Shared Trauma: An evolutionary model concept analysis in light of COVID-19.

Shared trauma (ST) is a term historically applied to social work experiences, but other healthcare professionals (HCP) also experience ST. With the occurrence of COVID-19, ST has impacted HCP globally and has led to new discoveries and more questions regarding its scope, impact and duration. This article aims to explore the concept of ST applied to nurses in light of COVID-19 using the Rogers and Knafl Evolutionary Model for Concept Analysis. Further examination and evolution of 'shared trauma', particularly during COVID-19, has led to the development of an adapted model to explore the implications of ST on health-related outcomes for nurses.

Exploratory factor analysis of shared trauma in psychiatric-mental health nurses using the Shared Trauma Professional Posttraumatic Growth Inventory (STPPG).

INTRODUCTION: The Shared Trauma Professional Post Traumatic Growth Inventory (STPPG) was developed by Tosone et al. (2014) to help understand shared trauma (ST) in social workers. ST occurs when the healthcare professional and client both experience the same collective traumatic event. This inventory has been adapted for use with mental health nurses. A cross-sectional study of N = 552 mental health nurses was completed in the spring of 2023 to assess the feasibility of using the STPPG to explore shared trauma in mental health nurses. METHODS: An exploratory factor analysis was run for the STPPG using squared multiple correlations with the maximum likelihood method. RESULTS: The alpha coefficient ranged from 0.82 to 0.89 for 2-factors and 0.73 to 0.89 for 3-factors. The results indicated that all correlations were significant among the total scales and subscales. All correlations were positive, ranging from 0.81 to 0.95 for two factors and 0.58 to 0.89 for three factors. CONCLUSION: The STPPG has confirmed a two-factor analysis for mental health nurses. The STPPG is a valid inventory to measure ST in mental health nurses and will allow the concept to be further studied.

Exploring Health Care Access Among Lesbian, Gay, Bisexual, and Transgender Populations in Orange County, California: A Pilot Cross-sectional Study.

There are approximately 90 000 lesbian, gay, bisexual, and transgender (LGBT) individuals in Orange County, California. LGBT individuals have significant health disparities, particularly if they are from racial or ethnic minority groups and/or have a disability. There are structural and access barriers in the health care system that increase these health disparities. These individuals experience discriminatory situations when accessing health care and mental health services, which may affect their health-seeking behaviors. The purpose of this pilot quantitative cross-sectional study was to gather information about the current health care experiences and needs of this LGBT population including priority health issues, physical and mental health care utilization, and perceived adequacy of LGBT-friendly physical and mental health care providers. These findings will inform organizational strategies for nursing administrators and other health care leaders when tailoring, planning, and redesigning structures that meaningfully address the service needs of this at-risk group. Seventy-five participants were recruited from 2 organizations serving the LGBT community to complete an online survey. Findings include trouble finding an LGBT competent provider, delays or being unable to access care, and worried about losing insurance. Most participants needed to visit multiple different locations to receive care and preferred a 1-stop shop.

Developing Family Nurse Practitioner Student Competencies: A Two-Part Mental Health-Focused Telehealth Education Activity.

Telehealth is becoming a vital option for increasing access to health care. Family Nurse Practitioners (FNPs) are often the primary providers for rural and disadvantaged populations. They may be the first to encounter patients experiencing depression and other psychiatric problems. This article describes a two-part simulated telehealth education initiative to build FNP student competencies in the use of telehealth technology to interview clients with depressive symptoms. In Part 1, students completed didactic modules that introduced them to telehealth concepts. In Part 2, they participated in a simulated telehealth encounter with a standardized patient experiencing depression. Preparation included a review of care of patients with depression and focused content on telehealth etiquette. After the encounter, they received feedback from the standardized patient, debriefed with faculty, and documented their simulated telehealth visit. The activity was evaluated through post-education surveys and a one-time focus group. Students were overwhelmingly positive regarding the relevance of the educational activity to their graduate preparation and future practice. Many shared suggestions for refinement of the activity. Integration into the current curriculum and use of existing resources increased the feasibility, cost-effectiveness, and potential for long-term sustainability of the educational initiative.

