A literature review of the psychological status of asylum-seeking children: implications for nursing practice.

Europe is in the midst of a large-scale migration crisis, which has implications for healthcare provision for asylum-seeking children and families. The authors set out to identify the psychological status of asylum-seeking children and highlight their needs. A search of three electronic databases was carried out, resulting in 15 studies. Data show that asylum-seeking children appear to experience many mental health difficulties, including post-traumatic stress disorder, depression, self-harm, sleep disturbance and behavioural difficulties. The daily living situation includes a range of psychological stressors, such as lack of space and control; fear of deportation; feelings of inadequacy and hopelessness; poor parental mental health; lack of recreational facilities; communication issues; and financial worries. Since many asylum-seeking children have experienced past trauma, hospitalisation and healthcare encounters may trigger traumatic memories and cause further distress. Awareness of the psychological impact of the situation on children and families may help nurses to provide empathetic, sensitive and culturally competent care.

Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI): protocol for a cluster-randomised clinical trial of a complex intervention.

INTRODUCTION: Acute psychological stress, as well as unusual experiences including hallucinations and delusions, are common in critical care unit patients and have been linked to post-critical care psychological morbidity such as post-traumatic stress disorder (PTSD), depression and anxiety. Little high-quality research has been conducted to evaluate psychological interventions that could alleviate longer-term psychological morbidity in the critical care unit setting. Our research team developed and piloted a nurse-led psychological intervention, aimed at reducing patient-reported PTSD symptom severity and other adverse psychological outcomes at 6 months, for evaluation in the POPPI trial. METHODS AND ANALYSIS: This is a multicentre, parallel group, cluster-randomised clinical trial with a staggered roll-out of the intervention. The trial is being carried out at 24 (12 intervention, 12 control) NHS adult, general, critical care units in the UK and is evaluating the clinical effectiveness and cost-effectiveness of a nurse-led preventative psychological intervention in reducing patient-reported PTSD symptom severity and other psychological morbidity at 6 months. All sites deliver usual care for 5 months (baseline period). Intervention group sites are then trained to carry out the POPPI intervention, and transition to delivering the intervention for the rest of the recruitment period. Control group sites deliver usual care for the duration of the recruitment period. The trial also includes a process evaluation conducted independently of the trial team. ETHICS AND DISSEMINATION: This protocol was reviewed and approved by the National Research Ethics Service South Central - Oxford B Research Ethics Committee (reference: 15/SC/0287). The first patient was recruited in September 2015 and results will be disseminated in 2018. The results will be presented at national and international conferences and published in peer reviewed medical journals. TRIAL REGISTRATION NUMBER: ISRCTN53448131; Pre-results.

The PTSD Toolkit for Nurses: Assessment, intervention, and referral of veterans.

Approximately 20% of veterans suffer from posttraumatic stress disorder (PTSD). NPs are well positioned to provide early detection and assist veterans with access to life-saving treatment. The PTSD Toolkit for Nurses helps nurses improve their skills in assessing PTSD and provides a specialized intervention and referral procedure that promotes help-seeking behavior among veterans.

Military Culture Implications for Mental Health and Nursing Care.

With over 13 years of war and military combat operations, the number of veterans, military families, and service members with mental health needs continues to increase across civilian and federal healthcare services. Knowledge about severe battle wounds, traumatic brain injury, and traumatic stress has influenced the delivery of healthcare. The invisible wounds of war associated with brain injury and traumatic stress will increase clinical care challenges into the foreseeable future. The purpose of this article is to describe two interrelated concepts, military cultural competence and stress injuries. The authors also differentiate stress reactions versus stress injury. Nurses with military cultural competence and knowledge about stress injuries will be better able to deliver patient-centered care to patients with military culture experiences.

Veterans' health care considerations for today's nursing curricula.

Although there have been several wars and conflicts since World War I, the escalating numbers of veterans since that time is now evident. Extraordinary survival results have evolved from effective triage, trauma treatment, and recovery maneuvers during Operation Iraqi Freedom and Operation New Dawn (OIF) in Iraq and Operation Enduring Freedom (OEF) in Afghanistan. Yet even with those results, the number of physical and mentally wounded individuals exceeded 32,000 from OIF and 16,000 from OEF. How will we help these service men and women meet the special challenges they may face after discharge from the military? This article presents a rationale for content integration, health concerns, and realistic educational suggestions for faculty as they prepare professional nurses to care for these veterans and their families. Future nurses need to be prepared to care for this patient population in community health care systems.

