Improving Resiliency in U.S. Air Force Healthcare Personnel: A Randomized Preventive Trial.

INTRODUCTION: The effectiveness of the Stress Management and Resilience Training (SMART) with U.S. military personnel has not been reported in the literature. The purpose of this study was to examine the effectiveness of SMART in increasing resilience in Air Force healthcare personnel. MATERIALS AND METHODS: We conducted a pilot, randomized preventive trial with active component Air Force healthcare personnel. SMART was offered via an in-person, 2-h training session delivered through face-to-face or synchronous video teleconference training, or via a self-paced, computer-based training. A baseline survey included demographics questions and the Connor-Davidson-10 Resilience Scale (CD-10), Perceived Stress Scale (PSS), Generalized Anxiety Disorder Scale (GAD-7), and overall quality of life (QOL) measure. Follow-up surveys with the CD-10, PSS, GAD-7, and quality of life were sent to participants at 12, 18, and 24 weeks after completing SMART. RESULTS: Fifty-six service members completed the baseline assessment and were randomized to either the in-person modality (comprised of video teleconference or face-to-face training) or the computer-based training modality, and 49 participants completed SMART. Significant increases in median CD-10 scores were observed among all participants, showing a 4-point (14%), 6-point (21%), and 5-point (17%) increase at week-12, -18, and -24, respectively, from the baseline. A significant overall decrease in median PSS scores from baseline were observed, with 5.5-points (22%), 7.81-points (32%), and 8.5-points (35%) decrease at 12, 18, and 24 weeks post-SMART, respectively. CONCLUSIONS: In this pilot study, SMART demonstrated significant and meaningful improvements in self-reported CD-10 and PSS-14 scores at 12, 18, and 24 weeks post-training completion. A future replication of the study is necessary to evaluate the effectiveness of SMART on a larger scale.

The Nursing Baccalaureate Dual Enrollment Model: Outcomes for A Community College and University Partnership.

The dual enrollment model in which universities collaborate with community colleges to provide the prelicensure Bachelor of Science in Nursing (BSN) education has been identified by the National Academy of Medicine as one of 5 viable academic progression models for transforming nursing education. The New Mexico Nursing Education Consortium (NMNEC) is a successful example of the dual enrollment model, which began in 2015 with one partnership. By 2018, 3 universities and 5 community colleges had partnered to offer the BSN jointly with the community college locations. In this retrospective, descriptive study, the 2 program types were compared to assess for differences in demographic and academic characteristics as well as program outcomes for the BSN graduates (n = 1018) from 2015 to 2018. The results of the analysis show that NMNEC has been successful in increasing the total number and diversity of BSN graduates for New Mexico. Importantly, NMNEC serves as an exemplar academic-practice partnership model because the success of the consortium would not have been possible without the involvement of practice partners. The outcomes from this study support academic-practice partnerships as instrumental in developing a better educated and more diverse nursing workforce that will improve patient outcomes and strive for health equity.

Employment and Retention of Nurses Who Completed an Internship and Residency Program.

BACKGROUND: The University of New Mexico Hospitals (UNMH) nurse residency and UNM College of Nursing nurse internship programs began in 2003 and 2004, respectively. This study evaluated the effectiveness of these programs in increasing RN hiring and retention. METHOD: Existing data from academic and human resources records were analyzed. Differences between demographic characteristics were assessed using descriptive statistics, and differences between groups were assessed with chi-square tests. RESULTS: Of 472 interns, 85.6% were hired by the UNMH. After 1 year, 341 continued their employment. Of RNs (n = 203) who could have been employed for 5 years, 43.3% remained at the UNMH. There were no differences in initial and 1-year RN employment based on age, gender, race, or ethnicity. RNs employed for 5 years were more likely to be male. CONCLUSION: The nurse internship program provided students with experience, knowledge, skills, and income. The UNMH hired graduate nurses and increased employee retention. [J Contin Educ Nurs. 2020;51(11):504-508.].

