Just Another Patient? Student Reflections on Providing Mental Health Care to Transgender and Gender Expansive People During Simulated Encounters.

AIM: This study analyzed psychiatric-mental health nurse practitioner (PMHNP) students' reflections following a virtual simulated encounter with a patient who identified as transgender or gender expansive (TGE). BACKGROUND: To reduce mental health disparities, PMHNP students must be prepared to deliver affirming care. Engaging in and reflecting on simulated encounters with standardized patients can improve PMHNP students' affirming care competency. METHOD: A thematic analysis process was used to analyze student reflections during simulation debriefings. RESULTS: Five themes emerged: application of affirming care principles, recognizing minority stressors, treating all patients the same, desire to learn more, and valuing authentic practice. CONCLUSION: PMHNP students' reflections on the experience of providing care to a standardized patient who identified as TGE support the use of virtual simulations to prepare future providers to deliver affirming, person-centered care.

Training future clinicians: An interprofessional approach to treating tobacco use and dependence.

The high prevalence of smoking among persons with mental illness and co-occurring substance use disorders has not changed in the past decade despite a decline in smoking among the general population. Interprofessional collaborative care offers clinicians the opportunity to engage their patients in tobacco cessation treatment that is coordinated and comprehensive. Investigators applied a 1-group, pre/post-test design with qualitative and quantitative descriptive analyses to estimate the impact of an interprofessional tobacco education program on perceived self-efficacy and self-reported counseling abilities of graduate nursing, social work, and pharmacy (PharmD) students (N = 36; nursing, n = 13, n = 9 PharmD, n = 14 social work) to treat tobacco dependence among this subpopulation of smokers, and to assess their perceptions of interprofessional education. All participants completed a 2-h web-based module, a 3-h classroom training, a simulation with a standardized patient, and a group audio-recorded debriefing session with faculty. Emergent themes from qualitative analyses were valuing simulations, demystifying disciplines, reflecting on and critiquing practice, and lessons learned. Participants' perceived self-efficacy, self-rated counseling ability, intention to ask about tobacco use, and intention to provide counseling for tobacco cessation increased significantly. Teaching students an interprofessional team approach appears to be effective in enhancing counseling abilities and self-efficacy and may positively influence health professions students' perceptions of interprofessional education. Larger studies are recommended to validate the results of this pilot study.

'Asking' but Not 'Screening': Assessing Physicians' and Nurses' Substance-Related Clinical Behaviors.

BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) is a promising public health approach for problematic substance use. A core component of SBIRT is the use of formal screening tools to categorize a patient's likely level of risk in order to provide an appropriately-matched service. Training in formal screening is included in many SBIRT training programs, but infrequently is emphasized. OBJECTIVES: To assess pre-training levels of SBIRT-related clinical behaviors, including screening, this study examined a secondary dataset collected from internal medicine residents and graduate nurse practitioner students. METHODS: Learners (n = 117) completed 13 self-report items assessing use of SBIRT-related behaviors. Researchers used exploratory factor analysis to identify underlying concepts in the questionnaire, then used mixed ANOVA to compare mean frequency of utilization of each factor (asking, screening, and intervening) by academic program. RESULTS: Learners reported asking about substance use frequently, intervening some of the time, and infrequently using formal screening tools. Interaction and between-academic-program effects were significant but small. CONCLUSIONS: Prior to SBIRT training, most clinical practitioners reported asking patients about substance use, but few reported regularly using formal substance use screening tools. This may have implications for the importance of SBIRT training as part of curricular work, and for the internal content foci of SBIRT curricula.

Current Smokers' Preferences for Receiving Cessation Information in a Lung Cancer Screening Setting.

The purpose of this study was to identify current smokers' communication format preferences for receiving smoking cessation information in a lung cancer screening setting. A cross-sectional correlational design using survey methodology with 159 screening-eligible current smokers was the method used. Data was dichotomized (digital versus traditional preference) and analyzed using Pearson's chi-squared test, Mann-Whitney U test, and logistic regression. Race was a statistically significant predictor with White participants having four times greater odds of reporting preference for a digital format for receiving smoking cessation information such as social media and/or supportive text messages (OR: 4.06; p = 0.004). Lung cancer screening is a new venue where current long-term smokers can be offered information about smoking cessation while they are engaging in a health-promoting behavior and potentially more likely to contemplate quitting. It is important to consider the communication format preference of current smokers to support cessation uptake. This study is the first to examine communication format preference of current smokers in the context of the lung cancer screening venue. Key differences noted by race support the need for further research examining multiple formats of communication with efforts to maximize options in the cancer screening setting.