Addressing the Mental Health of Nursing Students During the Pandemic: The Evaluation of a Needs Assessment by a College of Nursing Mental Health Task Force.

BACKGROUND: A Mental Health Task Force (MHTF) was developed in a large public college of nursing in the Southeastern United States to address the urgent mental health needs expressed by growing numbers of nursing students related to the coronavirus disease 2019 (COVID-19). AIMS: The purpose of this study was to report on a needs assessment conducted by the MHTF. METHODS: The needs assessment study design was a 16-item cross-sectional online survey and four "Town Hall" focus groups with nursing students, faculty, and staff (n = 1-8 participants per group). Survey data were analyzed using descriptive statistics and free-text questions from the survey and focus groups were analyzed using a qualitative descriptive approach. RESULTS: Undergraduate and graduate students (n = 115) ranging in age from 17 to 50 years completed the survey; 95% female, 94% full-time, 56% employed, 77% White, and 81% in the Bachelor of Science in Nursing program. Eleven students participated in the focus groups. The analysis of the free-text survey questions identified the students' perceived needs. Mental health care was the most frequently requested, followed by faculty check-ins, stress management, and peer support. CONCLUSIONS: The administration of the survey provided an opportunity for students to communicate concerns and make requests. To address the ongoing effects of the COVID-19 pandemic on nursing students, multi-modal needs assessments should be conducted periodically to identify priority mental health needs.

Leveraging digital technology for social connectedness among adults with chronic conditions: A systematic review.

Purpose: To review the evidence about the impact of digital technology on social connectedness among adults with one or more chronic health conditions. Methods: PubMed, Embase, Social Sciences, CINAHL, and Compendex were systematically searched for full-text, peer-reviewed empirical evidence published between 2012 and 2023 and reported using the PRISMA flow diagram. Articles were critically appraised applying the Joanna Briggs Institute checklists. Specific data were extracted based on the framework for social identity and technology approaches for health outcomes and then analyzed and synthesized. Results: Thirty-four studies met study criteria. Evidence showed heterogeneity among research methodology, chronic health conditions, digital technology, and health outcomes. Technology use was influenced by factors such as usability, anonymity, availability, and control. More advanced digital technologies require higher digital literacy and improved accessibility features/modifications. Social support was the most measured aspect of social connectedness. The emotional and informational forms of social support were most reported; instrumental support was the least likely to be delivered. Self-efficacy for using technology was considered in seven articles. Sixteen articles reported health outcomes: 31.2% (n = 5) described mental health outcomes only, 18.8% (n = 3) reported physical health outcomes only, 31.2% (n = 5) detailed both physical and mental health outcomes, whereas 18.8% (n = 3) denoted well-being or quality-of-life outcomes. Most often, health outcomes were positive, with negative outcomes for selected groups also noted. Conclusion: Leveraging digital technology to promote social connectedness has the potential to affect positive health outcomes. Further research is needed to better understand the social integration of technology among populations with different contexts and chronic health conditions to enhance and tailor digital interventions.

Next generation nurse scientists: A systems approach to engaging undergraduate students in research.

BACKGROUND: Nursing Doctor of Philosophy program enrollment has declined. Undergraduate nursing student (UGS) research engagement is associated with future graduate education, an essential element for building the nursing faculty pipeline. PURPOSE: (a) To describe the infrastructure and culture-enhancing resources and strategies associated with building UGS research engagement and (b) to evaluate UGS research engagement. METHODS: Guided by a socioecological systems model university and college documents, databases, and college of nursing survey results were used to identify approaches to, and outcomes of, engaging UGS in research. Descriptive statistics were calculated to illustrate 5-year UGS research engagement trends. FINDINGS: Resources and strategies included grant funding, research assistant funding, student research showcases, and faculty mentorship. UGS research 5-year engagement trends included (a) a 75% increase in the number of students mentored, (b) a 30% rise in funded research proposals, and (c) a 54% increase in paid research assistantships. DISCUSSION: Purposefully using existing resources, growing the college of nursing infrastructure, and cultivating a culture recognizing faculty contributions were approaches associated with increased UGS research engagement.

