Shared Trauma: An evolutionary model concept analysis in light of COVID-19.

Shared trauma (ST) is a term historically applied to social work experiences, but other healthcare professionals (HCP) also experience ST. With the occurrence of COVID-19, ST has impacted HCP globally and has led to new discoveries and more questions regarding its scope, impact and duration. This article aims to explore the concept of ST applied to nurses in light of COVID-19 using the Rogers and Knafl Evolutionary Model for Concept Analysis. Further examination and evolution of 'shared trauma', particularly during COVID-19, has led to the development of an adapted model to explore the implications of ST on health-related outcomes for nurses.

Exploratory factor analysis of shared trauma in psychiatric-mental health nurses using the Shared Trauma Professional Posttraumatic Growth Inventory (STPPG).

INTRODUCTION: The Shared Trauma Professional Post Traumatic Growth Inventory (STPPG) was developed by Tosone et al. (2014) to help understand shared trauma (ST) in social workers. ST occurs when the healthcare professional and client both experience the same collective traumatic event. This inventory has been adapted for use with mental health nurses. A cross-sectional study of N = 552 mental health nurses was completed in the spring of 2023 to assess the feasibility of using the STPPG to explore shared trauma in mental health nurses. METHODS: An exploratory factor analysis was run for the STPPG using squared multiple correlations with the maximum likelihood method. RESULTS: The alpha coefficient ranged from 0.82 to 0.89 for 2-factors and 0.73 to 0.89 for 3-factors. The results indicated that all correlations were significant among the total scales and subscales. All correlations were positive, ranging from 0.81 to 0.95 for two factors and 0.58 to 0.89 for three factors. CONCLUSION: The STPPG has confirmed a two-factor analysis for mental health nurses. The STPPG is a valid inventory to measure ST in mental health nurses and will allow the concept to be further studied.

Developing Family Nurse Practitioner Student Competencies: A Two-Part Mental Health-Focused Telehealth Education Activity.

Telehealth is becoming a vital option for increasing access to health care. Family Nurse Practitioners (FNPs) are often the primary providers for rural and disadvantaged populations. They may be the first to encounter patients experiencing depression and other psychiatric problems. This article describes a two-part simulated telehealth education initiative to build FNP student competencies in the use of telehealth technology to interview clients with depressive symptoms. In Part 1, students completed didactic modules that introduced them to telehealth concepts. In Part 2, they participated in a simulated telehealth encounter with a standardized patient experiencing depression. Preparation included a review of care of patients with depression and focused content on telehealth etiquette. After the encounter, they received feedback from the standardized patient, debriefed with faculty, and documented their simulated telehealth visit. The activity was evaluated through post-education surveys and a one-time focus group. Students were overwhelmingly positive regarding the relevance of the educational activity to their graduate preparation and future practice. Many shared suggestions for refinement of the activity. Integration into the current curriculum and use of existing resources increased the feasibility, cost-effectiveness, and potential for long-term sustainability of the educational initiative.

Addressing the Mental Health of Nursing Students During the Pandemic: The Evaluation of a Needs Assessment by a College of Nursing Mental Health Task Force.

BACKGROUND: A Mental Health Task Force (MHTF) was developed in a large public college of nursing in the Southeastern United States to address the urgent mental health needs expressed by growing numbers of nursing students related to the coronavirus disease 2019 (COVID-19). AIMS: The purpose of this study was to report on a needs assessment conducted by the MHTF. METHODS: The needs assessment study design was a 16-item cross-sectional online survey and four "Town Hall" focus groups with nursing students, faculty, and staff (n = 1-8 participants per group). Survey data were analyzed using descriptive statistics and free-text questions from the survey and focus groups were analyzed using a qualitative descriptive approach. RESULTS: Undergraduate and graduate students (n = 115) ranging in age from 17 to 50 years completed the survey; 95% female, 94% full-time, 56% employed, 77% White, and 81% in the Bachelor of Science in Nursing program. Eleven students participated in the focus groups. The analysis of the free-text survey questions identified the students' perceived needs. Mental health care was the most frequently requested, followed by faculty check-ins, stress management, and peer support. CONCLUSIONS: The administration of the survey provided an opportunity for students to communicate concerns and make requests. To address the ongoing effects of the COVID-19 pandemic on nursing students, multi-modal needs assessments should be conducted periodically to identify priority mental health needs.

