A Pilot RCT of A Body-Oriented Group Therapy For Complex Trauma Survivors: An Adaptation of Sensorimotor Psychotherapy.

This study is a pilot randomized controlled trial that examined the efficacy of a body-oriented group therapy designed to address chronic fear states in the body due to complex trauma. The Trauma and the Body Group (TBG) is a 20-session group psychotherapy that draws upon the principles and techniques of sensorimotor psychotherapy. Thirty-two women with a history of childhood trauma were randomized to immediate treatment or a waitlist control condition. Assessments were conducted one month prior to treatment, immediately after treatment, and six months post-treatment. Significant improvements were found in body awareness, anxiety, and soothing receptivity when comparing treatment to no treatment. The TBG appears to be a valuable tool for helping clients acquire mindfulness and self soothing skills that they can use to reduce posttraumatic symptoms. This study provides preliminary evidence that the TBG provides complex trauma survivors an opportunity to challenge their avoidance of two prominent trauma-related triggers - their bodies and interpersonal relationships - and in so doing may help survivors develop greater body awareness, increase their capacity for self and relational soothing, and reduce their anxiety symptoms.

Factors Associated With Barcode Medication Administration Technology That Contribute to Patient Safety: An Integrative Review.

In an effort to prevent medication errors, barcode medication administration technology has been implemented in many health care organizations. An integrative review was conducted to understand the effect of barcode medication administration technology on medication errors, and characteristics of use demonstrated by nurses contribute to medication safety. Addressing poor system use may support improved patient safety through the reduction of medication administration errors.

A naturalistic study of a brief treatment program for survivors of complex trauma.

The impact of chronic trauma can be longstanding, affecting survivor affect regulation, consciousness, interpersonal functioning, perceptions of self and others, self-regulation, and somatic experience. There is a growing consensus that multimodal and staged approaches to treatment are necessary to promote healing. However, empirical investigations of such treatments are still needed. The current study used a naturalistic design to examine the impact of a brief, yet intensive, outpatient program on complex PTSD symptoms and attachment classification among women with histories of chronic trauma. Fifty-four women were assessed and followed over an 8-week intervention and six-month follow-up. Significant improvement over time was found for PTSD symptoms, dissociation, emotion regulation, interpersonal problems, sexual problems, alexithymia, and posttraumatic growth. Nearly, all women met criteria for PTSD at baseline, a third of the women who completed the measures no longer had PTSD post-treatment, and 60% showed a clinically significant reduction in PTSD symptoms. Finally, thirty-six women were classified as unresolved on the Adult Attachment Projective. Post-treatment, nine of 26 women who provided follow-up data were no longer classified as unresolved. Notably, those women whose attachment category changed also showed the greatest improvement in all other outcomes. Altogether, these findings suggest that an intensive, stage 1, and multimodal treatment program can benefit women with histories of chronic traumatization.

Relation of life sciences students' metacognitive monitoring to neural activity during biology error detection.

Metacognitive calibration-the capacity to accurately self-assess one's performance-forms the basis for error detection and self-monitoring and is a potential catalyst for conceptual change. Limited brain imaging research on authentic learning tasks implicates the lateral prefrontal and anterior cingulate brain regions in expert scientific reasoning. This study aimed to determine how variation in undergraduate life sciences students' metacognitive calibration relates to their brain activity when evaluating the accuracy of biological models. Fifty undergraduate students enrolled in an introductory life sciences course completed a biology model error detection task during fMRI. Students with higher metacognitive calibration recruited lateral prefrontal regions linked in prior research to expert STEM reasoning to a greater extent than those with lower metacognitive calibration. Findings suggest that metacognition relates to important individual differences in undergraduate students' use of neural resources during an authentic educational task and underscore the importance of fostering metacognitive calibration in the classroom.

"You Never Exhale Fully Because You're Not Sure What's NEXT": Parents' Experiences of Stress Caring for Children With Chronic Conditions.

Children with chronic conditions are experiencing improved survival worldwide, and it is well-known that their parents are stressed. Yet, despite this knowledge, parents continue to experience stress. Our study explored the lived experience of parental stress when caring for children with various chronic conditions to identify opportunities to potentially reduce stress for these parents. This was an exploratory qualitative study using semi-structured interviews. To ensure appropriate research priorities were addressed, the study was co-designed with consumer and stakeholder involvement. Twenty parents were interviewed. Parents were recruited through a recognized family support organization for children with various care needs in Western Australia. Interviews were audio-recorded, transcribed verbatim, anonymized, and analyzed using Interpretative Phenomenological Analysis. Two superordinate themes were identified: (1) Gut instinct to tipping point included parents as unheard experts and their experiences of stress and becoming overwhelmed. (2) Losses and gains covered the parents' identity and relationship challenges and coping strategies with their children's unpredictable conditions. Parents' experiences of stress caring for children with chronic conditions can be applied to the Job-Demand Control-Support Model for occupational stress. Not only does this application provide a useful framework for practitioners but it adds a unique perspective that reflects the dual role of parents in caring for their children with chronic conditions as a parent but also a professional with a 24/7 workload. The parents' experiences highlight a need for improved support access, effective communication between parents and health care professionals, discharge preparation and information provision, and regular screening of parental stress with a referral pathway.