Treatment-Seeking Beliefs and Behaviors in Air Force Nursing Personnel.

INTRODUCTION: Perceptions of stigma and barriers associated with seeking mental health services have been described in past research with military service members who reported or screened positively for mental health concerns or who reported an intention to seek care. The reported influence of stronger perceptions of stigma on treatment seeking has varied. MATERIALS AND METHODS: An anonymous, online survey was administered to Air Force nursing personnel (N = 250) at three locations to describe beliefs associated with seeking mental health treatment and to investigate the extent to which stigma and barriers, stress, and resilience were related to mental health treatment seeking. RESULTS: Over 40% reported having accessed mental health services in their lifetime. A majority who accessed mental health services did so during their service, but there was no significant relationship with a deployment. Approximately 44% reported experiencing a current stress or emotional problem, and 28% accessed mental health services within the past 6 months. Levels of stress were significantly higher among individuals who accessed mental health care in the previous 6 months. There were no significant differences in stigma, barriers to care, or resilience on the basis of having accessed mental health care. Military resources were preferred to address a mental health concern, and respondents preferred to seek care from a mental health professional rather than other providers. CONCLUSION: Additional resources may be needed to address military personnel's nondeployment-related mental health concerns. Improved screening for increased levels of stress may aid in identifying service members who could benefit from referral to a mental health professional.

Building academic-military research collaborations to improve the health of service members.

BACKGROUND: Academic-military research collaborations are desirable for many reasons; however, little guidance in the literature exists to help researchers understand collaboration requirements. PURPOSE: To describe the process for establishing academic-military research collaborations. METHOD: Specific collaboration requirements researchers must be aware of are outlined, two case studies are provided, and opportunities for and challenges with collaborations are discussed. DISCUSSION: Academic-military collaborations made it possible to conduct studies of stigma and barriers with mental health care among military nursing personnel and the utilization of secure messaging for health concerns with service members and healthcare providers. Planning these efforts began in the earliest stages of developing research proposals, and additional time was required to complete regulatory requirements prior to study implementation. Understanding military-specific considerations and establishing clear expectations and responsibilities were essential. CONCLUSIONS: Despite the challenges involved, academic-military collaborations improve the quality of the research by enhancing access to funding, expertise, and resources.

A Concept Analysis of Stigma Perceived by Military Service Members Who Seek Mental Health Services.

PROBLEM: The aim of this concept analysis is to clarify military service members' stigma associated with seeking mental health services (MHS). Since 2001, over 2 million military service members have been deployed for or assigned to support military operations. Many service members develop a mental health concern during or after a deployment. Although researchers have assessed perceptions of stigma associated with accessing MHS, defining stigma is difficult, and conceptual clarity regarding stigma is lagging behind studies focused on its effects. METHODS: Stigma was explored using Walker and Avant's method of concept analysis. Thirty articles were found in the PsycARTICLES, PsycINFO, and PubMed databases and selected for inclusion and synthesis. FINDINGS: Military service member stigma is a set of beliefs, based on the member's military and prior civilian enculturation, that seeking MHS would be discrediting or embarrassing, cause harm to career progression, or cause peers or superiors to have decreased confidence in the member's ability to perform assigned duties. CONCLUSIONS: Nurses are ideally suited and situated to play an important role in decreasing stigma inhibiting service members from seeking MHS. Healthcare providers and civilian and uniformed leaders must communicate the value of seeking MHS to ensure service members' health, unit readiness, and overall force preparedness.

Symptoms among patients receiving in-center hemodialysis: A qualitative study.

