Mental health intervention development for indigenous youth: Essential elements and guiding principles.

There is a need for intervention studies to address mental health issues with Indigenous youth. The purpose of this work is to: 1) consider calming approaches introduced by Native-American adolescents who described in writing how they manage day-to-day stress; and 2) identify culturally relevant constructs (elements and principles) for development of mental health promotion interventions for use with Indigenous youth. Central ideas shared by Native-American adolescents were merged with existing literature to identify essential elements and guiding principles for intervention development. Three essential elements (talking circles; mindfulness practice; tailored educational content) with associated guiding principles are recommended for intervention development.

COVID-19 Pandemic and Posttraumatic Growth in Residents of a Continuing Care Retirement Community: A Mixed Methods Study.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic impacted life for older adults living in residential settings, affecting their psychosocial well-being. Risk for COVID-19 is associated with increasing age and pre-existing health conditions. The current study aimed to describe the challenges of COVID-19 and post-traumatic growth (PTG) for residents of a continuing care retirement community (CCRC) in South Florida. METHOD: A parallel mixed methods approach was used to explore the experience of older adults with PTG. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis to identify emergent themes. RESULTS: Ninety-eight older adults living in a single CCRC completed a survey. Age ranged from 67 to 99 years (mean age = 86 years), with >90% identifying as non-Hispanic White and female (78%). Using the PTG theoretical framework, experiences were categorized into five dimensions: new possibilities, relating to others, personal strength, spiritual growth, and appreciation for life. CONCLUSION: The current study focused on the challenges and growth experienced by older adults, as framed by PTG theory. Findings shed light on the capacity of this demographic, with an average age of 86 years, to overcome obstacles and achieve PTG. [Journal of Gerontological Nursing, 50(6), 25-33.].

My Dog, My Hero: Assessing the Feasibility of a Cross-Generational Digital Storytelling Intervention for Veterans.

During the COVID-19 pandemic, social isolation had a devastating effect on well-being. Veterans were among the most vulnerable given their high rates of military trauma-related conditions. Research supports that dogs can provide veterans with a sense of purpose, social support, and stress management. Digital storytelling provided a unique perspective with focus on a recognized hero, the veteran's dog, and an opportunity for engagement with other veterans during COVID-19. The purpose of the study was to assess the feasibility of this digital storytelling intervention based on Story Theory framework and tailored to encompass components of cross-generational collaboration in combination with individual and group virtual sessions as a mechanism to promote social engagement. The research was conducted using a descriptive exploratory design. Veterans (N = 8) were paired with a trained student and grouped in sets of four. There were eight guided 1-hour weekly virtual sessions to create their digital story. Demographic and pre-post intervention survey data were also collected. Based on eight established criteria, this article systematically evaluates the feasibility of the digital storytelling intervention for veterans. The findings suggest practical considerations to ensure viability of digital storytelling as a therapeutic intervention for veterans and other populations at-risk for suboptimal well-being.

Adding Ritualized Chanting to the Palliative Care of Cancer Patients at the End of Life: A Randomized Controlled Trial.

This study examined the changes in comfort when adding ritualized chanting to the palliative care of cancer patients at the end of life. The method was a randomized control trial (RCT) performed with 60 cancer patients. Comfort was measured using the End of Life Planning Questionnaire (EOLPQ) with 30 participants in each group [ritualized chanting with palliative care (RCPC) and palliative care alone (PCA)] at baseline (T1), at a 3-week (T2) and the 6-week (T3) time frame. Comfort data were analyzed using two (groups) X three (time) repeated measures MANOVA. There were no significant statistical differences between the groups at baseline. Between-group differences indicated that comfort experienced by participants with the addition of ritualized chanting to palliative care significantly increased (p < .001) over time. The addition of ritualized chanting to the palliative care for cancer patients at the end of life can create changes in their comfort.

Death of an infant: Accessing the voices of bereaved mothers to create healing. A qualitative study.