A pilot study of an electronic interprofessional evidence-based care planning tool for clients with mental health problems and addictions.

BACKGROUND: The health system must develop effective solutions to the growing challenges it faces with respect to individuals who suffer with mental health disorders and addictions. The purpose of this study was to evaluate the usability and potential impact on outcomes of a knowledge translation system aimed at improving client-centered, evidence-based care for hospitalized individuals with schizophrenia. METHODOLOGY: A pre-posttest design was used. The e-Volution-TREAT system was implemented on two inpatient units at a large mental health facility. Thirty-seven nurses, allied health workers, and physicians participated from two units. Data collection involved questionnaires, semistructured interviews, and observations. Thirty-eight consenting clients' outcome data were collected from organizational records. RESULTS: Overall, staff participants were very satisfied with the functions of the e-Volution-TREAT system. Barriers to using the system were identified by participants related to the work environment, to understaffing, equipment problems, discomfort with technology, and a focus on short-term rather than long-term goals. There was moderate uptake of guidelines related to social issues, and low uptake of guidelines related to family support and addictions. There were significant improvements in four client outcomes over time, specifically aggressive behavior, depression, withdrawal, and psychosis. CONCLUSIONS: In conclusion, users were overall satisfied with the e-Volution-TREAT system, although expressed challenges related to workload that interfered with time to utilize the system. It would be premature to conclude the change in client outcomes was related to the e-Volution-TREAT system without a randomized controlled trial with outcomes compared to a control group. Future research needs to incorporate strategies for modifying the context and engage clinicians who are in a position of influence to model change.

Integrating evidence-based interventions into client care plans.

Within the mental health care system, there is an opportunity to improve patient safety and the overall quality of care by integrating clinical practice guidelines with the care planning process through the use of information technology. Electronic assessment tools such as the Resident Assessment Inventory - Mental Health (RAI-MH) are widely used to identify the health care needs and outcomes of clients. In this knowledge translation initiative, an electronic care planning tool was enhanced to include evidence-based clinical interventions from schizophrenia guidelines. This paper describes the development of a mental health decision support prototype, a field test by clinicians, and user experiences with the application.

Patient and Family Member Readiness, Needs, and Perceptions of a Mental Health Patient Portal: A Mixed Methods Study.

Patient portals are a form of technology that supports patients in accessing their health information, and other functions like scheduling appointments. The presence and utilization of patient portals in mental health contexts is relatively new. Despite research existing in the mental health literature that indicates that there may be benefits when patients have access to their mental health notes, there is limited information as to how best to implement portals, and support adoption among patients and their family members. Given this gap in literature, this study aimed to identify patient and family readiness, needs, and perceptions of a mental health patient portal. Surveys were administered to patients (n = 103) and family members (n = 7) either in-person or over the phone by a Peer Support Worker. The sample of participants consisted of patients and family members affiliated with Canada's largest mental health hospital located in Toronto, Ontario. Study results indicated that patients had the highest interest in the following portal functions: scheduling appointments, checking appointment times, and accessing their health record. Both patients and family members expressed their concerns about cybersecurity and potential privacy breaches. The results of this study, as well as the approach, can inform future patient portal planning and implementation activities at other healthcare organizations.

Predictors of Mental Health Professionals' Perceptions of Patient Portals.

Mental healthcare settings have lagged behind other care areas in their adoption of patient portals. One of the commonly cited reasons for this lower adoption rate is the perceptions and comfort level of mental health professionals in sharing their clinical notes with this population. The purpose of this study was to identify predictors of mental health professionals' perceptions of a) whether mental health patients should have access to a patient portal; b) whether their documentation might change as a result of mental health patients having access to a patient portal, and c) whether access to a patient portal by mental health patients makes them feel uncomfortable. A cross-sectional survey was administered to 250 health professionals employed in a mental health teaching hospital in Toronto, Canada. Multiple linear regression and content analysis were performed.

A contemporary assessment of polybrominated diphenyl ethers (PBDE) in the ambient air and soil of Azerbaijan.