Leveraging Digital Technology to Support Pregnant and Early Parenting Women in Recovery from Addictive Substances: A Scoping Review.

Little is known about digital health interventions used to support treatment for pregnant and early parenting women (PEPW) with substance use disorders (SUD). METHODS: Guided by the Arksey and O'Malley's Scoping Review Framework, empirical studies were identified within the CINAHL, PsycInfo, PubMed, and ProQuest databases using subject headings and free-text keywords. Studies were selected based on a priori inclusion/exclusion criteria, and data extraction and descriptive analysis were performed. RESULTS: A total of 27 original studies and 30 articles were included. Varying study designs were used, including several feasibility and acceptability studies. However, efficacious findings on abstinence and other clinically important outcomes were reported in several studies. Most studies focused on digital interventions for pregnant women (89.7%), suggesting a dearth of research on how digital technologies may support early parenting women with SUD. No studies included PEPW family members or involved PEPW women in the intervention design. CONCLUSIONS: The science of digital interventions to support treatment for PEPW is in an early stage, but feasibility and efficacy results are promising. Future research should explore community-based participatory partnerships with PEPW to develop or tailor digital interventions and include family or external support systems to engage in the intervention alongside PEPW.

Building Spiritual Care Competency in Undergraduate Psychiatric Mental Health Nursing Students: A Quality Improvement Project.

Purpose: The spiritual care of patients is often overlooked in health care as many nurses are unprepared to provide competent, holistic care that addresses patients' spiritual needs. Since undergraduate academic instruction prepares nurses for practice, innovative strategies that train pre-licensure nurses to care for the spiritual needs of patients are essential. Design: A course needs assessment identified spiritual care as the most deficient competency for undergraduate psychiatric students. A three-phase quality improvement project designed to increase student awareness and practice of spiritual care included (a) development of a quality improvement plan, (b) implementation, and (c) outcome evaluation. Methods: Spiritual care was introduced into the Spring 2020 semester through didactic content and experiential practice. Additionally, an evidence-based spiritual assessment tool (i.e., HOPE questions) was integrated into the course to train students for use in clinical and simulation. Surveys were used to compare the 2019 and 2020 cohorts. Findings: Results showed a statistically significant increase in students' perception of spiritual care competency after project completion. Conclusions: Future implications include the use of similar methods to improve spiritual care competency for pre-licensure nursing students. Keywords: Spiritual care, undergraduate nurse, spiritual assessment.

Understanding Alcohol Use Discourse and Stigma Patterns in Perinatal Care on Twitter.

(1) Background: perinatal alcohol use generates a variety of health risks. Social media platforms discuss fetal alcohol spectrum disorder (FASD) and other widespread outcomes, providing personalized user-generated content about the perceptions and behaviors related to alcohol use during pregnancy. Data collected from Twitter underscores various narrative structures and sentiments in tweets that reflect large-scale discourses and foster societal stigmas; (2) Methods: We extracted alcohol-related tweets from May 2019 to October 2021 using an official Twitter search API based on a set of keywords provided by our clinical team. Our exploratory study utilized thematic content analysis and inductive qualitative coding methods to analyze user content. Iterative line-by-line coding categorized dynamic descriptive themes from a random sample of 500 tweets; (3) Results: qualitative methods from content analysis revealed underlying patterns among inter-user engagements, outlining individual, interpersonal and population-level stigmas about perinatal alcohol use and negative sentiment towards drinking mothers. As a result, the overall silence surrounding personal experiences with alcohol use during pregnancy suggests an unwillingness and sense of reluctancy from pregnant adults to leverage the platform for support and assistance due to societal stigmas; (4) Conclusions: identifying these discursive factors will facilitate more effective public health programs that take into account specific challenges related to social media networks and develop prevention strategies to help Twitter users struggling with perinatal alcohol use.