Impact of Tobacco Quitlines on Smoking Cessation in Persons With Mental Illness: A Systematic Review.

Persons with mental illness smoke at rates two to four times higher than do persons without mental illness and comprise 30.9% of the U.S. tobacco market. Given the prevalence of mental illness and the known detrimental effects of tobacco, concerted efforts are needed to promote the use of evidence-based treatment options. We conducted a systematic review of studies that examined the impact of tobacco quitline interventions in this population. Results revealed an overall positive impact of cessation services delivered via a tobacco quitline. More research is needed to determine intervention components and patient characteristics that are associated with cessation success.

Students' Perceptions of a Tobacco Education Intervention.

Persons living with a mental illness represent an especially vulnerable and disadvantaged subgroup of smokers. Compared to those in the general population, they smoke more, die younger, and suffer disproportionately from cardiovascular disease, diabetes, stroke, and cancer, all diseases and conditions directly associated with, and exacerbated by, smoking. Despite strong evidence that tobacco cessation counseling by a health professional can approximately double patients' odds of quitting, clinicians across disciplines are reluctant to offer these individuals effective means by which to quit smoking. This disinclination is due, at least in part, to inadequate tobacco cessation training during degree education. The purpose of this qualitative study was to assess undergraduate nursing students' perceptions of a tobacco education intervention. Findings support the integration of tobacco education into undergraduate nursing curricula.

Integrating Simulation into a Reflection-Centered Graduate Psychiatric/Mental Health Nursing Curriculum.

The purpose of this qualitative study was to explore reflections of student learning following a simulation experience integrated into a psychiatric/mental health nurse practitioner course. As the demand for clinical placement sites increases and availability of preceptors declines, students require experiences that will prepare them for competent patient care. This experiential learning activity was grounded in reflection-centered pedagogy, utilizing standardized patients. Three main themes emerged from the data: importance of feedback, insight gained, and improved confidence. Findings suggest that simulation is a promising approach to promote the development of competencies in graduate nursing education.

Evaluation of a theory-based education program to motivate nursing students to intervene with their seriously mentally ill clients who use tobacco.

Tobacco dependence is a major health problem for persons with a serious mental illness (SMI). Nurses working with psychiatric clients often lack the knowledge, ability, and confidence to offer their clients meaningful, effective help to quit smoking. The purpose of this study was to evaluate the effects of a tobacco education program on the perceived competence and motivation of baccalaureate nursing students (BSN) to intervene with SMI clients who use tobacco. The education program significantly improved the competence and motivation of BSN students to deliver cessation interventions to this vulnerable population of smokers.

Making a case for systematic integration of theory-based tobacco education into graduate psychiatric/mental health nursing curriculum.

Tobacco use and dependence is a serious public health issue that disproportionately affects the mentally ill client population. Mental health professionals, including psychiatric/mental health advanced practice nurses (PMHAPNs), are disinclined to integrate tobacco cessation interventions into their practice, due in part, to a general lack of tobacco-related knowledge (C. Essenmacher, C. Karvonen-Gutierrez, J. Lynch-Sauer, & S. A., Duffy, 2008; A. J. Molina, T. Fernandez, D. Fernandez, M. Delgado, S. de Abajo, & V. Martin, 2012; L. Sarna, L. L. Danao, S. Chan, S. Shin, L. Baldago, E. Endo, & M. E. Wewers, 2006); D. Sharp, S. Blaakman, R. Cole, & J. Evinger, 2009). This paper provides an in-depth literature review of tobacco education in nursing curricula and proposes the systematic integration of theory-based tobacco content into psychiatric/mental health graduate nursing programs.

Doctoral Education and Preparation for Nursing Faculty Roles.

