Biobehavior Life Regulation (BLR) scale for living well in chronic pain: Preliminary scale development and validation.

Currently available pain assessment scales focus on pain-related symptoms and limitations imposed by pain. Validated assessment tools that measure how pain is regulated by those who live well with pain are missing. This study seeks to fill this gap by describing the development and preliminary validation of the Biobehavior Life Regulation (BLR) scale. The BLR scale assesses engagement, social relatedness, and self-growth in the presence of chronic pain and the unpredictability of chronic pain. Sources for items included survivor strategies, patient experiences, existing scales, and unpredictable pain research. Review for suitability yielded 52 items. Validation measures were identified for engagement, social relatedness, self-growth, and unpredictability of pain. The study sample (n = 202) represented patients treated in the Phoenix VA Health Care System (n = 112) and two community clinics (n = 90). Demographic characteristics included average age of 52.5, heterogeneous in ethnicity and race at the VA, mainly Non-Hispanic White at the community clinics, 14 years of education, and pain duration of 18 years for the VA and 15.4 years for community clinics. Exploratory factor analysis using Oblimin rotation in the VA sample (n = 112) yielded a two-factor solution that accounted for 48.23% of the total variance. Confirmatory factor analysis (CFA) in the same sample showed high correlations among items in Factor 1, indicating redundancy and the need to further reduce items. The final CFA indicated a 2-factor solution with adequate fit to the data. The 2-factor CFA was replicated in Sample 2 from the community clinics (n = 90) with similarly adequate fit to the data. Factor 1, Pain Regulation, covered 8 items of engagement, social relatedness, and self-growth while Factor 2, Pain Unpredictability, covered 6 items related to the experience of unpredictable pain. Construct validity showed moderate to higher Pearson correlations between BLR subscales and relevant well-established constructs that were consistent across VA and community samples. The BLR scale assesses adaptive regulation strategies in unpredictable pain as a potential tool for evaluating regulation resources and pain unpredictability.

Adaptive Homeostatic Strategies of Resilient Intrinsic Self-Regulation in Extremes (RISE): A Randomized Controlled Trial of a Novel Behavioral Treatment for Chronic Pain.

Current treatments for chronic pain have limited benefit. We describe a resilience intervention for individuals with chronic pain which is based on a model of viewing chronic pain as dysregulated homeostasis and which seeks to restore homeostatic self-regulation using strategies exemplified by survivors of extreme environments. The intervention is expected to have broad effects on well-being and positive emotional health, to improve cognitive functions, and to reduce pain symptoms thus helping to transform the suffering of pain into self-growth. A total of 88 Veterans completed the pre-assessment and were randomly assigned to either the treatment intervention (n = 38) or control (n = 37). Fifty-eight Veterans completed pre- and post-testing (intervention n = 31, control = 27). The intervention covered resilience strengths organized into four modules: (1) engagement, (2) social relatedness, (3) transformation of pain and (4) building a good life. A broad set of standardized, well validated measures were used to assess three domains of functioning: health and well-being, symptoms, and cognitive functions. Two-way Analysis of Variance was used to detect group and time differences. Broadly, results indicated significant intervention and time effects across multiple domains: (1) Pain decreased in present severity [F ( 1, 56) = 5.02, p < 0.05, η2 p = 0.08], total pain over six domains [F ( 1, 56) = 14.52, p < 0.01, η2 p = 0.21], and pain interference [F ( 1, 56) = 6.82, p < 0.05, η2 p = 0.11]; (2) Affect improved in pain-related negative affect [F ( 1, 56) = 7.44, p < 0.01, η2 p = 0.12], fear [F ( 1, 56) = 7.70, p < 0.01, η2 p = 0.12], and distress [F ( 1, 56) = 10.87, p < 0.01, η2 p = 0.16]; (3) Well-being increased in pain mobility [F ( 1, 56) = 5.45, p < 0.05, η2 p = 0.09], vitality [F ( 1, 56) = 4.54, p < 0.05, η2 p = 0.07], and emotional well-being [F ( 1, 56) = 5.53, p < 0.05, η2 p = 0.09] Mental health symptoms and the cognitive functioning domain did not reveal significant effects. This resilience intervention based on homeostatic self-regulation and survival strategies of survivors of extreme external environments may provide additional sociopsychobiological tools for treating individuals with chronic pain that may extend beyond treating pain symptoms to improving emotional well-being and self-growth. Clinical Trial Registration: Registered with ClinicalTrials.gov (NCT04693728).