Building Spiritual Care Competency in Undergraduate Psychiatric Mental Health Nursing Students: A Quality Improvement Project.

Purpose: The spiritual care of patients is often overlooked in health care as many nurses are unprepared to provide competent, holistic care that addresses patients' spiritual needs. Since undergraduate academic instruction prepares nurses for practice, innovative strategies that train pre-licensure nurses to care for the spiritual needs of patients are essential. Design: A course needs assessment identified spiritual care as the most deficient competency for undergraduate psychiatric students. A three-phase quality improvement project designed to increase student awareness and practice of spiritual care included (a) development of a quality improvement plan, (b) implementation, and (c) outcome evaluation. Methods: Spiritual care was introduced into the Spring 2020 semester through didactic content and experiential practice. Additionally, an evidence-based spiritual assessment tool (i.e., HOPE questions) was integrated into the course to train students for use in clinical and simulation. Surveys were used to compare the 2019 and 2020 cohorts. Findings: Results showed a statistically significant increase in students' perception of spiritual care competency after project completion. Conclusions: Future implications include the use of similar methods to improve spiritual care competency for pre-licensure nursing students. Keywords: Spiritual care, undergraduate nurse, spiritual assessment.

An academic-community interprofessional telehealth online training partnership: Impact on students and providers.

Telehealth can be used to improve rural communities' access to specialized healthcare services and ameliorate rural care barriers. Use of telehealth quickly increased with the COVID-19 pandemic, and universities shifted to online instruction for the safety of students and faculty. This rapid uptake of telehealth and online instruction has created an urgent need for examples of online training for health professional students in telehealth. Participants for this study included 44 students enrolled in an interprofessional online mental health telehealth course and four health care professionals from rural clinics. Qualitative data were collected and analyzed from students and providers. Four primary themes were identified: student benefits from the IPE telehealth course, patient benefits, clinic benefits, and technological challenges. Student subthemes included learning skills needed for telehealth, improving team skills, learning about professional roles and responsibilities, and understanding rural health needs. Clinic benefits included improving telehealth readiness. This study presents an early example of online interprofessional mental health telehealth training using an academic-community partnership. Our pilot findings suggest that this course experience resulted in positive benefits for students and rural clinic providers.

Building psychiatric advanced practice student nurse competency to conduct comprehensive diagnostic interviews using two types of online simulation methods.

BACKGROUND: Through innovative use of established technologies, online nursing programs can provide psychiatric mental health nurse practitioner (PMHNP) students with robust virtual experiences for learning professional competencies, including those involving psychomotor and affective domains. PURPOSE: To describe a virtual simulation teaching methodology using online text-based simulations of patient visits prior to a virtual standardized patient (SP) encounter in an asynchronous online course for PMHNP students. METHOD: Student learning experiences were framed by the Framework for the 21st Century Learning. Two types of online simulations were employed: (1) four text-based exercises, created with a testing tool in a learning management system, allowed students to practice the critical thinking processes behind diagnostic interviewing, and (2) a telehealth simulation with an SP, where students engaged the patient, conducted a diagnostic interview, and discussed the treatment plan with the patient. Following the telehealth simulation, students completed self-assessments, received individual feedback from the SP and clinical faculty, and discussed experiences in small groups. RESULTS: Students demonstrated professional competencies and developed self-awareness and self-efficacy through reflection and discussion. CONCLUSION: This teaching approach can potentially enhance learning and build greater career skills including conducting diagnostic interviews using therapeutic communication skills for patients with stigmatizing mental health conditions.

Use of a Paper Checklist to Increase Clinician Adherence to Mammography Screening Guidelines.

