Perspectives of emergency department physicians and nurses on reasons for preventable emergency department visits by patients with cancer.

BACKGROUND: Patients with cancer frequently visit the emergency department (ED) for medical care, yet approximately half of ED visits for patients with cancer are thought to be preventable. Preventable ED visits are associated with increased healthcare costs and poor patient experiences and outcomes. The voices of ED providers who work with patients with cancer in their everyday practices have not been solicited as it pertains to preventable visits. OBJECTIVES: The purpose of this study is to describe the perspectives of ED physicians and nurses on reasons for preventable ED visits by patients with cancer. METHODS: A qualitative descriptive design guided the study. We conducted 23 semi-structured interviews with ED physicians and nurses to query them about their perspectives on the reasons for preventable ED visits by patients with cancer. Content analysis was conducted to list and describe the reasons they discussed. RESULTS: Participants identified five "medical" and five "non-medical" causes of preventable ED visits. Medical reasons included uncontrolled cancer pain, gastrointestinal symptoms, anemia, fever, and on-going undiagnosed signs and symptoms. Non-medical reasons include patient hesitancy to contact primary care providers, lack of availability or responsiveness of primary providers, lack of access, lack of care coordination, and fears about diagnosis and treatment. CONCLUSION: The voices of ED providers should be included in discussions about the problem of preventable ED visits by patients with cancer. The reasons supplied by the participants suggest that solutions to the problem will need to occur at the patient, provider, system, and societal levels.

Implementation of Research in Community Mental Health Centers: The Challenge of Provider Engagement.

Conducting clinical research in public sector community mental health centers (CMHCs) can be challenging. The purpose of this report is to describe the challenges our research team encountered in engaging CMHC providers in a clinical trial aimed at testing an intervention to improve parent activation and engagement in their child's behavioral healthcare. We discuss the intervention we aimed to test, the challenges we encountered engaging providers, and the barriers to engagement that we identified. The barriers included restrictive inclusion criteria, an ambitious randomized controlled design, a dyadic (provider-parent) recruitment plan, a requirement to record provider-parent sessions, and high day-to-day practice demands on providers. The strategies we used to address the barriers and a discussion of the "trade-offs" these strategies introduced are presented. Improving provider engagement in research in CMHCs can avoid research delays or termination of studies and ultimately mitigate an early blockage in the research-to-practice pipeline.

Mentoring in Academic Nursing From the Perspectives of Faculty Mentors.

AIM: The aim of this study was to create a theoretical framework that describes how mentoring relationships in academic nursing unfold from the perspectives of nurse faculty mentors. BACKGROUND: Mentoring is a strategy that can promote the satisfaction and retention of nurse faculty. Although research has focused on the experiences of protégés in mentoring relationships, little is known about mentoring from the perspectives of nurse faculty mentors. METHOD: Constructivist grounded theory was used to interview 24 experienced nurse faculty about their mentoring experiences. RESULTS: The theoretical framework Growing Together: Mentors' Perspectives on Mentoring included four phases (getting together, getting going, going together, going beyond) and three strands (relationship with protégé, work of mentoring, emotional impact of mentoring). CONCLUSION: Participants experienced a variety of benefits from mentoring while also experiencing a variety of challenges. Findings suggest that more resources are needed for experienced faculty who mentor novice nurse faculty.

Exploring Mentoring Relationships Among Novice Nurse Faculty: A Grounded Theory.

AIM: The aim of this study was to develop a theoretical framework that describes the mentoring process from the perspectives of novice nurse faculty. BACKGROUND: Additional nurse faculty are needed to help combat the nurse faculty shortage, but many who enter the faculty role come from professional and educational backgrounds that may not equate to success with the tripartite faculty role. Mentoring is promoted as an intervention for career development. Little is known about the process of mentoring relationships and the transition among novice nurse faculty into academia. METHOD: Grounded theory was used to interview full-time novice nurse faculty (N = 21) with three years or less in the faculty role from US nursing programs. RESULTS: The theoretical framework Creating Mentorship Pathways to Navigate Academia captures the process of mentoring as experienced by novice nurse faculty. CONCLUSION: Participants created mentorship pathways to navigate academia by acquiring knowledge, meeting expectations, and functioning in the faculty role.

