The Effects of Mindfulness Meditation on Nursing Students' Stress and Anxiety Levels.

AIM: The aim of this study was to evaluate the effects of a virtual mindfulness meditation intervention on stress and anxiety levels of 145 nursing students. BACKGROUND: Because of the twin demands of classroom and clinical workloads, nursing students experience greater amounts of stress and anxiety than the average college student. Mindfulness meditation is a promising method to alleviate stress and anxiety. METHOD: A pretest-posttest randomized controlled design was used. Participants received either weekly mindfulness meditation recordings or recordings on nursing information. Participants completed the Perceived Stress Scale and the Generalized Anxiety Disorder-7 Scale. RESULTS: A two-way mixed analysis of variance and follow-up simple main effects tests revealed that participants in the experimental group, who received meditation recordings, experienced significantly lower levels of stress and anxiety on posttest surveys than the control group. CONCLUSION: Mindfulness meditation can reduce stress and anxiety levels in nursing students. This can improve students' overall mental and physical well-being.

Decreasing Prejudicial Attitudes of Fear and Avoidance Toward Those Who Live with a Mental Illness-A Quasi-Experimental Controlled Study.

The undergraduate mental health nursing course is an optimal time to address stigma and prejudice, while developing positive student attitudes toward those who live with mental health conditions. A quasi-experimental, pretest-posttest, nonequivalent-group study with a sample of undergraduate nursing students in New York City (N = 126) was conducted to determine the impact of an undergraduate mental health nursing course on attitudes toward people living with a general mental illness, depression, or schizophrenia. The intervention resulted in a significant reduction in total prejudice scores toward those with a general mental illness when compared to the control (p = 0.033, partial η2 = 0.062). The intervention had no significant impact on total prejudice scores regarding those with depression, or schizophrenia. Subscale analysis revealed the intervention significantly reduced attitudes of fear/avoidance regarding general mental illness (p = 0.040, partial η2 = 0.058) and schizophrenia (p < 0.001, partial η2 = 0.164). There was no impact on authoritarian or malevolent attitudes. Though some attitudes were not amenable to change, this study provides evidence that positive attitudes can be cultivated through undergraduate nursing education. Curricular reform is needed to reduce all facets of prejudice and best prepare future nurses to care for those with mental health conditions.

A Missed Opportunity to Cultivate Positive Attitudes about Mental Health Recovery among Undergraduate Nursing Students - A Quasi-Experimental Controlled Study.

INTRODUCTION: Mental health recovery is a critical concept that needs to be thoroughly understood and supported by nurses. Undergraduate nurse educators have the opportunity to clarify misconceptions and cultivate positive recovery attitudes. AIM: To assess the impact of an undergraduate nursing course on attitudes toward mental health recovery and the relationship between recovery attitudes and prejudice toward those who experience a mental illness. METHODS: A quasi-experimental pretest-posttest, nonequivalent-control group study was conducted using a sample of undergraduate nursing students in New York City (N = 126). The intervention group was assigned to an undergraduate mental health nursing course and the control group to a pediatric/maternal health nursing course. Attitudes toward mental health recovery and prejudice were measured at the beginning and end of the semester. Two-way mixed analyses of variance were used to determine the differences in students' attitudes. Pearson product-moment correlation analyses were used to assess the relationship between prejudice toward people who experience a mental illness and attitudes toward recovery. RESULTS: The mental health nursing course had no measurable impact on students' recovery attitudes. However, there was a moderate-to-strong inverse relationship between recovery attitudes and prejudice toward those who experience a general mental illness (r = -0.54), depression (r = -0.60), or schizophrenia (r = -0.43). CONCLUSIONS: Curriculum reform is needed to optimize the impact of undergraduate education on students' attitudes. Possible changes include a more holistic approach to mental health that does not over accentuate the biomedical model, the use of nontraditional clinical sites that provide students an opportunity to interact with those further along in their recovery, and the inclusion of those in recovery in curriculum development. As there was a moderate-to-strong inverse relationship between recovery attitudes and prejudice, educational interventions that positively impact one may also impact the other. Further research is needed to investigate if the relationship is causal.

Toileting behaviors, urinary cues, overactive bladder, and urinary incontinence in older women.

