Tai Chi as a Complementary Therapy for Depression and Anxiety Among U.S. Veterans in a Mental Health Inpatient Setting.

BACKGROUND: Depression and anxiety are two of the top five mental illnesses veterans report. Treatment for depression and anxiety includes medications and psychiatric treatment in inpatient, outpatient, and residential treatment programs; the use of complementary and alternative medicine (CAM) can have beneficial results by decreasing symptoms, recognize patients' preference for CAM, and be cost-effective. AIM: This study aimed to evaluate the effects of Tai Chi on depression and anxiety symptoms on inpatient psychosocial or substance use disorder (SUD) rehabilitation treatment program residents since little evidence exists regarding the effectiveness of Tai Chi on participants in residential mental health treatment programs. METHOD: A mixed-method, cohort design with 88 participants (41 usual treatment without Tai Chi, 47 intervention) used a demographic survey, Hamilton Anxiety Scale, Quick Inventory of Depressive Symptomatology, self-report, and the Patient Health Questionnaire-9 at Weeks 1 and 4 of the treatment program. After Week 4, the intervention group responded to six open-ended questions about Tai Chi's effects on their overall depression and anxiety. RESULTS: The anxiety level of the intervention group was significantly decreased, as evidenced by the Hamilton Anxiety Scale scores (p = .02). However, the measures of depression did not differ between the groups. Two themes, mindfulness and satisfaction, were identified from the written responses regarding the Tai Chi intervention. CONCLUSION: Tai Chi effectively reduced symptoms of anxiety that varied by age and ethnicity. This study increased the insight regarding the benefit of including Tai Chi as a complementary therapy for those participating in residential treatment programs.

The Experience of Frontline Nurses during the COVID-19 Pandemic: A Phenomenological Study.

The purpose of this phenomenological study was to describe the experience of frontline nurses working during the COVID-19 pandemic. The first author conducted two individual audiotaped interviews with 23 qualified staff nurses. All the authors analyzed the professionally transcribed data according to hermeneutic principles. The researchers identified five major themes: (a) we are family; (b) heroes work here; (c) fear of contagion; (d) mental health and well-being; and (e) new reality. Given the uncertainties of working during the COVID-19 pandemic, findings revealed the value of supportive collegial relationships and the need to support the mental health and well-being needs of frontline nurses during the pandemic. Nurses need supportive environments to help ease the challenges associated with serving on the frontline during times of crisis. Findings have implications for future public health preparedness and response efforts.

Effects of Implementing an Acuity Tool on a Psychiatric Intensive Care Unit.

BACKGROUND: Staff shortages, reduced budgets, and high acuity of violent psychiatric patients can create challenges in psychiatric intensive care units (PICUs). LOCAL PROBLEM: Staffing of the psychiatric unit was based on patient census rather than evidence-based practices. METHODS: A pre-/postintervention design was used to examine changes in nursing satisfaction and patient outcomes as measured with the National Database of Nursing Quality Indicators (NDNQI) survey results. INTERVENTIONS: A psychiatric specific acuity tool was implemented on the PICU of a Veterans Administration hospital. RESULTS: After an initial decrease related to the COVID-19 pandemic, total acuity and the total number of nurses remained relatively stable while the unit census declined. NDNQI survey results improved with the largest being a 52-percentile increase for the quality-of-care summary measure. CONCLUSIONS: An acuity tool can help standardize practice, determine fair patient assignments among staff, increase nurse satisfaction, and promote best practices for patient safety.

Comparison of Recertification Methods on CPR Quality.

BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) is vital to improving survival from cardiac arrest. This study compared participant performance of CPR with three American Heart Association (AHA)-approved CPR recertification programs because current literature does not show which method is superior. Our goal is to investigate the best training methods to deliver high-quality CPR. METHOD: Participants were within 90 days of recertification in face-to-face, Heart Code, or Resuscitation Quality Improvement (RQI). RESULTS: No statistically significant differences were found among training modalities or demographic characteristics. The only significant difference was among those who had performed CPR on a human. CONCLUSION: Mean scores for the three modalities did not reach the passing requirement for AHA, suggesting that one method of CPR training is not better than the others. Recommendations for translating these findings into clinical practice include mock codes with the ability to measure CPR metrics and simulations of cardiac responses to provide vicarious CPR experience. [J Contin Educ Nurs. 2022;53(1):43-48.].

