Implementation of a Mindfulness Intervention for Women in Treatment for Opioid Use Disorder and Its Effects on Depression Symptoms.

Background: Many women in treatment for opioid use disorder (OUD) also experience mental health co-morbidities. Mindfulness intervention has demonstrated effectiveness for improving mental health in the general population, but has not been tested with female populations in OUD treatment. The purpose of this study was to describe characteristics associated with participation in a mindfulness intervention provided to women in treatment for OUD, and also to evaluate the effectiveness of a mindfulness intervention on depression symptoms. Aims: To evaluate participation characteristics associated with a mindfulness intervention and to assess the impact of a mindfulness intervention on depression symptoms for women with OUD. Methods: A secondary data analysis of a mindfulness intervention with women in treatment for OUD was accomplished. Bivariate analysis was conducted to determine any sociodemographic variables associated with intervention participation. Depression scores were assessed pre and post intervention using paired samples t tests for the intervention group (n = 65) and the control group (n = 8). Results: A 45% of women in the study reported moderate to severe depression symptoms at baseline, and 63% reported high levels of childhood trauma. There was a significant decrease in depression scores (M = 3.6 [1.2,6.1]) following the mindfulness intervention for the intervention group (t(64) = 3.1, p = .003). Participants entering the intervention group with moderate to severe depression scores experienced the most significant decrease in depression symptoms (M = 6.6, SD = 13.5), (t(64) = -2.1, p < .05). Conclusions: Women in treatment for OUD experience high levels of depression symptoms and past trauma, and mindfulness is a feasible intervention for OUD populations which may improve depression symptoms.

Measuring Distress Levels of Refugee Women to Enhance Community-Based Psycho-social Interventions.

The purpose of this investigation was to gain an understanding of the levels of distress in resettled refugee women as a basis for the development of improved community based interventions to enhance the resettlement experience. A convenience sample of female refugees (n = 23) in a southern US city were interviewed using a socio-demographic questionnaire; the Refugee Health Screener-15 (RHS-15); and semi-structured, exploratory questions. Results showed consistently high levels of distress, indicated by responses to the RHS-15. Women ages 19-25 and over 50 displayed the highest risk. Categories of stressors included a lack of access to health and psycho-social support services, difficulty with communicating in the English language, and social isolation. In addition, women reported that a lack of trained interpreters contributes to reduced access to health and social service, causing further distress.

Rural Postpartum Women With Substance Use Disorders.

The incidence of perinatal opioid use and neonatal withdrawal continues to rise rapidly in the face of the growing opioid addiction epidemic in the United States, with rural areas more severely affected. Despite decades of research and development of practice guidelines, maternal and neonatal outcomes have not improved substantially. This focused ethnography sought to understand the experience of accessing care necessary for substance use disorder recovery, pregnancy, and parenting. Personal accounts of 13 rural women, supplemented by participant observation and media artifacts, uncovered three domains with underlying themes: challenges of getting treatment and care (service availability, distance/geographic location, transportation, provider collaboration/coordination, physical and emotional safety), opportunities to bond (proximity, information), and importance of relationships (respect, empathy, familiarity, inclusion, interactions with care providers). Findings highlight the need for providers and policy makers to reduce barriers to treatment and care related to logistics, stigma, judgment, and lack of understanding of perinatal addiction.

Sleep profiles in children with Down syndrome.

Down syndrome (DS) is the most common genetic cause of intellectual disability and results from an extra chromosome 21 (Trisomy 21). Sleep issues and/or obstructive sleep apnea (OSA) are assumed to be part of the DS phenotype with a high prevalence but are often under recognized. This cross-sectional study of children with DS examines the caregiver-reported sleep behaviors of 108 children with DS, ranging in age from 1.50 to 13.40 years (mean = 5.18 years) utilizing a standardized assessment tool, the Children's Sleep Habit Questionnaire (CSHQ). The CSHQ revealed 76% of children with DS had sleep problems, which began at a young age, and continue to persist and may recur with increasing age. Furthermore, children with DS who undergone adenoidectomy and tonsillectomy for OSA continued to have sleep problems suggesting that ongoing monitoring of sleep issues is needed in this population. Implications of sleep problems and recommended anticipatory guidance and intervention are discussed.