Student perceptions of faculty caring in online nursing education: A mixed-methods study.

BACKGROUND: As the prevalence of online nursing education increased, so did the need for faculty to understand student perceptions of faculty behaviors that demonstrate caring and promote student success. Literature from both education and nursing journals supported this study. OBJECTIVES: Primary objectives were to identify how the value of caring is made visible in online learning, to understand how students prioritized faculty caring behaviors and to identify any significant differences in perceptions related to student demographics. A secondary objective was to provide professional development tools for faculty who teach nursing students in the online environment. DESIGN: Mixed methods. SETTING: A College of Nursing within a large public university in the Southeastern United States. PARTICIPANTS: One hundred and forty-one (141) nursing students pursuing graduate degrees (MSN or DNP) participated in the student survey and 15 participated in the focus groups/interviews; 28 faculty members responded to the survey. METHODS: A validated survey tool was used to identify how students prioritized faculty caring behaviors. Facilitator-led focus groups were used to gain additional insights. Faculty members were surveyed to compare faculty and student priorities. Descriptive and correlational analyses were performed. RESULTS: Graduate nursing students perceived a course that is well-designed, with clear instructions and communication, and a supportive environment, to be evidence of faculty caring. There were significant differences in student responses when analyzed by demographic characteristics such as gender and race. Student perceptions aligned with previous research on this topic; faculty and student perceptions differed in some areas. CONCLUSION: Quantifying graduate student perceptions about faculty caring behaviors provided information that is used for faculty professional development. Further research is needed to explore perceptions of faculty caring in different student populations. Multi-site studies to explore race and gender differences in perception are also recommended.

Using community-based participatory methods to design a digital intervention for mothers with substance use disorders: Qualitative results from focus group discussions.

PURPOSE: This community-based participatory research project explored the feasibility of delivering parenting and recovery supports through digital technology for mothers recovering from addictive substances. DESIGN AND METHODS: A community advisory board of key stakeholders (n = 7) served as a focus group of advisors to discuss needed supports. Data were analyzed through qualitative descriptive analysis. FINDINGS: Results revealed themes about challenges and supports needed, and whether supports delivered through digital technology may improve recovery and parenting. PRACTICE IMPLICATIONS: Future exploration needs to examine the extent to which the use of community-guided, tailored digital support applications that supplement prescribed treatment can enhance parenting and recovery.

Building psychiatric advanced practice student nurse competency to conduct comprehensive diagnostic interviews using two types of online simulation methods.

BACKGROUND: Through innovative use of established technologies, online nursing programs can provide psychiatric mental health nurse practitioner (PMHNP) students with robust virtual experiences for learning professional competencies, including those involving psychomotor and affective domains. PURPOSE: To describe a virtual simulation teaching methodology using online text-based simulations of patient visits prior to a virtual standardized patient (SP) encounter in an asynchronous online course for PMHNP students. METHOD: Student learning experiences were framed by the Framework for the 21st Century Learning. Two types of online simulations were employed: (1) four text-based exercises, created with a testing tool in a learning management system, allowed students to practice the critical thinking processes behind diagnostic interviewing, and (2) a telehealth simulation with an SP, where students engaged the patient, conducted a diagnostic interview, and discussed the treatment plan with the patient. Following the telehealth simulation, students completed self-assessments, received individual feedback from the SP and clinical faculty, and discussed experiences in small groups. RESULTS: Students demonstrated professional competencies and developed self-awareness and self-efficacy through reflection and discussion. CONCLUSION: This teaching approach can potentially enhance learning and build greater career skills including conducting diagnostic interviews using therapeutic communication skills for patients with stigmatizing mental health conditions.

Exploring substance use and mental health for minority transgender youth: Implications for advanced practice nurses.