PBDEs were measured in air and soil across Azerbaijan to establish contemporary concentrations at 13 urban and rural sites. Polyurethane foam passive air samplers (PUF-PAS) were deployed for a period of a month with surface soil samples collected at the same sites. Unlike organochlorine pesticides previously surveyed by our group, PBDE concentrations in both contemporary air and soil were low in comparison to recent European and Asian studies. For example, mean ∑9PBDE concentrations in air and soil were 7.13 ± 1.66 pg m-3 and 168 ± 57 pg g-1, respectively. The fully brominated BDE-209 was the most abundant congener observed in soil (174.8 ± 58.5 pg g-1), comprising ~ 96% of ∑10PBDE. However, the PAS-derived air concentrations for highly brominated congeners must be viewed with caution as there is uncertainty over the uptake rates of particle-bound chemicals using these devices. Some of the highest concentrations in air were observed at sites with the highest wind speeds and at several remote locations in the north of the country and this requires further research. Levels of BDE-47 and 99 (the two most abundant congeners in the widely used penta-formulation) were lower than levels reported elsewhere suggesting limited use/import of the penta-BDE formulation in Azerbaijan.

Thank you for asking: Exploring patient perceptions of barcode medication administration identification practices in inpatient mental health settings.

BACKGROUND: Barcode medication administration systems have been implemented in a number of healthcare settings in an effort to decrease medication errors. To use the technology, nurses are required to login to an electronic health record, scan a medication and a form of patient identification to ensure that these correspond correctly with the ordered medications prior to medication administration. In acute care settings, patient wristbands have been traditionally used as a form of identification; however, past research has suggested that this method of identification may not be preferred in inpatient mental health settings. If barcode medication administration technology is to be effectively used in this context, healthcare organizations need to understand patient preferences with regards to identification methods. PURPOSE: The purpose of this study was to elicit patient perceptions of barcode medication administration identification practices in inpatient mental health settings. Insights gathered can be used to determine patient-centered preferences of identifying patients using barcode medication administration technology. METHODS: Using a qualitative descriptive approach, fifty-two (n=52) inpatient interviews were completed by a Peer Support Worker using a semi-structured interview guide over a period of two months. Interviews were conducted in a number of inpatient mental health areas including forensic, youth, geriatric, acute, and rehabilitation services. An interprofessional team, inclusive of a Peer Support Worker, completed a thematic analysis of the interview data. RESULTS: Six themes emerged as a result of the inductive data analysis. These included: management of information, privacy and security, stigma, relationships, safety and comfort, and negative associations with the technology. Patients also indicated that they would like a choice in the type of identification method used during barcode medication administration. As well, suggestions were made for how barcode medication administration practices could be modified to become more patient-centered. CONCLUSION: The results of this study have a number of implications for healthcare organizations. As patients indicated that they would like a choice in the type of identification method used during barcode medication administration, healthcare organizations will need to determine how they can facilitate this process. Furthermore, many of the concerns that patients had with barcode medication administration technology could be addressed through patient education.

Reflections on empowerment in community mental health: giving shape to an elusive idea.

Empowerment has achieved a prominent position in the doctrine of community mental health. This paper conceptualizes empowerment, describes its historical development in the field and its relation to power theory. While there has been a recent erosion of social-political forces enabling empowerment, we contend a legacy of empowerment will endure. Four examples of this legacy are discussed: (a)focus on social determinants of health; (b) development of conceptual models; (c) tolerance for professional self-reflection; and (d) growth of formal consumer controlled organizations.

Advancing the recovery orientation of hospital care through staff engagement with former clients of inpatient units.

OBJECTIVES: This study was undertaken to assess the impact of consumer narratives on the recovery orientation and job satisfaction of service providers on inpatient wards that focus on the treatment of schizophrenia. It was developed to address the paucity of literature and service development tools that address advancing the recovery model of care in inpatient contexts. METHODS: A mixed-methods design was used. Six inpatient units in a large urban psychiatric facility were paired on the basis of characteristic length of stay, and one unit from each pair was assigned to the intervention. The intervention was a series of talks (N=58) to inpatient staff by 12 former patients; the talks were provided approximately biweekly between May 2011 and May 2012. Self-report measures completed by staff before and after the intervention assessed knowledge and attitudes regarding the recovery model, the delivery of recovery-oriented care at a unit level, and job satisfaction. In addition, focus groups for unit staff and individual interviews with the speakers were conducted after the speaker series had ended. RESULTS: The hypothesis that the speaker series would have an impact on the attitudes and knowledge of staff with respect to the recovery model was supported. This finding was evident from both quantitative and qualitative data. No impact was observed for recovery orientation of care at the unit level or for job satisfaction. CONCLUSIONS: Although this engagement strategy demonstrated an impact, more substantial change in inpatient practices likely requires a broader set of strategies that address skill levels and accountability.