INTRODUCTION: Assessment of dialysis-related symptoms is not currently a requirement for hemodialysis (HD) providers in the United States. The purpose of this study was to describe patients' perspectives on symptoms associated with end-stage chronic kidney disease treated with thrice-weekly, in-center HD. METHODS: We performed a qualitative study using interpretive description. Interview questions were based on a KDIGO (Kidney Disease Improving Global Outcomes) controversies conference and a literature review. Semi-structured interviews were analyzed for characterizations of symptoms. FINDINGS: Fifty participants (48% female; 42% Hispanic; 30% American Indian; 14% Black; 12% non-Hispanic White) were recruited from six outpatient dialysis centers (four urban, two rural) in the southwestern United States. Median HD duration was 4 years. Of 13 symptoms assessed, nearly all participants reported difficulties with muscle cramping, fatigue, or both. Negotiating fluid removal with dialysis personnel helped to manage cramping. Some participants tried to adjust dialysis days and shift to mitigate fatigue. Most participants reported having experienced depression early in the course of dialysis; for some, it was a persistent or recurrent problem. Relatively few participants reported using antidepressants or counseling to cope with depression. Itching was highly distressing for those who experienced it frequently. Topical treatments, antihistamines, dietary modifications, and phosphate binders were identified as potentially helpful by some participants. DISCUSSION: The major symptoms attributed to HD treatment by participants were cramping, fatigue, depression, and itching. Greater attention by health care providers to the most common and bothersome symptoms could positively impact daily life for HD patients.

Resilience, Stress, Stigma, and Barriers to Mental Healthcare in U.S. Air Force Nursing Personnel.

BACKGROUND: Stigma may deter military service members from seeking mental health (MH) services. Previously, substantial proportions of U.S. Air Force (USAF) registered nurses and medical technicians reported concerns about stigma with accessing MH services; in particular, that unit members might lose confidence in them or perceive them as weak, unit leadership might treat them differently, or accessing care might affect career advancement. OBJECTIVE: This study assessed the extent to which stigma and barriers to accessing MH services as perceived by USAF nursing personnel are associated with resilience, stress, previous deployment, or demographic characteristics. METHODS: An anonymous, online survey was administered to active-duty USAF registered nurses and medical technicians at three locations (N = 250). The survey included demographic items, the Stigma and Barriers to Care scales, Conner-Davidson Resilience Scale, and Perceived Stress Questionnaire. RESULTS: Mean resilience was high, and perceived stress was moderate. About half of participants agreed that unit members might have less confidence in me (54%) or unit leadership might treat me differently (58%). Many also had concerns that it would harm my career (47%), I would be seen as weak (47%), or there would be difficulty getting time off work for treatment (45%). Stigma was positively correlated with perceived stress (r = .40, p < .01) and negatively correlated with resilience (r = -.24, p < .01). Officers had significantly higher stigma and resilience scores and lower stress scores compared with enlisted personnel, but those differences were small. DISCUSSION: This study validated previous findings that substantial percentages of USAF nursing personnel have concerns that accessing MH services may adversely affect their careers and how they are viewed by unit leaders and peers. In addition, higher levels of concern about stigma were associated with higher levels of stress and lower levels of resilience. Limitations included a low response rate (18%) and self-selection biases.

Stigma and barriers to accessing mental health services perceived by Air Force nursing personnel.

We investigated perceptions of stigma and barriers associated with accessing mental health services among active component U.S. Air Force officer and enlisted nursing personnel (N = 211). The Britt and Hoge et al Stigma scale and Hoge et al Barriers to Care scale were administered via an anonymous, online survey. Stigma items pertained to concerns that might affect decisions to seek mental health treatment. Most of the sample agreed with the items "Members of my unit might have less confidence in me" and "My unit leadership might treat me differently." Approximately 20% to 46% agreed with the other four stigma items. Officer nursing personnel were significantly more likely than enlisted to agree that accessing mental health services would be embarrassing, harm their career, or cause leaders to blame them for the problem (p ≤ 0.03 for each comparison). Getting time off from work for treatment and scheduling appointments were perceived as barriers by 41% and 21% of respondents, respectively. We conclude that proportions of Air Force nursing personnel reporting concerns about potential stigmatizing consequences of seeking mental health care are substantial and similar to ranges previously reported by military service members screening positive for mental health problems after deployment.