Lost in translation: staff and interpreters' experiences of the edinburgh postnatal depression scale with women from refugee backgrounds.

This paper explores the cross-cultural application of the Edinburgh Postnatal Depression Scale (EPDS) and the difficulties associated with administration to women from refugee backgrounds. Assessing women's comprehension of individual scale items identified problems associated with "Western" terminology and concepts. Re-interpretation of discrete items on the scale was often necessary, raising doubts about the objectivity and reliability of scores. Our findings call for a closer examination of the ethnocentric assumptions underpinning the EPDS items, and the need to incorporate a more diverse range of cross-cultural understandings into future iterations.

[Breaking the silence in Colombia to resist violence 2/2]. / Briser le silence en Colombie pour résister a la violence 2/2.

The war in Columbia is the source of permanent and widespread violence, of which the civilian population is the main victim. Medical-psychological teams from Médecins Sans Frontières France worked in Tolima, a region particularly affected by the conflict, between 2001 and 2008, and were able to study the complexity of the forms of violence and their consequences. While the consequences for individuals, analysed in part one, are devastating, the impact of the conflict on society and families provides a better understanding of this society and its generalised violence.

Testing two global models to prevent violence against women and children: methods and baseline data analysis of a seven-year prospective study.

Worldwide, two models of care are offered most often to abused women-safe shelter and justice services. No evidence exists on the differential effectiveness of the models. To provide evidence for best practice and policy, 300 abused women, 150 first-time users of a shelter and 150 first time-applicants for a protection order, participated in a seven-year study. Safety, abuse, and the emotional and physical functioning of the women and their children were measured. The procedural logistics, sampling process, metrics, and baseline descriptors for these 300 women and 300 children is presented along with implications for practice and policy.

Health and social needs of traumatized refugees and asylum seekers: an exploratory study.

PURPOSE: The purpose of this study was to describe the care needs of adult traumatized refugees and asylum seekers. DESIGN AND METHODS: A mixed-methods design was used. A survey was conducted using the Camberwell Assessment of Need (CAN) among 30 patients. Semistructured in-depth interviews were subsequently conducted with eight of these patients. FINDINGS: Key themes among refugees are loneliness and grief. Refugees are in severe psychological distress. They also encounter all kinds of practical problems that influence their quality of life. Furthermore, many of them suffer from serious psychiatric and trauma-related problems. PRACTICE IMPLICATIONS: The results of this explorative study can contribute to the quality of care for traumatized refugees.

Identification of domains and measures for assessment battery to examine well-being of spouses of OIF/OEF veterans with PTSD.

Family members play an important role in the physical and mental recovery of soldiers returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Posttraumatic stress disorder (PTSD) has been associated with strained marital and family relations and parenting difficulties, and many veterans with PTSD experience difficulty finding and maintaining employment. Family members who assist with the veteran's recovery also experience significant strain and may have to leave employment to care for the veteran. Our objective was to identify appropriate assessment measures for examining the well-being of spouses assisting with veterans' recovery and to identify opportunities for supporting veterans' spouses. We used a combination of expert panel input and qualitative methods (focus group interviews) to develop a battery of instruments for use in future research with OIF/OEF family members to examine well-being. Research is needed to elucidate and refine the special needs and issues surrounding PTSD in current and future OIF/OEF veterans and their families. This study provides a first step toward understanding appropriate measures. Expert panel methods and focus group interviews yielded valuable input on the domains and measures that should be included in the assessment battery as well as opportunities for assisting spouses.

Assessment for and response to adverse childhood experiences.

Literature strongly suggests that early exposure to adverse childhood experiences (ACEs) disrupts crucial normal stages of childhood development and predisposes these individuals to subsequent psychiatric sequelae. Even with these data, little is found in nursing literature that discusses ACEs and their impact on adult mental health. Therefore, the purpose of this article is to address how nurses approach communication with clients about and assess for traumatic life experiences. In addition, screening measures for ACEs will be presented, along with discussion about ethical responsibilities of health professionals and researchers in asking about abuse.

Children who witness violence: what services do they need to heal?

Children are witnesses to violence far too often in their daily lives. To elicit information on the needs of children and adolescents living in the United States who have witnessed violence in their homes, neighborhoods, or communities, we held focus groups with mothers who have survived interpersonal violence and whose family included child witnesses to violence (CWV), professionals who work with families affected by violence, and with adolescents who have witnessed violence. Based on four separate focus group discussions held in Massachusetts, involving a total of 45 participants, recommendations for screening, programming, and the development of healing interventions are offered to mental health professionals.

