A County-Level Case Study of Early Psychosis in the Context of a Hybrid Juvenile Competency Restoration and Mental Health Problem-Solving Court and Linkage to Coordinated Specialty Care Services.

An important and unresolved question in the context of the implementation of coordinated specialty care (CSC) for early psychosis in the United States is the extent to which youth and young adults from marginalized backgrounds are able to equitably access CSC services. In this brief report, we describe pathways between a county hybrid juvenile competency restoration and mental health problem-solving court ('Court'), serving youth with high rates of psychosis and multiple risk factors for poor long-term outcomes, and local CSC services. We found that the Court was overall successful in linking youth with psychosis to care, but in the majority of cases this was not CSC programming more specifically. Drawing on Court and CSC records as well as family interviews, we report on factors contributing to low linkage to CSC, including family-side barriers (lack of transportation, preference for lower intensity / lower demand services) and provider-side barriers, including eligibility criteria such as duration of psychosis, that ultimately exclude otherwise eligible Court-involved youth.

American Academy of Nursing expert panel consensus statement on inequities in the juvenile justice system rooted in systemic and structural racism.

The overrepresentation of youth of color has long been acknowledged and accepted in juvenile justice and legal systems. Many risk factors contribute to the detention and incarceration of youth; however, there is little evidence to explain how structural inequities and systemic racism add to that vulnerability. Historically, laws were passed to benefit the White society and resulted in outcomes that caused grave aftereffects for people of color and in some cases, ethnic minorities. Within the context of juvenile justice and the lens of critical race theory, the authors of this paper seek to illuminate selected historical educational, environmental, legal, and health care policies, practices, and decisions that led to their detrimental consequences. Recommendations for mitigating both intended (through law, funding, policies) and the unintended barriers as experienced by youth of color are presented.

COVID-19 vaccination readiness among nurse faculty and student nurses.

BACKGROUND: Unprecedented efforts are underway to develop COVID-19 vaccines, widely seen as critical to controlling the pandemic. Academic nursing leaders must be proactive in assuring widespread faculty and student vaccination uptake. PURPOSE: The purpose of this study was to describe nursing faculty and student nurse factors associated with COVID-19 vaccine readiness. METHODS: Cross-sectional online survey of nursing faculty and student nurses at a university affiliated with an academic medical center was conducted. FINDINGS: Most full-time faculty (60%) intended to receive the vaccine; but only 45% of adjunct faculty and students reported intending to get vaccinated. The major reasons for not getting vaccinated were vaccine safety and side effects. Collectively, participants reported a low level of knowledge related to vaccine development. DISCUSSION: As the most trusted profession, nurses will play a decisive role in counseling patients about COVID-19 risks and benefits. Findings suggest that academic nursing leaders need to consider faculty and student vaccine concerns and provide vaccine development education.

Clinical Decision Making at the Bedside.

The complexity and rapidly changing environment of health care places significant pressure on nurses. How nurses make decisions within this environment has been an area of inquiry in the literature. Clinical decision making is the application of distinct thinking patterns and analysis of data at hand used to make judgements about patient care. Models of clinical decision making provide a foundation for understanding how nurses make decisions. Key factors associated with clinical decision making include experience, intuition, use of information and sources, and environment. Further work is needed to increase understanding of the processes by which nurses make clinical decisions.

Operational Failures Detected by Frontline Acute Care Nurses.

Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.

Complementary and Integrative Therapies for Persistent Pain Management in Older Adults: A Review.

Management of persistent pain in older adults is challenging given the prevalence of multiple comorbid painful conditions, polypharmacy, age-related changes restricting pharmacological options, and socioeconomic factors. The influences of these factors along with current concern for the use of opioid analgesics highlight the importance of incorporating complementary and integrative medicine approaches. Evidence suggests efficacy and satisfaction with integrating complementary pain management strategies for older adults, especially yoga, massage, and natural products. Nurses and other providers, given their emphasis on holistic care, are in a unique position to lead the transformation of pain management to a patient-centered, self-management style that integrates complementary therapies. [Journal of Gerontological Nursing, 42(12), 40-48.].

Cytogenetic evaluation: a primer for pediatric nurse practitioners.

Patients with genetic disorders require specific types of cytogenetic testing for accurate diagnosis and prognosis followed by prompt treatment. This primer will serve as a guide for pediatric nurse practitioners on the use of various cytogenetic testing for the diagnosis of genetic disorders. Knowledge of the latest cytogenetic technologies will facilitate diagnosis and counseling related to genetic abnormalities such as inherited disorders, mental retardation, developmental delay, and autism. This reference will enable pediatric nurse practitioners to help identify patients with various inherited genetic disorders and provide subsequent monitoring and treatment.

Leveraging Academic-Service Partnerships: Implications for Implementing the RWJ/IOM's Recommendations to Improve Quality, Access, and Value in Academic Medical Centers.

Transformation of the current healthcare system is critical to achieve improved quality, safety, value, and access. Patients with multiple, chronic health conditions require integrated care coordination yet the current health care system is fragmented and complex. Nursing must play a key role in constructing a system that is value based and patient focused. The Robert Wood Johnson/Institute of Medicine (RWJ/IOM) report on the future of nursing outlines strategic opportunities for nursing to take a lead role in this transformation. Partnerships across academic institutions and health care systems have the potential to address issues through mutual goal setting, sharing of risks, responsibilities, and accountability, and realignment of resources. The purpose of this paper is to present Stony Brook University Medical Center's (SBUMC) academic-service partnership which implemented several of the RWJ/IOM recommendations. The partnership resulted in several initiatives that improved quality, safety, access, and value. It also characterized mutual goal setting, shared missions and values, and a united vision for health care.