AIMS AND OBJECTIVES: To describe the health challenge for mothers whose infants have died and approaches and resources they used to manage the loss. BACKGROUND: The death of an infant is a devastating experience for families. Bereaved mothers have higher rates of mental distress, loneliness and isolation. While some learn to cope, others remain consumed by grief, unable to function, with persistent affective, cognitive and physical symptoms. DESIGN: Qualitative design guided by story theory. METHODS: In-depth, semi-structured interviews were conducted with mothers 13-36 months after the death of their infant. Looking at the present, past and future, mothers were asked to describe the health challenge of losing an infant and approaches used to manage the loss. The COREQ checklist was used. RESULTS: These mothers' experiences were captured in six main themes: 'Painful aloneness', 'Blemished identity', 'Burden of being misunderstood', 'Being with and being heard', 'Being present and building a future' and 'Finding meaning in the tragedy'. In sharing their stories, mothers identified positive and negative encounters with healthcare professionals following the death of their infant. CONCLUSION: After losing an infant, mothers experience an array of challenges as they move forward. They describe their approaches used to manage the loss. This included a need to be heard, feel supported and find meaning in the loss as they try to build a new future. Their stories express a need for health care encounters to be healing, allowing mothers to feel cared for and supported on their unique journeys towards a new sense of well-being. RELEVANCE TO CLINICAL PRACTICE: In sharing their stories what matters most to these mothers having lost an infant emerged. The study findings can be used to guide nursing practice, incorporated into healthcare providers bereavement training, increase knowledge and build effective communication skills.

Feasibility of a brief mindfulness intervention: Examining stress, anxiety and mindfulness for Thai parents of children with developmental disabilities.

AIM: To examine the feasibility of using a 2-weekend Brief Culturally Tailored Thai Mindfulness intervention (BCTTMi) to affect stress, anxiety, and mindfulness in Thai parents of children with developmental disabilities (DDs), based on eight feasibility study criteria. METHODS: A BCTTMi was implemented with 22 Thai parents and caregivers of children with DDs with an experimental waitlist control crossover design. All participants were Thai and Buddhist; more than half had practiced meditation. The outcomes (stress, anxiety, mindfulness) were assessed with three Thai translated questionnaires, which had reported acceptable reliabilities. To address the feasibility criteria, data were gathered using virtual engagement, diary recordings, and a pre-, post-test trial. RESULTS: Assessment of the eight qualities of feasibility indicated: 1) acceptability: the BCTTMi appealed to the participants; 2) demand: the participants practiced mindfulness at home; 3) implementation: the mindfulness practitioner was qualified; 4) practicality: anxiety was the only outcome measure sensitive to the BCTTMi (p = .005); 5) adaptation: there was no attrition with the shortened mindfulness intervention; 6) integration: the BCTTMi may be included as part of the participants' routine club meeting; 7) expansion: a home visit and booster sessions may add strength; 8) limited efficacy: future work with 50 participants will allow adequate power when anxiety is the outcome. CONCLUSIONS: Further studies testing the BCTTMi are warranted in broader populations and across varied settings. However, it will be important to do preliminary work to identify outcomes measures, other than anxiety, that are sensitive to the BCTTMi.

Guidance for using mixed methods design in nursing practice research.

The mixed methods approach purposefully combines both quantitative and qualitative techniques, enabling a multi-faceted understanding of nursing phenomena. The purpose of this article is to introduce three mixed methods designs (parallel; sequential; conversion) and highlight interpretive processes that occur with the synthesis of qualitative and quantitative findings. Real world examples of research studies conducted by the authors will demonstrate the processes leading to the merger of data. The examples include: research questions; data collection procedures and analysis with a focus on synthesizing findings. Based on experience with mixed methods studied, the authors introduce two synthesis patterns (complementary; contrasting), considering application for practice and implications for research.

The Effect of Chair Yoga on Biopsychosocial Changes in English- and Spanish-Speaking Community-Dwelling Older Adults with Lower-Extremity Osteoarthritis.

