Research Priorities in Psychiatric Mental Health Nursing: Funding Availability, Recently Published Work, and Future Directions for Advancing Our Science.

BACKGROUND: Identifying and sharing psychiatric mental health (PMH) research priorities can help identify gaps in the literature, determine training needs for nurses, and assist investigators in locating funding. AIMS: The aims for this project included: (1) identify PMH nursing specialty research priorities from large, public funding entities; (2) compare the identified research priorities and scholarly articles published in 2020; and (3) outline future directions for advancing the science of PMH nursing. METHODS: Strategic plans of funding entities for PMH research were reviewed for research priorities. Summarized priorities were then compared with publications from peer-reviewed PMH nursing journals. Work conducted in the United States was extracted and categorized as original research, evidence-based practice (EBP), or quality improvement (QI), then design and population. RESULTS: Priorities from 13 funding entities comprised three domains (education, research, and practice), with nine areas, 30 topics, and subtopics. Eight journals produced 432 articles with 99 (23%) conducted in the United States. Among these journals, publications fitting research priorities ranged from 1 to 33 articles. Of the 99 articles, 85% were original research and 15% were either EBP or QI. Descriptive articles comprised 64% and 23% tested interventions. Populations studied included workforce; adults; infants, children, and adolescents; and parents. CONCLUSIONS: All published articles by the U.S. PMH nurses matched the funding priorities, but not all funding priorities were addressed by 2020 publications. The majority of work was conducted outside of the United States and most published from the United States was descriptive, contrary to many United States funders' priorities for interventional research.

An Exploration of Coping with Childhood Sexual Abuse in Arab American Women.

This research used a descriptive qualitative approach to explore coping with childhood sexual abuse (CSA) and to identify long-term psychological outcomes among Arab American women. Ten Arab American women participated in the study. Data were collected by individual semi-structured interviews and analyzed using content analysis. Five categories emerged for CSA experience among the participants: CSA characteristics, social support, Arabic culture, coping, and long-term psychological outcomes. Most of the women had experienced familial and contact CSA . and had disclosed their CSA and received different reactions from family and friends. Arabic cultural values influenced the women's experience of CSA and their coping strategy, especially regarding the CSA disclosure and seeking mental health services. The women used a spectrum of strategies to cope with their abuse including seeking support, positive reappraisal,,, accepting responsibilities, avoidance and protective coping. All women experienced negative long-term psychological outcomes of CSA such as flashbacks and low self-esteem. Prior to this research, no known studies have explored coping with CSA experience among Arab American women. Thus, this study can be used to inform practice guidelines to minimize the stigma of CSA and to promote help-seeking behavior for Arab American female CSA survivors and their families.

Challenges and strategies for conducting sensitive research with an Arab American population.

Recruiting minority groups such as Arab Americans (Ar-Am) for research studies has been challenging. To date no studies were found that explicitly addressed challenges to recruit Ar-Am for sensitive research. The purpose of this article is to present the challenges across three pilot studies that involved Ar-Am samples and the strategies that were implemented to overcome these challenges. The challenges faced with conducting studies with Ar-Am included difficulty for participants to express emotions, influence of male/female authority to consent for the study, lack of trust to disclose sensitive information, language barrier, and slow recruitment. Having bilingual female recruiters of Arabic descent, engaging the women's family members in the consent process, and addressing the sensitive topics in culturally appropriate language were effective strategies to overcome these challenges. These strategies might be helpful for other researchers who recruit Ar-Am for sensitive research.

Mother-Child Relational Quality of Women in Substance Abuse Treatment.

BACKGROUND: Mothers who abuse substances are more likely to have impaired parenting and lose custody of their young children. OBJECTIVE: The pilot study described mother-child relational quality of women in substance abuse treatment. The identification of mothers' perceptions of being parented, current level of depression, discrete and potentially modifiable mothering behaviors, and self-appraisals of their role. DESIGN: The descriptive study implemented audio-video-recorded mother-child interactions for coding. RESULTS: Twenty-nine dyads participated with children age 4 weeks to 5 years. Mothers had lower levels of caring from their parents and moderate depression that was correlated with many of the relational quality behaviors. Eleven of 29 maternal behaviors were coded as concerning. Reflections by mothers revealed modest, yet confident self-appraisals of their maternal role. CONCLUSIONS: Women who experienced higher depression demonstrated lower maternal quality. Some maternal behaviors were identified as less optimal although many were strengths.

Development of a Child Abuse Level Management (CALM) Guide for Research with Young Children.

