Opioid Literacy Among Individuals Living in Rural Alabama: The Role of Social Determinants of Health.

Using the social determinants of health (SDOH) framework, the current study aimed to examine opioid literacy and the role of SDOH on opioid literacy. This study used a cross-sectional survey design to collect self-reported data from people living in four rural Alabama counties affected by the opioid crisis. Participants reported moderate levels of opioid knowledge. There were no significant predictors of general knowledge. For opioid overdose knowledge, the strongest individual predictors were educational level (Bachelor's degree) and self-rated financial strain, which contributed to higher scale scores. For the models evaluating opioid overdose response knowledge, the strongest individual predictors were minority status (inverse), self-rated mental health, and interpersonal safety. Our findings indicate that SDOH, such as financial strain and interpersonal safety, are significantly linked to opioid literacy. Educational efforts to enhance opioid literacy, proper usage, and management in rural counties should consider SDOH factors. Findings further outline the team's integrative approach to developing intervention strategies for opioid treatment and recovery that can benefit the northwest Alabama community and beyond. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 52-59.].

Affirmative Palliative Care for Transgender and Gender Nonconforming Individuals.

ABSTRACT: Nurses have a professional and ethical responsibility to provide inclusive, affirmative palliative care to transgender and gender nonconforming (TGNC) individuals experiencing life-limiting illness or injury. In accordance with standards for professional nursing and health organizations, nurses must continue to take tangible steps to achieve a level of care that is affirming, holistic, nonprejudicial, and collaborative. Providing quality care for TGNC individuals requires informed, competent integration of palliative nursing care, gender-affirmative care, and trans-person-centered health care within nursing practice. An interdisciplinary national team of experts collaborated to identify ways nurses could better uphold their professional responsibilities to TGNC individuals with serious illness. The purposes of this article are to: 1) describe elements of TGNC-inclusive palliative nursing care; and 2) present eight concrete recommendations to achieve affirmative clinical practice for TGNC patients living with life-limiting illness and their family of origin and/or family of choice. These recommendations address professional development, communication, medication reconciliation, mental health, dignity and meaning, social support and caregivers, spiritual beliefs and religion, and bereavement care.

Determining Clinical Judgment Among Emergency Nurses During a Complex Simulation.

INTRODUCTION: Clinical judgment is imperative for the emergency nurse caring for the acutely ill patients often seen in the emergency department. Without optimal clinical judgment in the emergency department, patients are at risk of medical errors and a failure to rescue. METHODS: A descriptive observational approach using the Lasater Clinical Judgment Rubric evaluated nurses during a task that required recognition of clinical signs of deterioration and appropriate clinical care for simulated patients. RESULTS: A total of 18 practicing emergency nurses completed only 44.6% of the patient assessments leading to low levels of clinical judgment throughout the simulation. Nurses expressed 4 levels of clinical judgment: exemplary (n = 1), accomplishing (n = 6), developing (n = 9), and beginning (n = 2). On average, nurses completed 69% of required tasks. DISCUSSION: Assessments were completed less than half the time, demonstrating a breakdown in the noticing phase of clinical judgment. The nurses shifted to task completion focus with minimal use of clinical judgment. As the nurses remained task oriented, several medication and medical errors were noted while caring for the simulated patients. Experience and education did not influence observed clinical judgment among the participants. Given the extreme demands placed on the emergency nurse, it cannot be assumed that nurses have developed or can use clinical judgment when caring for their patients. Time and training targeting clinical judgment are essential for emergency nurse development.

Bridging the Gap Between Practice Guidelines and the Therapy Room: Community-Derived Practice Adaptations for Psychological Services with Transgender and Gender Diverse Adults in the Central United States.

