples are warranted to further explore health correlates of PTSD. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Associations Between Diaper Need and Child Sleep in Under-resourced Families.

OBJECTIVE: Sleep is critical for child health, but factors related to poverty create barriers to the achievement of healthful sleep. In this study, we examined the associations of insufficient diaper supply, a measure of material hardship, with child sleep. METHODS: This cross-sectional study included 129 parents of very young children. Each participant responded to an online material hardship assessment and the Brief Infant Sleep Questionnaire-Revised. Multiple linear regression was used to analyze the relationship between diaper need and sleep. RESULTS: Controlling for family and socioeconomic variables, diaper need was associated with disrupted, shorter sleep periods (ß = -11.95, p < 0.001) and lower total sleep scores (ß = -6.49, p = 0.004). High diaper need was associated with parent perception of poor sleep (ß = -7.28, p = 0.017). CONCLUSION: The findings suggest that an inadequate supply of diapers adversely affects children's sleep. Further research should evaluate how screening and connecting families to resources may improve pediatric sleep.

'You just really have to assert yourself:' social work, nursing, and rehabilitation counseling student experiences of providing integrated behavioral health services before and after the immediate start of COVID-19.

BACKGROUND: Educators who train healthcare students to provide behavioral health services in primary care settings frequently encounter challenges as they work to ensure that students acquire the knowledge and skills to effectively function on interprofessional practice teams. This has become increasingly important during COVID-19, as interprofessional collaborative practice is needed more than ever to address the interrelated health, mental health, and social structural issues linked to the pandemic. METHODS: We used qualitative focus groups to understand the experiences of 6 interprofessional teams (comprised of graduate social work, nursing, and rehabilitation counseling students; n = 19) providing behavioral health services in primary care settings before and after the immediate start of COVID-19. To triangulate data and enrich findings, one focus group with students' faculty supervisors was also conducted; n = 5). Data were analyzed using thematic analysis. RESULTS: Four themes highlighted student participants' need to assert themselves at the beginning of their educational experience, to communicate and learn from one another to develop positive team dynamics, to contend with role confusion and missed opportunities for collaboration, and to manage the emotional impact of COVID-19 on learning. CONCLUSION: Findings indicate that educators should work with clinical faculty and agency supervisors to orient students to ensure they have role clarity within the agency. Graduate students providing behavioral health services should also learn to work collaboratively within their scopes of practice to serve patients virtually, especially in preparation for public health emergencies.

Integrating Behavioral Health into Primary Care: The Role of Psychiatric Nursing in the Development of the Interprofessional Team.

BACKGROUND: Integrated behavioral health in a primary care setting is a paradigm shift that requires academic reconfiguration on how health care professionals are educated and trained in the clinical arena. METHOD: An academic university was able to create interprofessional didactic and clinical learning experiences for students within the Schools of Nursing, Social Work, Health Professions-Rehabilitation Counseling Department and Pharmacy resulting in improved models for patient care delivery. RESULTS: Interdisciplinary faculty developed the didactic, clinical and evaluative areas based on the HRSA grant work plan. Deliverables included 18 modules, case studies focused on population health, and team-focused standardized patient experiences to test their behavioral health and psychiatric skills in a primary care setting. CONCLUSIONS: Faculty from the different disciplines were able to collaborate on the deliverables, take the opportunities to engage students and collaborate on scholarly presentations at a national, state and local professional organizations. Academic course for interprofessional practice has been developed and implemented as an outcome of this grant.

Parent Perspectives on Sleep and Sleep Habits Among Young Children Living With Economic Adversity.

OBJECTIVE: To examine the perspectives of ethnically diverse, low-income parents of young children regarding sleep, sleep habits, and preferences for sleep promotion for themselves and their children. METHOD: We recruited a sample of mothers who had a 15- to 60-month-old child enrolled in the Special Supplemental Nutritional Program for Women, Infants and Children in a Northeastern U.S. city. We used a convergent mixed-methods design to conduct semistructured interviews and questionnaires to measure parent sleep quality (Pittsburgh Sleep Quality Index), sleep apnea (Berlin Apnea Questionnaire), mood (Centers for Epidemiological Studies of Depression), children's sleep (Children's Sleep Habits Questionnaire), and behavior (Child Behavior Checklist). RESULTS: Thirty-two mothers (M age = 30.97 [SD 6.34] years; n = 21 [65%] African American) and children (N = 14 [44% female]; M age =38 [SD 12.63] months) participated. Children's average sleep duration was 10 hr, which is below the recommendation for this age group; overall sleep difficulty was high despite most mothers reporting that their children had normal sleep. Five children had abnormal Child Behavior Checklist scores, suggesting internalizing and externalizing behaviors. More than half of the mothers had poor sleep quality and 24 (75%) were at high risk for sleep apnea. Mothers viewed sleep as important for themselves and their children and identified both effective and ineffective practices to promote sleep, including practices learned from their own families. CONCLUSIONS: Ethnically diverse mothers who are living with economic adversity value sleep for themselves and their children. The high value placed on sleep, despite misconceptions about normal sleep, suggest opportunities to promote sleep interventions. The content and delivery methods should be tailored to their knowledge, preferences, and cultural practices.