Reporting child abuse or neglect is an ethical expectation and a legislated mandate of behavioral and health care professionals in the United States. In particular, researchers who investigate parent-child dyads are responsible for submitting procedures and informed consent documents to institutional review boards that provide for the protection of children. The challenge for researchers is to recognize failing quality of parent-child interaction, prior to any event of maltreatment and to intercede in a deteriorating dynamic. The obligation to report any suspicions of child maltreatment supersedes the responsibility to provide for confidentiality of research data. The purpose of this paper is to describe the rationale for the development of a research protocol guide, Child Abuse Level Management (CALM), and address protection of children in research. The CALM is a brief, flexible guide designed for use by researchers to help identify and respond to negative trends in the parent-child interaction during data collection. Suggested intervention scripts are provided that can be modified for specific culture-focused samples. The CALM guide can be used for training of data collectors using simulations prior to initiating any study involving higher-risk dyads.

Model Development of Mothering by Women with Bipolar Illness.

A sensitive, secure, and consistent relationship with their mother is critical for young children. There is a dearth of knowledge about the quality of mothering of young children by women with bipolar disorder. These mothers are frequently challenged, unable to provide consistency, and are at risk for loss of child custody. The model described in this article reflects a critical analysis of conceptual and empirical literature regarding mothering quality, resourcefulness, disorder severity, medication adherence, social supports, and child-rearing beliefs. The model can provide a conceptual framework for research, direct the selection of research instruments, and hypothesize the relationships among constructs.

Using Liberating Structures to Increase Engagement in Identifying Priorities for the APNA Research Council.

BACKGROUND: In 2015, the Co-Chairs and Steering Committee of the Research Council members recognized the need to reevaluate the council's priorities. OBJECTIVE: To determine the top priorities for the Research Council. DESIGN: Use of liberating structures: Impromptu Speed Networking, 1-2-4-all, and Crowd Sourcing. RESULTS: Identified Research Council priorities included the following: efforts to increase psychiatric mental health (PMH) research funding; serve as a connector to bring researchers together; foster research through state chapters; increase collaboration between PhDs and DNPs; and develop models for organizational support for PMH staff nurse involvement in research. CONCLUSIONS: The liberating structures used are valuable strategies for engaging groups of people to identify what matters most to the group. Through the use of these novel techniques, the American Psychiatric Nurses Association Research Council has identified priorities for the work of the council. This has led to actions planned for the coming future with the intent to move PMH nursing research forward.

Gender-related sexual abuse experiences reported by children who were examined in an emergency department.

The purpose of this study was to examine the experiences of sexual abuse by 95 children of two gender groups to determine differences in their reported sexual exploits by perpetrators. Significant differences between female and male children were reported. Male child-victims experienced more anal penetration by penis (54.5%, 10.7% respectively) and finger (27.3%, 2.7% respectively), however; female child-victims experienced more mouth contact to their genitalia (22.7%, 10.0% respectively) and body kisses (47.9%, 9.1% respectively). A more gender-specific approach could help to facilitate prevention, and produce better outcomes.

An online evidence based medicine exercise prompts reflection in third year medical students.

BACKGROUND: Reflective practice is a desirable trait in physicians, yet there is little information about how it is taught to or learned by medical students. The purpose of this study was to determine whether an online Evidence Based Medicine (EBM) exercise with a face-to-face debriefing session would prompt third year medical students to reflect on their current skills and lead them to further reflection on clinical decision making in the future. METHODS: All third year medical students at the University Of Maryland School Of Medicine who completed their pediatrics clerkship between 7/1/09 and 2/11/11 were required to complete the EBM exercise. Following completion each student received a personal report (Learning Profile) of their responses and attended a one hour large group debriefing session. Student responses to a survey following the debriefing sessions were analyzed using a post-test survey design with a single experimental cohort. RESULTS: Ninety-five percent of students completing the debriefing survey indicated that the debriefing session helped them better understand their learning profiles; 68% stated that their profiles allowed them to evaluate themselves and their decisions. Sixty-three percent noted that participating in the exercise and the debrief would lead them to either learn more about EBM and use EBM more in the future or reflect more on their own decision making. CONCLUSIONS: The EBM exercise was a successful way to introduce the concept of reflective practice to third year medical students, and the graphic Learning Profiles were effective instigators of discussion and reflection.

Interrater reliability of an oral case presentation rating tool in a pediatric clerkship.