Improving nurse practitioner assessment of woman veterans.

PURPOSE: To provide nurse practitioners (NPs) with brief screening tools that can be used to identify postmilitary healthcare concerns common among women veterans. DATA SOURCES: Existing screening tools for posttraumatic stress disorder, traumatic brain injury, and military sexual trauma. CONCLUSIONS: Women represent more than 10% of military veterans who have served in combat settings during the current wars in Afghanistan and Iraq. As a result of their military service, women veterans may present in community healthcare settings with one or more of a variety of functional health problems, posttraumatic stress disorder, depression, anxiety, or other evidence of significant physical or psychiatric stress. Their families may be temporarily or permanently unstable as a result of the disruption caused by their military service, deployment, or health status. IMPLICATIONS FOR PRACTICE: NPs who are aware of the unique healthcare needs of women veterans returning from combat will be better prepared to assess and intervene when these patients present with symptoms or health consequences of military service. Simple, straightforward assessments can determine the extent to which women veteran patients require intervention during wartime and/or referral.

Mental health needs in a post-disaster environment.

Maintenance of a daily routine, which includes scheduled medications, access to a health care provider, and a stable environment, forms an anchor point in the lives of people diagnosed with mental illness. When a disaster, either man made or natural, interferes with these, patients often experience an acute exacerbation of their illness. Efforts to mitigate the ensuing disruption require a contingency plan in the event of a disaster; a plan ensuring access to medications, health information, and caregiver stability, allows those with mental illness to continue to function at an acceptable level. Recent world events, such as the Asian Tsunami in 2004 and Hurricane Katrina in 2005, indicate that minimal research exists regarding the magnitude of the effects of disasters on those with mental illness. A review of the literature indicates that the impact on survivors' mental well-being is directly related to the level of exposure to a disaster. Mental health professionals must include crisis management, planning, and communication in pre- and post-disaster interventions with people who have mental illness.

Predictors of healthy behaviour in long-term survivors of childhood cancer.

AIM: The objective of this study was to examine the factors contributing to healthy behaviour in young adult long-term survivors of childhood cancer. BACKGROUND: Young adult childhood cancer survivors can adopt more healthy behaviour than the general population as a way to minimize the adverse consequences, that is, late effects of cancer and its treatment. Knowledge about the predictors of healthy behaviour in childhood cancer survivors can help providers assist young adult survivors with minimizing late effects. DESIGN AND METHODS: A cross-sectional correlational design and convenience sampling were used. Data were collected by mailed survey. Study measures included an investigator-developed demographic and disease form, the Mishel Uncertainty in Illness Scale-Community, the Post-traumatic Stress Disorder Index and the Health Promoting Lifestyle Profile II. Fifty-one per cent (N = 46) of eligible survivors responded to the survey. Data from 45 participants were used in the analyses. RESULTS: 43.3% of variance in healthy behaviour was explained by a model that included uncertainty (beta = -0.37, p = 0.007), post-traumatic stress symptoms (beta = -0.10, p = -0.44), interactions with primary care providers (beta = 0.33, p = 0.01) and a history of special educational assistance (beta = -0.23, p = 0.06). CONCLUSION: Young adult childhood cancer survivors who have higher levels of uncertainty, higher levels of symptoms of post-traumatic stress, lower frequency of primary healthcare interaction and poorer cognitive resources were more likely to report lower levels of healthy behaviour. RELEVANCE TO CLINICAL PRACTICE: The findings can guide the clinical assessment of young adult survivors with regard to their health behaviours and needs they may have for education and supportive care. Findings also help inform the design of health promotion interventions for this specific group of cancer survivors.

Perilous work: nurses' experiences in psychiatric units with high risks of assault.

Psychiatric facilities struggle to maintain therapeutic environments made increasingly difficult by severe nursing shortages. Related safety concerns prompted a phenomenological inquiry about nurses' experiences working in environments with high risks of assault. Ten registered nurses participated in open-ended interviews. Analysis of interview transcripts generated four categories and 13 subcategories subsumed under the primary construct of "perilous work," providing the frame for the exhaustive description and essential structure of participants' lived experiences. Outcomes suggest that serious work-related hazards exist and provide insight into possible remedies and a springboard for follow-up studies.

Post-traumatic stress disorder in asylum seekers.

Asylum seekers can present with a wide range of psychological problems caused by traumatic experiences in the country they have fled. They may also experience adjustment problems in the host country. This article describes a nurse-led, three-phased model of intervention to aid recovery in stages, addressing the biological, psychological and social needs of the individual.