BACKGROUND: Despite increased enrollment in doctoral programs and the encouraging numbers of graduates intending to pursue faculty positions, lack of adequate preparedness to assume the faculty role may adversely impact retention and consequently undermine efforts to reduce the shortage. PURPOSE: Understanding doctoral nursing students' and recent graduates' expectations of their educational experience related to preparation for an academic career is needed to inform curricular revisions and advise guidance to ensure role readiness. METHODS: A secondary analysis of 24 interviews with current PhD and doctor of nursing practice (DNP) students and recent graduates from both degree programs was performed to gain a deeper understanding of expectations and perceptions of doctoral education. RESULTS: Two themes emerged: (1) met and unmet expectations of programs and (2) equivocal preparation for teaching. CONCLUSIONS: PhD and DNP curricula should include coursework on teaching, as well as research, to prepare graduates for faculty roles.

Study protocol testing toolkit versus usual care for implementation of screening, brief intervention, referral to treatment in hospitals: a phased cluster randomized approach.

BACKGROUND: Alarming rates of unhealthy alcohol, non-prescription drug, and tobacco use highlight the preventable health risks of substance abuse and the urgent need to activate clinicians to recognize and treat risky use. Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and effective processes to identify, reduce and prevent risky use of substances. This paper describes a study protocol testing implementation of a toolkit to enhance use of SBIRT in acute care settings to recognize and address patient risky alcohol, drug, and tobacco use. METHODS: This study uses a phased cluster randomized mixed method design to test nurse-led implementation of an SBIRT toolkit on one medical-surgical unit at 14 acute care hospitals (critical access, community and academic health centers). Medical surgical units will be randomly assigned to implement the SBIRT toolkit (engagement and communication, assessment, planning, training, and evaluation tools) or a wait-list usual care control group that begins implementation 6 months later. Primary endpoints are documentation of SBIRT delivery in randomly selected electronic medical records at baseline, 6 months and 12 months after group 1 implementation (61 records per unit per time period, N = 2562). Two surveys will be administered to unit nurses: smoking cessation activities will be assessed at baseline and SBIRT use will be assessed on randomly-selected days after implementation. In addition, site coordinators will complete a baseline capacity assessment, an implementation fidelity survey post-implementation, and a structured interview at the end of the study. Multilevel mixed-effects effects logistic and linear models will be used to analyze use of SBIRT and cost outcomes. DISCUSSION: This study will guide subsequent SBIRT implementation, dissemination, and spread across rural, community and urban healthcare systems throughout the state and beyond. The long-term objective is to activate clinicians to recognize, intervene and refer people with risky substance use to improve health and decrease substance use disorders. Trial registration ClinicalTrials.gov NCT03560076.

Curricular Innovations in Tobacco Cessation Education for Prelicensure Baccalaureate Nursing Students.

BACKGROUND: Tobacco use is the primary preventable cause of morbidity and mortality in the United States, resulting in enormous health care expenditures. The burden of smoking is higher among disadvantaged populations, such as individuals with mental illness. As the largest group of health care providers, nurses must assume a leading role in tobacco control efforts to decrease the deleterious impact on health outcomes. METHOD: Investigators used a randomized control group design to assess the effectiveness of a theory-based tobacco education program on the perceived competence and intrinsic motivation of prelicensure BSN students (N = 134) to engage in cessation interventions with patients with mental illness. RESULTS: Students completing the program reported a significant increase in perceived competence, compared with their peers who received standard instruction only. Intrinsic motivation did not increase significantly for either group. CONCLUSION: Findings suggest that the program improves students' perceived competence, but further research is needed to determine its effect on motivation and its usefulness in other health care contexts. [J Nurs Educ. 2016;55(8):425-431.].

If You Teach It, They Will Screen: Advanced Practice Nursing Students' Use of Screening and Brief Intervention in the Clinical Setting.

BACKGROUND: In the United States, approximately 30% of adults drink at risky levels or meet the criteria for harmful or dependent alcohol use. Screening, brief intervention, and referral to treatment (SBIRT) in primary care settings is indicated. This study assessed whether knowledge, attitudes, and beliefs about SBIRT, evaluated after a three-part, mixed-methods training, predicted whether 21 family nurse practitioner (FNP) students screened for alcohol use during clinical patient encounters. METHOD: After training, students completed a survey and documented implementation of SBIRT during their clinical practice-specific management courses. RESULTS: FNP students who reported higher levels of perceived competence in their posttraining surveys were more likely to screen for alcohol in the clinical setting. CONCLUSION: Screening for alcohol misuse and identifying patients engaged in hazardous drinking meet important nurse practitioner competencies. Further research is needed to explore training programs that specifically emphasize activities to increase perceived competence, knowledge, and comfort regarding SBIRT.