INTRODUCTION AND HYPOTHESIS: Overactive bladder (OAB) and urinary incontinence (UI) are prevalent in older women. We investigated relations of toileting behaviors and urinary urge cues to OAB and UI in women ≥ 65 years. We tested mediation hypotheses that toileting behaviors lead to higher sensitivity to urinary urge cues (the mediator), which leads to both OAB and UI. METHODS: An e-panel was recruited to respond to an electronic survey that included demographic information, Urinary Cues Scale version 2, Toileting Behaviors-Women's Elimination Behaviors (TB-WEB) scale, and the International Consultation on Incontinence Questionnaire Short Forms for Urinary Incontinence (ICIQ-SF-UI) and Overactive Bladder (ICIQ-SF-OAB). Descriptive statistics were conducted; correlation matrices were created to explore relationships among major variables. Regression analyses were conducted to test our mediation hypotheses. RESULTS: There were 338 respondents with average age 70.9 (SD + 5.55) years. Most were white, overweight or obese, and had UI. Urinary urge cues fully mediated the relationship of TB-WEB with OAB. Urinary urge cues partially mediated the relationship of TB-WEB with UI; the direct effect of toileting behaviors on UI remained significant. Age and body mass index had significant partial correlations with UI but not with OAB. DISCUSSION: Toileting behaviors appear to contribute to sensitivity to urinary cues, which are related to both OAB and UI. Toileting behaviors have indirect effects on OAB and both indirect and direct effects on UI. Interventions to change toileting behaviors and extinguish urinary cues are needed. CONCLUSIONS: Behavioral and conditioning factors contribute to UI in older women.

Acknowledging Stigma: Levels of Prejudice among Undergraduate Nursing Students toward People Living with a Mental Illness-A Quasi-Experimental Single-Group Study.

INTRODUCTION: The undergraduate mental health nursing course may be an optimal time to cultivate students' positive attitudes toward people living with a mental illness. AIM: To determine the impact of an undergraduate mental health nursing course on students' attitudes toward people living with a mental illness, depression, and schizophrenia. METHOD: A quasi-experimental single-group pretest posttest study was conducted using a sample of undergraduate nursing students in New York City (N = 44). Self-reported measures of prejudice toward those living with a mental illness were collected at the beginning of a mental health nursing course and again at its conclusion. RESULTS: A statistically significant decrease in prejudice scores was found concerning mental illness (p = .03, d = 0.23), depression (p = .01, d = 0.31), and schizophrenia (p = .013, d = 0.34). Subscale analysis revealed significant decreases in the fear/avoidance and unpredictability subscales. Yet no significant change was found in the subscales of authoritarianism and malevolence for any of the three conditions. DISCUSSION: A mental health course led to a modest decrease in prejudice. However, certain facets of prejudice remain unchanged. IMPLICATIONS FOR PRACTICE: Major curricular reform is needed to optimize the impact of undergraduate nursing education.

Experimental and Quasi-Experimental Studies of Teaching Methods in Nursing Education, 1972-2017.

Review of 145 experimental and quasi-experimental studies of teaching strategies in nursing education revealed that 52 percent were published outside the United States, 80 percent with undergraduate students. Seventy-seven percent assessed learning outcomes, and 80 percent had statistically significant findings. A surge in studies since 2010 showed no increase in methodological rigor. Two thirds had sample sizes less than 100, 77 percent were quasi-experimental, and 23 percent were one-group designs. Few authors published more than one experimental study of teaching methods. Findings underscore the need for more sophisticated methods and more funding for nursing education research.

Relationship of cue-induced urinary urges to nocturia in women ages 18 to 40 years.

AIMS: Although physiological factors have a role in nocturia, research suggests that behavioral processes, especially classical conditioning may also play an important role in nocturia and other lower urinary tract symptoms. The study aimed to assess the relationship of stimulus-associated urges during the day to nocturia in a sample of women aged 18 to 40, after controlling for physiological symptoms (eg, overactive bladder [OAB]; daytime frequency). METHODS: An online study was conducted using a panel of 356 female participants between the ages of 18 to 40. One-third of the participants self-reported an OAB diagnosis as determined by their physician. Almost 80% of participants reported having at least one nocturnal voiding per night. Participants completed the Urinary Cues Questionnaire, which assessed the frequency with which respondents experienced the urge to urinate in the presence of a variety of cues and the Overactive Bladder Screening Scale (OABSS), which assesses symptoms of OAB syndrome. RESULTS: Controlling for OABSS scores and daytime urinary frequency, the Situational Cues Subscale had a significant relationship with nocturia such that with each unit increase in the subscale, the probability of nocturia increased by 12% to 14% depending on the definition of nocturia. DISCUSSION: Behavioral techniques, such as habituation to decrease the association between awakening at night and feeling an urge to urinate, may be an appropriate intervention to mitigate nocturnal urination. Theoretically, this would translate to decreasing this disorder throughout the lifespan, if behavioral techniques could be effectively utilized in early adulthood.

