Stress Impact and Care for COVID-19: Pilot Education and Support Course Decreases Burnout Among Nursing Students.

BACKGROUND: Nurses and nursing students have been at the forefront of the fight against COVID-19, often working in conditions that produce stress injuries and burnout. Early recognition and mitigation of stress and emotional trauma help prevent burnout. AIMS: To evaluate the effectiveness of an online 8-hour stress awareness course and associated 1-hour support group in reducing stress and burnout among nursing students. METHODS: We conducted a program evaluation for an online stress awareness pilot course offered to nursing students. The course, and associated support groups led by trained psychiatric mental health nurse practitioner students, included a common language for talking about stress, screening tools for recognizing stress injuries, and strategies for improving self-care. Students completed pre- and post-course surveys. Outcome measures included changes on course learning objectives, level of burnout, health-related locus of control, and experiences of stress and coping. RESULTS: Nursing students (n = 360) enrolled in the course, and 224 (62%) completed pre- and post-course surveys. Sixty percent rated the course excellent or very good. Depression Anxiety and Stress Scales and Impact of Event Scale Revised scores were within established normal ranges. There was a significant increase in all nine course learning objectives (p < .001) and decreased signs of stress (p < .001). Students' level of burnout decreased by odds ratio = 0.58 (95% CI: [0.4, 0.9], p < .006). CONCLUSIONS: Nursing leaders can use psychoeducational strategies to mitigate the impact of stress, build confidence, and support nursing students entering the workforce during these unprecedented times.

Preventing intimate partner violence among foreign-born Latinx mothers through relationship education during nurse home visiting.

AIMS: This study aimed to examine the effectiveness of an augmented home visiting programme in preventing intimate partner violence among Latinx mothers by nativity. BACKGROUND: Intimate partner violence diminishes home visit programmes' effectiveness. Immigrant Latinx mothers are especially vulnerable and need culturally tailored prevention. METHODS: We performed secondary analyses of 33 US-born and 86 foreign-born Latinx mothers at baseline and 1- and 2-year follow-up in a longitudinal randomized controlled trial of the Nurse-Family Partnership programme augmented with nurse-delivered Within My Reach relationship education curriculum and violence screening and referrals in Oregon. We estimated proportional odds models via generalized estimating equations on total physical and sexual victimization and/or perpetration forms (an ordinal variable), adjusting for intervention, wave, age and education. RESULTS: The intervention-nativity interaction was not significant (p = .953). Foreign-born status was associated with lower reported violence at baseline (adjusted odds ratio: 0.29, 95% confidence interval: 0.13-0.67, p = .004). This association was marginally significant at 1-year follow-up (0.43, 0.17-1.08, p = .072) and not significant at 2-year follow-up (0.75, 0.33-1.67, p = .475). CONCLUSIONS: This augmented programme was not effective for Latinx mothers by nativity. Their nativity gap diminished over time. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders should support culturally tailored home visiting programmes to detect and prevent intimate partner violence affecting Latinx immigrants. CLINICAL TRIAL REGISTRATION: This study is registered at www. CLINICALTRIALS: gov NCT01811719. The full trial protocol can be accessed at https://clinicaltrials.gov/ct2/show/NCT01811719.

Learned resourcefulness, danger in intimate partner relationships, and mental health symptoms of depression and PTSD in abused women.

The study investigated the relationships among learned resourcefulness, dangerousness in abusive relationships, and symptoms of depression and post-traumatic stress disorder (PTSD) in a sample of abused sheltered women. A cross-sectional descriptive research design was utilized and 42 women met criteria for participation. Data were collected over a ten-month period from June 2010 to March 2011 using the following instruments: (1) demographic data collection form, (2) Self-Control Schedule (SCS), (3) Danger Assessment (DA), (4) Index of Spouse Abuse (ISA), (5) Beck Depression Inventory, Second Edition (BDI-II), and (6) Posttraumatic Stress Diagnostic Scale (PDS). Results indicated that 74% of the sample reported symptoms of depression and 67% met criteria for PTSD. In addition, there was 62% comorbidity between depression and PTSD. High levels of danger and low levels of resourcefulness were associated with increased symptoms of depression and PTSD. Further research is necessary, but results of the study suggest that resourcefulness may be an important consideration for abused women in reducing the impact of violence and abuse on mental health issues.