Nurse practitioner education: Uniting the 2021 essentials with The Core Competencies on Disability Health Care Education.

ABSTRACT: People with disabilities (PWD) are the largest minority group in the world, making up 16% of the world's population, an estimated 1.3 billion people. People with disabilities die earlier, have poorer health outcomes, and are more affected by emergencies and natural disasters. Factors contributing to health inequities can be characterized as socioeconomic, political, involve social determinants of health, include higher risk factors, and display a wide spectrum of health system barriers. Too often, health care training programs exclude specific standards for disability training. By mapping the new American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Education with The Core Competencies for Disability Health Care Education , we can provide a synergistic relationship that will prepare future advanced practice nurses to provide effective care to people with disabilities across the lifespan and in every delivery care system.

Impact of a Professional Development Course for Doctoral Nurses and Students on Genomic Conceptual Knowledge and Competencies.

BACKGROUND: Universally, nurses' limited educational opportunities to expand their genomic literacy may have implications on patient care management, research, and training. PURPOSE: To evaluate the impact of a self-paced online course on genomic knowledge and competency acquisition in a sample of nurses possessing a doctoral degree and doctoral students. METHODS: Pre- and postcourse data were collected using the "Genomic Nursing Concept Inventory" (GNCI) (N = 129) and a self-report survey based on the Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees (N = 131). RESULTS: GNCI scores in all 4 topical categories and in 9 of the 16 domains significantly improved. All Genetic Competency scores significantly improved. Significant correlations were observed between Genetic Competency self-ratings and GNCI scores precourse and change of scores. CONCLUSIONS: The positive outcomes should encourage the development of more accessible educational opportunities for nurses and other healthcare professionals to improve genomic literacy and competency.

Autism Severity, Adverse Childhood Experiences, and Oral Health: A Comparative Study of Adolescents in the United States.

Dental health significantly influences overall child physical well-being, academic success, and psychosocial development. This paper explores the intersection of a range of Autism Spectrum Disorder (ASD) functionality, multiple types of Adverse Childhood Experiences (ACEs), and dental health in adolescents. The purpose is to investigate the independent and interactive effects of ASD severity and ACEs on dental outcomes. Data from the 2018 and 2019 National Surveys of Children's Health were analyzed, focusing on 28,263 adolescents (ages 11-17). Logistic regressions assessed associations between ASD severity (mild, moderate, severe), cumulative number of ACEs, and dental outcomes (teeth condition, cavities or bleeding gums, check-ups, cleanings). Covariates included demographic and socioeconomic factors. Controlling for covariates, severe autism independently increased the odds of poor teeth (odds ratio = 6.17), cavities or bleeding gums (OR = 3.76), no previous year check-up(OR = 2.94), and no previous year cleaning (OR = 4.20). Higher ACE scores also independently increased the odds of all dental outcomes. Interactions revealed a cumulative effect of multiple ACEs on poor dental outcomes only for adolescents with severe levels of autism. This study illuminates the heightened vulnerability of adolescents with severe autism and a history of ACEs, emphasizing the need for targeted interventions. Multidisciplinary strategies integrating dental care and mental health support within tailored interventions are crucial for improving dental health and access for older youth with low functioning autism. While these findings provide valuable insights, the cross-sectional design and reliance on parental reports necessitate cautious interpretation.

Integrating genomics and precision health knowledge into practice: A guide for nurse practitioners.

ABSTRACT: Nurse practitioners (NPs) are the fastest growing group of health care providers, with an increase of 8.5% over the past year and anticipated growth of more than 40% by 2031. Improving NPs' knowledge of how genes influence health enables them to assess, diagnose, and manage patients in all states of health in a safe, efficient, and competent manner. Nurse practitioners may also care for patients who obtain direct-to-consumer (DTC) genetic tests without provider oversight and share their results; improved knowledge of genetics can provide NPs with the information and resources needed to interpret and understand DTC test results. The literature indicates that NPs have limited understanding of basic genetic concepts and guidelines for prescribing drugs affected by genomic variability. As a result, NPs report low confidence in their ability to accurately interpret and apply genetic test results, which inhibits genomics-informed precision health care. This article provides resources and clinical recommendations for using the 2021 American Association of Colleges of Nursing Essentials and the American Nurses Association Essentials of Genomic Nursing to facilitate the integration of genomics into NP curricula and practice. These resources will help future and practicing NPs integrate genomics into practice and improve precision health care.