Individuals who identify as transgender or gender diverse (TGD) are presenting at mental health clinicians' offices with increasing frequency. Many TGD clients are seeking care related to affirming their gender identity but also may present with anxiety, depression, trauma, substance abuse, or other problems for which a clinician may commonly provide services. Some clinicians may hesitate to accept TGD clients into their practice if they have little specialized training to work with this population in an affirming manner, especially in more underserved areas where a generalist practice is the norm. Numerous professional associations and experts have developed guidelines for affirmative behavioral health care for TGD people. However, what is needed are community informed recommendations to bridge from the official guidelines to clinicians' in-session activities. The Trans Collaborations Practice Adaptations for Psychological Interventions for Transgender and Gender Diverse Adults are derived from iterative interviews with TGD community members and affirming mental health clinicians in the Central United States. The 12 practice adaptations are intended to guide clinicians to adapt their usual treatment approach to be TGD affirming, especially in underserved and rural areas. The practice adaptations cover numerous aspects of practice including the office setting and paperwork, understanding gender identity and incorporating it into the case conceptualization, therapist's self-awareness, and referrals. The Trans Collaborations Practice Adaptations will help clinicians work confidently and competently with adult TGD clients, regardless of the presenting problem, to ensure TGD communities receive the best interventions for their behavioral health concerns.

An Opioid Education Program for Baccalaureate Nursing Students.

BACKGROUND: Unintentional drug overdose is the leading cause of accidental death in the United States. Previous research identified training health caregivers in the rescue medication naloxone as a strategy to prevent death from opioid overdose. Existing research on naloxone training with nursing students is limited. This educational research project investigated whether training on opioids, opioid toxicity, and overdose response could impact student knowledge, skills, and confidence responding to overdoses. METHOD: Data were collected from baccalaureate nursing students using three sources: the Brief Opioid Overdose Knowledge questionnaire, a rubric based on the Substance Abuse and Mental Health Services Administration opioid overdose prevention toolkit, and a researcher-developed evaluation. RESULTS: Planned repeated-measures analyses of variance conducted on data from 284 baccalaureate students indicated high uptake of knowledge and skills for opioid toxicity and naloxone administration. Results were maintained with slight enhancement at 1 week, and training was highly rated. Cohort analysis suggests efficacy across semesters. CONCLUSION: Education improved student opioid knowledge, skills, and confidence and was relevant across undergraduate nursing curricula.

Caring for an Unconscious Transgender Patient at the End of Life: Ethical Considerations and Implications.

Individuals who identify as transgender (trans) or other gender-diverse identities are highly marginalized populations within the United States health care system. Transgender individuals experience a broad range of health disparities leading to devastating health outcomes. Experiences with discrimination and biased care often result in a lack of trust in providers and reduced care seeking, yet providers frequently rely on communication with trans patients to build competence. Consequently, when a trans patient has restricted communication, whether due to biological or psychological reasons, their care can be further disrupted. The nursing code of ethics compels the provision of competent care to all patients, regardless of demographics or gender identity, including individuals with serious illness and injury. This article describes an approach to the provision of affirmative, trans-inclusive care in a palliative nursing context that integrates cultural humility and self-reflection into an established patient care framework. The approach is then applied to identify ethical dilemmas present in the case of a trans patient who arrived at a hospital in an unconscious state following serious injury. Nurses' use of the ethical approach when caring for seriously ill trans patients would represent important progress toward fostering a health care system that provides affirmative, trans-inclusive care.

Development and Feasibility Testing of a Contextual Patient Movement Intervention.

INTRODUCTION: Nurses and emergency medical services workers frequently suffer musculoskeletal injuries at a disproportionate rate in relation to the rest of the population. The most common form of this musculoskeletal injury is lumbar spine injury. The purpose of this study was to develop and conduct phase 1 feasibility testing of a contextual lifting intervention that reduces the risks of low back injury. METHODS: This study was an intervention development and phase 1 feasibility test. The intervention was created on the basis of weightlifting techniques to specifically reduce the incidence injury related to valgus knee, asymmetrical lifting technique, and rotation of the trunk and pelvis. Motion capture technology (Xsens; Xsens Technologies) was used while 17 nursing students completed the direct patient lift from the floor, the lift from the floor with a manikin attached to a rigid spine board, the push portion of the horizontal transfer, and the pull portion of the horizontal transfer. Pre- and postintervention data were collected. Linear mixed model regression, with pairwise comparisons, was conducted for each lift at the time points of preintervention, immediately after the intervention, and 1-month postintervention. RESULTS: Significant changes were noted between the initial lifting techniques used and those used after the intervention. The maximum lever arm distance, defined as the distance from L5-S1 to the center of the force applied to the load, showed a significant reduction after the intervention in 3 of the 4 movements. DISCUSSION: Our results support the idea that injury risk can be reduced through appropriate contextual training methods.