Student-Led Stress Reduction Support Groups: A Qualitative Program Evaluation.

BACKGROUND: Burnout and attrition in nursing have been accelerated by the coronavirus disease 2019 (COVID-19) pandemic. Nursing students experience greater stress than non-nursing students but often lack adequate institutional support to build resiliency. Support groups are an effective strategy for processing stress that are underused in nursing education. An innovative online stress impact course was developed at a college of nursing to address students' stress during the pandemic. The course culminated in a voluntary virtual support group led by a Psychiatric Mental Health Nurse Practitioner graduate student. The aim of this qualitative program evaluation was to determine how graduate nursing students experienced the stress support group. METHOD: This study used qualitative exploratory analysis of support group reflections from 47 graduate nursing students. RESULTS: Four themes emerged: (1) Making Positive Connections; (2) Leveraging Skills to Manage Stress; (3) Beneficial; and (4) Facing Trauma. CONCLUSION: Graduate student-led support groups are a feasible and effective strategy to mitigate stress and improve nursing student resiliency. [J Nurs Educ. 2023;62(12):711-715.].

Including Voices of Adolescents With Chronic Conditions in the Redesign of Children's Mental Health Systems: Implications for Resource Allocation.

INTRODUCTION: Adolescents with chronic conditions have disparate mental health outcomes. This study aimed to explore the perspectives of adolescents with chronic conditions on mental health system redesign to improve outcomes. METHOD: Within an interpretive phenomenological approach, semistructured interviews with 17 adolescents aged 10-20 years with chronic conditions were conducted. Purposive sampling and recruitment occurred at three ambulatory sites. Data were analyzed using inductive and deductive thematic analysis until information saturation was achieved. RESULTS: Four themes were identified: (1) Brushed off: I need to be heard, (2) I need someone I can really talk to and trust, (3) They need to reach out to us. Check in on us, and (4) the school nurse is for physical illness only. DISCUSSION: Mental health system redesign should be considered for adolescents with chronic conditions. The findings can inform future research to test innovative health care delivery models to reduce mental health disparities in this vulnerable population.

Adolescents with chronic conditions: Engagement with children's mental health systems during the Covid-19 pandemic.

PURPOSE: The Covid-19 pandemic contributed to adverse adolescent mental health outcomes globally. Adolescents with chronic conditions have four times the odds of self-harm than peers. Little evidence exists to guide pediatric nurses on how to engage this vulnerable population with mental health support as the pandemic continues. In adults with chronic conditions, positive health assets (health access literacy, health self-efficacy, and emotional well-being) are directly related to improved patient engagement. The objective of this study was to gain a deeper understanding of engagement with mental health supports in adolescents with chronic conditions to inform practice. DESIGN AND METHODS: Using mixed methods, we surveyed and interviewed adolescents with chronic conditions aged 10-20 years. Random sampling was applied to avoid bias. Valid and reliable scales were used to measure health access literacy, health self-efficacy, and emotional well-being. Textual data were collected using a semistructured interview guide. Integrated data analysis was conducted using structural equation models and interpretive phenomenology. RESULTS: One hundred fifty-four participants provided numerical data and 17 participants provided textual data (mean age 15.5 years; 56% female, 5.8% agender; 56% White; 16.9% Black or African American, 4.5% Asian; 51.9% Hispanic or Latinx; 23.4% LGBTQ+). The structural model was an acceptable fit for the data (comparative fit index [CFI] = 0.97, Tucker-Lewis index [TLI] = 0.95). Participants reported higher levels of health access literacy (M = 3.88, SD = 0.848) than health self-efficacy (M = 2.98, SD = 0.646), and engagement (M = 1.78, SD = 1.71). Health access literacy predicted emotional well-being (ß = .33, p < .001, 95% confidence interval [CI] [.20, .50]) and health self-efficacy (ß = .52, p < .001, 95% CI [0.42, .062]). Emotional well-being positively predicted health self-efficacy (ß = .21, p < .003, 90% CI [0.10, 0.033]). Health self-efficacy predicted engagement (ß = .20, p < .01, 90% CI [0.07, 0.034]). Participants reported not engaging until "it was really, really bad" citing fear, stigma, and lack of connectedness with providers as barriers. PRACTICE IMPLICATIONS: Regardless of health access literacy and health self-efficacy, adolescents with chronic conditions may not engage until crisis levels. Pediatric nurses can aim to engage with this vulnerable population proactively.

