Function of a Psychological Nursing Intervention on Depression, Anxiety, and Quality of Life in Older Adult Patients With Osteoporotic Fracture.

BACKGROUND: Osteoporotic fracture is a serious complication of osteoporosis. The long-term therapy process and the heavy restriction to physical activities give rise to a psychological burden on osteoporotic fracture patients, especially older adult patients. Psychological nursing interventions significantly alleviate negative emotional reactions in cancer patients. This research aimed to investigate the function of psychological nursing interventions in the reduction of depression and anxiety and the improvement of quality of life in older adult patients with osteoporotic fracture. METHODS: Osteoporotic fracture patients (n = 106) were divided into control group (n = 53) or intervention group (n = 53). In the control group, the participants were given conventional nursing care. In the intervention group, the participants were given psychological nursing interventions. Anxiety, depression, and quality of life were evaluated and compared between the two groups. RESULTS: After 5 weeks of psychological nursing intervention, the anxiety and depression scores significantly decreased in the intervention group. The Mental Function in Quality of Life Questionnaire of the European Foundation for Osteoporosis score also decreased in the intervention group. LINKING EVIDENCE TO ACTION: Psychological nursing interventions alleviate anxiety and depression in older adult osteoporotic fracture patients and enhance their mental function.

Multiple brief training sessions to improve nurses' knowledge, attitudes, and confidence regarding nursing care of older adults with depression in long-term care facilities.

In long-term care facilities (LTCFs), nurses are key healthcare providers for older residents who have depressive symptoms or depression; therefore, they need accurate knowledge of late-life depression, positive attitudes towards depression, and confidence in providing depression care. This cluster-randomized trial was designed to examine the effectiveness of multiple, face-to-face, brief training sessions in improving nurses' knowledge, attitudes, and confidence in providing late-life depression care in LTCFs. Nine LTCFs were included in the study. In total, 30 nurses from the four LTCFs assigned to the intervention group received three 30-min training sessions and 36 nurses in the five comparison group LTCFs did not. A self-report questionnaire was administered before and after the intervention. There were significant differences between groups concerning improvement in nurses' knowledge of late-life depression, attitudes towards depression, and confidence in providing depression care. The effect size (Cohen's d) was 1.55 for knowledge, 1.38 for attitudes, and 0.89 for confidence. This training program was effective in improving LTCF nurses' knowledge, attitudes, and confidence in providing depression care. On the basis of these findings, we recommend that nurse managers and directors implement similar training programs for nurses in LTCFs to enhance the care quality for older residents.

Systemic assessment of depressive symptoms among registered nurses: A new situation-specific theory.

BACKGROUND: A mentally-healthy nursing workforce is vital to providing quality healthcare. While there has been research conducted internationally on depressive symptoms in nurses, most studies have lacked a theoretical framework. PURPOSE: The purpose of this article is to describe the development of a situation-specific theory, the Systemic Assessment of Depressive Symptoms among Registered Nurses (SAD-RN). METHODS: The SAD-RN was developed through theory synthesis using the Roy's Adaptation Model (RAM) as a framework. Sixty-four research articles were selected to abstract relevant concepts based on a priori RAM concepts. FINDINGS: Using depressive symptoms as the anchor concept, related emergent concepts of SAD-RN include context, stressors, protective factors, negative health outcomes, and low patient care quality. DISCUSSION: SAD-RN is an evidence-based comprehensive model that offers researchers a guiding theory to be used in their future research on depressive symptoms among RNs.

The Effect of FAmily-CEntered (FACE®) Pediatric Advanced Care Planning Intervention on Family Anxiety: A Randomized Controlled Clinical Trial for Adolescents With HIV and Their Families.