Hoping to Pass: Randomized Trial of a One-Time Hope Intervention on Standardized Exam Passing Rates in BSN Students.

BACKGROUND: National standardized nursing exams serve as critical measures of student readiness for practice and carry significant consequences for students and academic institutions. Educational interventions that can enhance a student's performance increase the probability of academic success. Previous studies link hope to grade point average in college students and on standardized exam (SE) scores in nursing students, yet it is not clear if hope can be increased utilizing a one-time intervention in ways that produce lasting benefits for passing SEs. AIMS: Aim 1 tested the efficacy of a one-time hope intervention on increasing SE passing rates among BSN nursing students. Aim 2 examined the role of the interventions, selected state-mechanism variables, and trait characteristics in predicting SE passing. METHOD: This comparative-effectiveness trial utilized a randomized, controlled, multiple-cohort experimental design to compare a one-time 90-minute hope intervention to an attention-matched progressive muscle relaxation intervention on SE passing scores among BSN nursing students. RESULTS: Levels of hope briefly increased following the hope intervention. Both interventions demonstrated short-term improvement in state-level psychosocial indicators but did not affect SE scores. Among trait and mechanism factors, only academic self-efficacy was linked with passing SEs. CONCLUSIONS: This study demonstrated that a single-session hope intervention can increase short-term hope. In this sample of 292 BSN students, there was no statistically significant long-term effect on passing SEs; however, this study may lay the groundwork for future interventions investigating booster sessions, or how to modify the intervention for struggling students.

Neurophysiologic evidence for increased retrieval suppression among negative ruminators.

INTRODUCTION: Events (e.g., seeing a familiar face) may initiate retrieval of associated information (e.g., person's name), but not all cue-initiated memory retrieval is welcome (e.g., trauma). Retrieval suppression refers to the ability to halt unwanted retrieval, and any erosion of memory associations in response to repeatedly excluding a memory from consciousness. The current study sought to examine event-related potential (ERP, averaged scalp electrical recordings) correlates of inhibitory cognitive control of memory retrieval and any linkage of such control to ruminative memory styles. METHODS: Participants (N = 23) first learned face-picture pairings. ERPs were then recorded as they viewed face cues while either bringing the associated picture to mind (think trial), or not allowing the associated picture to come to mind (no-think trial). RESULTS: Emotional valence of learned pictures (negative versus neutral) modulated a posterior (P1, 100-150 ms) ERP associated with attention to the face cue. Memory strategy (think versus no-think) modulated a frontal (P3, 350-450 ms) associated with alerting of the need to control retrieval. Both valence and strategy worked in combination to modulate a late posterior (LC, 450-550 ms) ERP associated with successful memory retrieval. Brooding, a negative form of rumination, was found to be positively correlated with the LC ERP. CONCLUSION: The results suggest early separation of emotional and strategic control of retrieval, but later combined control over access to working memory. Moreover, the positive correlation of brooding and the LC suggest that individuals who are high in application of perseverative strategies to memory retrieval will show greater modulation of the retrieval-related LC ERP.

A Laboratory Word Memory Test Analogue Differentiates Intentional Feigning from True Responding Using the P300 Event-Related Potential.

Symptom exaggeration and feigned cognitive impairment occur commonly in forensic and medicolegal evaluations. As a result, methods to detect feigned cognitive impairment are an indispensable component of neuropsychological assessments. This study reports the results of two neurophysiological experiments using a forced-choice recognition task built from the stimuli of the Word Memory Test and Medical Symptom Validity Test as well as a new linguistically informed stimulus set. Participant volunteers were instructed either to do their best or to feign cognitive impairment consistent with a mild traumatic brain injury while their brain activity was monitored using event-related potentials (ERP). Experiment 1 varied instructions across individuals, whereas Experiment 2 varied instructions within individuals. The target brain component was a positive deflection indicating stimulus recognition that occurs approximately 300 ms after exposure to a stimulus (i.e., the P300). Multimodal comparison (P300 amplitude to behavioral accuracy) allowed the detection of feigned cognitive impairment. Results indicate that, for correct responses, P300s were equivalent for the simulated malingering and good effort conditions. However, for incorrect responses, feigned impairment produced reliable but significantly reduced P300 amplitudes. Although the P300 is an automatic index of recognition-even when knowledge is hidden-its amplitude appears capable of modulation by feigning strategies. Implications of this finding are discussed for research and clinical applications.