Community partnership for healthy sleep: Research protocol.

Beginning early in life, sleep health, including adequate quality, quantity, and consistent sleep routines, is critical to growth and development, behavior, and mental and physical health. Children who live in economically stressed urban environments are at particular risk for sleep deficiency and its negative consequences. Although efficacious sleep health interventions are available, few address the context of economically stressed urban environments. The purpose of this paper is to describe a two-phase protocol for an ongoing NIH/NINR-funded community-engaged study designed to understand the perspectives of parents, community child care and pediatric health care providers about sleep habits, factors that contribute to sleep and sleep habits, sleep difficulty, and potentially useful sleep promotion strategies among children living in economically stressed urban environments. The social-ecological model guides this study. Phase I employs a convergent mixed-methods design, in which we are conducting semi-structured interviews with parents, childcare providers, and primary health care providers. We are collecting 9 days of objective sleep data (wrist actigraphy) from children who are 6-18 months (n = 15) and 19-36 months of age (n = 15) and parent reports of sleep and sleep-related factors using standard questionnaires. In Phase I, we will use a qualitative descriptive approach to analyze the interview data, and descriptive statistics to analyze the survey and actigraph data. In Phase II, we will use the information to develop a contextually relevant program to promote sleep health. Our long-term goal is to improve sleep health and sleep-related outcomes in these children.

Experiences of stigma among family members of persons living with schizophrenia: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The aim of this qualitative systematic review is to explicate the experiences of stigma among family members of persons living with schizophrenia in any setting where they receive care. More specifically, the review will: (i) describe the experiences of stigma among family members of persons living with schizophrenia, (ii) describe the factors that influence the experiences of stigma, and (iii) describe the strategies and approaches used to cope with the stigma.

Evaluation of Cholesterol as a Biomarker for Suicidality in a Veteran Sample.

A reduction in total cholesterol may alter the microviscosity of the brain-cell-membrane, reducing serotonin receptor exposure. The resulting imbalance between serotonin and dopamine may lead to an increased risk for suicidality. The objective of this research was to evaluate total cholesterol as a biological marker for suicidality in a sample of US military veterans. The study population consisted of veterans who received care at the Coatesville Veterans Affairs Medical Center (VAMC) and were included in the Suicide Prevention Coordinator's database for having suicidal ideation with evidence of escalating intent, a documented suicide attempt, or committed suicide between 2009 and 2015. The veterans' medical data were obtained from the facility's computerized patient record system. The final sample was 188 observations from 128 unique veterans. Veterans with total cholesterol levels below 168 mg/dl appeared to have a higher suicide risk than those with higher levels. The cholesterol levels of veterans reporting suicidal ideation or attempt were significantly lower than the group reporting neither [F(2, 185) = 30.19, p < .001]. When data from multiple visits were available, veterans reporting suicidal ideation or attempt had experienced a significant (20%) decrease in cholesterol levels from an earlier visit in which they did not report suicidality. A latent class analysis revealed that among other differences, suicidal veterans were younger, leaner, and had more anxiety, sleep problems, and higher education than those being seen for an issue unrelated to suicidality. © 2017 Wiley Periodicals, Inc.

Maternal stress and psychological status and sleep in minority preschool children.

OBJECTIVES: Minority women living in inner city environments may be at more risk for psychological distress. Maternal stress, anxiety, depression, and psychological trauma can influence the preschool child's behavior and may have a negative impact on the preschool child's sleep patterns. The purpose of the study was to: (a) examine objective and subjective preschool children sleep patterns and (b) explore the relationship between objective and subjective sleep patterns in preschool children and maternal psychological status. DESIGN AND SAMPLE: A cross-sectional observational design was used. Descriptive analyses and correlations were conducted to examine the data. Twenty-one minority women were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children Program. MEASURES: Preschool children wore wrist actigraphs, and their sleep efficiency, time in bed, and sleep periods were analyzed. Mothers completed measures on depression, anxiety, stress, and psychological trauma. RESULTS: Mothers' self-report of their children's sleep habits indicated at risk scores for sleep problems. Life stress in the mothers was statistically significant and negatively related to preschool child's sleep duration. Mild to severe symptoms of depression and mild anxiety were reported and criteria for Post Traumatic Stress Disorder were found in 12 of the 21 mothers. The results of the study indicate that parent education on sleep and the minority preschool child should be part of community interventions and screening preschool parents for psychological distress should be considered with referrals for support services.

Moving evidence to practice: reflections on a multisite academic-practice partnership.

This paper describes the challenges encountered by an academic team when working with clinical teams to translated knowledge for the purposes of quality improvement in multiple sites. The sites were four differing health care settings in a Northeastern US state: two acute care hospital sites (one rural, one urban), one visiting nurse service and one psychiatric specialty hospital were purposively chosen for the action research study. In conducting this study at these diverse sites the importance of developing relationships and trust, understanding the context and dealing with real world complexities were evident. We conclude with observations and recommendations on important elements for effective knowledge translation work.