Clinicians fear pediatric advance care planning (pACP) for adolescents is too distressing for families. Multisite longitudinal randomized controlled trial of adolescents with HIV tested the effect of FAmily-CEntered (FACE®) pACP intervention on families' anxiety and depression. One hundred five adolescent/family dyads were randomized to FACE® (n = 54 dyads) or control (n = 51 dyads). Families were 90% African American, 37% HIV-positive, and 22% less than high school educated. Families reported lower anxiety 3 months post-FACE® intervention than control (ß = -4.71, 95% confidence interval [CI] = [-8.20, -1.23], p = .008). Male family members were less anxious than female family members (ß = -4.55, 95% CI = [-6.96, -2.138], p ≤ .001). Family members living with HIV reported greater depressive symptoms than HIV-uninfected families (ß = 3.32, 95% CI = [0.254, 6.38], p = .034). Clinicians can be assured this structured, facilitated FACE® pACP model minimized family anxiety without increasing depressive symptoms. Adolescent/family dyads should be invited to have access to, and provision of, evidence-based pACP as part of patient-centered/family-supported care in the HIV continuum of care.

Excessive daytime sleepiness in general hospital nurses: prevalence, correlates, and its association with adverse events.

OBJECTIVE: To investigate the prevalence and correlates of excessive daytime sleepiness (EDS) in a population of hospital nurses in South China as well as the influence of EDS on the occurrence of adverse events. METHODS: A total of 1102 nurses working in a large medical center were invited to participate in this cross-sectional study (96.9% females, mean age 29.6 years). They all completed a self-reported questionnaire consisting of items on demographic variables, lifestyle factors, insomnia, anxiety, depression, and both work-related and sleep-related characteristics. RESULTS: A total of 1048 nurses gave a valid response (response rate 95.1%). Among them, 169 (16.1%) reported EDS as defined as an Epworth Sleepiness Scale ≥ 14. Depression (adjusted odds ratio = 2.24, 95% confidence interval 1.51-3.31), anxiety (1.65; 1.02-2.67), insomnia (2.29; 1.56-3.36), rotating shift work (1.98; 1.03-3.83), and low interest in work (1.74; 1.01-2.99) were all independent risk factors of the occurrence of EDS. EDS is associated with the occurrence of adverse events after controlling for confounding factors (adjusted OR 1.83, CI 1.26 to 2.67). CONCLUSIONS: EDS was common among this relatively young and healthy nurse population in south China. There were clear associations between EDS and depression, anxiety, insomnia, rotating shift work, and low work-related interest. Furthermore, EDS was an independent risk factor in the occurrence of adverse events (AEs) in our subjects.

The effects of depressive symptom management interventions on low-income mothers: A systematic review and meta-analysis.

AIM: To evaluate the effects of depressive symptom management interventions (DSMI) for low-income mothers. BACKGROUND: Depressive symptoms and depression are common complications following childbirth. Depressive symptoms experienced by low-income mothers negatively affect infant-toddler development. DESIGN: A systematic review and meta-analysis was conducted to provide a synthesized and critical appraisal of the included studies. DATA SOURCES: We conducted a systematic search of randomized controlled trials in the following electronic databases through November 2017: PubMed, EMBASE, CINAHL, PsycInfo, and Cochrane Library CENTRAL. REVIEW METHODS: Ten studies were found in the systematic review of DSMI in terms of content, mode of delivery, session, and provider. We then conducted a meta-analysis of nine randomized controlled trials with 798 participants, comparing low-income mothers with and without DSMI. RESULTS: A significant effect was noted for DSMI in improving depressive symptoms in low-income mothers with young children and for interventions lasting 8 weeks or less. CONCLUSION: The meta-analysis suggested that DSMI for low-income mothers can be effective; however, the effectiveness varies by intervention type, intervention duration, and whether the mothers had other children. IMPACT: The findings of this study will contribute to the development of effective DSMI by providing scientific evidence for the development of such programmes for low-income mothers, especially with respect to target population and intervention duration.

Prevalence and correlates of depression, anxiety and symptoms of stress in vocational college nursing students from Sichuan, China: a cross-sectional study.