Clinical Nurses Research Priorities in Hospital Settings: A Delphi Survey.

This study aimed to identify the research priorities of clinical nurses to develop a research program at a health care services system that includes three hospitals. A Delphi survey was emailed to all clinical nurses in two rounds. The Delphi method was used to collect data from the nurses in regards to their priority research themes, and the data were analyzed using descriptive and comparative statistics. A total of 933 clinical nurses returned the first round of the Delphi survey and 543 nurses answered the second round. Clinical nurses identified 89 potential research themes. Patient safety and ethical challenges were the two highest ranked research priorities. The 40 highest ranked priority research themes were closely associated with issues concerning patient care and ethics. However, the nurses also gave high ratings to issues relating to the work environment, questions about technology implementation, and patient involvement in clinical care decisions.

Symptom and Illness Experience for English and Spanish-Speaking Children with Advanced Cancer: Child and Parent Perspective.

Understanding the symptom and illness experience of children with advanced cancer facilitates quality care; yet, obtaining this understanding is complicated by the child's developmental level and physical and psychological health factors that affect communication. The purpose of this study was to describe the symptom and illness experience of English- and Spanish-speaking children with advanced cancer as described by the child and parent. We conducted hermeneutic phenomenological, descriptive, and interpretive interviews with eligible children and parents. The interdisciplinary research team analyzed transcripts hermeneutically until consensus on theme labels was reached. Four themes and associated subthemes were identified from the interviews of the 10 child-parent dyads: 1. symptoms disrupt life (path to diagnosis, life is disrupted), 2. isolation (lack of understanding, family separations/relationships), 3. protection, and 4. death is not for children. Children and parents readily described the impact symptoms and cancer treatment had on their lives and relationships. These findings underscore the salient aspects of daily life disrupted by cancer. With a deeper understanding of symptom burden and its interference, relationship and communication implications, and anticipatory grief, the treating team may better optimize care for children and their families living with advanced cancer.

Impact of an Extended Nursing Shift Schedule in a Rural and Urban Primary Care Setting.

Two primary care clinics in rural and urban settings implemented a 9-hour nursing shift schedule. The purpose of this project was to use a quasiexperimental mixed-methods research design to assess outcomes for a 1-year implementation of nursing staff maintaining 9-hour shifts. Pre- and postdata were collected before and after implementation. The rural clinic demonstrated significant improvements in nurse satisfaction, overtime, compensatory time, and postacute follow-up. The urban facility showed significant decreases in sick leave. Patient satisfaction scores did not show significant changes for either clinic.

Cancer as Communal: Understanding Communication and Relationships from the Perspectives of Survivors, Family Caregivers, and Health Care Providers.

With cancer increasing in prevalence and high priorities placed on concurrent oncological and palliative care to help meet the familial, spiritual, and individual needs of stakeholders in cancer, research is needed that assesses the factors that facilitate coping across stakeholders in cancer care. We were interested in synthesizing our understanding of communication and relationships among patients, caregivers, and providers based on the reasoning that illness is relational, but often conceptualized and researched from the individual perspectives of various stakeholders. The current study examined the experiences of relational and communication opportunities and challenges during cancer for current and former family caregivers, cancer survivors, and palliative and oncology health care practitioners. The thematic analysis of 30 semi-structured interviews revealed an overarching theme on the benefits of orienting toward cancer as communal, which was, in turn, facilitated or impeded by four additional themes/sets of behaviors: support, presence, perspective-taking, and reframing hope. Results of a cross-case data matrix analysis reveal that stakeholders in different roles experience qualitative differences in their experience of cancer as communal, isolated, or ambivalent. Implications for education, palliative care, and interventions are discussed.