Sleep in Children With Neurodevelopmental Disabilities During COVID-19: An Integrative Review.

INTRODUCTION: Sleep issues occur at higher rates in children with neurodevelopmental disorders than in the typical population. Little is known about the impact of COVID-19 on sleep issues in this population METHOD: This integrative review aimed to characterize studies during the COVID-19 pandemic (2020-2022) addressing the prevalence and management of sleep issues in children and youth with neurodevelopmental disorders.Comprehensive database searches were used to identify articles, and 31 studies were considered suitable for this review. RESULTS: Most studies reported worsening sleep disturbances during COVID-19 restrictions. All studies were conducted when clinics were closed; only two studies addressed treatment options such as music therapy and sleep hygiene education and found improvement in sleep issues. DISCUSSION: Future research needs to concentrate on developing interventions to assist families remotely and empower families with a toolkit of preparedness in times of crisis.

Exploring Genetic Literacy in a Small Hispanic Population.

Introduction: Genetic literacy recognizes one's ability to gather, understand, and apply genomic information to make informed health care choices and social decisions. A limited understanding of genomic literacy carries the potential for poor health outcomes. The aim of this pilot study was to determine the usefulness of an assessment tool to ascertain genetic literacy in a small Hispanic clinic population. Methodology: Mixed-method, cross-sectional pilot study requiring forward-back translation of an established questionnaire. Twenty Spanish-speaking adults were recruited through purposive and convenience sampling. Results: Forward-back translation provided a comparable questionnaire. Participants indicated information was relevant. Qualitative feedback uncovered regional differences. Quantitative results reported descriptive statistics, frequencies, and Cronbach alphas. Discussion: Findings from this study reveal the need for genetic literacy assessment tools that are attuned to the linguistic, ethnic, and cultural differences within the Hispanic population.

Retracted: Music Therapy: A Core Service in Integrative Palliative Care.

The Journal of Alternative and Complementary Medicine (JACM) officially withdraws the article entitled, "Music Therapy: A Core Service in Integrative Palliative Care" by Noah Potvin, Molly Hicks, and Rebecca Kronk (epub: 27 April 2021; DOI: https://doi.org/10.1089/acm.2020.0025). The article had been "provisionally accepted" for possible publication in a special issue of JACM, but by the time articles were selected for that issue, the Guest Editors determined it should not be included and the Editor rescinded the provisional acceptance. Regrettably, the acceptance was reversed after the article was processed through normal production processes and was mistakenly released to the Journal's online platform. After the article was posted, the publisher learned that the authors had submitted and published the article elsewhere since the provisional acceptance had been reversed. Because of this, and in keeping with standard peer review practices, JACM must withdraw the article. It is important to note that this was an editorial error and that the authors bear no fault. The publisher of JACM and its editorial team deeply regret this error and sincerely apologize to Dr. Potvin, Dr. Hicks, and Dr. Kronk.

Music Therapy and Nursing Cotreatment in Integrative Hospice and Palliative Care.

Integrative hospice and palliative care is a philosophy of treatment framing patients as whole persons composed of interrelated systems. The interdisciplinary treatment team is subsequently challenged to consider ethical and effective provision of holistic services that concomitantly address these systems at the end of life through cotreatment. Nurses and music therapists, as direct care professionals with consistent face-to-face contact with patients and caregivers, are well positioned to collaborate in providing holistic care. This article introduces processes of referral, assessment, and treatment that nurses and music therapists may engage in to address family support, spirituality, bereavement, and telehealth. Clinical vignettes are provided to illustrate how cotreatment may evolve and its potential benefits given diverse circumstances. As part of this framing, music therapy is positioned as a core-rather than alternative or complementary-service in hospice that satisfies the required counseling services detailed in Medicare's Conditions of Participation for hospice providers. The systematic and intentional partnering of nurses and music therapists can provide patients and caregivers access to quality comprehensive care that can cultivate healthy transitions through the dying process.

Impact of a Digital Intervention on Perceived Stress, Resiliency, Social Support, and Intention to Leave Among Newly Licensed Graduate Nurses: A Randomized Controlled Trial.