Nursing students from vocational college programs contribute to over 60% of the nursing student population in China. However, there remains a lack of systematic, quantitative studies examining the prevalence of mental health problems in this population. The purpose of this study was to explore the prevalence of depression, anxiety and stress symptoms and associated factors in vocational college nursing students in Sichuan, China. A total of 554 nursing students from vocational colleges participated in this cross-sectional study. Outcomes were measured with the Depression, Anxiety and Stress Scale 21 (DASS 21). Logistic regressions analysis was performed to examine correlates of mental health problems. The prevalence rates of depression, anxiety and stress symptoms among vocational college nursing students in China were 28.7% (95% CI 24.9%-32.5%), 41.7% (95% CI 37.6%-45.9%) and 20.2% (95% CI 16.8%-23.6%). Mental health problems were elevated as compared to a reference population of Chinese college students of all majors. However, only two percent indicated to seek treatment. The most consistent correlates of mental health problems were reduced engagement in physical and other leisure activities, poor sleep quality, experience of negative life events and poor self-perceived mental health.

Prevalence of Chronic Health Conditions in Australian Adults with Depression and/or Anxiety.

The association between psychotic illness and poor physical health is now clearly articulated in the literature. By contrast the impact of depression and/or anxiety on physical health is considerably less understood, despite depression being the leading cause of disability worldwide and is associated with significantly higher prevalence of physical comorbidities than found in the general population. An Australia national cross-sectional population-based survey was conducted to ascertain the prevalence of chronic physical health conditions in persons with, and without depression and/or anxiety, allowing for demographic characteristics and lifestyle factors. The telephone-based survey was conducted using trained interviewers. Survey questions included those eliciting information about demographics, health status, and health behaviours. Independent t-tests and chi square tests showed demographic, health behaviours, and physical illness differed between those with and without depression and/or anxiety. Heart disease, high blood pressure, stroke, cancer, arthritis, chronic neck and/or back pain, and asthma were significantly higher in participants diagnosed with depression and/or anxiety. Binary logistic regression showed the strongest predictor of chronic illness was having a diagnosis of depression and/or anxiety. Depression and anxiety present major health problems impacting a considerable proportion of the population. A greater understanding of the associated physical health issues should provide impetus to broaden the physical health and mental illness research agenda to include these diagnoses.

Impacting Depression in Homebound Elderly: A CREATION Health Intervention for Faith Community Nurses.

Depression among homebound older adults is a significant problem. This pilot project examined the effect of a faith community nurse (FCN) educational intervention based on the CREATION Health Model, on depression in older homebound adults. Results showed a downward trend in depression scores on the Geriatric Depression Scale: Short Form, suggesting that FCN interventions and the CREATION Health Model may be helpful for decreasing depression in this group.

Creating a safety net for patients with depression in primary care; a qualitative study of care managers' experiences.

OBJECTIVE: The aim of this study was to explore nurses' experiences and perceptions of working as care managers at primary care centers. DESIGN: Qualitative, focus group study. Systematic text condensation was used to analyze the data. SETTING: Primary health care in the region of Västra Götaland and region of Dalarna in Sweden. SUBJECTS: Eight nurses were trained during three days including treatment of depression and how to work as care managers. The training was followed by continuous support. MAIN OUTCOME MEASURES: The nurses' experiences and perceptions of working as care managers at primary care centers. RESULTS: The care managers described their role as providing additional support to the already existing care at the primary care center, working in teams with a person-centered focus, where they were given the opportunity to follow, support, and constitute a safety net for patients with depression. Further, they perceived that the care manager increased continuity and accessibility to primary care for patients with depression. CONCLUSION: The nurses perceived that working as care managers enabled them to follow and support patients with depression and to maintain close contact during the illness. The care manager function helped to provide continuity in care which is a main task of primary health care. Key Points The care managers described their role as an additional support to the already existing care at the primary care center. • They emphasized that as care managers, they had a person-centered focus and constituted a safety net for patients with depression. • Their role as care managers enabled them to follow and support patients with depression over time, which made their work more meaningful. • Care managers helped to achieve continuity and accessibility to primary health care for patients with depression.

What Interventions Improve Outcomes for the Patient Who Is Depressed and in Pain?