Reasons for and associated characteristics with early study termination: Analysis of ClinicalTrials.gov data on pregnancy topics.

BACKGROUND: Prematurely terminated studies are unlikely to provide data for evidence-based practice. There has been no systematic review on premature study termination on pregnancy-related research. PURPOSE: This study investigated the reasons why studies on pregnancy topics are terminated and the associated characteristics with early termination. METHODS: A total of 3,623 studies (332 terminated and 3,291 completed) were retrieved from ClinicalTrials.gov registry. Reasons for termination were grouped into four categories, including accrual difficulty, research operation issues, data-related recommendations, and external factors. Study characteristics were statistically compared between terminated and completed studies. FINDINGS: Accrual difficulty (44.6%) and research operation issues (21.4%) were most frequently cited reasons for termination. Study design characteristics of intervention, randomization, masking, treatment and drug trial, and low funding from federal agencies were significantly associated with early termination. DISCUSSION: Population tailored subject recruitment strategies, scientifically sound research protocols, and well-planned research operations may mitigate premature study termination.

Implementation of screening, brief intervention, and referral to treatment (SBIRT) by nurses on acute care units: A qualitative descriptive study.

Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention for patients with substance use disorders, but this intervention is under-utilized. Little is known about the implementation of SBIRT in acute care facilities. The purpose of this study is to describe implementation of SBIRT by nurses in acute care hospitals. Methods: A qualitative descriptive design was used for this study. Registered nurses who agreed to participate in the study completed a 1:1 interview using a semi-structured interview guide. Interviews were audio recorded and transcribed and then data were analyzed using qualitative content analysis. Results: When implementing SBIRT in an acute care setting, participants identified several factors that affect implementation. Some nurses felt that it is "one more thing to do" but other nurses feel that it was a "good, simple" screening tool that does not take long to do and can "plant the seeds of change" for patients. Additionally, participants mentioned barriers and facilitators related to the patients' responses to SBIRT and organizational factors. Conclusions: This study identified several barriers and facilitators to SBIRT implementation related to the nurses, patients, and organization. By understanding the factors that influence implementation, healthcare providers can develop strategies to support effective implementation of SBIRT.

The Influence of Peer Relationships on Latina Adolescents' Experiences with Depressive Symptoms.

PURPOSE: Previous research has demonstrated that peers may play an integral role in the development of depressive symptoms among Latina adolescents; however, little is known about the function of peers in the ongoing management of depressive symptoms for Latina adolescents. The purpose of this study was to describe how peers influence Latina adolescents' experiences with the onset and ongoing management of depressive symptoms. DESIGN AND METHODS: Qualitative descriptive methods were used in conducting semi-structured interviews with twenty-five young Latinas (ages 13-20) who had a history of depressive symptoms during adolescence. Participants were asked to describe their experiences with depressive symptoms and how they interacted with others in relation to their depressive symptoms. Thematic analysis methods were used to identify common themes in how peers influenced Latina adolescents' experiences with depressive symptoms. RESULTS: Latina adolescents experienced tensions with peers in the development, disclosure, and self-management of depressive symptoms. Peers were: 1) allies and bullies; 2) confidants and betrayers; and 3) up-lifters and downers. CONCLUSIONS: Peer relationships can be a source of risk and resiliency for Latina adolescents throughout the process of experiencing depressive symptoms. PRACTICE IMPLICATIONS: Interventions preventing or treating depression among Latina adolescents should capitalize on the strengths of peer relationships, while recognizing that peers may also contribute to risk.

Barriers to and Facilitators of Mental Health Treatment Engagement Among Latina Adolescents.

