American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Value-Based Payment: What Does It Mean for Nurses?

Among the many lessons that have been reinforced by the SARS-COVID-19 pandemic is the failure of our current fee-for-service health care system to either adequately respond to patient needs or offer financial sustainability. This has enhanced bipartisan interest in moving forward with value-based payment reforms. Nurses have a rich history of innovative care models that speak to their potential centrality in delivery system reforms. However, deficits in terms of educational preparation, and in some cases resistance, to considering cost alongside quality, has hindered the profession's contribution to the conversation about value-based payments and their implications for system change. Addressing this deficit will allow nurses to more fully engage in redesigning health care to better serve the physical, emotional, and economic well-being of this nation. It also has the potential to unleash nurses from the tethers of a fee-for-service system where they have been relegated to a labor cost and firmly locate nurses in a value-generating role. Nurse administrators and educators bear the responsibility for preparing nurses for this next chapter of nursing.

Complicating Counterspaces: Intersectionality and the Michigan Womyn's Music Festival.

The counterspaces framework articulated by Case and Hunter (2012), follows from community psychology's long-standing interest in the potential for settings to promote well-being and liberatory responses to oppression. This framework proposes that certain settings (i.e., "counterspaces") facilitate a specific set of processes that promote the well-being of marginalized groups. We argue that an intersectional analysis is crucial to understand whether and how counterspaces achieve these goals. We draw from literature on safe spaces and present a case study of the Michigan Womyn's Music Festival (Michfest) to illustrate the value of an intersectional analysis and explore how these processes operate. Based on 20 in-person interviews, 23 responses to an online survey, and ethnographic field notes, we show how Michfest was characterized by a particular intersection of identities at the setting level, and intersectional diversity complicated experiences at the individual level. Moreover, intersectional identities provided opportunities for dialogue and change at the setting level, including the creation of counterspaces within counterspaces. Overall, we demonstrate the need to attend to intersectionality in counterspaces, and more broadly in how we conceptualize settings in community psychology.

Health survey of U.S. long-haul truck drivers: work environment, physical health, and healthcare access.

OBJECTIVE: While trucking in industrialized nations is linked with driver health afflictions, the role of trucking in U.S. truckers' health remains largely unknown. This paper sheds light on links between the trucking work environment and drivers' physical health. METHODS: Using a cross-sectional design, 316 truckers were enrolled in the Healthy Trucker Survey. Questions included work history, physical and mental health, and healthcare access. PASW 18 was used to examine patterns among factors. PARTICIPANTS: 316 truckers participated. RESULTS: Respondents were mainly full-time, long-haul drivers with over 5 years of experience, and who spent over 17 days on the road per month. While almost 75% described their health as good, 83.4% were overweight/obese, 57.9% had sleeping disturbances, 56.3% fatigue, 42.3% musculoskeletal disorders, and about 40% cardiovascular disease concerns. About 33% had no health insurance, 70% had no regular healthcare visits, 24.4% could not afford insurance, and 42.1% took over-the-counter drugs when sick, while 20.1% waited to reach home for medical care. Exercise facilities were unavailable in over 70% of trucking worksites and 70% of drivers did not exercise regularly. CONCLUSIONS: The trucking occupation places drivers at high risk for poor health outcomes. Prospective studies are needed to delve into how continued exposure to trucking influences the progression of disease burden.

Trucking organization and mental health disorders of truck drivers.

There are over 3 million truck drivers employed in the commercial transportation and material moving occupations, one of the largest occupational groups in the United States. Workers in this large and growing occupational segment are at risk for a range of occupational health-induced conditions, including mental health and psychiatric disorders due to high occupational stress, low access and use of health care, and limited social support. The purpose of this study was to explore male truck drivers' mental health risks and associated comorbidities, using a cross-sectional and quantitative design. Data were collected from a random sample of 316 male truckers between the ages of 23 and 76 at a large truck stop located within a 100-mile radius of Greensboro, North Carolina, USA, using a self-administered 82-item questionnaire. Surveyed truckers were found to have significant issues affecting their mental health, such as loneliness (27.9%), depression (26.9%), chronic sleep disturbances (20.6%), anxiety (14.5%), and other emotional problems (13%). Findings have potential to help researchers develop interventions to improve the emotional and occupational health of truck drivers, a highly underserved population. Mental health promotion, assessment, and treatment must become a priority to improve the overall trucking environment for truckers, the transportation industry, and safety on US highways.