SPECIFIC CLINICAL ISSUE: The purpose of this clinical consultation is to offer nurses evidence-based strategies to provide holistic care to their patients with comorbid depression and pain. The combination of depression and pain is common and, if not managed effectively, has negative outcomes. Treatment-resistance is one negative outcome. The worst-case scenario for unrelieved depression and/or pain is suicide. MAJOR PRACTICE RECOMMENDATIONS BASED ON BEST EVIDENCE: Antidepressants, particularly duloxetine, have had efficacy for pain and depression. Cognitive behavioral therapy, an evidence-based treatment for depression, has been found to decrease pain. Examples of additional interventions include exercise, relaxation techniques, mindfulness, and music. Providing holistic nursing care and working with other disciplines optimizes more effective management of these co-occurring conditions.

Feasibility of a nurse-led intervention for the early management of depression after stroke in hospital.

AIM: To explore the feasibility of the Post-Stroke Depression toolkit in terms of fidelity and acceptability in daily nursing practice. BACKGROUND: Depression after stroke is common and influences patients' recovery significantly. Although stroke guidelines recommend early depression screening and treatment, depressive symptoms remain unrecognized. To enhance adoption of evidence into the context of the daily practice of stroke treatment, we developed the Post-Stroke Depression toolkit, an evidence-based nurse-led intervention for the early management of depressive symptoms after a stroke for use in the hospital setting. DESIGN: An explanatory mixed-methods before-and-after study design. METHODS: Data were collected continuously from March 2012 - June 2013 during three phases: pre-implementation, the implementation phase (where implementation strategies guided the implementation) and the sustainability phase (executed without the implementation strategies) and involved patient chart audits and surveys and individual and focus group interviews with nurses. RESULTS: A total of 775 patient charts were audited to examine fidelity. Implementation of the Post-Stroke Depression toolkit during the implementation phase resulted in an increase in depression screening (+72.9%) and more patients receiving nursing interventions (+11.1%). During the sustainability phase, screening for depression decreased (-16.3%), while the application of the nursing interventions remained unchanged (+0.6%). The acceptability of the toolkit was judged to be good. CONCLUSIONS: The Post-Stroke Depression toolkit was found to be feasible in terms of fidelity and acceptability, improving structural screening for depressive symptoms as well as the application of nursing interventions in case of a positive screening. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03500250.

Risking existence: The experience and handling of depression.

AIMS AND OBJECTIVES: To gain insight into how people suffering from depression experience and manage life. BACKGROUND: Depression is the leading cause of incapacitation and constitutes the second largest healthcare burden worldwide, causing considerable discomfort for depression sufferers and their significant others. Depression must be understood against the backdrop of a person's context as well as biological, psychological and social factors. While various studies have been conducted on the process of depression, only a few studies have examined its existential aspects. DESIGN: A classical grounded theory methodology employing open and selective coding was used to identify the participants' main concern and the strategies they used to handle it. METHOD: Data were collected in 2015-2016 during 18 in-depth interviews with people with current or former moderate depression. The data were analysed through constant comparisons until the grounded theory emerged. RESULTS/FINDINGS: The main concern of the participants was Longing for belonging, and they handled their depression through a process named Risking existence. The process comprised four phases: (i) Ungraspable processing; (ii) Giving clues; (iii) Daring dependence; and (iv) Courage to be. The process of risking existence was accompanied from beginning to end by three essentials: to hope, to endure and shame. CONCLUSION: Working in mental health care involves encountering the pain, suffering and despair that humans endure. This challenges nurses to go beyond the symptoms and to listen for their meaning to each individual person. RELEVANCE TO CLINICAL PRACTICE: The grounded theory of risking existence provides a model by which nurses can orient themselves when working with people who are depressed. Each phase describes different strategies that patients use that can help the nurse recognise what is going on, thus enabling him or her to understand and guide his or her patients.

Predicting family health and well-being after separation from an abusive partner: role of coercive control, mother's depression and social support.