Latina adolescents are more likely to experience depressive symptoms and less likely to receive mental health treatment than White peers. The purpose of this study is to describe barriers to and facilitators of engagement in depression treatment among Latina adolescents. Twenty-five Latina young women (mean age = 16.7 years) with a history of depressive symptoms during adolescence participated in this qualitative descriptive study. Participants were recruited from clinical and community settings and were interviewed about their experiences with depression treatment. Using qualitative content analysis, we identified barriers to and facilitators of engagement in treatment for depression. Barriers included beliefs about depression and its treatments, negative experiences with treatment, and logistical problems. Facilitators included positive treatment outcomes, meaningful connection with a therapist, and family support of depression treatment. Mental health providers should minimize barriers and maximize facilitators to promote mental health treatment use and engagement among Latina adolescents with depressive symptoms.

Understanding the decision to screen for lung cancer or not: A qualitative analysis.

BACKGROUND: Although new screening programmes with low-dose computed tomography (LDCT) for lung cancer have been implemented throughout the United States, screening uptake remains low and screening-eligible persons' decisions to screen or not remain poorly understood. OBJECTIVE: To describe how current and former long-term smokers explain their decisions regarding participation in lung cancer screening. DESIGN: Phone interviews using a semi-structured interview guide were conducted to ask screening-eligible persons to describe their decisions regarding screening with LDCT. The interviews were transcribed and analysed with conventional content analytic techniques. SETTING AND PARTICIPANTS: A subsample of 40 participants (20 who had screened and 20 who had not) were drawn from the sample of a survey study whose participants were recruited by Facebook targeted advertisements. RESULTS: The sample was divided into the following five groups based on their decisions regarding lung cancer screening participation: Group 1: no intention to be screened, Group 2: no deliberate consideration but somewhat open to being screened, Group 3: deliberate consideration but no definitive decision to be screened, Group 4: intention to be screened and Group 5: had been screened. Reasons for screening participation decisions are described for each group. Across groups, data revealed that screening-eligible persons have a number of misconceptions regarding LDCT, including that a scan is needed only if one is symptomatic or has not had a chest x-ray. A physician recommendation was a key influence on decisions to screen. DISCUSSION AND CONCLUSIONS: Education initiatives aimed at providers and long-term smokers regarding LDCT is needed. Quality patient/provider communication is most likely to improve screening rates.

Getting a Grip on My Depression: How Latina Adolescents Experience, Self-Manage, and Seek Treatment for Depressive Symptoms.

Latina (female) adolescents are more likely to experience depressive symptoms and less likely to receive mental health services than their non-Latina White peers. We aimed to develop a framework that explains how Latina adolescents experience, self-manage, and seek treatment for depressive symptoms. Latina young women (n = 25, M age = 16.8 years) who experienced depressive symptoms during adolescence were recruited from clinical and community settings and interviewed about experiences with depressive symptoms. The framework was developed using constructivist grounded theory methods. Participants experienced a psychosocial problem that we labeled being overburdened and becoming depressed. They responded to this problem through a five-phase psychosocial process that we labeled Getting a Grip on My Depression. Family members, peer groups, and mainstream authorities were influential in how participants experienced these phases. Future research should further develop this framework in diverse samples of Latino/a youth. Clinicians can use this framework in discussions with Latina adolescents about depressive symptoms.

Cultural stressors experienced by young Latinas with depressive symptoms living in a tumultuous sociopolitical climate in the United States.

The purpose of this study is to describe the cultural stressors experienced by Latina young women with depressive symptoms from 2016 to 2018 in the United States. Twenty-four Latina young women (mean age = 16.7 years) participated in this qualitative descriptive study. Content analysis of interviews revealed four cultural stressors: Parental oversight, pressure to succeed, being treated differently, and fears of deportation. Experiences with cultural stressors varied across generational status. Clinicians should provide Latina young women with a safe space for discussing cultural stressors, assess how they are managing their stress, and advocate for policies that will benefit the well-being of Latina young women.

A feasibility test of an online intervention to prevention dating violence in emerging adults.

Dating violence in emerging adults is a significant problem and few prevention programs based on the developmental needs of this age group have been developed. Our research team developed an online dating violence prevention program called WISER (Writing to Improve Self-in-Relationships) for emerging adults. The program is based on narrative therapy principles and uses structured writing techniques. A single group pre-post feasibility test of WISER was conducted with 14 college women. WISER was demonstrated to be feasible and acceptable and to show promise as an effective program to decrease dating violence in this population.