Chair yoga (CY), a mind-body therapy, is a safe nonpharmacological approach for managing osteoarthritis (OA) in older adults who cannot participate in standing exercise. However, there is no linguistically tailored CY program for those with limited English proficiency (LEP). This 2-arm randomized controlled trial compared the effects of a linguistically tailored yoga program (English and Spanish versions) on the outcomes of pain, physical function, and psychosocial factors compared to the effects of a linguistically tailored Health Education Program (HEP; English and Spanish versions). Participants with lower-extremity OA, recruited from 2 community sites, completed the Spanish (n = 40) or English (n = 60) version of twice-weekly 45-min CY or HEP sessions for 8 weeks. Data were collected at baseline, 4 weeks, 8 weeks, and 1- and 3-month follow-ups. English and Spanish CY groups (but neither HEP language group) showed significant decreases in pain interference. Measures of OA symptoms, balance, depression, and social activities were not significantly different between English and Spanish versions of CY and English and Spanish versions of HEP. It was concluded that the Spanish and English versions of CY and HEP were equivalent. Linguistically tailored CY could be implemented in aging-serving communities for persons with LEP.

Approaches for Moving Beyond Abrupt Widowhood: A Case Analysis With One Muslim Thai Woman.

This preliminary study aimed to describe approaches used to resolve the health challenge of abrupt widowhood when one's spouse was killed in the socio-political conflict areas in South Thailand. A story theory was used to guide content analysis from an interview of a middle-aged Muslim widow. Four main approaches were identified including accepting support from close friends and family, connecting with her Muslim faith, holding on to concern for her children's well-being, and reaching out to other widows. The findings could be used to guide an appropriate intervention for improving mental health outcomes for Thai widows.

An Evolving Structure of Nature Immersion: Roots in Nightingale's Vital Power.

Background: In Florence Nightingale's view, vital power resides in both earthy materials and human nature and is an essential element of health. Vital power is defined as a health force that manifests in states of being while doing in nature to generate well-being, but little is known about the generative process of vital force. Purpose: This secondary study explored the vital power of children who experienced well-being while doing in nature. Methods: Using a framework of the Nature Immersion Model, directed content analysis of parental reflections on their children's vital power experiences sought to explore patterns of being while doing in nature observed in association with parental reports of: (a) change in their children's well-being and (b) qualities of vital power evident in parental descriptions of those changes in well-being. Conclusions: The essence of vital power encompassed feelings of a life-spark, natural energy that prompted a healing shift. Implications for Practice: Linkage between a middle-range Theory of Nature Immersion and Nightingale's perspective adds a new avenue for integrating the spiritual-physical-mental dimension of self during creative nursing praxis.

The Lived Experience of Parents of Children and Youth With Special Healthcare Needs on Public and Private Insurance: A Phenomenological Study.

PURPOSE OF THE STUDY: The number of children and youth with special health care needs (CYSHCN) is steadily growing in the United States. There are significant differences between private and public health plans in terms of cost, adequacy, and parent satisfaction. The purpose of this study was to understand the experiences of parents with CYSHCN enrolled in public and private insurance with or without a nurse care coordinator. This study also sought to understand parents' experience of support. PRIMARY PRACTICE SETTING: The primary practice setting was participants' choice of location. METHODOLOGY AND SAMPLE: A qualitative descriptive design was used with 16 parents of children and young adults aged 2 to 21 years. Semistructured interviews were used, and Colaizzi's (1978) eight steps was the selected interpretive method. RESULTS: Five themes emerged for parents navigating their child's insurance in the presence or absence of a nurse care coordinator: (1) Struggle with Self-Preservation, (2) Abandonment and Isolation, (3) Self-Reliance and Advocacy, (4) Interdependence, and (5) Lifeline. These themes were also dependent on the type of insurance and sources of support available. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Models centered on care coordination can also be used as a mechanism to guide nurse care coordinators in practice. Providing care coordination support could help lessen the caregiver burden especially while navigating public or private insurance. Results highlighted how insurance companies can make potential changes within the health plan infrastructure. Incorporating nursing care coordination activities not only results in health care savings for the health plan but also improved health outcomes for its enrollees.

