A Clinic for the People: Toward an Antiracist Psychiatry at the Tuskegee Institute 1947-1965.

From 1947 until 1963, a small group of psychiatrists from the Tuskegee Veterans Administration Hospital ran a Mental Hygiene Clinic designed to provide outpatient care and education to the Black residents of Macon County, Alabama. In an analysis of the clinic and the work of its Director, Dr. Prince Barker, we see the ways that Black psychiatrists tried to develop an antiracist approach to psychiatry and to develop their own autonomy in segregated Alabama. But there were limitations to this work. Tensions between the state funding body, local politics, and the internal racism of psychiatry itself all made it difficult for Tuskegee psychiatrists to provide alternatives to care beyond the veil of the color line.

Racism and Redlining in the History of Psychiatric Policy and Practice in Atlanta: Implications for Nursing.

Recently, the Georgia state House of Representatives passed House Bill 1013, also called The Mental Health Parity Act. The bill sought to address access to and insurance coverage for mental health services, first identified in a report in 2020. The budget for mental health services was reduced by $8 m in 2020, despite an all-time high demand due to the beginning of the Covid-19 pandemic. There is an increasing inability to secure mental health care in the state. Georgia is ranked 37th in the country for access to quality mental health care (Reinert, Fritze, and Nguyen, 2022) and half the counties in the state have no psychiatrist; the projected mental health workforce will be able to meet only 12% of consumer demand by 2025. Problems with mental health care in Georgia have a long history which intersects with the history of racism, geographical segregation, and policing. HB1013 does not consider any of this history in its recommendations, which barely include nursing. At the same time, policy and practice in Georgia continues to entangle nurses and other professionals with a carceral and punitive system which not only threatens the safety of patients, but also nurses themselves. Nurses need to understand this history if they hope to develop policy that will intervene in the mental health care crisis.

Different Places, Different Ideas: Reimagining Practice in American Psychiatric Nursing After World War II.

In 1952, Hildegard Peplau published her textbook Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. This was the same year the American Psychiatric Association (APA) published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (1st ed.; DSM-I; APA). These events occurred in the context of a rapidly changing policy and practice environment in the United States after World War II, where the passing of the National Mental Health Act in 1946 released vast amounts of funding for the establishment of the National Institute of Mental Health and the development of advanced educational programs for the mental health professions including nursing. This article explores the work of two nurse leaders, Hildegard Peplau and Dorothy Mereness, as they developed their respective graduate psychiatric nursing programs and sought to create new knowledge for psychiatric nursing that would facilitate the development of advanced nursing practice. Both nurses had strong ideas about what they felt this practice should look like and developed distinct and particular approaches to their respective programs. This reflected a common belief that it was only through nurse-led education that psychiatric nursing could shape its own practice and control its own future. At the same time, there are similarities in the thinking of Peplau and Mereness that demonstrate the link between the specific social context of mental health immediately after World War II and the development of modern psychiatric nursing. Psychiatric nurses were able to gain significant control of their own education and practice after the war, but this was not without a struggle and some limitations, which continue to impact on the profession today.

History as reflective practice: A model for integrating historical studies into nurse education.

The role of history in developing professional identity in nursing is well known, and the discipline of nursing history research continues to flourish. Yet this work often struggles to find its way into undergraduate university nurse education courses. We put forward a model for "history as reflective practice" in which we suggest that historical studies can be used as a form of evidence to develop critical thinking and clinical reasoning, as well as situate nursing practice within its social and political context. In this model, we draw on historical scholarship related to the profession, practice and person, focusing on work which demonstrates nursing's contribution to broader systems of health care. Drawing on Lewenson and Lynaugh's 'history by stealth' approach, curriculum mapping and constructive alignment techniques are used to identify the moments in an existing programme where historical scholarship is relevant to an intended learning outcome. We then use an interdisciplinary team to develop learning activities and assessment tasks drawing on both primary and secondary sources that are then embedded within existing subjects. This model encourages students to consider history as a way of knowing and as a form of evidence within their reflective practice. Furthermore, it creates knowledge that continues to foster and acknowledge nurses', and nursing's, contribution to the development of human health.

What Will People Think? How College Students Evaluate Bystander Intervention Behavior.