Heterogeneity of Treatment Effects in a Randomized Trial of Literacy-Adapted Group Cognitive-Behavioral Therapy, Pain Psychoeducation, and Usual Medical Care for Multiply Disadvantaged Patients With Chronic Pain.

Differences among patients can moderate the impact of evidence-based treatments (ie, heterogeneity of treatment effects), leading patients to get more or less benefit. The Learning About My Pain study was a randomized, comparative effectiveness trial of a 10-week literacy-adapted group cognitive-behavioral therapy for chronic pain (CBT) versus pain psychoeducation groups (EDU) versus usual medical care. We examined potential sociodemographic and cognitive moderators of treatment effect among participants with post-treatment assessments (N = 241). Analyses were conducted using moderation in the PROCESS macro in SPSS and significant interactions were explored further. Education and primary literacy moderated the difference between CBT and EDU on pain intensity, and primary literacy, health literacy, and working memory moderated the difference between CBT and EDU on pain interference. Analyses revealed few significant moderation effects relative to usual medical care. No moderators were identified for depression. Neither sex nor minority status moderated any differences between groups. Patients with lower education, literacy, and working memory gained more benefit from CBT than EDU. When provided sufficient guidance and structure in a way that is meaningfully adapted, highly disadvantaged patients achieved as much benefit as less disadvantaged patients, suggesting that the literacy-adapted CBT more successfully met the needs of this population. TRIAL REGISTRATION: clinicaltrials.gov identifier NCT01967342 PERSPECTIVE: This article presents findings related to heterogeneity of treatment effects for simplified group psychosocial treatments for chronic pain. The results suggest that educationally, cognitively, or literacy disadvantaged patients benefit most from the more structured approach of literacy-adapted CBT rather than EDU, whereas less disadvantaged patients benefit from either treatment.

Literacy-Adapted Cognitive Behavioral Therapy Versus Education for Chronic Pain at Low-Income Clinics: A Randomized Controlled Trial.

Background: Chronic pain is common and challenging to treat. Although cognitive behavioral therapy (CBT) is efficacious, its benefit in disadvantaged populations is largely unknown. Objective: To evaluate the efficacy of literacy-adapted and simplified group CBT versus group pain education (EDU) versus usual care. Design: Randomized controlled trial. (ClinicalTrials.gov: NCT01967342). Setting: Community health centers serving low-income patients in Alabama. Patients: Adults (aged 19 to 71 years) with mixed chronic pain. Interventions: CBT and EDU delivered in 10 weekly 90-minute group sessions. Measurements: Self-reported, postintervention pain intensity (primary outcome) and physical function and depression (secondary outcomes). Results: 290 participants were enrolled (70.7% of whom were women, 66.9% minority group members, 72.4% at or below the poverty level, and 35.8% reading below the fifth grade level); 241 (83.1%) participated in posttreatment assessments. Linear mixed models included all randomly assigned participants. Members of the CBT and EDU groups had larger decreases in pain intensity scores between baseline and posttreatment than participants receiving usual care (estimated differences in change scores-CBT: -0.80 [95% CI -1.48 to -0.11]; P = 0.022; EDU: -0.57 [CI, -1.04 to -0.10]; P = 0.018). At 6-month follow-up, treatment gains were not maintained in the CBT group but were still present in the EDU group. With regard to physical function, participants in the CBT and EDU interventions had greater posttreatment improvement than those receiving usual care, and this progress was maintained at 6-month follow-up. Changes in depression (secondary outcome) did not differ between either the CBT or EDU group and the usual care group. Limitations: Participants represented a single health care system. Self-selection bias may have been present. Conclusion: Simplified group CBT and EDU interventions delivered at low-income clinics significantly improved pain and physical function compared with usual care. Primary Funding Source: Patient-Centered Outcomes Research Institute.

