The association between mindfulness and health promotion in undergraduate nursing students: A serial multiple mediator analysis.

AIM: This study was conducted to examine the association between mindfulness and health promotion among undergraduate nursing students and explore the mediation effect of certain factors (perceived stress, depressive symptoms, self-care agency, and impulsivity) on this relationship. DESIGN: Cross-sectional quantitative design. METHODS: A total of 195 undergraduate nursing students from a public university in Jordan participated in this study. A demographic questionnaire was used in addition to using well-established, validated tools to measure health promotion, mindfulness, perceived stress, depressive symptoms, impulsivity, and self-care agency. Data were collected between March and November 2018. Data were analysed using PROCESS macros. RESULTS: The direct association between mindfulness and health promotion was positive but not statistically significant. Simple mediation analysis showed that perceived stress is the only statistically significant mediator (effect = 0.03; 95% CI: LL = 0.008, UL = 0.057). The serial multiple mediator analyses revealed that three combinations of the mediators made the mindfulness effect on health promotion statistically significant; perceived stress and self-care agency (effect = -0.01, 95% CI: LL = -0.022, UL = -0.01); depressive symptoms and self-care agency (effect = 0.016, 95% CI: LL = 0.006, UL = 0.03); and perceived stress with depressive symptoms and self-care agency (effect = 0.006, 95% CI: LL = 0.002, UL = 0.013). CONCLUSIONS: The results of this study add to the literature evidence concerning the mediation role of perceived stress, depressive symptoms, and self-care agency on the relationship between mindfulness and health promotion among nursing students. IMPACT: This study examined the complex relationship between mindfulness and health promotion. There is a mediation effect of nursing students' perceived stress, depressive symptoms, and self-care agency on the relationship between mindfulness and health promotion. Researchers interested in designing mindfulness-based interventions to optimize health promotion of nursing students could benefit from the findings of this study.

The impact of health literacy on college students' psychological disturbances and quality of life: a structural equation modeling analysis.

BACKGROUND: The literature regarding the effect of health literacy on college students' psychological health and quality of life is scarce. The purpose of conducting this cross-sectional study was to examine the effect of health literacy on certain psychological disturbances (perceived stress, depressive symptoms, and impulsivity) and quality of life of college students. METHODS: A cross-sectional quantitative design was utilized in this study. A total of 310 four-year college students participated in this study. The students completed a demographics questionnaire as well as already established and validated measures of health literacy, perceived stress, depressive symptoms, impulsivity, and quality of life. Structural equation modeling was performed to analyze the data to explore the effect of health literacy on the psychological disturbances and quality of life. RESULTS: The results showed that health literacy has a negative effect on three psychological disturbances commonly experienced by college students; perceived stress, depressive symptoms, and impulsivity. In addition, the effect of health literacy on the quality of life was positive. CONCLUSION: The proposed conceptual model was supported. College students' counseling staff could use the findings to better address students' needs pertinent to psychological health and quality of life. Future research is warranted to develop a more comprehensive model that explains the role of health literacy in determining college students' psychological health and quality of life.

Validation of the Arabic version of the center for epidemiologic studies depression-revised: A comparison of the CESD-R and CESDR-12.

BACKGROUND: The Center for Epidemiologic Studies Depression-Revised (CESD-R) is a widely used tool to screen for depression in the general population. An Arabic version of the CESD-R has not yet been translated and validated. Thus, this article reports the findings of two studies that were conducted to examine the psychometric properties of the Arabic version of the CESD-R. METHODS: Both studies were conducted using cross-sectional designs among college students from two large universities in Jordan. A total of 988 students were recruited from University A and 251 from University B. Data were collected using self-report measures of depression, perceived stress, and quality of life. Exploratory factor analysis was performed followed by a series of confirmatory factor analyses to compare different versions of the Arabic CESD-R. Measurement invariance was performed across both samples and gender of participants. RESULTS: The analyses revealed that the goodness-of-fit indices for the 20-item version of the Arabic CESD-R are not supported. Alternatively, a shorter version (CESDR-12) was created and the results supported its reliability, validity, and measurement invariance. This version, compared to a 10-item version, is supported theoretically as the items are more reflective of the DSM-V criteria for diagnosing depression. LIMITATIONS: The specificity and sensitivity of the CESDR-12 were not evaluated in this article. CONCLUSION: The Arabic CESDR-12 is a reliable, valid tool to screen for depression. Considering the prevalence and potential consequences of depression among college students, this tool could be used to identify those at risk and provide timely counseling and interventions.