Many colleges utilize bystander intervention programs to address gender-based violence. The goal of these programs is to help students overcome barriers to intervention, including evaluation inhibition, which occurs when bystanders expect to be viewed negatively for intervening. We have limited information, though, on how college students evaluate bystanders who intervene. Specifically, we do not know whether evaluations of bystanders who engage in different levels of intervention vary across situations or how men and women who intervene similarly are evaluated. Without this information, it is difficult to design prevention programs that help bystanders overcome evaluation inhibition. To gather this information, we conducted a vignette experiment with college student participants (n = 82). We specifically examined how students evaluated the reasonableness of male and female bystanders who engaged in different behaviors (direct intervention and threatening to tell an authority, direct intervention only, indirect intervention, doing nothing) across four situations (assault at a party, workplace harassment, harassment by a teaching assistant, and intimate partner violence). Analyses of variance found that there was situational variability in how the bystander is evaluated for different intervention tactics, though bystanders who did nothing were always evaluated the most negatively. Bystander's gender, however, did not affect evaluations, suggesting that intervention expectations for men and women are similar. These results indicate that while there is an underlying norm supportive of intervention behavior, situational characteristics influence whether college students think it is reasonable to call authorities, confront the perpetrator, or engage in indirect intervention. The central implication of this study is that bystander intervention training should provide opportunities for students to practice intervention behaviors across a wide variety of situations of gender-based violence in order build up their store of intervention tactics, thus increasing their ability to overcome evaluation inhibition.

Leverage pre-requisite courses to teach bachelor of science in nursing students about social determinants of health.

BACKGROUND: Nurses have frequent opportunities to address social determinants of health (SDOH) in practice. However, many nurses graduate without completing coursework in SDOH, and there remain barriers to incorporating SDOH content into nursing curricula. PURPOSE: We propose the revision of nursing pre-requisites to include substantive, introductory coursework on SDOH. METHOD: We explored the history and professional context surrounding nursing's current pre-requisite course expectations. We also performed an assessment of the credit hour requirements and pre-requisite course titles for the nation's 100 top-ranked nursing programs. FINDINGS: Our assessment revealed that the allocation of credit hour requirements for most programs leaves little room for SDOH-focused credits once nursing coursework starts; also, based on title analyses, foundational coursework on SDOH may be missing from most programs' pre-requisite listings. DISCUSSION: Nursing pre-requisites should include SDOH content for reasons including the limited availability of credit hours for SDOH-focused electives and the importance of students developing a strong foundation in SDOH before their nursing coursework begins.

Addressing Fear of Negative Consequences of Overdose Response: A Qualitative Study of the Perceptions of Service Industry Workers Who Encounter an Opioid Overdose in an Urban Commercial District in Atlanta, Georgia.

BACKGROUND: The increased contamination of illicit drugs with fentanyl in the United States drug market has contributed to escalating mortality from drug overdose. Leisure and hospitality service industry workers are encountering opioid-triggered overdoses in their workplaces, such as restaurants and bars. Consequently, this increases the need for overdose education and naloxone distribution (OEND) training, which has been limited. We aimed to describe the experiences among service industry workers encountering an overdose in their workplace. METHODS: We conducted in-depth qualitative interviews with service industry workers in Little Five Points (L5P), Atlanta, between October 2019 and April 2020 and triangulated methods with participant observations and fieldwork. Purposive criterion sampling methods were applied to recruit from different establishments in the L5P commercial district, which comprised restaurants, bars, retail shops, and theaters. After an initial seed sample was identified by engaging key stakeholders during fieldwork (business owners, managers, and the business association), a snowball sample followed for a final sample of N = 15. To contextualize the local population of harm reduction workers, people who use drugs and/or obtain safer drug consumption supplies in L5P (sterile syringes, safer using kits, naloxone), and service industry workers and their customers in L5P, the first author volunteered with an Atlanta syringe services program from October 2019 to April 2020. The first author conducted participant observations during the syringe exchange program and field notes were taken during observation (44 hours). This engagement ensured a rich, thick description. We used a pragmatic approach to thematic data analysis for this study. Data were analyzed iteratively and inductively from interviews and observations. Two independent researchers reviewed transcripts to identify passages in the data related to the question of interest. The passages were contextualized within the full data set independently to understand the relationships in developing a theory of what was commonly occurring across participants' experiences, and these relationships led to emerging salient themes regarding encountering an opioid overdose at work. RESULTS: One salient theme related to overdose response emerged with the service industry workers included fear of negative consequences of overdose response, specifically, fear of disease transmission from artifacts of drug use and overdose response, including the spread of blood-borne disease, violence, and exposure to unintentional overdose. When discussing drug use, participants' beliefs about the potential for personal danger from drug use artifacts (syringes and discarded drugs) and violence were identified as barriers to opioid overdose responses. CONCLUSIONS/IMPLICATIONS FOR OCCUPATIONAL HEALTH PRACTICE: Our findings provide valuable insights for tailoring OEND training for service industry workers to confront fears associated with opioid overdose response in their places of work to decrease mortality from the opioid epidemic. Harm reduction approaches need to be sensitive to the places in which overdose occurs and who the overdose responder is likely to be, which requires appropriately tailoring OEND training for service industry workers.