Engaging Perioperative Learners Using Online game-based Education.

Nurse educators may experience challenges (eg, distracted learners, inability to provide immediate feedback) when teaching in a classroom setting. Further, the perioperative workforce is multigenerational-younger staff members may have started using technology on a daily basis at a young age, so they may become distracted during traditional lectures and not retain important information. Online game-based learning (GBL) platforms are one technological solution that perioperative educators can use to maintain student engagement and foster learning. Educators at an academic medical center used an online GBL platform to develop presentations on instrument sterilization and surgical attire with sterile technique. At the conclusion of the sessions, the participants submitted surveys evaluating the teaching method. The survey results showed that the respondents found the GBL program to be a fun and positive interactive learning experience. Nurse educators should consider using this type of technology to improve participation and knowledge retention when developing educational programs.

Improving Preprocedure Time Out Compliance Using Remote Audiovisual Observation.

Health care organization leaders can help prevent surgical errors by ensuring compliance with standardized preprocedure time outs that require the active participation and engagement of the entire surgical team. Some surgical department leaders have used remote video observation without audio to monitor compliance with the time out. After a sentinel event occurred, leaders at our large academic medical center initiated a quality improvement project to audit compliance with the standardized preprocedure time out. We used remote audiovisual observation to ensure that all members of the procedure team were adhering strictly to the elements of the preprocedure time out in all invasive procedure areas. Since the beginning of this remote auditing process, team member compliance with the standardized preprocedure time out has improved.

Exploring General Practitioners' Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia.

The prevalence of people seeking care for Borderline Personality Disorder (BPD) in primary care is four to five times higher than in the general population. Therefore, general practitioners (GPs) are important sources of assessment, diagnosis, treatment, and care for these patients, as well as important providers of early intervention and long-term management for mental health and associated comorbidities. A thematic analysis of two focus groups with 12 GPs in South Australia (in discussion with 10 academic, clinical, and lived experience stakeholders) highlighted many challenges faced by GPs providing care to patients with BPD. Major themes were: (1) Challenges Surrounding Diagnosis of BPD; (2) Comorbidities and Clinical Complexity; (3) Difficulties with Patient Behaviour and the GP⁻Patient Relationship; and (4) Finding and Navigating Systems for Support. Health service pathways for this high-risk/high-need patient group are dependent on the quality of care that GPs provide, which is dependent on GPs' capacity to identify and understand BPD. GPs also need to be supported sufficiently in order to develop the skills that are necessary to provide effective care for BPD patients. Systemic barriers and healthcare policy, to the extent that they dictate the organisation of primary care, are prominent structural factors obstructing GPs' attempts to address multiple comorbidities for patients with BPD. Several strategies are suggested to support GPs supporting patients with BPD.

An Educational Implementation Process Staff Survey: Lessons Learned.

OBJECTIVE: To evaluate the education process for the effective use of the Munro Pressure Ulcer Risk Assessment Scale by practicing perioperative staff at an urban tertiary medical center. Given that pressure injury formation is tied to the surgical process, there is a need for a pressure injury risk assessment scale that addresses the uniqueness of the perioperative process. METHODS: Participants were staff who worked in the surgical admissions area, the main operating room, and the main postanesthesia care unit. The authors' facility was 1 of 8 participants in a multisite study. Each site was required to educate staff using standard written instructions and an instructional webinar. However, sites were also encouraged to consider any other methods that would successfully engage the staff in the learning process. After the education process, staff were surveyed and asked to evaluate the educational interventions. MAIN RESULTS: Findings indicated that the staff did not prefer written instructions alone but rather preferred a combination of different learning modalities and media to assist them in using the Munro Scale effectively. CONCLUSIONS: This article discusses the strategies required to engage staff in the implementation process of this scale, the barriers encountered during this implementation, and the implications for perioperative nursing using this scale. The lessons learned from conducting this research provided insight into engaging and educating the adult learner in a new process.

Operation Clean Air: Implementing a Surgical Smoke Evacuation Program.