Health literacy: exploring disparities among college students.

BACKGROUND: Health literacy is a multidimensional concept that is considered a primary public health concern. This concept is often neglected in research, and the evidence regarding health literacy in college students is limited. The aim of this study was two-fold: to determine the needs and limitations of health literacy among college students and to explore the relationships among the nine dimensions of health literacy and sociodemographic factors, including age, gender, nationality, year of study, field of study, smoking status, history of chronic diseases, use of on-campus gym, and the intention to exercise on-campus. METHODS: This study was conducted using a cross-sectional approach. A total of 520 college students participated in this study. The average age was 21.03 years (SD = 2.29), with 47.5% males and 52.5% females. Data were collected using a demographics questionnaire and the Health Literacy Questionnaire (HLQ). In addition to descriptive statistics, multivariate analysis of variance (MANOVA) and follow-up analyses were performed to explore any statistically significant mean differences among levels of health literacy and sociodemographic factors. RESULTS: The levels of health literacy on the nine HLQ scales were lower than the levels reported in the literature. Multivariate analysis showed a significant effect of age, gender, smoking status, year of study, and field of study on the level of health literacy. Follow-up analyses revealed that female students, students from the health-related faculties, and those who do not smoke have higher levels of health literacy compared to their counterparts. A detailed comparison between the levels of the HLQ scales was made based on students' demographic characteristics. The field of study had the most prominent effect on the level of college students' health literacy; mean differences were statistically significant (p < .001), and effect sizes were large (ranging from .66 to 1.35 for the nine scales of the HLQ). CONCLUSION: College students' health literacy is influenced by demographic characteristics. Such variations could amplify some of the existing health disparities. The implications of the findings on health, health promotion, and interprofessional education are discussed.

Advancing the Science of Recruitment for Family Caregivers: Focus Group and Delphi Methods.

BACKGROUND: Successful recruitment of participants is imperative to a rigorous study, and recruitment challenges are not new to researchers. Many researchers have used social media successfully to recruit study participants. However, challenges remain for effective online social media recruitment for some populations. OBJECTIVE: Using a multistep approach that included a focus group and Delphi method, researchers performed this study to gain expert advice regarding material development for social media recruitment and to test the recruitment material with the target population. METHODS: In the first phase, we conducted a focus group with 5 social media experts to identify critical elements for effective social media recruitment material. Utilizing the Delphi method with 5 family caregivers, we conducted the second phase to reach consensus regarding effective recruitment videos. RESULTS: Phase I utilized a focus group that resulted in identification of three barriers related to social media recruitment, including lack of staff and resources, issues with restrictive algorithms, and not standing out in the crowd. Phase II used the Delphi method. At the completion of Delphi Round 1, 5 Delphi participants received a summary of the analysis for feedback and agreement with our summary. Using data and recommendations from Round 1, researchers created two new recruitment videos with additions to improve trustworthiness and transparency, such as the university's logo. In Round 2 of the Delphi method, consensus regarding the quality and trustworthiness of the recruitment videos reached 100%. CONCLUSIONS: One of the primary challenges for family caregiver research is recruitment. Despite the broad adoption of social media marketing approaches, the effectiveness of online recruitment strategies needs further investigation.

Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey.

BACKGROUND: Further exploration of the practice roles of psychiatric mental health (PMH) advanced practice registered nurses (APRNs) is warranted. OBJECTIVE: In March of 2016, the American Psychiatric Nurses Association (APNA) conducted a national survey to gather data on the demographics, practice roles, and activities of certified PMH APRNs. DESIGN: The e-mail survey contained 46 questions consistent with minimum data set requirements of the Forum of State Nursing Workforce Centers. RESULTS: The data indicate that PMH APRNs are a clinically active workforce; the majority deliver a wide variety of mental health services including diagnosis and management of both acute and chronic mental illness, prescribing, and providing psychotherapy. CONCLUSION: PMH APRNs are delivering care to clients dealing with a range of serious mental illnesses across the life span in a variety of roles. It will be critical to monitor the activities and outcomes of this expanding behavioral health care workforce.

Care for the Caregiver: Evaluation of Mind-Body Self-Care for Accelerated Nursing Students.