AIMS AND OBJECTIVES: Drawing on the Strengthening Capacity to Limit Intrusion theory, we tested whether intrusion (i.e. unwanted interference from coercive control, custody and access difficulties and mother's depressive symptoms) predicted family health and well-being after separation from an abusive partner/father, and whether social support moderated intrusion effects on family health and well-being. BACKGROUND: Experiences of coercive control and the negative consequences related to those experiences have been documented among women who have separated from an abusive partner. DESIGN: We conducted a secondary analysis of data from 154 adult, Canadian mothers of dependent children who had separated from an abusive partner and who participated in Wave 2 of the Women's Health Effects Study. METHODS: We used hierarchical multiple regression to test whether intrusion predicts family health and well-being as well as whether social support moderated this relationship. RESULTS: Families were found to experience considerable intrusion, yet their health and well-being was similar to population norms. Intrusion predicted 11·4% of the variance in family health and well-being, with mother's depressive symptoms as the only unique predictor. Social support accounted for an additional 9% of explained variance, but did not buffer intrusion effects on family health and well-being. CONCLUSIONS: Although women had been separated from their abusive partners for an average of 2·5 years, the majority continued to experience coercive control. On average, levels of social support and family functioning were relatively high, contrary to public and academic discourse. RELEVANCE TO CLINICAL PRACTICE: In working with these families postseparation, nurses should approach care from a strength-based perspective, and integrate tailored assessment and intervention options for women and families that address both depression and social support.

The family health, functioning, social support and child maltreatment risk of families expecting a baby.

AIMS AND OBJECTIVES: To describe the family health, functioning, social support and child maltreatment risk and associations between them in families expecting a baby. BACKGROUND: Finland was one of the first countries in banning corporal punishment against children over 30 years ago. Despite of this, studies have shown that parents physically abuse their children. In addition, professionals struggle in intervention of this phenomenon. Abusive parents should be recognised and helped before actual violent behaviour. DESIGN: A follow-up case-control study, with a supportive intervention in the case group (families with a heightened risk) in maternity and child welfare clinics. The baseline results of families are described here. METHODS: Child maltreatment risk in families expecting a baby was measured by Child Abuse Potential Inventory. The health and functioning was measured by Family Health, Functioning and Social Support Scale. Data included 380 families. RESULTS: A total of 78 families had increased risk for child maltreatment. Heightened risk was associated with partners' age, mothers' education, partners' father's mental health problems, mothers' worry about partners' drinking and mothers' difficulties in talking about the family's problems. Risk was associated with family functioning and health. Families with risk received a less support from maternity clinics. Families with child maltreatment risk and related factors were found. CONCLUSIONS: This knowledge can be applied for supporting families both during pregnancy and after the baby is born. Professionals working with families in maternity clinics need tools to recognise families with risk and aid a discussion with them about the family life situation. The Child Abuse Potential, as a part of evaluating the family life situation, seems to prove a useful tool in identifying families at risk. RELEVANCE TO CLINICAL PRACTICE: The results offer a valid and useful tool for recognising families with risk and provide knowledge about high-risk family situations.

Violence and depression in a community sample.

AIMS AND OBJECTIVES: To understand the relation between the experience of violence and sociodemographic and clinical factors, and to determine whether diagnosed depression and the presence of anxiety and stress are related to having experienced workplace and domestic violence in different genders and age groups. BACKGROUND: Previous studies indicate that domestic and workplace violence increase the risk of suffering from depression. However, no studies have evaluated these two types of violence in a same cohort. DESIGN AND METHODS: We designed a descriptive cross-sectional study from 317 individuals randomly selected from the population in southern Catalonia (Spain). Sociodemographic and Goldberg anxiety-depression questionnaires were administered by telephone survey to 160 men and 157 women in December 2008. The data obtained were analysed by a logistic regression model. RESULTS: A quarter of the individuals had suffered from violence: 48·29% of them had experienced domestic violence and 32·9% had experienced workplace violence. Nearly half of the individuals with depression had experienced violence. No statistical difference has been observed between domestic and workplace violence regarding diagnosed depression. Women were twice as likely as men to have suffered from violence. People working outside their home and those who claimed to have no social support had a greater risk of suffering from violence. A greater consumption of medication, above all of psychotropic drugs, is associated with experiencing violence and with greater comorbidity. Predictive factors for suffering from depression are being women, having experienced violence, having suffered stress or anxiety, having little or no social support, having overload of task or having no secondary education and no tertiary education. CONCLUSIONS: This study suggests that when considering depression, anxiety and stress, especially in women, we must take into account whether an individual has suffered violence. RELEVANCE TO CLINICAL PRACTICE: Identifying violence can help health professionals, managers and researchers improve care and reduce suffering in families and communities.

