Emotional Intelligence in Neonatal Intensive Care Unit Nurses: Decreasing Moral Distress in End-of-Life Care and Laying a Foundation for Improved Outcomes: An Integrative Review.

End-of-life care in the neonatal intensive care unit (NICU) is one of the most challenging practices for nurses. Negative emotions associated with moral distress often cause care to be incomplete or nurse disengagement. Emotional intelligence in nurses holds potential to address this issue, while improving patient outcomes. The purpose of this study was to critically appraise the evidence about emotional intelligence in nursing and to explore the relationship between emotional intelligence, moral distress in NICU nurses, end-of-life care, and other priority nurse and patient outcomes. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)-structured integrative review was conducted, and CINAHL, Ovid, PubMed, and other databases were searched. Twelve studies were identified as relevant to this review after exclusion criteria were applied. Evidence supports the efficacy of emotional intelligence in bedside nurses as a method of improving key nurse and patient outcomes. Additionally, research suggests that emotional intelligence can be improved by training interventions. Clinical educators should integrate emotional intelligence concepts and strategies into staff training. Further research is recommended to validate previous findings in the NICU setting. Exploration of the relationship between emotional intelligence and moral distress in NICU nurses would provide a foundation for experimental designs to evaluate the effectiveness of emotional intelligence training interventions.

[Psychopathology of intrafamily violence]. / Psychopathologie des violences intrafamiliales.

Intrafamily violence is a major public health problem, due to its frequency and the severity of its consequences. The aim is to establish links between violence and psychopathology, for the perpetrators as well as the victims. Data reveal a higher frequency of certain mental health disorders and history of abuse in the perpetrators, without it being systematic. It is important to adopt a global and multidisciplinary approach, and a holistic perspective faced with the people concerned by these acts. Health professionals, from the social sector and associations must therefore work together in a network to manage and attempt to prevent crisis situations.

Humanization in healthcare arises from the need for a holistic approach to illness. / Implantación de un proyecto de humanización en una Unidad de Cuidados Intensivos.

Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments.

Integrating Trauma-Informed Care Into Maternity Care Practice: Conceptual and Practical Issues.

Adverse childhood experiences have a strong negative impact on health and are a significant public health concern. Adverse childhood experiences, including various forms of child maltreatment, together with their mental health sequelae (eg, posttraumatic stress disorder, depression, dissociation) also contribute to adverse pregnancy outcomes (eg, preterm birth, low birth weight), poor postpartum mental health, and impaired or delayed bonding. Intergenerational patterns of maltreatment and mental health disorders have been reported that could be addressed in the childbearing year. Trauma-informed care is increasingly used in health care organizations and has the potential to assist in improving maternal and infant health. This article presents an overview of traumatic stress sequelae of childhood maltreatment and adversity, the impact of traumatic stress on childbearing, and technical assistance that is available from the National Center for Trauma-Informed Care (NCTIC) before articulating some steps to conceptualizing and implementing trauma-informed care into midwifery and other maternity care practices.

Intimate partner violence and the experience of early motherhood: A cross-sectional analysis of factors associated with a poor experience of motherhood.

OBJECTIVE: to examine the relationship between intimate partner violence and other factors associated with the experience of early motherhood. DESIGN: cross sectional secondary data analysis (n=1534) from MOVE: a cluster randomised controlled trial that evaluated a model of enhanced nurse screening and supportive care for abused women. SETTING: Victoria, Australia. PARTICIPANTS: postpartum women attending community based maternal and child health clinics. MEASUREMENTS: survey included the Experience of Motherhood Questionnaire; measures of partner abuse, depression, anxiety, stress and social support. Multivariable robust regression analysis used. FINDINGS: independent of other factors, abused women were more likely to have a poorer mothering experience (Adj b=2.01, 95% CI=0.78, 3.25). Poor mental health, abuse as a child and being born overseas were also associated with a poor experience. Busy mothers who had a multiple birth and those balancing work and study simultaneously had higher experience of motherhood scores, indicating a poorer experience. Social support was protective. KEY CONCLUSIONS AND IMPLICATIONS: exposure to partner violence is adversely associated with early motherhood, independent of other correlates of poor motherhood experience. Greater awareness of factors associated with intimate partner violence and mothering would enable health care professionals and policy makers to improve support for women and children experiencing violence.

Could spirituality and religion promote stress resilience in survivors of childhood trauma?

