De-Escalation Training for Managing Patient Aggression in High-Incidence Care Areas.

Health care personnel who have close, face-to-face patient contact experience more workplace violence (WPV) than employees in other fields. Certain health care departments (i.e., high-incidence care areas) have elevated rates of WPV that can have adverse emotional, physical, and financial consequences for patients, employees, and institutions. Health care workers need de-escalation training to efficiently manage patient aggression while also safeguarding patients' dignity and patient-provider trust. The current Plan, Do, Study, Act quality improvement project used insights from an in-depth literature review to create a 1-hour, evidence-based, in-service de-escalation training for personnel from high-incidence care areas. A pre/post design was used to evaluate participants' responses to the Confidence Coping with Patient Aggression Instrument. Post-training, participants reported significantly increased feelings of safety regarding potential patient aggression (p = 0.001) and more efficacy regarding their aggression management techniques (p = 0.039). Based on the training's results, recommendations were made for future institutional de-escalation initiatives. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 17-24.].

Improving Depression Screening in Primary Care.

BACKGROUND: Depression is a serious problem in the United States. It not only impacts chronic illness and healthcare utilization, but it can also result in death, intentional or unintentional. Despite the seriousness associated with depression, it continues to be underdiagnosed and undertreated. The primary care setting provides an ideal location to screen and initiate treatment for depression in individuals who would otherwise not be screened. OBJECTIVE: The objective of this evidence-based practice project was to improve the diagnosis and treatment of depression in an adult primary care office. METHOD: An intervention consisting of a HealthWatcher reminder for depression screening, the administration of the PHQ-9 instrument, and a treatment algorithm was incorporated into the office workflow. The charts of a pre-intervention random sample were compared to a post-intervention random sample to test for significant differences in depression screening and treatment rates. RESULTS: Using the chi-squared test, the post-intervention sample screening rate was significantly higher than pre-intervention sample rate (90% vs 23.3%; χ2 = 54.3, df = 1, P < .000). CONCLUSION/IMPLICATIONS: It is feasible to improve the diagnosis and treatment of depression for adult primary care patients by modifying office protocols and using the PHQ-9 screening instrument and a treatment algorithm.

Improving Depression Screening in Primary Care.

BACKGROUND: Depression is a serious problem in the United States. It not only impacts chronic illness and healthcare utilization, but it can also result in death, intentional or unintentional.Despite the seriousness associated with depression, it continues to be underdiagnosed and undertreated. The primary care setting provides an ideal location to screen and initiate treatment for depression in individuals who would otherwise not be screened. OBJECTIVE: The objective of this evidence-based practice project was to improve the diagnosis and treatment of depression in an adult primary care office. METHOD: An intervention consisting of a HealthWatcher reminder for depression screening, the administration of the PHQ-9 instrument, and a treatment algorithm was incorporated into the office workflow. The charts of a pre-intervention random sample were compared to a post-intervention random sample to test for significant differences in depression screening and treatment rates. RESULTS: Using the chi-squared test, the post-intervention sample screening rate was significantly higher than pre-intervention sample rate (90% vs 23.3%; χ2 = 54.3, df = 1, P < .000). CONCLUSION/IMPLICATIONS: It is feasible to improve the diagnosis and treatment of depression for adult primary care patients by modifying office protocols and using the PHQ-9 screening instrument and a treatment algorithm.

Depression: Screening, Assessment, and Interventions in Oncology Nursing.

BACKGROUND: A high prevalence of depression exists among individuals with cancer, which negatively affects their health outcomes, quality of life, and adherence to cancer treatment. OBJECTIVES: This article provides an overview and synthesis of depression screening, assessment, and nonpharmacologic treatments to help oncology nurses in their practices. METHODS: Key insights are presented from a synthesized literature review regarding patients with cancer with depression. Resources for patient treatment and nurse training are also provided. FINDINGS: To improve patient outcomes, nurses need to understand and follow a process that addresses the screening, assessment, and nonpharmacologic treatment of depression in patients with cancer.

