Transgender and nonbinary young adults' depression and suicidality is associated with sibling and parental acceptance-rejection.

INTRODUCTION: Transgender and nonbinary young adults (TNB YA) report high rates of depression and more suicidality than their cisgender counterparts. Parental rejection is a known predictor of worse mental health among TNB YA; however, less is known about TNB YA experiences of sibling acceptance-rejection. The purpose of this study was to determine how TNB YA perception of sibling and parental acceptance-rejection are related to TNB YA depression and suicidality. DESIGN: Cross-sectional. METHODS: TNB YA (ages 18-25) who had disclosed their gender identity to an adult sibling were recruited to take part in an online study and completed measures of sibling and parent acceptance-rejection, depression, as well as lifetime and past year suicidality. Stepwise regressions were conducted to evaluate associations between acceptance-rejection and TNB YA depression and suicidality. RESULTS: The sample consisted of 286 TNB YA (Mage = 21.5, SD = 2.2) who were predominantly White (80.6%) and assigned female sex at birth (92.7%). Each family member's acceptance-rejection was associated with increased TNB YA depression scores when considered independently and combined. Independently, high rejection from each family member was associated with greater odds of reporting most suicidality outcomes. When all family members were considered together, only high rejection from a male parent was associated with four times greater odds of reporting lifetime suicidality. High rejection from both parents was associated with greater odds of reporting past year suicide attempt (OR: 3.26 female parent; 2.75 male parent). CONCLUSION: Rejection from family members is associated with worse depression and suicidality, and rejection from male parents may be particularly damaging. Sibling acceptance uniquely contributes to TNB YA's depression symptoms alone and in the context of parental support.

Transgender and nonbinary young adults' perception of sibling and parental support for gender identity.

Transgender and nonbinary young adults report frequent parental rejection was linked to poor mental health. There are limited data about transgender and nonbinary young adult sibling relationships following disclosure or discovery of gender identity. The purpose of this analysis is to compare transgender and nonbinary young adults' perception of parental and sibling support specifically for gender identity immediately after disclosure and in the present day. Eligible respondents were recruited via paid social media advertisements. Respondents provided data on demographics, family relationships, and perceived support for gender identity. The sample consisted of 348 transgender and nonbinary young adults (Mean age: 21.5 years) who lived in the United States, identified as White and were assigned female at birth. The majority reported on a nuclear family. Nearly three-quarters (71.3%) had disclosed their identity to at least one parent and had done so within the past 3 years. Overall, respondents perceived a significant increase in family members' support from the time of disclosure to the time of the survey. Most respondents reported improved family relationships since disclosing their gender identity. Siblings were perceived as significantly more supportive than either parent at both time points. Siblings could be an essential source of support for transgender/nonbinary young people, particularly if parents are not accepting or do not yet know their child's gender identity. Nurses and other professionals working with transgender and nonbinary young people in school, community, and clinical settings should assess perceived support across familial relationships.

Concept clarification of grief in mothers of children with an addiction.

AIM: To report an analysis of the concept of grief in mothers of children with an addiction. BACKGROUND: The concept of grief in this context is poorly understood and often synonymously used with concepts depression, loss and chronic sorrow. In the US, the core concept grief has been recently revised by both NANDA and the DSM-V in efforts to better understand and characterize the concept. The plethora of literature on grief worldwide often characterizes grief as a response to a death. DESIGN: Concept analysis. DATA SOURCES: Search terms 'parental grief' and 'substance abuse' yielded 30 articles. A second review using terms 'grief' and 'substance abuse' yielded 323 articles, in PsychInfo, CINAHL, PubMed databases from 1980-2013. Limits for articles in English and for the terms 'death' and 'child' yielded 13 usable articles. METHODS: The hybrid model of concept analysis, using a theoretical phase, an empirical phase and a final phase when a clarified definition of grief emerged. RESULTS: Definitions in the literature and defining characteristics of grief outline bio-psycho-social aspects of the concept. For one mother grief was accompanied by recurring feelings of sadness across time, while for the other mother grief was seen as coping, after having passed through a variety of stages of grief. For both, grief was seen to fall on a continuum. CONCLUSIONS: Grief is a universal concept and has a trajectory. Case study data have been essential in clarifying understandings of grief as experienced by mothers of addicted children and will provide direction for meaningful and tailored interventions.

'That's What I Mean by a Hundred Little, a Thousand Little Deaths...': A Case Study of the Grief Experienced by the Mother of a Substance Abusing Child.