Trauma is a precursor to many mental health conditions that greatly impact victims, their loved ones, and society. Studies indicate that neurobiological associations with adverse childhood experiences are mediated by interpersonal relationships and play a role in adult behavior, often leading to cycles of intergenerational trauma. There is a critical need to identify cost effective community resources that optimize stress resilience. Faith-based communities may promote forgiveness rather than retaliation, opportunities for cathartic emotional release, and social support, all of which have been related to neurobiology, behavior, and health outcomes. While spirituality and religion can be related to guilt, neurotic, and psychotic disorders, they also can be powerful sources of hope, meaning, peace, comfort, and forgiveness for the self and others. This article provides an overview of religion and spirituality as they relate to the neurobiology of resilience in victims of childhood trauma.

Cuidados psicosociales de enfermería en el paciente gran quemado / Psychosocial nursing care patient with major burns

Debemos considerar al paciente desde el punto de vista holístico, esto es, no sólo desde una perspectiva física, sino también mental, emocional y espiritual (que no ha de confundirse con la religiosidad). Un paciente gran quemado en el lugar del accidente es visto por el profesional que lo atiende como un paciente crítico, y para él lo primordial es su supervivencia. Es al ingresar en la Unidad de Grandes Quemados cuando comienza su largo y no fácil camino hasta su recuperación, entendiendo esta como el inicio en la mayoría de los casos de una nueva manera de integrarse, sentir, percibir y, en definitiva, de aprender de nuevo a vivir. El papel de la enfermería durante esta andadura resultará vital. Del vínculo que se establezca entre la enfermera o el enfermero y el paciente dependerá en gran medida su pronta y mejor recuperación y, por lo tanto, su integración y reinserción en la nueva vida que le espera. En este artículo se desarrollan los siguientes apartados: · Evolución psicoemocional durante su estancia en la unidad (duelo). · Cuidados psicoemocionales de la enfermería (miedos, dolor, cambio de imagen, larga estancia, recursos). · Manejo de las medidas de autoprotección del personal de enfermería para mantener la propia estabilidad psicoemocional (AU)

We must consider the patient as a human being from a holistic point of view; that is, not only from a physical point of view, but also from a mental emotional and spiritual perspective (not to be confused with religion). A patient with major burns is seen as a critical patient by the physician, and for him the most important issue is the survival of the patient. It is when the patient is admitted in the Burns Unit when the long and not easy road to recovery begins, in the understanding this is a new way to integrate, feel and ultimately learn to live again. The role of nursing during this journey will be vital. The prompt and better recovery of the patient will largely depend on the link established between nurse and patient, as well as his/her integration in the new life that awaits him. The following topics are developed in this article: · Emotional evolution during his stage in the Burns Unit. · Psychoemotional nursing care (fear, pain, image change, long hospital stay, resources). · Management of the self-protection measures of the nursing staff to maintain its own emotional stability (AU)

Tormented by ghosts from their past': a meta-synthesis to explore the psychosocial implications of a traumatic birth on maternal well-being.

BACKGROUND: women can experience an array of serious and enduring morbidities following a difficult or traumatic childbirth. These complications have a negative impact on maternal behaviours and infant and family well-being. OBJECTIVE: to undertake a meta-synthesis of existing qualitative research to explore the psychosocial implications of a traumatic birth on maternal well-being. METHOD: a systematic review across 10 databases was undertaken: Nursing and Allied Health Source, Medline, the Allied and Complementary Medicine Database (AMED), Embase, PsychINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), International Bibliography of Social Sciences (IBSS), Science Direct, Academic Search Complete and Health Management Information Consortium. Quality appraisal was conducted and Noblit & Hare's meta-ethnographic method adopted to identify first, second and third order constructs within the selected papers. FINDINGS: 13 papers were included in the final synthesis. Three third order constructs were identified and are described as 'consumed by demons' (through the intense negative emotions and responses they endured and the subsequent dysfunctional coping strategies employed); an 'embodied sense of loss' (through women's loss of self and family ideals) and 'shattered relationships' (which reflected the fractious and difficult relationships that women described with their infants and partners). A line of argument synthesis was developed which revealed how women are 'tormented by ghosts' from their past. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this synthesis reveals how a traumatic birth experience can lead to women being drawn into a turmoil of devastating emotions that have long-term, negative repercussions on self-identity and relationships. Professionals require training, awareness and skill development to prevent against trauma and to enable them to identify and sensitively respond to women's psychosocial concerns. Further insights and research into the timing and type of interventions to resolve postnatal morbidity following a traumatic birth are needed.

Dutch midwives' behavioural intentions of antenatal management of maternal distress and factors influencing these intentions: an exploratory survey.