BACKGROUND: Transgender youth, particularly if they are transgender female and of a minority racial or ethnic group (i.e., minority transgender youth [MTY]), are known to have higher incidence of new HIV infections, substance abuse, and suicidality when compared with cisgender youth. Mental health disparities and substance use among MTY, between the ages of 13-24 years, have been underexplored in the United States, although they have serious public health concerns contributing to morbidity and mortality. OBJECTIVES: To examine the US literature to discover what is known about the intersection of substance use, mental health disorders, and associated health risks for MTY. DATA SOURCES: An integrative review exploring experimental and nonexperimental research was conducted from 2010 to 2018 using Cumulative Index for Nursing and Allied Health (CINAHL), PsycINFO, and PubMed. Articles were selected if the research identified MTY, mental health and/or substance use risks, data-driven outcomes, or considerations that could potentially influence MTY outcomes. Ten articles were included in the final selection. CONCLUSIONS: All studies addressed mental health, substance use, and/or health risks, although many of the articles explored all transgender youth outcomes without a particular focus on MTY. Identified factors linked to poor health outcomes included socioeconomic vulnerability, substance use, mood disorders, self-harm, and risky sexual behaviors. IMPLICATIONS FOR PRACTICE: The authors have provided recommendations regarding culturally appropriate, compassionate, evidence-informed practices for engaging MTY and their families to promote greater well-being for all youth, regardless of gender identity.

A feasibility study exploring self-care and parenting for adults recovering from addictive substances.

Little information is available on parental self-care while in recovery from addictive substances, and its relationship to parenting and recovery outcomes. We evaluated the feasibility of obtaining self-care and parenting outcomes for adults in long-term recovery from addictive substances, and explored potential contributing factors. Nineteen mothers and fathers who self-reported at least two years of sobriety participated in this study. Feasibility challenges included recruitment and scheduling interviews, given multiple work and personal demands on participants' schedules. Possible associations of self-care to parental efficacy (PE), parenting behaviors, resilience, and total recovery years were examined as indicators to parental functioning. The exploratory analyses showed a significant moderate correlation between PE and parenting behaviors (r = 0.45, p < 0.05) as well as total years in recovery and age (r = 0.43, p < 0.05); total years in recovery differed significantly when compared by race (χ2 (1) = 5.63; p = 0.018) and education (χ2 (1) = 3.94; p = 0.048). There was also a significant inverse relationship between total years in recovery and PE (r = -0.43, p < 0.05) and parental self-care (r = -0.59, p < 0.01). Recruiting parents (especially minorities) in long-term recovery was very challenging indicating that recruitment through community organizations was not feasible without a site champion. Preliminary findings showed statistically significant correlations among self-care, parental efficacy, age, and total years in recovery. As researchers and clinicians, it is necessary to determine the role and impact of self-care for future intervention development, however, recruitment strategies need to be modified to ensure sufficiently large study samples.

Exploring Self-Care and Preferred Supports for Adult Parents in Recovery from Substance Use Disorders: Qualitative Findings from a Feasibility Study.

Very little is known about the self-care behaviors (SCB) that adult parents employ and the preferred supports they utilize to maintain their recovery from substance use disorders (SUD) while also parenting their children. This study used a qualitative descriptive approach to explore perceptions of self-care and parenting to inform future self-care interventions for parents in early recovery. Nineteen mothers and fathers of at least one child between the ages of 6-18 were interviewed by telephone about parental self-care practices while in recovery from SUD, recovery management, and preferred supports in the community. Participants described the experience of parenting as challenging, with variations in the level of support and resources. Self-care included meaningful connection with recovery support and children, taking care of physical health, maintaining spirituality, healthy eating, exercise, journaling, continuing education, staying busy, sponsorship, establishing boundaries, self-monitoring, abstinence, and dealing with destructive emotions. Participants reported SCB as being a critical component of their ongoing recovery and their parenting practices, though differences in SCB by gender and for minorities require further exploration. Parental gains were perceived as benefits of SCB that minimized the negative impact of prior parental drug use on their children.