Parents of substance abusers experience stigma, regret, disrupted lives, loss of support, and loss of quality of life. Health professionals are in a unique position to locate or provide resources to support the family of the substance-abusing individual.

Pregnant Women's Experiences of Seeking Treatment for Opioid Use.

PURPOSE: The purpose of this study was to describe women's experiences seeking treatment for opioid use disorder during pregnancy. STUDY DESIGN AND METHODS: This was an exploratory multi-method study to understand women's experiences seeking treatment for opioid use disorder during pregnancy using surveys and interviews. Women pregnant within the past 5 years while using opioids were recruited from a private Facebook group for mothers on medication for opioid use disorder. Members of this group assisted with the development of the survey. Descriptive statistics were used for the 18-question survey and interviews were recorded, transcribed, and analyzed for themes. RESULTS: Twenty-one women completed an online survey, and six participated in an in-depth virtual interview about their experience. Five themes describing their experiences were identified: (1) fear of child protective services, (2) family and partner support, (3) health care providers' reactions, (4) accessing treatment centers, and (5) awareness of support services during pregnancy . CLINICAL IMPLICATIONS: Participants reported an overall negative experience seeking treatment for opioid use disorder during pregnancy. Nurses can improve the outcomes for pregnant women with opioid use disorder by using a non-stigmatizing approach, promoting early identification, and providing information, including harm reduction education. Facilitation of resources for treatment, mother and child programs, and advocating for partner treatment can improve maternal and neonatal outcomes.

Nursing Students' Use of Harm Reduction in the Clinical Setting.

BACKGROUND: The use and awareness of harm reduction education strategies are missing from nursing care of people with substance use disorder (SUD). PURPOSE: To determine whether targeted training improved nursing students' application of harm reduction education in the clinical setting. METHODS: This was an experimental 2-group repeated-measures survey study. Nursing students in a baccalaureate program received targeted training for 3 semesters. Training included presentations by people with lived experience, an addiction-trained physician, and a role-play exercise. Students received harm reduction education and reported on the application of this education. RESULTS: Students in the traditional track cared for more people with SUD than students in the accelerated track. Referral for treatment was the most common education provided, and information related to injection drug use was the least commonly taught education. CONCLUSIONS: Targeted training increased the number of harm reduction options nursing students presented to people with SUD in the clinical setting.

Hospital Experiences of Dignity in People Who Inject Drugs.

BACKGROUND: Dignity is a complex concept necessary for the adequate treatment of patients in the healthcare setting. Autonomy, self-sufficiency, respect, and equality are concepts used to define dignity. Dignity has not been studied in people who inject drugs (PWID). OBJECTIVE: This study aimed to determine how PWID maintain or have their dignity threatened during hospitalization in an acute care unit. DESIGN: The qualitative descriptive study was a deductive thematic analysis of secondary data on PWID experiences with received nursing care. In-depth, semistructured interviews were conducted and transcribed verbatim with a constant comparison method for thematic analysis using NVivo. A priori codes of dignity concepts from the literature and dignity scales were used as a guide to examine the nine qualitative transcripts. FINDINGS: The three most common threats to dignity during hospitalization were lack of equality compared with other patients, not feeling valued as an individual, and not feeling respected by the healthcare workers providing care. The three most common protectors of dignity were feeling respected by healthcare workers, having autonomy in treatment choices, and feeling valued as an individual. CONCLUSIONS: Protecting dignity significantly affects whether PWID are willing to seek healthcare in the hospital setting. Preserving dignity in PWID during their hospitalizations can encourage this population to seek care earlier. Nurses must be experienced in caring for PWID and provide nonjudgmental care for this population.

Building Therapeutic Commitment in University Nursing Students.

BACKGROUND: Nurses report feeling unprepared to care for people with a substance use disorder (SUD). PURPOSE: The purpose was to determine whether targeted antistigma interventions improved nursing students' attitudes and perceived stigma toward people with SUD. METHODS: This was a quasi-experimental, repeated-measures survey study. Participants completed the 20-item Drug and Drug Problems Questionnaire (DDPPQ) and the 8-item Perceived Stigma of Substance Abuse Scale (PSAS) at baseline and postintervention in their first clinical semester. Booster sessions were held for 2 additional clinical semesters after the initial intervention in the first clinical semester. The DDPPQ and PSAS were completed at the end of each semester for 3 semesters of the nursing program. RESULTS: After the educational interventions, there was a significant improvement in overall therapeutic attitudes except for 1 sub-scale, role-related self-esteem. CONCLUSIONS: Antistigma interventions led to a decrease in stigma and improved overall therapeutic attitudes toward people with SUD.