OBJECTIVE: To increase clinician adherence to mammography screening guidelines. DESIGN: Quality improvement initiative. SETTING/LOCAL PROBLEM: At a nurse practitioner-led primary care practice, a chart audit of adherence to American Cancer Society mammography screening guidelines indicated a 12% adherence rate for clinicians writing mammography orders. PARTICIPANTS: Nurse practitioners providing care to women ages 40 years and older. INTERVENTION/MEASUREMENTS: The intervention was a screening checklist that was completed by the woman at registration and given to the clinician during the examination. The pre- and postintervention measurement was the percentage of mammogram orders. A Fisher exact test was used to examine changes from pre- to postintervention rates of adherence. RESULTS: After the intervention, the percentage of women for whom a mammogram was recommended and ordered was 69.6%, compared to 12% from the original chart audit. This change was statistically significant (p = .01). CONCLUSION: Clinicians must find efficient approaches to improve processes within their practice settings to ensure that preventive care recommendations are made during visits. Although the screening checklist was deemed useful, improvement in adherence rates is still needed, and a paperless system should be initiated.

Mammography Adherence: Creation of a Process Change Plan to Increase Usage Rates.

BACKGROUND: Mammography is the optimal tool to mitigate breast cancer morbidity and mortality; however, in many healthcare settings, mammography adherence rates are decreasing. OBJECTIVES: This nurse-led quality improvement project was conducted to improve patient adherence to annual mammography screening. METHODS: Data collection included clinical information from the electronic health record, chart reviews, tracking documentation used by the clinic's social worker, interviews with staff, observation of the clinical setting, creation of a process flow map to identify barriers, and identification of internal and external resources. Strategies to reduce barriers included communication with staff about problems, a streamlined referral process, a scripted message about mammography, an up-front assessment of financial and social barriers to adherence, and an early referral to resources. FINDINGS: A pre-process change chart audit showed a 22% mammography adherence rate. The post-process change rate was 51%, representing a statistically significant difference in adherence.

Developing and Implementing a Quality Assurance Strategy for Electroconvulsive Therapy.

BACKGROUND: The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care; however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. OBJECTIVE: The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. METHODS: An audit tool was developed utilizing quality criteria derived from a systematic review of ECT practice guidelines, peer review, and facility policy. All ECT procedures occurring over a 2-month period of May to June 2017 were retrospectively audited and compared against target compliance rates set for the facility's ECT program. Facility policy was adapted to reflect quality standards, and audit findings were used to inform possible practice change initiatives, were used to create benchmarks for continuous quality monitoring, and were integrated into regular hospital quality meetings. RESULTS: Clarification on standards of care and the use of clinical auditing in ECT was an effective starting point in the development of a quality assurance strategy. Audit findings were successfully integrated into the hospital's overall quality program, and recognition of practice compliance informed areas for future quality development and policy revision in this small community-based hospital in the southeastern United States. CONCLUSIONS: This project sets the foundation for a quality assurance strategy that can be used to help monitor procedural safety and guide future improvement efforts in delivering ECT. Although it is just the first step in creating meaningful quality improvement, setting clear standards and identifying areas of greatest clinical need were crucial beginning for this hospital's growing program.

Using Debates to Teach Evidence-Based Practice in Large Online Courses.

BACKGROUND: To engage in evidence-based practice (EBP), baccalaureate nursing graduates' competencies must include locating, interpreting, appraising, and applying research findings. Faculty are challenged to find effective ways to incorporate this content in large online courses. METHOD: Faculty in a thriving college of nursing used interactive debates to teach EBP skills in a large (200+ students) online undergraduate course. RESULTS: Students remain highly engaged while practicing critical thinking, team-work, leadership, delegation, communication skills, and peer evaluation through participation in a series of faculty-facilitated online debates. CONCLUSION: Meticulous course organization and use of structured debates allows one instructor to teach skills for EBP, while keeping students engaged with each other, the instructor, and the material. Use of debates and the amount of engagement among students and faculty achieved could not be accomplished in a large face-to-face course.

Redesigning a graduate research course for evidence-based competencies.