Cancer-related Fatigue Reported in Online Discussion Groups.

Fatigue is a prevalent cancer-related symptom that is difficult to communicate, define, and treat. To obtain robust descriptions of symptoms, participants were recruited into two online groups that consisted of their dialoguing together in an asynchronous, threaded discussion forum. Participants dialogued for 5 months and completed pre- and post-participation demographic data and symptom ratings. Survey data were described, and change scores were calculated. Excerpts from the dialogue were analyzed using phenomenological techniques. The 28 participants reported low symptoms that did not change significantly from pre- to post-participation. Phenomenological analysis revealed three themes: descriptions of "bone-sucking fatigue," a search for meaning or answers about the fatigue, and attempted remedies. Online support groups provide a venue for sharing symptom experiences, adding to existing knowledge about symptoms in survivors. These descriptions provide information that will aid in developing patient-centered interventions.

The Meaning of Self-efficacy for Symptom Management in the Acute Phase of Hematopoietic Stem Cell Transplantation.

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is an intensive treatment that offers the potential for longer life or cure for some types of cancer. Hematopoietic stem cell transplant is associated with decreased quality of life and functional status and distressing symptoms. Self-efficacy for symptom management (SESM) is a person's belief in his/her ability to implement behaviors to manage these symptoms. Presence of SESM can affect symptom distress, healthcare utilization, and posttransplantation outcomes. OBJECTIVE: The aim of this study was to explore the meaning of SESM in adults during the acute phase of HSCT. METHODS: Interviews were conducted before and at 30 days after transplantation. Descriptive thematic analysis was performed on verbatim interview transcripts. RESULTS: Themes of confidence, being responsible, and caring for mind, body, and spirit were identified, with subthemes of self-confidence, confidence in others, confidence and symptom level, vigilance, self-advocacy, and normalcy. Participants reported having high SESM before transplantation and having much less or no SESM when symptom distress was the most severe. CONCLUSIONS: This is the first study to examine the patient's perspective of self-efficacy in the acute phase of HSCT. This contributes to existing literature on the concept of symptom management and expands nursing knowledge of SESM in patients undergoing HSCT. IMPLICATIONS FOR PRACTICE: Nurses can assess SESM before transplantation and implement interventions to enhance SESM when symptoms are at their most distressing after HSCT. The findings from this study can provide the basis for creating behavioral interventions to enhance self-efficacy for symptom management in HSCT patients.

Vicarious Experience to Affect Physical Activity in Women: A Randomized Control Trial.

People compare themselves to others for self-evaluation, practical information, and motivation for healthy behaviors. The effect of active peer models on comparative thinking is unknown. The purpose of this 12-week, randomized, two-group pilot study was to evaluate the effect of a workplace peer modeling intervention on self-efficacy, motivation, and comparative thinking. The attention control group (ACG; n = 24) received general health information. The intervention group (n = 26) met with active peer models, received an exercise prescription and information. No significant group by time interaction effects were found. Comparisons on ability (how well am I doing), opinions (what should I think or believe), future self (think about my future), and modeling (be like someone else) all increased in the intervention group (n = 21) but decreased in the ACG (n = 22). Active peer models may support physical activity behavior change through specific lines of comparative thinking.

Self-efficacy for symptom management in the acute phase of hematopoietic stem cell transplant: A pilot study.

PURPOSE: Hematopoietic stem cell transplant (HSCT) is an intensive treatment associated with distressing treatment and disease-related symptoms that affect patient outcomes such as functional status and quality of life. Self-efficacy for symptom management (SESM) is a person's belief in their ability to perform behaviors to prevent and relieve symptoms. Presence of SESM can impact symptom distress and functional status. This study describes the changes over time and relationships among SESM, symptom distress, and physical functional status in adults during the acute phase of HSCT. METHODS: Patients (n = 40) completed measures of symptom distress, SESM, and physical function at time points prior to and at days 7, 15 and 30 post-transplant. Clinical outcomes were length of stay and number of readmissions. RESULTS: Symptom distress, physical function, and SESM changed significantly over time. There was a significant negative relationship between symptom distress and physical function and between symptom distress and SESM at all points. The lowest levels of SESM and physical function were at day 7 when symptom distress was highest. Symptom distress was a moderator for the relationship between physical function and SESM at day 15. CONCLUSION: This was the first study to examine SESM in the acute phase of HSCT. Higher SESM was associated with fewer symptoms and increased physical function. Less symptom distress was associated with higher physical function and confidence to manage symptoms. These findings provide the basis for development of patient-centered interventions to enhance SESM when symptoms are at their highest immediately after HSCT.