Student Nurse Screening, Brief Intervention and Referral to Treatment Training Program: Analysis 2016-2019.

BACKGROUND: Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based set of skills and strategies used by health care providers. Data have suggested SBIRT should be used in detecting persons at risk for substance use and be included in every primary care encounter, as many needing substance abuse treatment do not receive it. METHODS: This descriptive study evaluated data for 361 undergraduate student nurses who participated in SBIRT training. Pretraining and 3-month posttraining surveys were used to evaluate changes in trainees' knowledge, attitudes, and skills toward people with substance use disorder. A satisfaction survey immediately after the training measured satisfaction with and usefulness of the training. RESULTS: Eighty-nine percent of students self-reported that the training increased their knowledge and skills related to screening and brief intervention. Ninety-three percent reported that they intended to use these skills in the future. Pre-post measures indicated statistically significant increases in knowledge, confidence, and perceived competence on all measures. CONCLUSIONS: Both formative and summative evaluation assisted in improving trainings each semester. These data confirm the need to integrate SBIRT content across the undergraduate nursing curriculum and include faculty and preceptors to improve rates of screening in clinical practice.

Significance of Self-Care Management as Persons Prepare to Reintegrate Into the Community.

INTRODUCTION: Persons reentering the community after incarceration often confront a range of challenges that influence their ability to engage in self-care. This study sought to gain insight and understanding of how persons recently released from an incarceration experience perceive their preparedness for reentry and how this affects their ability to engage in self-care management. METHOD: Using focus group methodology, four male, two female, and one mixed focus groups (N = 31) were held at a syringe access program, a medication-assisted recovery clinic, and a postincarceration support service. The Rediscovery of Self-Care (RSC) model served as the framework. The a priori RSC constructs guided data analysis. FINDINGS: Participants defined self-care as basic hygiene, eating well, engaging with family, and managing mental health and their substance use issues. Depending on the interview location, self-care also included using clean injection materials, taking prescribed medications, or adhering to treatment programs. Reported challenges to self-care included transportation, substance addiction, job and housing instability, and mental illness. Our results indicate that there is value in applying the RSC model to guide nursing interventions in promoting self-care for persons with an incarceration experience. CONCLUSION: There is a need for reskilling, especially pertaining to sober environments, mental health services, syringe access programs, and continuity of care. Self-care ability, self-efficacy, motivation, sense of internal control, and social support were identified as critical to the successful transition to full reentry after incarceration.

Teaching Those Who Care How to Care for a Person With Substance Use Disorder.

BACKGROUND: Substance use disorder (SUD) is on the rise globally, and nurses are not prepared to care for this population. PURPOSE: The purpose was to determine if a 4-hour antistigma intervention improved prelicensure student nurse attitudes and perceived stigma toward people with SUD. METHODS: This was a nonrandomized quasi-experimental survey study. Participants completed the 20-item Drug and Drug Problems Perception Questionnaire (DDPPQ), the 8-item Perceived Stigma of Substance Abuse Scale (PSAS), and the 13-item Marlowe-Crowne Social Desirability Scale at baseline and repeated the DDPPQ and PSAS postintervention. Paired t tests were used to determine the mean differences in the total DDPPQ and total PSAS scores. RESULTS: After the antistigma intervention, there was a significant improvement in overall therapeutic attitudes (t = 8.4, df = 108, P < .001) and perceived stigma (t = -2.5, df = 108, P = .01) in undergraduate nursing students (n = 126). CONCLUSIONS: Incorporating antistigma educational approaches may lead to more involvement and compassionate care for people with SUD.

Exploration of the unmet health care needs of people who inject drugs.

BACKGROUND AND PURPOSE: Access to adequate health care in the United States is often hindered by an individual's location, socioeconomic status, and lifestyle. Among those underserved are people who inject drugs (PWID), who are affected by stigma and discrimination. The purpose of this study was to describe the utilization of preventative health care services obtained by PWID. METHODS: A survey querying participants about their utilization of preventative health care services and health education over the past year was administered to PWID at 2 syringe access programs. Descriptive statistics were used to analyze the data. CONCLUSION: Of the 141 participants surveyed, 60.6% saw a provider within the past year and 62.1% indicated that their provider was aware of their drug use. Data analysis revealed that providers counseled PWID on three of nine drug-related harm reduction items. Only 30% of PWID talked with their provider about five or more items. Mean number of items discussed was significantly different between PWID whose provider was aware of their drug use and PWID whose provider was unaware of drug use (t = 10.7, p < 0.001). IMPLICATIONS FOR PRACTICE: Results indicated that PWID are not receiving adequate preventative services or harm reduction education from their primary care provider. A need for assessment of substance use, preventative vaccinations, counseling and testing for infectious diseases, and harm reduction education is essential during health care visits. Nurse practitioners and nurses have a role in screening for and educating PWID in a variety of health care settings.