BACKGROUND: Composing and delivering effective oral case presentations is an important skill for medical students to learn, but the large variety of patients and presenting problems makes teaching and evaluating this skill complex. Few published tools are available for educators to use, and those that are described are not well studied. PURPOSE: The authors describe the development of the Patient Presentation Rating tool and the study to establish its interrater reliability. METHODS: Three raters reviewed 15 recorded new patient presentations delivered by 3rd-year medical students on their pediatrics clerkship. Intraclass correlation coefficients were used to determine the interrater reliability of the tool as a whole, its subsections, and each individual item. RESULTS: The tool was found to reliably rate the technical aspects of presenting patients as well as several aspects of clinical reasoning embedded in that process. CONCLUSIONS: The Patient Presentation Rating tool is a reliable instrument for evaluating medical students' oral patient presentations.

Social determinants of adolescent depression: an examination of racial differences.

Conventional behavior theories that assert adolescent risk behaviors are determined by peer and parental relationships are being challenged as research begins to consider broader socioenvironmental factors. This study, using data from the Longitudinal Study for Adolescent Health (Add Health), Wave II, Public Use Data, and the Social Determinants of Adolescent Risk Behaviors (SDOARB) framework, examines relationships among socioeconomic status (SES), academic performance, perceived peer prejudice, and perceived teacher discrimination as predictors of depressive symptoms among high school adolescents. Overall, the study found that GPA was a significant predictor of depressive symptoms across all three racial groups (Black, White, and Other Minority). Teacher discrimination predicted depressive symptoms among White and Other minority adolescents, but not Black adolescents. These findings suggest the need for interventions within schools for both students and teachers around racial differences in perceptions of prejudice and discrimination. Failure to address overt and covert subtleties of discrimination and prejudice within schools and policies which affect these interpersonal dynamics may have a significant impact on the overall mental wellbeing of adolescents.

Living with the loss of a child: mothers in the criminal justice system.

OBJECTIVE: Bereaved mothers have expressed the need to maintain a bond with their children who have died, to retain control over the funeral rituals, and to express their loss to others who are empathetic. This study describes grief over the loss of a child in women who have been or are currently incarcerated, and the influence of the women's family members. METHOD: This descriptive qualitative study consisted of open-ended interview questions to encourage the women to describe their experience in their own words. A purposive sample (N = 10) was recruited from a prison re-entry program and a county jail. RESULTS: All of the participants described maladaptive responses such as the use of alcohol and drugs, restricted family support, and dysfunctional coping. None of the participants had received focused bereavement services. SIGNIFICANCE OF RESULTS: The descriptive perspective from the participants can inform clinicians who work with women who have a history of involvement with the criminal justice system, and recommends that they should inquire about the women's children and experiences with loss. Community re-entry and jail/prison counselors should provide access to confidential and group-based therapeutic support, including Compassionate Friends.

University of Maryland School of Medicine increases medical student education in primary care.

In August 2012 the University of Maryland School of Medicine will start a new Primary Care Track for incoming first year medical students as a collaborative program of the departments of Family and Community Medicine, Internal Medicine, and Pediatrics. Its focus will be to introduce all students to primary care role models early in medical school, and to offer a longitudinal experience in primary care in rural and urban underserved communities to interested students, with the intention of increasing the number of UMD medical students who choose primary care careers in these communities.

Synchronous virtual interprofessional education focused on discharge planning.

COVID-19 required innovative approaches to educating health professions students who could no longer attend in-person classes or clinical rotations. Interprofessional education (IPE) activities were similarly impacted. To replace an in-person IPE activity slated for this spring, nursing and medical students with similar levels of clinical experience came together to attend a synchronous virtual session focused on discharge planning. The class objectives focused on the IPEC competencies of Role/Responsibility and Interprofessional Communication. Discussion revolved around the discharge planning process for an elderly patient with multiple medical problems, as this is a time when interprofessional collaboration has a clear benefit to patients. Twenty-eight nursing students and eleven medical students attended a 90 min session via Zoom. Students received pre-readings, the day's agenda, learning objectives, and discussion questions in advance. The session had three sections: introduction/welcome, breakout sessions, and debrief and evaluation. Four faculty leaders and four students who participated in a similar in-person session in the past served as facilitators. They received a supplemental facilitator guide for use if students were not able to sustain their discussions for the allotted time. Materials can be accessed by contacting the corresponding author (BR). Students completed a post-session survey, and qualitative analysis demonstrated that they had addressed the two relevant IPEC competencies in their groups and showed evidence of touching on the additional two IPEC competencies as well. Overall, they enjoyed the experience. This virtual experience made scheduling simpler than planning an in-person session and allowed this activity to occur despite restrictions secondary to the pandemic. This might remain a useful format for similar sessions in the future.