Correlates of Student Performance during Low Stakes Simulation.

BACKGROUND: Simulation plays a vital role in nursing education, however, modifiable factors influencing students' simulation performance have not been sufficiently examined. The purpose of this study was examine relationships among anxiety, self-efficacy, nursing knowledge, and performance during simulation. METHODS: The study used a mixed-methods design. Anxiety, self-efficacy, academic achievement, and performance during simulation were measured quantitatively; correlations between key variables were calculated. Qualitative data were collected during post-simulation debriefing and triangulated to inform quantitative findings. RESULTS: Significant relationships were identified between knowledge of nursing care and simulation performance. Student qualitative reports of heightened anxiety and lack of confidence and uncertainty contrasted from quantitative measures. Potential reasons for this finding were explored. CONCLUSIONS: The relationship between knowledge of nursing care and simulation performance supports the effectiveness of simulation as a means to evaluate the application of knowledge in a clinical laboratory setting. Further research is needed to explain the complex relationships between anxiety, self-efficacy, and performance during simulation.

Understanding Functional Communication in Head and Neck Cancer Survivors Using a Mixed Methods Design.

BACKGROUND: Functional communication, defined as everyday communication with family and friends, at work, and in the community, is an important but understudied concept in the head and neck cancer (HNC) survivor population. OBJECTIVE: The aim of this study was to better understand functional communication by using a mixed methods approach. METHODS: Head and neck cancer survivors participated in semistructured interviews and completed self-report questionnaires assessing multiple aspects of well-being and health-related quality of life (HRQOL). These qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated. RESULTS: Survivors' perceptions of functional communication ranged from "Communication is good" to "Communication has changed" to "Communication is difficult." Using these qualitative results, survivors were categorized into 3 mutually exclusive groups. Clinically meaningful cut points were exceeded on measures of depressive symptoms (18%), state (40%) and trait (54%) anxiety, and pain (18%). Health-related quality of life scores were moderate to high for the sample as a whole. Statistically significant group differences were found only on the HNC-specific measure of HRQOL. A surprising finding was that the lowest mean score on social function was in the "Communication has changed" group. This group perceived changes in speech and voice that bothered them when communicating in social situations, although their speech was clear to a listener. CONCLUSION: An underrecognized subpopulation of HNC survivors may exist, whose day-to-day functional communication has changed in ways that impact their relationships and sense of self. IMPLICATIONS FOR PRACTICE: Clinical identification of this subpopulation and provision of appropriate interventions are essential to facilitate optimal HRQOL after HNC treatment.

Pearls and Pitfalls of Team Science.

Formidable health problems are often best addressed by teams of scientists with varied expertise. This diversity among team members and complexities in managing teams can lead to challenges in designing, funding, conducting, and reporting research. Team science difficulties can be addressed by sophisticated planning, frequent reassessment and realignment of team strategies with goals, and consistent transparent communication. This article addresses specific strategies to build and sustain research teams, manage team meetings, strategically develop publications and grants, thrive in the midst of disciplinary and individual team member differences, embrace new ideas and change to maintain creativity, and build future team scientists and projects. The potential value in team science justifies the effort required to build and maintain efficient and effective research teams.

Self-Efficacy for Management of Symptoms and Symptom Distress in Adults With Cancer: An Integrative Review.