Assertive community treatment and the physical health needs of persons with severe mental illness: issues around integration of mental health and physical health.

BACKGROUND: Assertive community treatment (ACT) is characterized as a service delivery platform and represents an ideal setting in which mental health and physical health care can be integrated. OBJECTIVE: Little is known about the extent to which ACT integrates physical health care with mental health care or the challenges ACT teams experience. To address this gap, focus groups were conducted with five ACT teams in a Midwestern US state to explore how ACT teams address the physical health care needs of persons with severe mental illness. DESIGN: A qualitative study design was used. RESULTS: Three major themes emerged: ACT teams recognize serious and chronic physical health problems, ACT teams take on a variety of roles to address physical health problems, and there are challenges to integrating primary and mental health care within an ACT setting. CONCLUSIONS: ACT needs to be adapted to incorporate promising practices designed to better integrate physical health care and mental health care.

Occupational stressors and the mental health of truckers.

Trucking has been classified as one of the highest-risk occupations in the United States. Occupational stress is even greater for long-haul truckers who are away from home, family, friends, and other support networks for several days or weeks at a time. Occupational stressors and the mental health of truckers was studied using data collected as part of a large multisite ethno-epidemiological study of trucker networks. Findings from the current study show that truckers face many occupational stressors including constant time pressures, social isolation, disrespectful treatment from others, driving hazards such as weather changes, traffic, and road conditions, and violence or fear of violence. Facing such stressors may be a factor in the prevalence of risky behaviors including drug use and paying for sex. Therefore, mental health promotion and treatment for truckers is an important area of concern and must be examined within the broader context of the transportation environment.

Perspectives of college students on their childhood ADHD.

PURPOSE: To determine what successful young adults perceive was helpful to them when they were struggling with their attention-deficit hyperactivity disorder (ADHD) symptoms as children. STUDY DESIGN AND METHODS: Sixteen young adult -college students with a history of ADHD participated in semistructured interviews that asked them which people and what strategies they had found most helpful to them during their childhood. Data were analyzed -using content analysis. RESULTS: The most helpful people were parents and teachers; the most helpful strategies were caring behaviors and active teaching/learning strategies. Participants remembered helpful people as "giving me strategies to help me keep my mind focused on something; keep me involved, keep me interested." CLINICAL IMPLICATIONS: Children with ADHD need the support of caring adults who use active teaching strategies. Nurses working with children and adolescents in any setting can educate parents about the best ways to help children with ADHD succeed, using some of the results of this research.

Older adults with bipolar disorder: guidelines for primary care providers.

The purpose of this article is to present evidence-based guidelines to facilitate early diagnosis and appropriate treatment of older adults with symptoms of bipolar disorder. Assessment criteria, diagnostic tools, and interventions to optimize care of older adults with bipolar disorder--with a focus on implications for primary care providers--are described.

A cognitive-behavioral group therapy intervention with depressed Spanish-speaking Mexican women living in an emerging immigrant community in the United States.

This article reports feasibility issues with the implementation of an intervention study for depression in Latina women from Mexico living in an emerging immigrant community in the United States. Based on the PRECEDE-PROCEED model, the study explores implementation issues such as the intervention and retention, logistical issues such as transportation and childcare, and possible measurement issues such as reliability and validity of the Center for Epidemiologic Studies-Depression Scale, Spanish version. Future studies should evaluate the Center for Epidemiologic Studies-Depression Scale, Spanish version, and test the modified cognitive-behavioral group therapy intervention in larger samples and through randomized controlled studies.

Mental health service needs of a Latino population: a community-based participatory research project.

Community-based participatory research bridges the gap between academic researchers and the real-life issues of communities and offers promise for addressing racial and ethnic disparities in mental health care. The purpose of this community-based participatory research was to identify factors that affect access, use, and perception of mental health services by a Latino population at individual, organizational, and community levels. Individual level factors included health beliefs about mental illness and care, suspicions of providers, financial concerns, and culturally determined gender roles. Organizational factors included problems with access to care related to cost, lack of bilingual providers, and culturally competent care; and community level factors included distance between resources and the need for services to be provided in community sites. Immigration status and acculturation were identified as factors at all levels.