Perceptions of Persons Who Inject Drugs About Nursing Care They Have Received.

The experience and meaning attributed to care by nurses and received by nine persons who inject drugs during a healthcare encounter in the acute care medical setting was examined. A descriptive case study approach using an interpersonal nursing model served as the theoretic framework. Four overarching themes were discovered: marginalization, defensiveness, repeated victimization, and understanding addiction. Findings suggest that role support, application of an interpersonal nursing theory, and implementations of addiction-trained healthcare teams were missing from the hospital experience of persons who inject drugs. However, when the nurse connected with the patient who injects drugs on an interpersonal level, positive outcomes followed.

Teaching Nursing Students How to Decrease the Stigma Against People Who Use Drugs.

BACKGROUND: People who use drugs (PWUD) experience bias and stigmatization from their health care providers at higher rates than do people with other health conditions. PROBLEM: Nursing students are ill-prepared to care for PWUD. APPROACH: Nursing students received 2 educational sessions targeted at caring for PWUD. One hour focused on identifying and intervening in the case of an opioid overdose. The other was about stigmatization experienced by PWUD, harm reduction, nonstigmatizing language, and ways in which nurses can improve care for PWUD. OUTCOMES: Students demonstrated the use of destigmatizing language, applied learned harm reduction concepts, and incorporated referral to area resources for counseling or treatment during care of PWUD. CONCLUSIONS: By using the reflective learning taught in the classroom, nursing students were able to establish the human connection needed to improve care for this vulnerable population.

Self-Care Management in Corrections: Perspectives From Persons With an Incarceration Experience.

The purpose of this study was to explore the perceptions and beliefs of what self-care management looks like for a person with an incarceration experience. This is the first phase of a two-phase study. This qualitative study, held in three county jails in Massachusetts, utilized a focus group methodology. The Rediscovery of Self-Care: A Care Intervention for Persons with Incarceration Experience (RSC) model served as the framework for this study. On the basis of a priori constructs from the RSC model, a protocol was established and targeted questions outlined. The results from these focus groups support the constructs of the RSC model. Participants in all focus group interviews reported that self-care was very important and defined self-care, most of the time, in terms of meeting physical needs such as exercising and eating healthy and, more importantly, self-identified mental health and substance use needs such as individual or group counseling. In conclusion, open-ended questions used to identify all instances of potential categories of self-care management supported the central concepts of the RSC model and will inform treatment interventions and modification of an existing self-care management instrument or provide the foundation for the development of a new instrument.

Improving Outcomes of Opioid Overdose: Preparing Nursing Students to Intervene.

PROBLEM: Death by overdose has been steadily increasing since 1992 and has become a public health epidemic. With the rise of prescription pain medications for nonmedical use and the highest use of illicit substances by those ages 18-25, the need for action is imperative. PURPOSE: The aim of the study was to determine whether an educational intervention had an effect on nursing students' knowledge and skills regarding administration of intranasal naloxone for opioid overdose. METHOD: A convenience sample of baccalaureate nursing students was recruited for the study. A pretest/posttest design was used to evaluate the educational intervention. A paired t test was used to compare differences in pre- and posttest scores. RESULTS: A total of 49 students completed the study. The majority were women ages 25 and below, 31 (63.2%) had some or no background knowledge of opioid overdose, and 42 (85.7%) had not received previous training on intranasal naloxone. Student knowledge increased significantly (p < .001) following the educational intervention. Twenty-four students requested hands-on training for implementation of the intranasal naloxone and scored 100% accuracy in return demonstration. CONCLUSIONS: Implementation of this brief training was effective for increasing the knowledge of opioid overdose for an at-risk population. The nursing student is in a unique position to educate, train, and intervene for peers, friends, and family members who are at high risk for an opiate overdose. Nursing students have a pronounced advantage to assess for respiratory depression and initiate CPR, thereby interrupting a fatal overdose.