The Role of Self-Care for Parents in Recovery From Substance Use Disorders: An Integrative Review of Parental Self-Care.

BACKGROUND: Lack of stress modifiers, such as self-care behaviors (SCBs), can increase vulnerability to drug use for parents in recovery from substance use disorders (SUDs). PURPOSE: The purpose of this integrative review was to determine how the existing literature describes, conceptualizes, and measures SCB for parents in the general population for its application to parents with a history of SUD. METHODS: Framed by Bandura's Social Cognitive Theory of Substance Abuse, four qualitative and five quantitative studies identify SCB, although only one study describes SCB of parents in recovery. RESULTS: Few studies addressed parental SCB, and most of those studies focused on behaviors for new mothers with or without SUDs during the early child years. CONCLUSIONS: Exploring the role of SCB in relation to parental well-being for the general population is a needed area for further research, even more so for parents who are recovering from SUDs.

Attitudes and perceptions of patients on the kidney transplant waiting list toward mobile health-delivered physical activity programs.

CONTEXT: Dialysis patients' lifestyles are associated with low levels of physical activity, increasing the chances of being removed from kidney waiting lists or dying while awaiting transplant because of increased cardiovascular risk factors and deteriorating health conditions. Personalized mobile health (mHealth) delivered programs may support their engagement in healthier lifestyles, maintain transplant eligibility, and reduce premature mortality. OBJECTIVE: To explore barriers and perceptions of physical activity behaviors and gauge interest in using mHealth in a physical activity wellness program for dialysis patients on the kidney transplant waiting list. PARTICIPANTS AND DESIGN: In-depth key informant interviews were conducted with 22 randomly selected dialysis patients during dialysis treatment in an urban Southeastern coastal city. A theory-guided community-based participatory research approach was used to develop the interview content. Constructivist grounded theory guided the data analysis using NVIVO 10 (QSR Int). The 32-item checklist from the Consolidated Criteria for Reporting Qualitative Studies was used in the qualitative reporting. RESULTS: Dialysis patients had a mean age of 46 (SD, 10.7) years, 45% were female, and 82% were African American. Their mean duration on transplant waiting lists was 6.7 (SD 4.3) years, and 73% owned smartphones. After saturation was reached, predominant themes included (1) physical activity was perceived as optional, (2) social support both encouraged and limited physical activity, (3) chronic stress and coping influenced physical activity, (4) spirituality provided strength to engage in physical activity, (5) self-care management practices varied considerably, and (6) high interest (95%) for using mHealth to promote physical activity was found. Patients preferred their home and neighborhood environments to intradialytic settings for engaging in physical activity.

An exploration of the factors influencing parental self-efficacy for parents recovering from substance use disorders using the social ecological framework.

BACKGROUND: The evidence strongly links parental self-efficacy (PSE) to parenting behaviors and child health outcomes. PURPOSE: The purpose of this article is to apply the social ecological model to the exploration of contextual factors that influence PSE for parents recovering from substance use disorders (SUDs). METHODS: An integrative review of the literature was conducted on PSE, parenting behaviors, and parents recovering from alcohol and other SUDs through the application of the social ecological model. RESULTS: The results indicated that there are many individual, interpersonal, and environmental variables that influence PSE for parents with or without addiction. CONCLUSIONS: Because PSE is a strong predictor of parenting behaviors and child health outcomes, interventions designed to improve PSE may improve the overall health outcomes of families affected by SUD. These interventions would need to address intrapersonal factors of guilt and shame associated with addiction, parenting knowledge (individual), social support (interpersonal), social networking of church, and other community support programs. The integral role of community support, multiagency collaboration (organizational), and national policies (policy) impacting funding for SUD should also be considered. Intervening on multiple ecological systems simultaneously can mitigate negative factors predictive of PSE, improve access to healthcare and service delivery, and transform and sustain positive behavioral changes for parents recovering from SUD.