Stress affects the well-being of both nursing students and the individuals with whom they work. With the theory of cognitive appraisal as a framework for this study, it is proposed that mind-body self-care strategies promote stress management by stabilization of emotions. Outcomes will be a perception of less stress and more mindful engagement with the environment. Objective of the study was to describe an evaluation of student perceived stress and mindfulness to 1-hour per week of class time dedicated to mind-body self-care (yoga, mindful breathing, Reiki, and essential oil therapy). It was a quasi-experimental study; data collection took place at 4 time points. Participants were entry-level accelerated nursing students from 3 US universities: 50 in the treatment group, 64 in the comparison group. Data included health-promoting practices using Health-Promoting Promotion Lifestyle Profile II as a control variable, stress and mindfulness (Perceived Stress Scale [PSS] and Mindful Attention Awareness Scale [MAAS]), and demographic information; analysis using mixed-design repeated-measures analysis of variances. There was a statistically significant interaction between intervention and time on PSS scores, F(3, 264) = 3.95, P = .009, partial η(2) = 0.043, with PSS scores of the intervention group decreasing from baseline to T3 when intervention ended whereas PSS scores of the comparison group increased from baseline. The average scores on the MAAS did not differ significantly. Evaluation of an embedded mind-body self-care module in the first nursing course demonstrated promising improvements in stress management. The findings support the appropriateness of integrating mind-body self-care content into nursing curricula to enhance students' ability to regulate stress.

Adherence to antidepressant medications: a randomized controlled trial of medication reminding in college students.

OBJECTIVES: To determine if medication reminding via smartphone app increases adherence to antidepressant medications in college students. PARTICIPANTS: College students (N = 57) enrolled at a state-funded institution who had a current prescription for an antidepressant and regularly used a smartphone device. METHODS: Participants were randomized to either a reminder group or a control group. Both groups were asked to complete a survey and undergo a manual pill count at the beginning of the study and 30 days later. RESULTS: There was a strong trend suggesting that the use of a medication reminder app was beneficial for adherence to antidepressant medication regimens. Factors influencing medication adherence in college students included health beliefs, use of illicit drugs, and type of professional care received. CONCLUSIONS: Use of a medication reminder may increase adherence to antidepressant medications in college students.

The effect of telephone support on depressive symptoms among HIV-infected pregnant women in Thailand: an embedded mixed methods study.

Depressive symptoms negatively impact the lives of HIV-infected individuals and are correlated with faster progression to AIDS. Our embedded mixed methods study examined and described the effects of telephone support on depressive symptoms in a sample of HIV-infected pregnant Thai women. HIV-infected pregnant Thai women (n = 40) were randomly assigned to either the control or the intervention group. A registered nurse provided telephone support to the intervention group. Depressive symptoms were measured at three points in both groups. In-depth interviews were conducted at Time 2 and Time 3. Results show that depressive symptoms in the intervention group decreased over time. Qualitative results describe how telephone support can work, but also reveal that telephone support did not work for everyone. We recommend that a larger mixed methods study be conducted to examine the effects of telephone support on depressive symptoms among HIV-infected women, including the costs and benefits of such support.

HIV disclosure by perinatal women in Thailand.

Little is known about HIV disclosure among perinatal women, although we do know that disclosure can facilitate timely initiation of appropriate interventions for infected individuals and their families. This study, therefore, examined predictors of HIV disclosure among perinatal Thai women. Data (N = 207) were extracted from two larger studies of depressive symptoms in HIV-positive pregnant or postpartum women in Thailand in which participants completed questionnaires. Most participants had low socioeconomic status. Logistic regression indicated that significant predictors of disclosure included older age, employment, and high family support. Psychiatric mental health nursing interventions to promote family support are critical during this time.

Geospatial study of psychiatric mental health-advanced practice registered nurses (PMH-APRNs) in the United States.