The Journey Through and Beyond Mental Health Services in the United Kingdom: A Typology of Parents' Ways of Managing the Crisis of Their Teenage Child's Depression.

OBJECTIVE: Depression is a common mental illness experienced by young people. Yet we know little about how their parents manage their symptoms at home, and how parents may experience their treatment at child and adolescent mental health services (CAMHS). Thus, the aim of our study was to create a typology of parents' experiences over a 2-year period, beginning with their teenage child's referral to CAMHS in the United Kingdom. METHOD: A total of 85 semistructured interviews were conducted with one or both parents of 28 adolescents at 3 time points, and qualitatively analyzed using ideal type analysis. RESULTS: Three distinct types or patterns of parental experience were identified: the learning curve parents, the finding my own solutions parents, the stuck parents. CONCLUSION: These patterns of parental experience could perhaps provide a basis for clinicians working in CAMHS to reflect on the families that they see and to adapt their ways of working accordingly to best support these families.

Conflicting Cultural Values, Gender Role Attitudes, and Acculturation: Exploring the Context of Reproductive and Mental Health of Asian-Indian Immigrant Women in the US.

Asian-Indians, one of the fastest growing US immigrant groups, experience depression and anxiety, particularly among women. In this mixed-methods study, quantitative (n = 217) and qualitative (n = 36) data explored egalitarian vs. traditional views regarding women's roles and rights. Bicultural integration, family planning decision-making ability, and anxiety were associated with more egalitarian views, while Punjabi language preference, depression, and more births were associated with traditional views. Health care professionals serving this population need to be aware of the potential cultural values conflicts and gender role expectations that influence decisions around reproductive health and mental health care for Asian-Indian immigrant women.

Living with the Choice: A Grounded Theory of Iraqi Refugee Resettlement to the U.S.

Though the United States has become a place of increasing resettlement for refugees, particularly Iraqi refugees who have been forced to flee their homeland due to violence, persecution and civil unrest, little is known about Iraqi refugee resettlement in the United States, or the way in which resettlement impacts health and adjustment. A grounded theory study was conducted to develop a substantive theory of Iraqi refugee resettlement. Participants in the qualitative study included 29 Iraqi refugees and 2 community partners who participated in face-to face interviews. Data analysis and interpretation revealed fundamental concepts related to Iraqi refugee resettlement. Results of analysis showed that for Iraqis choosing to resettle here, the outcome is dichotomous: satisfaction or regret. The outcome is influenced by contextual factors as well as facilitating and hindering intervening conditions during the basic social process of resettlement transition. Each refugee's story is unique, yet all share common threads. This study allowed Iraqi refugees the opportunity to voice their personal experiences of resettling in America, and revealed life stories that inspire and illuminate a process that can guide health care delivery as they cope with the stresses of their journey. As a result, an in-depth storyline was established to explain the process of resettlement for Iraqi refugees. The development of this resettlement theory, grounded in Iraqi refugee experience, has the potential to guide nursing education, enhance the efficacy of practice, inform policy development and form the basis for research.

Methodological Challenges in Conducting Research with Refugee Women.

The purpose of this pilot study was to evaluate the acceptability and feasibility of a 10-week community-based, culturally tailored mental health intervention, called Healthy Sudanese Families, with 12 South Sudanese refugee women living in a metropolitan area of the Midwestern United States. This mixed-methods study used the Dinka and Arabic versions of the Hopkins Symptoms Checklist-25 to measure indicators of anxiety and depression and a final focus group to evaluate the women's responses to the intervention. The women found the mental health intervention acceptable and relevant. Methodological challenges encountered in cross-cultural research with refugees are discussed.