Tracking physical activity in baccalaureate nursing students in the United States prior to graduation: A longitudinal study.

OBJECTIVE: To evaluate changes in physical activity among baccalaureate nursing students over time. DESIGN: Longitudinal descriptive study. SETTING: Baccalaureate nursing program at a four-year university in the United States. PARTICIPANTS: Fifty-two male (n = 4) and female (n = 48) nursing students. METHODS: At the beginning and end (weeks 1-2 and 15-16) of the three semesters prior to graduation, students completed the International Physical Activity Questionnaire (IPAQ) and their body mass index (BMI) was calculated. Based on the IPAQ, physical activity was calculated as MET-minutes per week of vigorous, moderate, and walking activities, using metabolic equivalents of 8.0 METS for vigorous, 4.0 METS for moderate, and 3.3 METS for walking. RESULTS: At baseline, students were 21.3 ±â€¯1.4 years old with a BMI of 23.5 ±â€¯2.9 kg/m2. BMI increased throughout the study and prior to graduation was 23.9 ±â€¯3.2 kg/m2 (p = 0.039). Overall, students maintained high physical activity levels that did not change statistically. Walking was the predominant activity, followed by vigorous and then moderate activity. Walking and vigorous activity displayed opposing patterns. Vigorous activity decreased over the first three measurement periods (p = 0.029), increased for the fourth period, and then decreased again over the last two periods (p = 0.037 compared to baseline). By comparison, walking increased over the first three measurements (p = 0.002) and then decreased again (p = 0.015). When students were grouped by physical activity level (moderate vs. high), there were significant between-group differences in vigorous activity and walking. At baseline and end of study, the moderate activity group participated in 58% and 49% less vigorous activity, and 83% and 45% less walking than the high activity group. CONCLUSION: In this group of baccalaureate nursing students, overall physical activity did not decline with time. Students participated in sufficient physical activity to promote health, and after graduation, they are likely to provide effective patient counselling regarding healthy lifestyles.

An Evaluation of Two Dating Violence Prevention Programs on a College Campus.

Dating violence is a serious and prevalent public health problem that is associated with numerous negative physical and psychological health outcomes, and yet there has been limited evaluation of prevention programs on college campuses. A recent innovation in campus prevention focuses on mobilizing bystanders to take action. To date, bystander programs have mainly been compared with no treatment control groups raising questions about what value is added to dating violence prevention by focusing on bystanders. This study compared a single 90-min bystander education program for dating violence prevention with a traditional awareness education program, as well as with a no education control group. Using a quasi-experimental pre-test/post-test design with follow-up at 2 months, a sample of predominately freshmen college students was randomized to either the bystander ( n = 369) or traditional awareness ( n = 376) dating violence education program. A non-randomized control group of freshmen students who did not receive any education were also surveyed ( n = 224). Students completed measures of attitudes, including rape myth acceptance, bystander efficacy, and intent to help as well as behavioral measures related to bystander action and victimization. Results showed that the bystander education program was more effective at changing attitudes, beliefs, efficacy, intentions, and self-reported behaviors compared with the traditional awareness education program. Both programs were significantly more effective than no education. The findings of this study have important implications for future dating violence prevention educational programming, emphasizing the value of bystander education programs for primary dating violence prevention among college students.