OBJECTIVE: The objectives of this study were to identify geographic regions with shortages of psychiatric mental health-advanced practice registered nurses (PMH-APRNs), describe rural-urban differences in the distribution of PMH-APRNs, and discuss implications of the uneven geographic distribution. METHODS: The data source was a complete listing, provided by the American Nurses Credentialing Center, of the employment zip codes of certified PMH-APRNs during 2007 (N=10,452). Geographic information science techniques and spatial statistics were used to conduct a cluster analysis of the spatial distribution of PMH-APRNs. RESULTS: After adjustment for population on the basis of U.S. census reports, statistically significant clusters of counties with high and low density of PMH-APRNs, an indicator of uneven accessibility, were identified. Rural-urban differences in the distribution were also illustrated. CONCLUSIONS: The interdisciplinary approach, including both mapping and statistical analyses, identified shortage areas and provided the groundwork for directing future education, clinical practice, and public policy initiatives.

National survey of psychiatric mental health advanced practice nursing: the adequacy of educational preparation: voices of our graduates.

BACKGROUND: Little is known about the fit between practice and graduate education from the perspective of psychiatric mental health advanced practice registered nurses (PMH APRNs). OBJECTIVE: With the purpose of addressing this gap in our knowledge, an e-mail survey that was sent to certified PMH APRNs included a query "Did your program prepare you for your role?" and an open-ended follow-up question: "Please explain how your graduate program did not prepare you adequately for your role?" DESIGN: Descriptive survey. RESULTS: Although 70% of respondents reported satisfaction with their educational programs, content analysis of the comments indicated that the most pressing concerns related to instructional content about psychopharmacology, the practice of prescribing and psychiatric diagnosing, and that there was a perception of a disconnect between the role they were prepared for and their role in the present-day world of work. CONCLUSIONS: The findings reinforce the need for the PMH nursing specialty to further define the optimal methods for preparing APRNs for the full scope of psychiatric services they are licensed to provide as the size of the PMH APRN workforce increases.

National survey of psychiatric mental health advanced practice nursing: development, process, and finding.

A survey was sent to all Psychiatric Mental Health (PMH) Advanced Practice Registered Nurses (APRNs) who had a registered e-mail address with the American Nurses Credentialing Center, resulting in 1,899 usable surveys. The practice of two groups of APRNs was examined and contrasted: those certified to treat children and adolescents and PMH-APRNs certified only to treat adults. Our findings raise concerns about the numbers of PMH-APRNs treating children. Considering the national demand for mental health professionals prepared to treat children, the specialty must move to increase the number of qualified APRN child providers.

Emergency department visits for suicidality in three hospitals.

The purposes of this study were to describe suicidal persons who come to the emergency department (ED) and to examine the relationship between clinical and health service characteristics and decisions regarding post-ED care. Data were collected from three hospital EDs by means of a retrospective review of records. During the 1-month study period, 163 ED visits were for suicidal ideation (f = 110) or behavior (f = 53). The mean age of the patients was 36.5 years (range = 5-87 years); 51% were female patients. Clinical decisions about post-ED care tended to be cautious, regardless of a patient's level of suicidality, with 71% of patients either transferred for psychiatric evaluation or admitted to the psychiatric unit. Emergency department staff tended to be slightly more conservative than mental health professionals, but the difference in their decisions about disposition was not significant.

Effect of environment and research participant characteristics on data quality.

The purpose of this study, a component of a randomized clinical trial, was to assess the influence of the emergency department environment and participant characteristics on the accuracy of self-reported health care utilization. Interviews of 612 seniors aged 65 to 93 were conducted in two emergency departments. The research assistant, upon completion of each interview, rated characteristics of the emergency department and compared participants' self-reports of emergency department use and hospitalization during the previous 4 weeks with data from hospital records: 3.6% overreported and 2.2% underreported visits to the emergency department. Regarding hospitalizations, 2.6% overreported and 1.2% underreported. Discrepancies were associated with male gender, cognitive deficits, and risk status. Inconsistencies were not related to any of the environmental variables. These findings suggest that seniors without cognitive decline report reliable data even in a potentially challenging environment.

A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department.