The Study of Nursing Care project: back to the future for contemporary nursing research?

AIMS: To discuss the Study of Nursing Care project, an initiative from the late 1970s in the UK. The article explores the impact of the Study of Nursing Care on nursing research, and considers to what extent it presents a useful model for contemporary nursing research. BACKGROUND: It is acknowledged internationally that the nursing academic workforce is ageing and dwindling. Many possible solutions are being debated with all agreeing that the next generation of evidence based nurse leaders is urgently required. DATA SOURCES: In this article, the authors survey existing workforce schemes, describe the Study of Nursing Care series, published in the 1970s, and draw on interviews and correspondence conducted in 2009 with four of the original Study of Nursing Care research assistants. DISCUSSION: The Study of Nursing Care project poses a potential response to academic workforce issues. This article discusses the evolution of the project, its methods and operation and considers its possible implications for contemporary practice. Implications for nursing. The Study of Nursing Care model demonstrates the clear benefits of fully committed funding, a programmatic approach towards research development, and the importance of selecting the right kind of people for the work, in a national scheme. CONCLUSION: The authors argue that although the clinical outcomes it set out to achieve remain elusive, the project produced a cohort of nurse researchers who went on to give important leadership in nursing, including in nursing academia/research. A contemporary version of the Study of Nursing Care has important potential to generate the next generation of nurse researchers, and leaders, into the twenty-first century.

Scholarship reconsidered: implications for reward and recognition of academic staff in schools of nursing and beyond.

AIMS: This paper discusses the issues facing the nursing academic workforce and the development of a project at the University of Wollongong in Australia which attempts to address this problem. BACKGROUND: The project draws on Boyer's work around 'scholarship reconsidered' to enable new ways of thinking about the nature of 'research' and how the work of a diversifying workforce can be recognized and rewarded within institutions. METHODS: We conducted a series of interviews with senior university staff to identify key issues around academic promotion processes. Feedback from these interviews, along with extensive internal and external consultation and benchmarking, will be used to redraft promotion documentation that includes discipline-specific performance expectations. RESULTS: Interviews revealed a number of perceived and actual barriers to promotion of academic staff who did not conform to a 'traditional' view of research expectations. It was widely felt that unspoken expectations about research performance were being used to judge applications for promotion, and that this disadvantaged people from practice or professional backgrounds, or people who had heavy administrative or clinical roles. CONCLUSIONS: Internal university processes need to reflect the reality of a diversified workforce. Practice and professional disciplines have responsibilities beyond meeting traditional research output measurements. More flexible and transparent expectation guidelines and career development pathways are needed to build holistic schools and faculty and enable maximum staff productivity. IMPLICATIONS FOR NURSING MANAGEMENT: By redefining scholarship, schools and faculties are able to meet the multiple demands of the government, the institution, individual staff, students and the profession. Not everyone can do traditional research all the time, and staff involved in other scholarly work should be able to rewarded and promoted. By taking the lead in this issue, nursing as a discipline can set its own agenda, and pave the way for other disciplines. It can also go a long way to solving issues around the dwindling academic workforce.

The development of a model of education for casual academic staff who support nursing students in practice.

Nursing is predominantly a practice based profession where clinical placement for pre-registration nursing students is a significant component of their programme, as this is pivotal in achieving work readiness of the graduate registered nurse. It is therefore important to ensure nursing students have high quality clinical placements that are supervised by well-prepared experienced registered nurses. This paper discusses one component of the reconnaissance phase of a wider action research project being undertaken in a metropolitan university in NSW, Australia seeking to enhance the development and support of casual academic staff known as clinical supervisors who support students in clinical placement. The outcomes attributed to this project are the development of a participation model which has resulted in a collaborative partnership between the university and clinical supervisors and secondly, the embedding of solution focused ways of working and practice development into the program. The information from the reconnaissance phase of this project confirms the need for further research into the implementation of the participatory model to ensure that future education and support process are developed through collaboration.