Improving the Initial Breast Cancer Consultation.

BACKGROUND: Research shows providing cancer patients with adequate information has many benefits, but how do nurse practitioners know whether the initial consultation meets the information needs of their patients? Furthermore, how can the initial consultation be improved? OBJECTIVE: A low-cost continuous quality improvement process centered on decreasing distress and increasing information satisfaction was piloted to determine its effectiveness and feasibility. METHODS: Immediately before and after an initial consultation with a breast cancer surgeon, 59 women completed a questionnaire to measure distress and specific problems they were having. They then completed a questionnaire to measure information satisfaction. Pre-post changes in the distress score and number of problems were analyzed, as was information satisfaction. Feasibility was qualitatively examined. RESULTS: For the study sample, pre-post median distress scores decreased significantly (from 5 to 3, Chi-square = 5.73, p < .017). Information dissatisfaction scales were identified. The process was deemed feasible. CONCLUSIONS: This effective and feasible process may help the nurse practitioner continuously improve the initial consultation process. IMPLICATIONS FOR NURSING: (a) the initial breast cancer consultation is important, (b) a novel process for improving the initial breast cancer consultation is proposed, and (c) this feasible, low-cost process should be embedded into normal practice operations.

The Nursing Knowledge Pyramid: A Theory of the Structure of Nursing Knowledge.

A theory of the structure of nursing knowledge is proposed. Using retroductive reasoning to build upon an existing theory, the goal of the Nursing Knowledge Pyramid is to integrate disparate forms of nursing knowledge into a comprehensive, coherent, and useful structure to enhance the learning, development, automation, and accessibility of nursing knowledge. Education uses are discussed.

Piloting an Automated Distress Management Program in an Oncology Practice.

BACKGROUND: New administrative requirements to provide assessment and treatment for distress in patients with cancer, as well as concern for positive patient outcomes, highlight oncology practitioners' need for a high-quality distress management program. OBJECTIVES: Researchers designed, developed, implemented, and evaluated a nurse-led quality-improvement project that pilot tested a distress management program in an outpatient medical oncology practice. METHODS: The program used a tablet computer for data collection, immediate analysis, and recommendation display to provide individually tailored psychosocial coping recommendations, referrals, or both to nurses and patients. FINDINGS: Pre- and postprogram evaluations suggest that the program is feasible, safe, and effective for detecting and reducing distress in patients with cancer. In addition, tailoring psychosocial coping strategies to the patient's emotional situation may have been key to the program's effectiveness.

Study of sexual functioning determinants in breast cancer survivors.

Our goal was to identify the treatment, personal, interpersonal, and hormonal (testosterone) factors in breast cancer survivors (BCSs) that determine sexual dysfunction. The treatment variables studied were type of surgery, chemotherapy, radiation, and tamoxifen. The personal, interpersonal, and physiologic factors were depression, body image, age, relationship distress, and testosterone levels. A sample of 55 female breast cancer survivors seen for routine follow-up appointments from July 2002 to September 2002 were recruited to complete the Female Sexual Functioning Index (FSFI), Hamilton Depression Inventory (HDI), Body Image Survey (BIS), Marital Satisfaction Inventory-Revised (MSI-R), a demographic questionnaire, and have a serum testosterone level drawn. The average time since diagnosis was 4.4 years (SD 3.4 years). No associations were found between the type of cancer treatment, hormonal levels, and sexual functioning. BCS sexual functioning was significantly poorer than published normal controls in all areas but desire. The BCSs' level of relationship distress was the most significant variable affecting arousal, orgasm, lubrication, satisfaction, and sexual pain. Depression and having traditional role preferences were the most important determinants of lower sexual desire. BCSs on antidepressants had higher levels of arousal and orgasm dysfunction. Women who were older had significantly more concerns about vaginal lubrication and pain. Relationship concerns, depression, and age are important influences in the development of BCS sexual dysfunction. The relationship of testosterone and sexual dysfunction needs further study with larger samples and more accurate assay techniques.