OBJECTIVES: To evaluate the predictive ability of a simple six-item triage risk screening tool (TRST) to identify elder emergency department (ED) patients at risk for ED revisits, hospitalization, or nursing home (NH) placement within 30 and 120 days following ED discharge. METHODS: Prospective cohort study of 650 community-dwelling elders (age 65 years or older) presenting to two urban academic EDs. Subjects were prospectively evaluated with a simple six-item ED nursing TRST. Participants were interviewed 30 and 120 days post-ED index visit and the utilization of EDs, hospitals, or NHs was recorded. Main outcome measurement was the ability of the TRST to predict the composite endpoint of subsequent ED use, hospital admission, or NH admission at 30 and 120 days. Individual outcomes of ED use, hospitalization, and NH admissions were also examined. RESULTS: Increasing cumulative TRST scores were associated with significant trends for ED use, hospital admission, and composite outcome at both 30 and 120 days (p < 0.0001 for all, except 30-day ED use, p = 0.002). A simple, unweighted five-item TRST ("lives alone" item removed after logistic regression modeling) with a cut-off score of 2 was the most parsimonious model for predicting composite outcome (AUC = 0.64) and hospitalization at 30 days (AUC = 0.72). Patients defined as high-risk by the TRST (score > or = 2) were significantly more likely to require subsequent ED use (RR = 1.7; 95% CI = 1.2 to 2.3), hospital admission (RR = 3.3; 95% CI = 2.2 to 5.1), or the composite outcome (RR = 1.9; 95% CI 1.7 to 2.9) at both 30 days and 120 days than the low-risk cohort. CONCLUSIONS: Older ED patients with two or more risk factors on a simple triage screening tool were found to be at significantly increased risk for subsequent ED use, hospitalization, and nursing home admission.

Case finding and referral model for emergency department elders: a randomized clinical trial.

STUDY OBJECTIVE: Elderly emergency department patients have complex medical needs and limited social support. A transitional model of care adapted from hospitals was tested for its effectiveness in the ED in reducing subsequent service use. METHODS: A randomized clinical trial was conducted at 2 urban, academically affiliated hospitals. Participants were 650 community-residing individuals 65 years or older who were discharged home after an ED visit. Main outcomes were service use rates, defined as repeat ED visits, hospitalizations, or nursing home admissions, and health care costs at 30 and 120 days. Intervention consisted of comprehensive geriatric assessment in the ED by an advanced practice nurse and subsequent referral to a community or social agency, primary care provider, and/or geriatric clinic for unmet health, social, and medical needs. Control group participants received usual and customary ED care. RESULTS: The intervention had no effect on overall service use rates at 30 or 120 days. However, the intervention was effective in lowering nursing home admissions at 30 days (0.7% versus 3%; odds ratio 0.21; 95% confidence interval [CI] 0.05 to 0.99) and in increasing patient satisfaction with ED discharge care (3.41 versus 3.03; mean difference 0.37; 95% CI 0.13 to 0.62). The intervention was more effective for high-risk than low-risk elders. CONCLUSION: An ED-based transitional model of care reduced subsequent nursing home admissions but did not decrease overall service use for older ED patients. Further studies are needed to determine the best models of care for this setting and for at-risk patients.

Trauma in the very elderly: a community-based study of outcomes at trauma and nontrauma centers.

BACKGROUND: Little research has examined trauma outcomes in the very elderly (>80 years), the fastest growing subset of our geriatric population. Our objective was to describe demographics, mechanism of injury and injury severity of very elderly trauma patients and examine the association between trauma center (TC) verification and hospital mortality in this age group. METHODS: Retrospective cohort study. Database consisted of a 1996 countywide trauma registry. Subjects consisted of patients > 80 years of age. The setting consisted of Level I (TCI) and Level II (TCII) trauma centers, and acute care (AC) hospitals. The z score analysis was performed using the Major Trauma Outcome Study and a county-specific risk/outcome equation. In addition, a logistic regression model examined hospital mortality (outcome variable) using age, ISS, arrival GCS, and TC verification as predictor variables. Statistical analysis included descriptive statistics; ANOVA; and forward stepwise logistic regression model (OR; 95% CI). RESULTS: Four hundred fifty-five patients with a mean age of 85.9 (+/-4.8) years (range 80-101). Overall mortality was 9.9%. Using z score analysis, survival at TCII performed as predicted (-1.59), while AC performed less than predicted (-3.41). In the regression model, GCS (OR 0.68; CI 0.57-0.79), ISS (OR 1.1; CI 1.05-1.2) and AC setting (OR 3.2; CI 1.1-9.5) predicted hospital mortality. TCs had significantly better outcomes than AC hospitals in a subset of severely injured patients (ISS 21-45) (56% v 8% survival; p < 0.01). CONCLUSION: Risk-adjusted outcomes, in this population, differed between TC and AC settings. Head injury, injury severity, and lack of TC verification are associated with hospital mortality in very elderly trauma patients.