BACKGROUND: The nursing shortage has been deemed a public health crisis as the turnover rate of newly licensed graduate nurses (NLGNs) continues to grow. One of five NLGNs are leaving the profession due to work dissatisfaction and feelings of inadequacy, risking patient safety. METHOD: A prospective, randomized controlled trial evaluated the impact of a 6-week digital intervention (text messaging) on NLGNs' self-reported stress, resiliency, sense of support, and intention to leave their jobs, organization, and profession. Messages to the experimental group (n = 10) conveyed emotional, esteem, and networking support, and messages to the control group (n = 11) were medical facts. RESULTS: The digital intervention in the form of medical facts increased the control group's sense of social support. Stress, resilience, and intention to leave their jobs, organizations, or profession did not change for either the control or experimental group. CONCLUSION: A digital intervention, such as text messaging, potentially can increase NLGNs' sense of support during their first year of hire. [J Contin Educ Nurs. 2021;52(8):367-374.].

Prevalence, nature, and correlates of sleep problems among children with fragile X syndrome based on a large scale parent survey.

STUDY OBJECTIVES: This study reports on current child sleep difficulties reported by parents of children with Fragile X syndrome (FXS). We address prevalence and type of sleep problems (e.g., difficulty falling asleep, frequent awakenings); type and effectiveness of medical and behavioral treatments (e.g., medication, surgery, environmental changes); and explore specific child and family characteristics (e.g., child age, child gender, co-occurring conditions) as possible predictors of child sleep difficulties. DESIGN/PARTICIPANTS: This study is part of a larger survey addressing needs of families with children with FXS. This article focuses on the families who responded to the survey sleep questions, had one or more children with the full mutation FXS, and who reside in the United States. The mean age for male and female children in this group was 15 years and 16 years respectively (N=1295). RESULTS: Parents reported that 32% of the children with FXS currently experience sleep difficulties; 84% of those children are reported to have > or =2 current sleep problems. Problems falling asleep and frequent night awakenings were the most frequently reported difficulties; 47% of males and 40% of females received > or =1 medication to help with sleep. Children with more problematic health or behavioral characteristics had a higher likelihood of having current sleep problems. CONCLUSIONS: Our survey provides the most representative sample to date of sleep problems in children with FXS or any other neurodevelopmental disability. This large scale survey establishes a foundation for the prevalence of sleep disorders in children with FXS.

Equity Access: Online Nursing Education on Care for People With Disabilities.

BACKGROUND: Few schools of nursing have explicit content that focuses on disability as a multidimensional construct. Time and expertise are two barriers to increasing that material. METHOD: To address this gap, a set of online modules were developed to provide an introduction to the specialized knowledge related to the care of individuals with disabilities, with a focus on advocacy. The modules include multiple teaching strategies and can be assigned as supplemental to existing coursework. The modules were tested with 256 undergraduate senior-level nursing students. RESULTS: Overall, students assessed the learning experience as very effective and reported achieving the stated learning objectives. Negative feedback was primarily issues related to technology and ease of use of one particular module. CONCLUSION: The Equity Access modules are a feasible way to supplement existing nursing curricula content specific to the care of individuals with disabilities. Additional systematic evaluation is needed to assess how the modules influence practice. [J Nurs Educ. 2020;59(6):349-351.].

A theory analysis of Mastery Learning and Self-Regulation.

This analysis examines the applicability of Mastery Learning and Self-Regulation theories as a combined approach to nursing education. The conclusion may serve as a foundation for an innovative, evidence-based approach to teaching nurses resulting in improved patient care and outcomes. Mastery Learning promotes a teaching approach that supports achievement of content taught. Self-Regulation describes individual student's actions or behaviors that promote learning. The effectiveness of Mastery Learning has been documented in current healthcare literature. Research on Self-Regulation, primarily conducted among students from middle-school through graduate education, confirms that Self-Regulation strategies can enhance skill development and promote job performance. The evidence is void of analysis of the two theories. Literature reviewed was retrieved from ERIC, CINAHL, PubMed, PsycINFO and Sage Premier, for the years 1968-2014. Search terms included: mastery learning, self-regulation and nursing education. Walker and Avant's (2011) Strategies for Theory Construction in Nursing was used as the framework for the analysis. This analysis supports the applicability of both Mastery Learning and Self-Regulation Theories to nursing education. Conducting educational research on the application of Mastery Learning theory and its influence on Self-Regulating practices might reveal a new approach for how nurses are educated resulting in improved patient care outcomes.