Nursing research is critical to establish the science for the discipline and to provide a foundation for evidence-based practice. All nurses need to understand the research process and engage in research at the level for which they were prepared. The American Association of Colleges of Nursing has clearly outlined essential learning outcomes for each level of nursing education, including the competent application of research findings to clinical problems. This article describes the evolution of a graduate-level research course to provide master's level students with a sound foundational understanding of the research process, the innovation undertaken to address identified learning needs, and the important lessons learned.

A pilot study of a weekend retreat intervention for family survivors of homicide.

Homicide causes negative unintended consequences for family survivors. Family survivors face complicated grief and overwhelming loss with minimal support from others. The authors offered a retreat intervention as a way to ameliorate the effects of the homicidal death for family survivors of homicide. An exploratory longitudinal pilot study examined the feasibility and acceptability of the intervention and explored the impact of the TOZI© Healing intervention on participants' distress symptoms. Eight family members participated in the 2-day retreat and completed surveys at five time intervals over 30 months. Descriptive statistics and correlations were used to analyze the data. Although sample sizes were too small to achieve statistical significance, changes on selected holistic health outcomes, supported by overwhelmingly positive focus group responses to the intervention, affirm the need for further study.

Using focus groups to understand mother-child communication about sex.

The purpose of this descriptive focus group study was to examine communication themes regarding sex and sexual risk behavior in low-income mothers of adolescent children. Focus group questions were guided by Jaccard's communication constructs. Data analysis provided three overriding themes in all five construct areas: mothers are often uncomfortable discussing sex with their male children, mothers feel strongly that their own values and beliefs must guide discussion, and mothers believe their children need developmentally appropriate information. This information may be useful in assisting pediatric nurses in discussing adolescent sex and sexual risk behavior with families.

Predictors of alcohol and drug problems in rural African American women.

African American women report less alcohol and other drug (AOD) use than Caucasian women. However, health care professionals cannot afford to dismiss AOD use as significant problems for some African-American women. Although we know much more about AOD problems in women in general, we still lack information about AOD disorders and associated factors among rural African American women. Stepwise multiple regression was used to identify the best predictors of alcohol and drug problems among 142 rural African American women who took part in a study of risk factors for AOD disorders in rural women.

Perceptions of survivors of loss by homicide: opportunities for nursing practice.

Ten adult family members of homicide victims were recruited to participate in interviews describing their experiences related to the loss of their loved ones. A phenomenological approach was used to guide data collection and analysis, resulting in the identification of four major themes. Participants described intense emotional responses and grief complicated by the suddenness, violence, and intentionality of the homicide; engagement in activities that both buffered the emotional effects of the loss and helped them purposefully integrate it into their lives; the strengthening and dissolution of relationships; and a transformative, perpetually evolving post-homicide experience that was viewed as "healing" and that was influenced by many factors. Implications of these findings for research and nursing practice are discussed.

Stress, coping, and alcohol expectancies in rural African-American women.

African-American women report less alcohol and other drug (AOD) use compared with Caucasian women. However, health care professionals cannot afford to dismiss AOD use as a significant problem for some African-American women. Although we know much more about AOD problems in women in general, we still lack information on AOD disorders and associated factors among rural African-American women. This article focuses on examining rural African-American women (n=142) with and without AOD disorders on the following variables: stressors, uplifts, coping, and alcohol expectancies.

Effects of stress management on PNI-based outcomes in persons with HIV disease.

A pretest-posttest, repeated-measures design was used to evaluate the effects of two stress management interventions on a battery of outcomes derived from a psychoneuroimmunological (PNI) framework. The effects of cognitive-behavioral relaxation training groups (CBSM) and social support groups (SSG) were compared with a WAIT-listed control group on the outcomes of psychosocial functioning, quality of life, neuroendocrine mediation, and somatic health. Participants were 148 individuals (119 men, 29 women), diagnosed with HIV disease; 112 (76%) completing the study groups. Using analysis of covariance, the CBSM group was found to have significantly higher postintervention emotional well-being and total quality-of-life scores than did either the SSG or WAIT groups. SSG participants had significantly lower social/family well-being scores immediately postintervention and lower social support scores after 6 months. The findings point to a pressing need for further, well-controlled research with these common intervention modalities.