Spiritual Openness, Revisiting a Potentially Important Aspect of Spirituality: Scale Review and Revision.

Religiousness and spirituality (R/S) exert important influences on individuals across a range of domains. Spiritual Openness is theoretically linked with the personality trait of Openness to Experience, suggesting promise for future research. Using responses from 366 undergraduates on the Spiritual Experience Index-Revised (SEI-R: subscales of Spiritual Openness and Spiritual Support), analyses evaluated and revised the SEI-R, deleting poor items and generating a 10-item measure. The new SEI-S exhibits better psychometric properties and reduced participant burden, and subscales displayed a curvilinear relationship in which increases in Spiritual Openness showed a trade-off in levels of Spiritual Support.

A Review of Contemporary Assessment Tools for Use with Transgender and Gender Nonconforming Adults.

There is increasing recognition of the need for culturally sensitive services for individuals who identify as transgender or gender non-conforming (TGNC), and only recently have empirical studies appeared in the literature that inform best practices for TGNC people. Competent, culturally appropriate clinical services and research depend upon methodologically sound assessment of key constructs, but it is unclear whether appropriate self-report or clinician-rated assessment tools for adults exist. This paper reviewed existing published measures to identify areas of strength as well as existing gaps in the available research. The search strategy for this systematic review identified any published paper describing a self-report or clinician-rated scale for assessing transgender-related concerns. Each measure was reviewed for information on its scope, reliability, validity, strengths, limitations, and source. The majority of these questionnaires were developed with the TGNC communities and targeted important factors that affect quality of life for TGNC people. Limitations included limited evidence for validity, reliability, and sensitivity to change. Overall, the field is moving in the direction of TGNC-affirming assessment, and promising measures have been created to monitor important aspects of quality of life for TGNC people. Future research should continue to validate these measures for use in assessing clinical outcomes and the monitoring of treatment progress.

The relationship of sociodemographic and psychological variables with chronic pain variables in a low-income population.

Chronic pain is a pervasive condition that is complicated by economic, educational, and racial disparities. This study analyzes key factors associated with chronic pain within an understudied and underserved population. The sample is characterized by a triple disparity with respect to income, education/literacy, and racial barriers that substantially increase the vulnerability to the negative consequences of chronic pain. The study examined the pretreatment data of 290 participants enrolled in the Learning About My Pain trial, a randomized controlled comparative effectiveness trial of psychosocial interventions (B.E.T., Principal Investigator, Patient-Centered Outcomes Research Institute Contract No. 941; clinicaltrials.gov identifier NCT01967342) for chronic pain. Hierarchical multiple regression analyses evaluated the relationships among sociodemographic (sex, age, race, poverty status, literacy, and education level) and psychological (depressive symptoms and pain catastrophizing) variables and pain interference, pain severity, and disability. The indirect effects of depressive symptoms and pain catastrophizing on the sociodemographic and pain variables were investigated using bootstrap resampling. Reversed mediation models were also examined. Results suggested that the experience of chronic pain within this low-income sample is better accounted for by psychological factors than sex, age, race, poverty status, literacy, and education level. Depressive symptoms and pain catastrophizing mediated the relationships between age and pain variables, whereas pain catastrophizing mediated the effects of primary literacy and poverty status. Some reversed models were equivalent to the hypothesized models, suggesting the possibility of bidirectionality. Although cross-sectional findings cannot establish causality, our results highlight the critical role psychological factors play in individuals with chronic pain and multiple health disparities.

The Learning About My Pain study protocol: Reducing disparities with literacy-adapted psychosocial treatments for chronic pain, a comparative behavioral trial.

Chronic pain is a critical public health problem that affects over 100 million Americans. Medical pain treatments carry undesirable side effects, whereas low-risk psychosocial treatments offer notable benefits, in combination or in isolation. This report presents the protocol for the Learning About My Pain study, one of the first comparative-effectiveness trials funded by the Patient-Centered Outcomes Research Institute. Adhering to published standards for clinical trials (e.g. Standard Protocol Items: Recommendations for Intervention Trials), it provides an overview of the trial (n = 294), comparing cognitive-behavioral and education pain interventions to usual care, and a detailed description of how its methodology reduces the risks from bias.