OBJECTIVE: to explore midwives' behavioural intentions and the determinants of these intentions with regard to the management of antenatal care of women with maternal distress. DESIGN: an exploratory survey using a questionnaire. Descriptive statistics calculated expanded TPB constructs, demographic information, personal characteristics and work related details. Multiple linear regression analyses were used to examine which factors influence midwives' intention to provide antenatal care of maternal distress. SETTING: midwives working in Dutch primary care. PARTICIPANTS: 112 midwives completed the survey. RESULTS: midwives did not report a clear intention to screen for maternal distress (3.46 ± 1.8). On average, midwives expressed a positive intention to support women with maternal distress (4.63 ± 1.57) and to collaborate with other health-care professionals (4.63 ± 1.57). Finding maternal distress an interesting topic was a positive predictor for the intention to screen (B=0.383; p=0.005), to support (B=0.637; p=<0.000) and to collaborate (B=0.455; p=0.002). Other positive predictors for the intention to screen for maternal distress were years of work experience (B=0.035; p=0.028), attitude about the value of screening (B=0.326; p=0.002), and self-efficacy (B=0.248; p=0.004). A positive attitude toward support for women with maternal distress (B=0.523; p=0.017) predicted the intention to support these women. Number of years of work experience (B=0.042; p=0.017) was a positive predictor for the intention to collaborate with other health-care professionals. KEY CONCLUSIONS: the intention to screen for maternal distress was less evident than the intention to support women with maternal distress and the intention to collaborate with other health-care professionals. Important factors predicting the midwife's intention to screen, support and collaborate were finding maternal distress an interesting topic, years of work experience, attitude about the value of screening and support and self-efficacy about screening. IMPLICATIONS FOR PRACTICE: to provide care involving all three components of antenatal management of maternal distress implies efforts to influence the factors that predict the intention to screen, to support women with maternal distress and the intention to collaborate with other health-care professionals.

Childbirth and criteria for traumatic events.

OBJECTIVE: for some women childbirth is physically and psychologically traumatic and meets Criterion A1 (threat) and A2 (intense emotional response) for Posttraumatic Stress Disorder of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV).This study differentiates Criterion A1 and A2 to explore their individual relationship to prevalence rates for posttraumatic stress, each other, and associated factors for childbirth trauma. DESIGN AND SETTING: women were recruited at three hospitals from October 2008 to October 2009. Questionnaires were completed at recruitment and at 14 days post partum. PARTICIPANTS: women in the third trimester of pregnancy (n=890) were recruited by a research midwife while waiting for their antenatal clinic appointment. Participants were over 17 years of age, expected to give birth to a live infant, not undergoing psychological treatment, and able to complete questionnaires in English. FINDINGS: this study found 14.3% of women met criteria for a traumatic childbirth. When the condition of A2 was removed, the prevalence rate doubled to 29.4%. Approximately half the women who perceived threat in childbirth did not have an intense negative emotional response. Predictors of finding childbirth traumatic were pre-existing psychiatric morbidity, being a first time mother and experiencing an emergency caesarean section. KEY CONCLUSIONS: the fear response is an important diagnostic criterion for assessing psychologically traumatic childbirth. The identification of risk factors may inform maternity service delivery to prevent traumatic birth and postpartum approaches to care to address long-term negative consequences. IMPLICATIONS FOR PRACTICE: prevention and treatment of traumatic childbirth are improved through knowledge of potential risk factors and understanding the woman's subjective experience.

A systematic review of midwife-led interventions to address post partum post-traumatic stress.

OBJECTIVE: to systematically identify interventions that midwives could introduce to address post-traumatic stress in women following childbirth. METHODS: a search strategy was developed and relevant papers were identified from databases including Cinahl, Cochrane Library, EMBASE, Maternity and Infant Care, MEDLINE, PsycINFO, and Web of Science. Key search terms used were post-traumatic stress, post partum, intervention, controlled trial and review. Papers eligible for inclusion were primary studies and reviews of research published from 2002-2012, focusing on interventions which could be implemented by midwives for the prevention and/or management of PTSD. For primary studies, RCTs, controlled clinical trials, and cohort studies with a control group were eligible. Eligible reviews were those with a specified search strategy and inclusion/exclusion criteria. Methodological quality was assessed using recognised frameworks. FINDINGS: six primary studies and eight reviews were eligible for inclusion. The majority of included studies or reviews focused on debriefing and/or counselling interventions; however the results were not consistent due to significant variation in methodological quality and use of dissimilar interventions. Two of the reviews considered the general management of post partum PTSD and one broadly covered anxiety during pregnancy and the post partum, incorporating a section on PTSD. The majority of women reported that the opportunity to discuss their childbirth experience was subjectively beneficial. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: no evidence-based midwifery interventions were identified from this systematic review that can be recommended for introduction into practice to address PTSD. It is recommended that future research in this area should incorporate standardised interventions with similar outcome measures to facilitate synthesis of results. Further research on interventions used in non-maternity populations is needed in order to confirm their usefulness in addressing post partum PTSD.