Cultural Stressors and Depressive Symptoms in Latino/a Adolescents: An Integrative Review.

BACKGROUND: Latino/a adolescents experience higher levels of depressive symptoms than Caucasian and African American adolescents. Many studies found that cultural stressors contribute to this disparity, but these findings have not been integrated into a cohesive picture of the specific cultural stressors that contribute to the development of depressive symptoms for Latino/a adolescents. OBJECTIVE: The purpose of this integrative review is to identify cultural stressors that are associated with depressive symptoms in Latino/a adolescents. DESIGN: Procedures outlined by Ganong were used to conduct the review. The results of 33 articles that met inclusion criteria were synthesized. RESULTS: Discrimination, family culture conflict, acculturative and bicultural stress, intragroup rejection, immigration stress, and context of reception were identified as cultural stressors that are associated with depressive symptoms in Latino/a adolescents. CONCLUSIONS: Clinicians should employ strategies to help Latino/a youth cope with cultural stressors and advocate for policies that support the mental health of Latino/a youth.

CYP2D6 drug-gene and drug-drug-gene interactions among patients prescribed pharmacogenetically actionable opioids.

PURPOSE: When codeine and tramadol are used for pain management, it is imperative that nurses are able to assess for potential drug-gene and drug-drug-gene interactions that could adversely impact drug metabolism and ultimately pain relief. Both drugs are metabolized through the CYP2D6 metabolic pathway which can be affected by medications as well the patient's own pharmacogenotype. The purpose of this brief report is to identify drug-gene and drug-drug-gene interactions in 30 adult patients prescribed codeine or tramadol for pain. METHODS: We used three data sources: (1) six months of electronic health record data on the number and types of medications prescribed to each patient; (2) each patient's CYP2D6 pharmacogenotype, and (3) published data on known CYP2D6 gene-drug and drug-drug-gene interactions. RESULTS: Ten patients (33%) had possible drug-gene or drug-drug-gene interactions. Five patients had CYP2D6 drug-gene interactions indicating they were not good candidates for codeine or tramadol. In addition, five patients had potential CYP2D6 drug-drug-gene interactions with either codeine or tramadol. CONCLUSION: Our findings from this exploratory study underscores the importance of assessing and accounting for drug-gene and drug-drug-gene interactions in patients prescribed codeine or tramadol.

Designing an Internet Intervention for Emerging Adults Who Experience Troubled Relationships.

This article describes how the Internet Intervention Model (IIM) was used as an organizing framework to design a theoretically based Internet intervention for emerging adults who experience troubled intimate partner relationships. In the design process, the team addressed six fundamental questions related to the several components of the IIM. Decisions made regarding the design of the intervention based on the six questions are described. We focus in particular on how the intervention is based on the Theory of Emerging Adulthood and the Theory of Narrative Identity.

Developing a Multiple Caregiver Group for Caregivers of Adolescents With Disruptive Behaviors.

This article describes the development of a 6-week multiple caregiver group intervention for primary caregivers of adolescents diagnosed with Oppositional Defiant Disorder or Conduct Disorder in low-income African American families. The intervention is aimed at increasing the primary caregivers' self-efficacy in managing interactions within the family and especially with child serving educational, mental health, juvenile justice, and child welfare systems. Development of the intervention involved seven iterative activities performed in a collaborative effort between an interdisciplinary academic team, community engagement specialists, members of the targeted population, and clinical partners from a large public mental health system. The intervention development process described in this article can provide guidance for teams that aim to develop new mental health interventions that target specific outcomes in populations with unique needs.

Nurses' experiences with errors in nursing.

BACKGROUND: Health care organizations seek to maximize the reporting of medical errors to improve patient safety. PURPOSE: This study explored licensed nurses' decision-making with regard to reporting medical errors. METHODS: Grounded theory methods guided the study. Thirty nurses from adult intensive care units were interviewed, and qualitative analysis was used to develop a theoretical framework based on their narratives. DISCUSSION: The theoretical model was titled "Learning Lessons from the Error." The concept of learning lessons was central to the theoretical model. The model included five stages: Being Off-Kilter, Living the Error, Reporting or Telling About the Error, Living the Aftermath, and Lurking in Your Mind. CONCLUSION: This study illuminates the unique experiences of licensed nurses who have made medical errors. The findings can inform initiatives to improve error reporting and to support nurses who have made errors.