Surgical smoke is a hazardous byproduct of any surgery involving a laser or an electrosurgical unit. Although research and professional organizations identified surgical smoke as harmful many years ago, this byproduct continues to be a safety hazard in the OR. An interdisciplinary team at a large academic medical center sought to address the exposure of patients and perioperative team members to surgical smoke. The team used the nursing process to resolve the lack of smoke-evacuator equipment and surgical smoke staff member knowledge. To increase awareness of the hazards of surgical smoke, we gave presentations to nursing staff members and surgeons, who then completed educational modules. We conducted audits in all ORs to monitor compliance. The use of smoke evacuation supplies has more than quadrupled since education began. Additional unit-based education continues every day and is a constant reminder that safety is the responsibility of all perioperative team members.

Goal-Directed Resilience in Training (GRIT): A Biopsychosocial Model of Self-Regulation, Executive Functions, and Personal Growth (Eudaimonia) in Evocative Contexts of PTSD, Obesity, and Chronic Pain.

This paper presents a biopsychosocial model of self-regulation, executive functions, and personal growth that we have applied to Goal-Directed Resilience in Training (GRIT) interventions for posttraumatic stress disorder (PTSD), obesity, and chronic pain. Implications of the training for the prevention of maladaptation, including psychological distress and health declines, and for promoting healthy development are addressed. Existing models of attention, cognition, and physiology were sourced in combination with qualitative study findings in developing this resilience skills intervention. We used qualitative methods to uncover life skills that are most salient in cases of extreme adversity, finding that goal-directed actions that reflected an individual's values and common humanity with others created a context-independent domain that could compensate for the effects of adversity. The efficacy of the resilience skills intervention for promoting positive emotion, enhancing neurocognitive capacities, and reducing symptoms was investigated in a randomized controlled trial with a veteran population diagnosed with PTSD. The intervention had low attrition (8%) and demonstrated improvement on symptom and wellbeing outcomes, indicating that the intervention may be efficacious for PTSD and that it taps into those mechanisms which the intervention was designed to address. Feasibility studies for groups with comorbid diagnoses, such as chronic pain and PTSD, also showed positive results, leading to the application of the GRIT intervention to other evocative contexts such as obesity and chronic pain.

Integration of negative experiences: A neuropsychological framework for human resilience.

We propose that the fundamental mechanism underlying resilience is the integration of novel or negative experiences into internal schemata. This process requires a switch from reactive to predictive control modes, from the brain's salience network to the default mode network. Reappraisal, among other mechanisms, is suggested to facilitate this process.

A resilience-oriented treatment for posttraumatic stress disorder: results of a preliminary randomized clinical trial.

This preliminary randomized trial examined the effect of a resilience-oriented intervention for posttraumatic stress disorder (PTSD) versus a waitlist control on anxiety and depressive symptoms, positive emotional health, and cognitive performance in 39 veterans with a variety of traumatic exposures. From pre- to posttreatment, the intervention but not the control group showed improvements that were large in magnitude for affective symptoms and positive emotional health (ds = 0.73-1.18), moderate in magnitude for memory (ds = 0.50-0.54), and small-to-moderate in magnitude for executive function (ds = 0.30-0.35). Findings suggest that treatment explicitly targeting resilience resources (e.g., positive emotional engagement, social connectedness) may provide broad benefits, including alleviation of anxiety and depressive symptoms and improved positive emotional and cognitive function.

Health risks associated with consumption of microcystin-contaminated fish and shellfish in three Chinese lakes: significance for freshwater aquacultures.

The risks associated with consuming aquatic products were systematically evaluated by analyzing 26 economically important fish and shellfish species which were harvested monthly from three large lakes in China during the fisheries catch season. Results indicate most of the aquatic products from the three large lakes seem to be unsafe for human consumption due to microcystin accumulations, with the estimated daily intake (EDI) values 5-148 times, 2-50 times and 1.5-4 times higher than the tolerable daily intake (TDI) value in Taihu, Chaohu and Dianchi, respectively. In addition, the toxin accumulation in the harvested organisms varied intensity from month to month and by species which suggests that consumption risks may be reduced or avoided by either adjusting the legal fishing seasons or the species of fish and shellfish harvested. This study will provide new information about the risks associated with the consumption of aquatic products and suggests possible management strategies to reduce or avoid potential health risks.