Age-Related Child Sexual Abuse Experiences.

The study aimed to describe differences in the types of sexual abuse injuries between two age groups of children presenting to an emergency department. This descriptive correlational study explored the relationships between sexual abuse type and child's age using data from the hospital health records of 95 children ages 6-14 years. Descriptive analysis indicated that sexually abused child victims' ages were significantly associated with different types of penetrations and mucosal tears or injuries (p < 0.05). These findings highlighted the need for increased awareness about the different types of physical trauma associated with the ages of the child victims.

Domestic violence in women with serious mental illness involved with child protective services.

The purpose of this study is to describe mothers with serious mental illness who have experienced domestic violence and are involved with child protective services. One hundred twenty-two files from the Department of Child and Family Services were reviewed. According to this retrospective review, the majority of the mothers and children had been exposed to domestic violence (62.6%). Mothers with the diagnoses of major depression-single episode and major depression-recurrent were most likely to have disclosed domestic violence exposure, compared to mothers with other serious mental illnesses. Our findings, and that of other cited studies, support the practice of routine assessment of domestic violence in women with serious mental illnesses, identification of safe havens for mothers and children, and access to continuing parenting support for these vulnerable family groups.

Improving education in primary care: development of an online curriculum using the blended learning model.

BACKGROUND: Standardizing the experiences of medical students in a community preceptorship where clinical sites vary by geography and discipline can be challenging. Computer-assisted learning is prevalent in medical education and can help standardize experiences, but often is not used to its fullest advantage. A blended learning curriculum combining web-based modules with face-to-face learning can ensure students obtain core curricular principles. METHODS: This course was developed and used at The Case Western Reserve University School of Medicine and its associated preceptorship sites in the greater Cleveland area. Leaders of a two-year elective continuity experience at the Case Western Reserve School of Medicine used adult learning principles to develop four interactive online modules presenting basics of office practice, difficult patient interviews, common primary care diagnoses, and disease prevention. They can be viewed at (http://casemed.case.edu/cpcp/curriculum). Students completed surveys rating the content and technical performance of each module and completed a Generalist OSCE exam at the end of the course. RESULTS: Participating students rated all aspects of the course highly; particularly those related to charting and direct patient care. Additionally, they scored very well on the Generalist OSCE exam. CONCLUSION: Students found the web-based modules to be valuable and to enhance their clinical learning. The blended learning model is a useful tool in designing web-based curriculum for enhancing the clinical curriculum of medical students.

Mothers with self-reported axis I diagnoses and child protection.

PURPOSE: To describe mothers with serious mental illness (SMI) and their children, who are involved with child protective services. METHODS: A retrospective review was conducted of 122 files from a large metropolitan Department of Child and Family Services. FINDINGS: The most frequently occurring diagnoses in these mothers were polysubstance dependence (39.3%) and dual diagnoses (mental illness with substance abuse; 19.7%). There was an overrepresentation of African American mothers (60%) compared with the county population and a greater prevalence of child neglect (59.0%) compared with national prevalence. Most mothers and children had been exposed to domestic violence (62.6%). Mental health services were seldom utilized, and foster care was the most common placement (36.5%). Also, there was close spacing of the age of the children, with an average of 1.25 years between siblings. CONCLUSIONS: Identifying common descriptive factors of mothers with mental illness can assist in responding to mothers with SMI and their children. There is a need to coordinate services of the Department of Child and Family Service and mental health providers that address parenting and the support of children.

The Impact of Cyberbullying on Physical and Psychological Health of Arab American Adolescents.

Utilizing a community-based, cross-sectional design, the present study explored Arab American adolescents' experiences in cyberbullying and its effect on their health. A convenience sample of 150 Arab American adolescents, ages 12-16, were recruited from two community centers located at Southeast Michigan. The survey focused on cyberbullying victimization and perpetration in the past year including frequencies and types of technology used. Thirty-four percent of adolescents reported cyberbullying victimization and 26.7% reported cyberbullying perpetration at least once in the past year. Males were significantly more involved in both victimization and perpetration. Text messaging, Instagram and Facebook were most commonly used. Perpetration predicted physical complaints (p = .001), whereas, victimization predicted psychological distress (p = .014) after controlling for all demographic variables. Arab American adolescents reported significant cyberbullying perpetration and victimization. Perpetrators experienced more physical symptoms while victims experienced more psychological distress. Implications for future research are discussed.