The evolution of the advanced practice role in psychiatric mental health in New Jersey: 1960-2010.

This historical perspective is focused on the contribution of Hildegard E. Peplau in laying the foundation for advanced practice nursing and the development of the roles of clinical nurse specialists and psychiatric nurse practitioners. An overview is provided of legal developments within the state that enabled Advanced Practice Nurses to provide mental health services. A description of a recent specialized state-funded initiative is outlined, focused on the development and contributions of psychiatric advanced practice nurses in community settings in New Jersey. Implications for the advanced practice nursing role in New Jersey are presented based on national and state initiatives.

Incorporating the treatment of medical and psychiatric disorders in the critical care area.

Critical care areas are fast moving, often chaotic, and therefore confusing, even frightening, to patients attempting to understand what has happened to them. The nurse acts to mitigate these reactions by understanding the range of possibilities that can occur with patients, including potential psychiatric issues, and serving as patient advocate to ensure that appropriate treatment is initiated. Certainly there may be other psychiatric problems not described in the preceding text. The main possibilities are covered in this article. Assessing and acting early are tools the critical care nurse uses to meet patient needs and prevent behavioral problems that can interfere with life-preserving care.

Psychiatric nursing practice and the recovery model of care.

This article provides an overview of the national actions by key groups on recovery from psychiatric disability and how a shift is needed to transform health care service delivery in mental health. Fundamental components of recovery are outlined, and examples are provided from the literature in nursing and related disciplines that reflect similar research and evidence-based practice interventions. It is recommended that professional nursing include consumers as active participants in the design of evidence-based practices in all settings.

Nurse-directed care model in a psychiatric hospital: a model for clinical accountability.

PURPOSE: The focus on recovery for persons with severe and persistent mental illness is leading state psychiatric hospitals to transform their method of care delivery. This article describes a quality improvement project involving a hospital's administration and multidisciplinary state-university affiliation that collaborated in the development and implementation of a nursing care delivery model in a state psychiatric hospital. DESCRIPTION OF THE PROJECT: The quality improvement project team instituted a new model to promote the hospital's vision of wellness and recovery through utilization of the therapeutic relationship and greater clinical accountability. Implementation of the model was accomplished in 2 phases: first, the establishment of a structure to lay the groundwork for accountability and, second, the development of a mechanism to provide a clinical supervision process for staff in their work with clients. Effectiveness of the model was assessed by surveys conducted at baseline and after implementation. OUTCOME: Results indicated improvement in clinical practices and client living environment. As a secondary outcome, these improvements appeared to be associated with increased safety on the units evidenced by reduction in incidents of seclusion and restraint. CONCLUSIONS: Restructuring of the service delivery system of care so that clients are the center of clinical focus improves safety and can enhance the staff's attention to work with clients on their recovery. IMPLICATIONS: The role of the advanced practice nurse can influence the recovery of clients in state psychiatric hospitals. Future research should consider the impact on clients and their perceptions of the new service models.

Moving psychiatric patients to a new hospital.

The focus of this article is on the process used to inform, prepare, and actually move (without incident) 129 psychiatric patients to a new hospital. Various strategies to prepare patients for and engage them in the move are detailed, including discussions with patients about various aspects of the move during daily morning life management meetings, surveys, tours of and luncheons at the new hospital, use of information packets with photographs of and captions describing the new hospital units, elicitation of input from and education of family members to provide support for the move, as well as individualized counseling and support of patients by staff.

Sleep patterns and psychological distress in women living in an inner city.

Psychological distress, including symptoms of anxiety, depression, and psychological trauma, is common in women living in inner cities and can be associated with disturbed sleep. The purposes of the study of 115 women were to examine: (a) objective and subjective sleep patterns; (b) extent of psychological distress; and (c) the relationship between objective and subjective sleep patterns and psychological distress. Wrist actigraphs were worn. High levels of life stress, sleep pattern disturbance, and psychological distress were common. Self-reported sleep patterns, but not objective sleep pattern variables, explained 12.5% to 44% of the variance in psychological distress, suggesting the importance of screening for sleep and psychological distress. These findings suggest that interventions focusing on sleep or psychological distress may reduce symptoms.

Implementing the clinical nurse specialist role in a regional state psychiatric hospital.

Clinical nurse specialists (CNSs) are essential to enhancing psychiatric-mental health nursing within state psychiatric hospital settings. This article presents a project focused on the CNSs in a state psychiatric hospital to expand their clinical role to increase the quality of care to individuals with serious mental illness and their numbers in other state psychiatric hospitals. As the patient population served in these settings becomes more complex, it is critical that advanced practice nurses are provided with appropriate updated state-of-the-art advanced knowledge and skills to collaborate within the interdisciplinary team. Furthermore, because of the complexity of the client and systems characteristics, the CNSs' clinical leadership is critical to promote the best practices in direct care services as well as provide support to various levels of nursing through staff development and training, role modeling, and mentoring of new staff.