Fusion of psychiatric and medical high fidelity patient simulation scenarios: effect on nursing student knowledge, retention of knowledge, and perception.

High fidelity patient simulation (HFPS) has become an increasingly popular teaching methodology in nursing education. To date, there have not been any published studies investigating HFPS scenarios incorporating medical and psychiatric nursing content. This study utilized a quasi-experimental design to assess if HFPS improved student knowledge and retention of knowledge utilizing three parallel 30-item Elsevier HESI(TM) Custom Exams. A convenience sample of 37 senior level nursing students participated in the study. The results of the study revealed the mean HESI test scores decreased following the simulation intervention although an analysis of variance (ANOVA) determined the difference was not statistically significant (p = .297). Although this study did not reveal improved student knowledge following the HFPS experiences, the findings did provide preliminary evidence that HFPS may improve knowledge in students who are identified as "at-risk." Additionally, students responded favorably to the simulations and viewed them as a positive learning experience.

Psychiatric-mental health nurses and the sex trafficking pandemic.

Nurses are in a unique position to treat survivors of human trafficking and are most likely to encounter patients who have been involved in the sex trade. In particular, psychiatric-mental health nurses can be effective because they are educated to think of clients holistically and can provide both short-term medical intervention and long-term psychotherapy. Additionally, they can recognize and refer these individuals for medical treatment. The purpose of this article is to present an overview of sex trafficking and what psychiatric-mental health nurses can do to treat survivors.

Trauma and its aftermath for commercially sexually exploited women as told by front-line service providers.

Commercial sexual exploitation of women and girls through forced prostitution and sex-trafficking is a human rights and public health issue, with survivors facing complex mental health problems from trauma and violence. An international and domestic problem, the average age of recruitment into sex-trafficking is between 11 and 14 years old. Given its secrecy and brutality, such exploitation remains difficult to study, which results in a lack of knowledge related to trauma and how best to develop specific services that effectively engage and meet the unique needs of survivors. This qualitative research, using thematic analysis, explored the stories of trauma and its aftermath for commercially sexually exploited women as told by front-line service providers. Three themes emerged regarding the experience of sex-trafficking and its outcomes-Pimp Enculturation, Aftermath, and Healing the Wound-along with seven subthemes. These have important implications for all service and healthcare providers.

Ben's story: a case study in holistic nursing and veteran trauma.

This case describes how returning veterans can be supported and healed through holistic nursing care, trauma informed care and a range of evidence based complementary and integrative therapies.

Inflammation and traumatic stress: the society to cells resiliency model to support integrative interventions.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a prevalent psychiatric disorder that develops following a traumatic event and has substantial health implications, including high rates of health morbidity and mortality, as well as significant health-related costs. Medical risks that are associated with PTSD often have an underlying inflammatory pathology, suggesting that inflammation contributes to these health declines. OBJECTIVES AND DESIGN: In this critical literature review, the authors examine the medical risks associated with PTSD and the inflammatory mechanisms that likely underlie these risks. RESULTS AND CONCLUSIONS: The authors offer a review of their "Cells to Society Resiliency Model" to motivate the development of integrative interventions that include factors of society, community, family, individual, physiological, and cellular factors to thereby reduce the health risks associated with PTSD.

Evaluation of effectiveness and satisfaction outcomes of a mental health screening and referral clinical pathway for community nursing care.

The study aimed to explore the effectiveness of a mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia on outcomes of client self-reported mental health, quality of life, and client and carer satisfaction. The pathway was developed by literature review and consultation, then trialled and evaluated. Validated screening tools were embedded within the pathway to support generalist nurses' mental health decision making. Pre- and post-measures were applied. Clients on whom the pathway was trialled were invited to complete an evaluation survey questionnaire, as were their informal carers. Most clients and carers who responded to these questionnaires were highly satisfied or satisfied with care provided through application of the pathway. This study adds understanding about one way that community nurses might identify people with mental health difficulties. The trialled pathway, which was modified and refined following the study, is now available on the Internet as an evidence-based resource for community nurses in Australia to guide practice and maximize holistic care for war veterans and war widow(er)s where that care is funded by Department of Veterans' Affairs.