Development of Prelicensure Nursing Competencies in Caring for People With Disabilities Through Delphi Methodology.

BACKGROUND: People with disabilities (PWDs) experience significant health disparities. The complex experience of disability requires that nurses are adequately and deliberately prepared to care for PWDs. However, there are no recognized nursing competencies to direct education and care. PURPOSE: The purpose of this study was to develop a set of nursing competencies to better prepare prelincensure nursing students to provide competent care to PWDs. METHODS: A 2-round Delphi survey was administered to experts in the field of disabilities (n = 47, n = 35). Quantitative and qualitative methods were used to analyze data. RESULTS: Three major themes emerged: unique knowledge, volume and repetition, and distinct disability culture. Competencies were reduced with a focus on 4 dimensions: environment and care, communication, culture, and referral. CONCLUSIONS: The 12 new competencies can serve as the foundation for the inclusion of disability content in nursing curricula.

Determining nurse practitioner core competencies using a Delphi approach.

BACKGROUND: Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined. PURPOSE: This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the current NP Core Competencies (NONPF, 2017), the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Common Advanced Practice Registered Nurse Doctoral-Level Competencies (AACN, 2017a) because these documents are the competencies-accredited NP programs commonly used in curriculum development. The primary aim of this study was to refine and reduce redundancy of these competencies; a secondary aim was to ensure that the final competencies were clear and measurable. METHODS: A Delphi approach was used to reach consensus among an expert panel who reviewed the core competencies via an online questionnaire. Descriptive statistics were used to calculate median and interquartile ranges; content analysis was conducted with qualitative data. RESULTS: Consensus was reached after 3 rounds and resulted in 49 final core competencies. IMPLICATIONS FOR PRACTICE: This study provides the NP community with a manageable list of relevant, clear, and measurable competencies that faculty members can use to implement CBE in their programs.

Nurses' Perspectives on the Dismissal of Vaccine-Refusing Families From Pediatric and Family Care Practices.

PURPOSE: Dismissal of families who refuse mandated childhood vaccines from pediatric practices has become more common among US pediatricians over the past 2 decades. While nurses (registered nurses [RNs] and advanced practice registered nurses [APRNs]) often are the first health-care professional to encounter parents' vaccine hesitancy and serve as a primary source of information, there are no published data on nurses' perspectives on dismissal as a response to vaccine refusal. This study examined nurses' perspectives on dismissal of vaccine-refusing families from primary care practices. DESIGN: Cross-sectional survey administered electronically from February to September 2018. Data analysis was conducted from November 2018 to March 2019. SETTING: Data were collected electronically from a national sample of nurses. SUBJECTS: A convenience sample of 488 primary care nurses (74% APRNs) was recruited and enrolled in the study through collaboration with 4 professional nursing associations. MEASURE AND ANALYSIS: A cross-sectional survey was conducted from February to September 2018. We explored correlates of nurses' (n = 488) attitudes toward dismissal by modeling attitude scores as a function of practice and respondent characteristics. We also modeled odds of encountering vaccine refusal and odds of reporting dismissal of a vaccine-refusing family in the last 12 months, each as a function of respondents' practice characteristics. RESULTS: Eighty-four percent of respondents encountered vaccine refusal in the previous 12 months, and 22% reported that their practice had dismissed a vaccine-refusing family within the previous 12 months. Twenty-eight percent agreed/strongly agreed that they would dismiss or support a decision to dismiss families who refuse all vaccines, and 12% supported dismissal of families for refusal of some but not all vaccines. Thirty-nine percent of respondents disagreed/strongly disagreed with dismissing families who refuse all vaccines, and 50% disagreed/strongly disagreed with dismissal for refusal of some but not all. CONCLUSION: Almost all nurses working in primary care encounter vaccine refusal, and most consider all Centers for Disease Control and Prevention-recommended childhood vaccines to be important to public health. There is significant polarization of nurses' attitudes toward the appropriateness of dismissal as a response to vaccine refusal. We recommend the development of professional nursing guidelines for responding to vaccine refusal. However, because there are no data on the community health impact of dismissal policies, we recommend further research on outcomes of dismissal policies to inform such guidelines.