Stimulus-associated urinary urges in overactive bladder syndrome.

AIMS: Although anecdotal reports of urinary urgency at one's front door are common in overactive bladder syndrome (OAB), little research has been done on how one's front door and other stimuli are related to urinary symptoms. We hypothesized that individuals with OAB would have higher scores on the Urinary Cues Questionnaire, developed for this study to assess stimulus-associated urinary urges, than those without OAB. METHODS: Online surveys were administered to 328 women age 18-40 years recruited from a respondent panel maintained by CINT such that one-third of the sample reported a diagnosis of OAB. The survey assessed OAB symptoms and the frequency with which participants associated 42 stimuli with the urge to urinate. RESULTS: Psychometric analyses showed internal consistency estimates of the Urinary Cues Questionnaire of α = 0.97 and a test-retest correlation of 0.91. Women with OAB had significantly higher Urinary Cues Scores than those without OAB, with a t-test showing a large effect size of d = 1.49 (95%CI 1.24, 1.74), P < 0.001. DISCUSSION: Behavioral treatments aimed at reducing the response to cues may be useful in OAB, but more research is needed on both treatment implications and on the trajectory of symptom development.

ICI-RS 2015-Is a better understanding of sleep the key in managing nocturia?

AIMS: Nocturia, or waking up at night to void, is a highly prevalent and bothersome lower urinary tract symptom. However, the applied treatment modalities do not improve symptoms in about half of the patients. The aim of this report is to generate new ideas for future nocturia research, with special emphasis on the role of sleep physiology and sleep disorders. METHODS: The following is a report of the presentations and subsequent discussion of the Nocturia Think Tank session at the annual meeting of the International Consultation on Incontinence Research Society (ICI-RS), which took place in September 2015 in Bristol. General information about the organization of the ICI-RS meeting can be found on the website "www.ici-rs.org." An overview of challenges within the existing evidence, future research ideas, and results of research with regard to nocturia and sleep were presented. RESULTS AND CONCLUSION: In order to optimize the management of nocturia and nocturnal polyuria (NP), future research has to focus on the development of unambiguous terminology regarding nocturia and NP, the role of renal function profiles and simplified frequency volume charts as guidance of individualized therapy and the role of sleep disorders such as periodic limb movements during sleep and habitual voiding as a response to awakening. Neurourol. Urodynam. 37:2048-2052, 2018. © 2016 Wiley Periodicals, Inc.

Near-Falls in Elderly Community-Dwelling Blacks From Two Out-Patient Clinics in Harlem.

BACKGROUND: Near-falls are a frequent, but not commonly studied, occurrence in the elderly Black population and may be related to prospective falls. OBJECTIVES: The purpose of this paper is to examine the relationship of near-falls to demographic characteristics, use of assistive devices, gait, and physical activity levels in elderly Blacks. METHODS: Community-dwelling, elderly Black patients aging 65 and older and attending two clinics of the Mount Sinai Hospital in Harlem in New York City were recruited. The number of near-falls during the past year was self-reported using the Elderly Falls Screening Test. The Rapid Assessment of Physical Activity was used to assess aerobic and anaerobic activity levels. Backward stepwise logistic regression was used to identify predictors of near-falls. RESULTS: A total of 120 elderly Black adults took part in the study. Prevalence of occasional or frequent near-falls was 52.5%. In the final trimmed model, time of the 5-m observed walk (OR = 1.41, p = .001) and being male (OR = 3.68, p = .02) were significant predictors of near-fall experiences. DISCUSSION: Future research needs to be done in elderly Black populations to determine what factors may contribute to men experiencing more near-falls and on the relation between near-falls and falls.

A Systematic Review of the Application of Simulation to Promote Empathy in Nursing Education.