PROBLEM IDENTIFICATION: Self-efficacy for symptom management plays a key role in outcomes, such as quality of life (QOL), functional status, and symptom distress, for adults with cancer. This integrative review identified and assessed evidence regarding self-efficacy for management of symptoms and symptom distress in adults with cancer. LITERATURE SEARCH: The authors performed a search of literature published from 2006-2018, and articles that examined the relationship among self-reported self-efficacy, symptom management, symptom distress or frequency, and severity in adults with cancer were selected for inclusion. DATA EVALUATION: 22 articles met the inclusion criteria. All articles were critically appraised and met standards for methodologic quality. SYNTHESIS: Evidence from this review showed that high self-efficacy was associated with low symptom occurrence and symptom distress and higher general health and QOL. High self-efficacy predicted physical and emotional well-being. Low self-efficacy was associated with higher symptom severity, poorer outcomes, and better overall functioning. IMPLICATIONS FOR RESEARCH: Self-efficacy can be assessed using developed instruments. Presence of a theoretical model and validated instruments to measure self-efficacy for symptom management have set the groundwork for ongoing research.

Feasibility and Effect of a Peer Modeling Workplace Physical Activity Intervention for Women.

Most working women do not meet current guidelines for physical activity (PA). A 12-week pilot study tested a workplace, peer modeling PA intervention. Inactive female employees from a health system were randomized to an attention control group (ACG; n = 26) or an intervention group (IG; n = 26). The ACG received health information. The IG participated in six group sessions with an active peer model and received an exercise prescription and PA information. Pre and post measures were PA (ActiGraph), Estimated VO2max (cycle ergometer), resting heart rate (HR), glucose and lipids, and cardiovascular risk. Using hierarchical linear modeling, no significant group by time effects were found. Although PA increased in both groups, F( df = 1) = 11.4, p = .002, the IG had greater improvements in fitness (VO2max, HR) and cardiovascular risk (total cholesterol, triglyceride, low density lipoprotein [LDL], calculated risk score) compared with ACG. Results support repeating this intervention in a fully powered study.

Perceptions of a Peer Modeling Workplace Physical Activity Intervention for Women.

A workplace physical activity (PA) study tested a novel use of peers to deliver the intervention. Peer models provided vicarious experience for living physically active lifestyles to a group of inactive women. The purpose of this study was to describe participants' perceptions of the peer modeling intervention. Nine women from the intervention group ( n = 26) participated in a 90-minute focus group. Qualitative description using thematic analysis was used to identify themes from the focus group transcript. Two themes about the intervention were "I am left wanting more" and "focus on food." Two themes about the peer models were "real people" and "it is doable." Focus group participants perceived the peer modeling PA intervention favorably; however, they desired more attention to healthy eating and more time with peer models. Replication of the study accounting for themes identified by focus group participants is needed to strengthen the peer modeling intervention.

Autism spectrum disorder and genetic testing: Parental perceptions and decision-making.

PURPOSE: Advances in genomic technology and research have led to genetic testing being recognized as an essential component of the etiological workup for children with autism spectrum disorder (ASD). Chromosomal microarray analysis (CMA) is a first-tier diagnostic test for patients with ASD, as recommended by the American College of Medical Genetics and other professional societies. An accurate underlying medical diagnosis for ASD has many potential benefits, including appropriate medical management, detailed therapeutic recommendations, and accurate recurrence risk. Genetic testing is relatively complicated, expensive, and, currently, in the majority of the cases, does not provide any organic improvement in the management of symptoms. DESIGN AND METHODS: We conducted semistructured interviews with 20 parents to explore the decision-making process of genetic testing from the perspectives and experiences of parents of children with ASD. Data were analyzed using qualitative content analysis. RESULTS: Parents had limited knowledge of genetic testing for ASD prior to a genetics clinic visit. The majority of the participants thought genetic testing would be beneficial for their child, their reproductive choices, and potential future generations. PRACTICE IMPLICATIONS: Various stakeholders (geneticists, primary care providers, nurses, and families) would benefit from future establishment of educational strategies to inform parental decision-making regarding genetic testing for children with ASD.