Risk taking in first and second generation Afro-Caribbean adolescents: an emerging challenge for school nurses.

School nurses are well positioned to address risk-taking behaviors for adolescents in their care. The purpose of this mixed-method exploratory study was to explore risk taking in Afro-Caribbean adolescents in South Florida, comparing first- to second-generation adolescents. Quantitative and qualitative data were collected from an immigrant group using the adolescent risk-taking instrument to evaluate risk-taking attitudes, behaviors, and self-described riskiest activities. One-hundred and six adolescents participated; 44% were first generation Afro-Caribbean. Data analysis included analysis of variance, frequencies, and content analysis. There were no differences in risk-taking attitudes; smaller percentages of first generation Afro-Caribbean adolescents reported sexual activity, substance use, and violence. Over one third of the sample, regardless of generational status, reported alcohol use, but did not note alcohol or other health-compromising behaviors as "riskiest" activities. It is important to better understand Afro-Caribbean adolescents' perspectives about risky behaviors, and school-based venues offer the best promise for reaching these adolescents.

Nature Immersion in an Extreme Environment: Hiroshima Survivors' Personal Emergence Following Their Atomic Bomb Experience.

INTRODUCTION: Nature immersion is defined as multidimensional connecting with earthy materials to generate personal emergence. Personal emergence is an embodied healing force observable via synchronization of bodily rhythms. Research has revealed positive effects of green space for healing. However, little is known about healing of survivors in the space impacted with radioactive nuclear energies. PURPOSE: To use the theory of nature immersion to guide exploration of the concepts of connecting with earthy materials, personal emergence and space-time expansion in a sample of people who had experienced the catastrophic nature upheaval of the Hiroshima bombings on 6 August 1945. METHOD: A descriptive exploratory design with directed content analysis was used with existing qualitative data consisting of 29 Hiroshima atomic-bombing survivors' description of their experience. RESULTS: Self-healing empirically manifested through 23 survivors' connection with earthy materials. There was synchrony between recuperating natural space and healing of survivors. CONCLUSIONS: Synchrony, as a dimension of human connection with nature, transcended the disharmony of bombing upheaval. Although further exploration is necessary, these findings serve as evidence about the essence of healing as related to nature for those in extreme environments.

Urban Children's Well-Being Factors and Qualities of Being and Doing in Natural Space: Nature Immersion.

Research has suggested positive effects of nature immersion-a state of being or an act of doing in natural space-for urban children who were otherwise at risk for emotional or behavioral problems. However, few studies have systematically investigated natural space qualities that predict child well-being at the clinical level. The purpose of this study was to increase the understanding of natural space qualities as factors of urban child well-being. Explanatory mixed methods were used. Quantitative data (N = 174) included a survey and two parental reports of child well-being. Interviews provided qualitative data (N = 15). Data were analyzed using generalized linear model and content analysis. Both data streams were merged into a point of meta-inference that contributed to parental assessment of enhanced child well-being: More frequent nature-child space-time immersion combined with parental valuing of nature connection (p < .001) as a soothing and safe resource. The factors of urban nature immersion affected child well-being over parental socioeconomic affluence alone. The evidence corresponds to Nightingale's tenet that an act of doing, which is considered an action of the child's own will, affects one's sense of well-being. The findings indicate that nature immersion can be applied to urban child self-care and holistic nursing modalities.

The Power of Documentary Theatre to Promote Cross-National Understanding: Personal Impact of Performing With Their Voices Raised by Japanese and American Youth Actors.