SUMMARY STATEMENT: This systematic review aimed to identify, appraise, and synthesize evidence for the effectiveness of simulation modalities in promoting nursing students' empathy. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was followed with 20 studies included. The Medical Education Research Study Quality Instrument (MERSQI) was used to evaluate the quality of the publications. The mean MERSQI score was 10.95 with an SD of 1.62, which was above the average in the literature.Five simulation modalities were identified: standardized patient, simulated suit, manikin, virtual simulation, and virtual reality simulation. Most of the studies (n = 15) reported significant differences in the measured outcomes after their simulation activities, including all 5 simulation modalities, but the most effective modality was the simulation suit. The simulation suit replicates the lived experiences of others, which enhances perspective taking by "turning the student into the patient" through the physical and sensory effects of simulated suits. However, outcome measures were limited to self-report instruments in the studies.

Making a difference: nursing scholarship and leadership in tobacco control.

This report from members of the Health Behavior Expert Panel of the American Academy of Nursing (AAN) provides an overview of nurse-led scholarship in tobacco control. We reviewed published reviews of nurse-led studies in the field. The synthesis includes theory development, methodological approaches, studies focused on prevention of tobacco use, nursing interventions for tobacco dependence including studies with selected populations, investigations to reduce secondhand smoke, and studies of health care systems and policy. Gaps in the literature provided direction for stimulating nursing science, accelerating adoption of evidence-based recommendations in practice, expanding nursing education, and increasing nursing visibility and influence in health care policy efforts. The AAN is positioned to maximize nursing leadership in this effort.

Using Meditation to Reduce Stress, Anxiety, and Depression in Nursing Students.

BACKGROUND: Nursing students experience higher rates of mental health issues than other college students. This study examined the effect of a mindfulness meditation intervention on nursing students' levels of self-reported depression, stress, and anxiety. METHOD: This randomized, experimental study implemented an online mindfulness meditation intervention for an experimental group of nursing students and provided nursing news modules for a control group of nursing students. Participants in experimental and control groups completed the Depression, Anxiety, and Stress Scale online before and after completing 4 weeks of audio modules. RESULTS: Results showed a statistically significant decrease in reported scores for depression, stress, and anxiety in the experimental group. CONCLUSION: This study demonstrated the potential benefits of implementing an online mindfulness meditation intervention to support and improve mental health for nursing students. [J Nurs Educ. 2023;62(8):443-449.].

When Did They Start? Age of Onset of Toileting Behaviors and Urinary Cues as Reported by Older Women.

Background: Lower urinary tract symptoms (LUTS) are prevalent across women's life course. Evidence shows toileting behaviors (TBs) and urinary urge cues are related to LUTS. It is unknown when women start using these behaviors and responding to urinary cues. Methods: An online survey was administered to 338 women, 65 years of age and older, to assess the age of onset for 20 TBs from the Toileting Behaviors-Women's Elimination Behavior (TB-WEB) questionnaire, 10 urinary urge cues from the Urinary Cues Questionnaire, and urinary urgency and leakage items from the International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB) Short Form. Descriptive statistics were reported for each TB and urinary cue. A timeline was generated with the average earliest age of onsets for each type of TB, urinary cues, and urinary urgency and leakage symptoms. Results: Place preference, delayed voiding, and hovering over toilets away from home were reported to have the earliest ages of onset. Urinary urge cues, premature voiding, and straining to void tended to start after 45 years of age, as did the symptoms of urinary urgency and leakage. The timeline indicated that the earliest place preference and position preference TBs started before 20 years of age. Conclusion: Some TBs begin early in life and persist into old age, while other TBs and urinary cues begin later. Bladder health promotion may depend on intervening at specific times in the life course to alter TBs and responses, and potentially making environmental changes.

Testing a model for parental acceptance of human papillomavirus vaccine in 9- to 18-year-old girls: a theory-guided study.

Gardasil is the first vaccine developed to prevent cervical cancer and other diseases caused by certain types of genital human papillomavirus in females, but little is known about parental acceptance of this vaccine. The purpose of this study was to test a model that predicts intention to vaccinate that includes constructs from the health belief model and the theory of reasoned action.

Environmental cues to urgency and leakage episodes in patients with overactive bladder syndrome: a pilot study.