Two worlds: Adolescents' strategies for managing life with a parent in hospice.

OBJECTIVE: This study aimed to generate an explanatory model of the coping strategies that adolescents employ to manage the stressors they experience in the final months of their ill parent's life and shortly after their death. METHOD: The sample included 26 families of adolescents with a parent receiving care in a large hospice program in northeastern Ohio. A semistructured interview was conducted with 14 ill parents, 17 well parents/guardians, and 30 of their adolescent children before the parent's death and, additionally, with 6 of these families after the death. The interviews were audiotaped, transcribed verbatim, and analyzed using a grounded-theory approach. RESULTS: The participants described two worlds that constituted the lives of the adolescents: the well world of normal adolescence and the ill world of having a parent near the end of life. The adolescents experienced a common challenge of living in two worlds and responded to the challenge with a process we labeled "managing two worlds." Five stages through which adolescents manage their worlds were identified: keeping the ill world and the well world separate; having the ill world intrude into the well world; moving between the ill world and the well world; being immersed in the ill world; and returning to the well world having been changed by the ill world. SIGNIFICANCE OF RESULTS: The explanatory model of "managing two worlds" outlines a complex and nuanced process that changes over time. The model can be used by health professionals who seek to help adolescents navigate this critical time when their parents are dying or have recently died. These results can also be used to inform the development of interventions that assist families with strategies tailored to an adolescent's specific needs. Future research should investigate associations among the process of "managing two worlds" and outcomes related to adolescent bereavement.

Unique Outcomes in the Narratives of Young Adults Who Experienced Dating Violence as Adolescents.

BACKGROUND: Narrative therapy, an approach based on the reauthoring of life narratives, may be a useful psychotherapeutic strategy for youth who have experienced dating violence. OBJECTIVE: A cornerstone of narrative therapy is the concept of unique outcomes, which are moments that stand in contrast to a client's otherwise problem-saturated narratives. The purpose of this study was to identify and categorize unique outcomes embedded in narratives about adolescent dating violence. DESIGN: Text units representing unique outcomes were extracted from transcripts of interviews with 88 young adults who had experienced dating violence and were categorized using standard content analytic techniques. RESULTS: Six categories of unique outcome stories were identified: facing-facts stories, standing-up-for-myself stories, cutting-it-off stories, cutting-'em-loose stories, getting-back-on-track stories, and changing-it-up stories. CONCLUSION: This typology of unique outcomes can inform clinicians who work with clients who have a history of adolescent dating violence.

Navigating the System: How Transgender Individuals Engage in Health Care Services.

PURPOSE: Transgender individuals (TIs) experience a number of healthcare disparities that result in compromised access to health care, placing them at high risk for poor health outcomes. Despite their unique health concerns, there is little known about how they engage in health care. The purpose of this grounded theory study was to construct a theoretical framework that depicts the process by which transgender individuals engage in health care. METHODS: In this grounded theory study, data from interviews with 25 individuals who self-identified as transgender were used to develop a theoretical framework that depicts the process by which TIs engage in health care. Data analysis included open coding, category formation, and theoretical coding. Constant comparative analysis was used to facilitate theory generation. CONCLUSIONS: The central phenomenon of how TIs engage in health care was the core process of navigating the system. The core process involves four subprocesses: needing to move forward, doing due diligence, finding loopholes, and making it work. CLINICAL RELEVANCE: The theoretical framework of navigating the system can provide healthcare providers with a way to understand how TIs engage in health care as they move through the subprocesses of moving forward, doing due diligence, finding loopholes, and making it work in order to get their healthcare needs met. With a better understanding of the healthcare journeys of TIs, healthcare providers can provide better care for this population and advocate for change in policies that contribute to the health disparities TIs experience.