PURPOSE: The purpose of this article is to share descriptions of the personal impact for cross-national youth actors (Japanese, American) who performed With Their Voices Raised (Voices), a documentary theater script that shares the stories of Pearl Harbor and Hiroshima survivors who lived through the bombings of December 7, 1941, and August 6, 1945, respectively. DESIGN/METHODS: This was a descriptive exploratory focus group study conducted immediately after student-actors from Funairi High School in Hiroshima (n = 15) and Farrington High School in Oahu, Hawaii (n = 8), performed Voices. Data were content analyzed by a cross-national research team to address the question "What was the personal impact of performing Voices for Japanese and American youth actors?" FINDINGS: There were three themes that crossed national boundaries: sense of power of the message from real-life people, new cross-national awareness, and moving beyond familiar history to engage and learn. The fourth theme distinguished the youth groups: for Japanese youth, performing Voices inspired an awareness of their local focus; for American youth, it enlivened youth-to-youth engagement as a learning approach. CONCLUSIONS: Documentary theater script is a creative, holistic approach with the potential to bridge divisiveness and promote cross-national understanding.

Linguistic analysis to assess the effect of a mindfulness intervention on self-change for adults in substance use recovery.

Substance use is a pervasive health problem. Therapeutic community (TC) is an established substance abuse treatment but TC environments are stressful and dropout rates are high. Mindfulness-based TC (MBTC) intervention was developed to address TC stress and support self-change that could impact treatment retention. Self-change was assessed through feeling and thinking word-use in written stories of stress from 140 TC residents in a historical control group and 253 TC residents in a MBTC intervention group. Data were collected 5 times over a 9-month period. Linguistic analysis showed no differences between the groups over time; however, over all time points, the MBTC intervention group used fewer negative emotion words than the TC control group. Also, negative emotion (P < .01) and anxiety (P < .01) word-use decreased whereas positive emotion word-use increased (P < .05) over time in both groups. Descriptive data from linguistic analyses indicated that sustained self-change demands participation in mindfulness behaviors beyond the instructor-guided MBTC intervention.

Claiming the Narrative Wave With Story Theory.

Over the past few decades, there has been a narrative wave that has advanced and subsided but consistently moved toward acceptance in health care circles. Despite the importance of narrative to nursing practice and research, the discipline has been slow to claim the narrative wave as its own. The purpose of this article is to claim the narrative wave for the discipline of nursing with story theory-guided research and practice and to describe dimensions of the narrative movement in health-related literature. Practical application of story theory is described for both nursing practice and nursing research.

Mindfulness-based stress reduction in therapeutic community treatment: a stage 1 trial.

OBJECTIVE: This trial compared Mindfulness-Based Stress Reduction, adapted for therapeutic community treatment (MBTC), with treatment as usual (TAU) for reducing stress and increasing retention in a residential facility for substance use disorders. METHOD: Four-hundred and fifty-nine participants, who met DSM-IV criteria for substance dependence were recruited (TAU = 164, MBTC = 295). RESULTS: A survival analysis of time to dropout did not show a significant difference between groups, however level of participation in MBTC was associated with decreased likelihood of dropout (p = < .01), and higher Symptoms of Stress Inventory (SOSI) scores at baseline were associated with increased likelihood of dropout (p = .03). CONCLUSION: The association between retention and level of stress on intake as well as level of participation in MBTC provides support for further research on integrating MBTC into therapeutic community treatment.

Substance abuser impulsivity decreases with a nine-month stay in a therapeutic community.

BACKGROUND: Substance abuse continues to be a major public health problem. Keeping substance abusers in treatment is a challenge, and researchers continue to investigate ways to increase retention. OBJECTIVE: The aim of this study was to investigate the relationship between impulsivity in substance abusers and length of stay in the context of therapeutic community. METHODS: The Barratt Impulsiveness Scale- 11 (BIS-11) was used to assess impulsivity in 138 substance abusers at admission and at nine months in a therapeutic community. RESULTS: Impulsivity significantly decreased in subjects who completed nine months in the therapeutic community. Legal stipulation increased length of stay, on average, by three months. On admission, female participants were on average more impulsive than their male counterparts. CONCLUSION: Impulsivity decreased in subjects who remained in therapeutic community for nine months although self-reported impulsivity at baseline did not seem to be associated with retention. SCIENTIFIC SIGNIFICANCE: Therapeutic community factors contribute to a decrease in self-reported impulsivity and these factors might be enhanced to increase retention in therapeutic community.