PURPOSE: To assess the frequency with which environmental cues, which might constitute Pavlovian-conditioned stimuli, occur with urgency and leakage symptoms associated with overactive bladder syndrome (OAB). SUBJECTS AND SETTINGS: The sample group comprised 17 adults (13 women and 4 men); their median age was 74.71 years. METHODS: A semistructured interview was conducted with a convenience sample of 17 patients diagnosed with OAB. Patients were interviewed about interoceptive and environmental cues they related to instances of urinary urgency and leakage. Interviews persisted for 6.11 to 59.38 minutes (M = 21.86 minutes) and were conducted by an interviewer who was trained to administer the interview guide. RESULTS: Most respondents associated at least 1 environmental cue with urgency and leakage, respectively. A mean of 6.1 urgency-related and 4.0 leak-related environmental cues were reported. The most commonly reported environmental cues were "on my way to the bathroom" reported by 88% and "opening the front door of my home" reported by 71%. CONCLUSION: These findings support the hypothesis that Pavlovian conditioning plays a role in OAB symptoms and suggest that treatment might be enhanced by inclusion of Pavlovian extinction procedures.

Theories used in nursing research on smoking cessation.

Theories tell how and why things work; how and why one variable is related to another. Research findings that are theory based can be placed in a framework that advances science further than findings that are unconnected to formal theory. However, much of the research in smoking cessation is atheoretical. This review of nursing research on smoking cessation published from 1989 through 2008 revealed that nearly half of the studies were based on explicit formal theories. The transtheoretical model and self-efficacy theory were the most frequently used explicit theories with most theories emanating from psychology. Five nursing theories were identified in this review. Studies that used implicit rather than explicit theories dealt with five major concepts: nicotine dependence, social support, high-risk situations, mood-affect, and the influence of clinical diagnosis. Largely missing from this set of studies were investigations based on biobehavioral models, including genetics and neuroscience. The relevance of the theories and concepts identified in this review to current clinical guidelines on smoking cessation is discussed. With their grounding in theory and their expert knowledge of clinical issues, nurses are in an excellent position to develop theories that will help researchers in every discipline make sense of smoking cessation.

Depression and language acculturation correlate with smoking among older Asian American adolescents in New York City.

OBJECTIVE: To explore the correlates of smoking status among a sample of Asian American adolescents in New York City (NYC). DESIGN AND SAMPLE: This descriptive, correlational study compared current smokers and current nonsmokers in terms of age, gender, ethnicity, academic performance, acculturation, depressive symptoms, smoking history, and parental, sibling, and peer smoking. The convenience sample included 328 Asian American adolescents, ages 16-19, who lived in NYC, and were recruited from members, friends, and affiliates of 6 organizational sources. MEASURES: The study used demographic, depression (Center for Epidemiological Studies Depression scale), English language acculturation, and smoking opportunity survey questionnaires. RESULTS: Statistical analyses revealed that being older, being more English-language acculturated, having poor academic performance, increased depressive symptoms, and having siblings and peers who smoked were significantly associated with current smoking. CONCLUSIONS: Asian American adolescents initiate smoking later than other groups. Depressive symptoms were at high levels in the sample and were correlated with smoking. Thus, for Asian American adolescents, smoking prevention programs should be extended to later grades, with particular attention to low-performing students and those who are more acculturated. Likewise, programs that identify and assist adolescents with depressive symptoms may be useful in smoking prevention.

Do resisted temptations during smoking cessation deplete or augment self-control resources?

A resource depletion model of self-control posits that for some period following performance of a task requiring self-control, self-control will be reduced and thus less available for use in a subsequent task. Using 2 substantial data sets collected in real time from individuals who were trying to quit smoking (1,660 and 9,516 temptation episodes collected from 61 and 248 individuals, respectively), we evaluated this model by testing the hypotheses that the number and length of resisted temptations and the intensity of the most recently reported urge during the prior 4 hr predict decreased self-control and increased likelihood of lapsing. Survival and multilevel regression modeling showed that contrary to the hypothesis, the number of recently resisted temptations predicted a lower risk of lapsing in both samples. Duration of resisted temptations had no significant effect in either sample. Intensity of most recently reported urge predicted lapsing in 1 data set but not in the other. Overall, there was little support for the resource depletion model. The protective effect of successfully resisting temptations was an unexpected but provocative finding.