The state of mental health and healthy lifestyle behaviors in nursing, medicine and health sciences faculty and students at Big 10 Universities with implications for action.

BACKGROUND: High rates of mental health conditions and poor healthy lifestyle behaviors are reported in nurses, other clinicians, and health science students but have not been compared across different professions. PURPOSE: The purpose of this study was threefold: (1) describe rates of mental health problems and healthy lifestyle behaviors across the Big 10 health professional faculty and students, (2) compare the health and healthy lifestyle behaviors of the Big 10 health sciences faculty and students across health sciences' professions, and (3) identify factors predictive of depression, stress, and anxiety. METHODS: Faculty and students from eight health science colleges at the Big 10 Universities responded to the study survey, which included: demographics, healthy lifestyle behavior questions, and three valid/reliable mental health scales. Descriptive statistics described the findings and multiple linear regression identified factors associated with mental health conditions. RESULTS: Eight-hundred and sixty-nine faculty and 1087 students responded. Approximately 50% of faculty and students reported 7 h of sleep/night, a third achieved 150 min of physical activity/week; 5.5%-9.9% screened positive for depression; and 11.5%-25.5% had anxiety. Age, sleep, and physical activity were associated with lower depression and anxiety. CONCLUSIONS: University leadership must build wellness cultures that make healthy lifestyle behaviors easy to engage in and enhance mental well-being.

Assisted Living Residents' Sense of Belonging and Psychosocial Outcomes.

Little is known about the psychosocial adjustment of older adults in the assisted living environment. A sense of belonging has been linked to psychological health and a lack of belonging could lead to loneliness. We conducted a cross-sectional descriptive study to examine relationships between social engagement, sense of belonging, and psychological outcomes. Seventy female and 30 male assisted living residents participated. The mean age was 83.9 (range 65-99) years. Structural equation modeling (SEM) revealed that older age, higher physical function, and greater sense of belonging were associated with fewer negative psychosocial outcomes (depression and loneliness) and that sense of belonging functioned as a mediator between social engagement and psychosocial outcomes. Additional work is needed to fully understand how sense of belonging and other factors influence psychosocial outcomes.

Development and testing of a self-regulation model for recurrent depression.

Self-regulation is a strategy for self-management of depression. Study aims were to (1) describe development of an intervention based on metacognition and self-regulation, (2) test intervention feasibility and utility, and (3) determine its effectiveness in reducing depressive symptoms. The Self-Regulated Illness Management of Depression intervention was developed and taught to 22 participants with recurrent depression. There was no attrition 6 months post intervention. At 6 months, there was a significant decrease in depressive symptoms (M = 10.21, standard deviation = 8.0), t(18) = 5.60, p < .001, and 73 percent of participants used Self-Regulated Illness Management of Depression frequently. Results indicated that Self-Regulated Illness Management of Depression was feasible and useful.

Testing the relationship between a self-management intervention for recurrent depression and health outcomes.

BACKGROUND: Depression is a leading cause of disability globally. It is a recurrent chronic illness that affects over three million people worldwide. Self-management has been found to positively impact depression outcomes but few techniques or interventions are theory-based and can be used either with or without the support of mental health care providers. OBJECTIVES: This study aimed to test the relationship between a self-management intervention called the Self-Regulated Illness Management of Depression (SRIM-D) intervention and specific health outcomes (depression, self-efficacy, social support and quality of life). SRIM-D was developed using metacognition and self-regulation theories. SAMPLE AND SETTING: Twenty-three individuals with major depressive disorder (MDD) participated in the study. Individuals over 21 years of age without a diagnosis of bipolar disorder, current substance abuse problem or suicidal ideations who suffered from MDD (BDI-II < 19) were considered for the study. METHODS: The intervention was delivered over three consecutive weeks of 1 ½â€¯hour sessions by two PhD prepared nurses with psychiatric experience. Participants were given a workbook manual with corresponding power point presentations conferring information about depression, and were led through a series of workbook activities designed to teach the self-regulation process as applied to their recurrent depression. Health outcomes were assessed via self-report survey prior to and six-month post-intervention. RESULTS: Six months post-intervention depressive symptoms decreased significantly (M = 6.62, SD = 14.76, t(15) = 5.60, p < .0001). Self-efficacy (M = 161.67, SD = 25.27); t(20) = -2.89, p < .01) and quality of life (13.25, SD = 3.61; t(19) = 2.62, p > .01) both improved significantly. Social support had a negligible, insignificant decrease from pre-intervention (M = 53.05, SD = 19.81) to six months post-intervention (M = 42.14, SD = 19.53). CONCLUSIONS: Overall, the SRIM-D intervention improved health outcomes in this study. The intervention demonstrated applicability to people with recurrent, chronic depression who might or might not have access to care.

Assessing Cognitive Representations of Antidepressants: Development and Validation of the Attitudes Toward Medication-Depression Inventory.

Antidepressant drugs represent the mainstay of treatment for depression; however, nonadherence is a major problem. Attitudes are predictors of long-term adherence and drive medication use. The Attitudes Toward Medication-Depression (ATM-D) Inventory was developed and tested with 131 patients in primary care settings who reported a diagnosis of depression. Content validity was assessed by experts with a 94.4% agreement on item relevancy. Exploratory factor analysis showed three factors (course of medication treatment, identity, and control) that accounted for 57% of the total variance in the final 17-item scale. The instrument demonstrated good internal consistency reliability (α = .76-.84) and test-retest reliability (α = .74-.83). Results support the construct validity and reliability of the instrument and revealed unique insights into patients' cognitive representations of their antidepressants. This study supported that patients have cognitive representations related to depression and antidepressants that go beyond simple concerns about the effects of the medication.

Identifying the Structure and Effect of Drinking-Related Self-Schemas.

Self-schemas have received increased attention as favorable targets for therapeutic intervention because of their central role in self-perception and behavior. The purpose of this integrative review was to identify, evaluate, and synthesize existing research pertaining to drinking-related self-schemas. Russell's integrative review strategy guided the search. Sixteen published works were identified, meeting criteria for evaluation ( n = 12 data-based publications and n = 4 models). The retrieved data-based publications rated fair-good using Polit and Beck's criteria; the overall body of literature rated "B" using Grimes and Schulz criteria. Retrieved models rated 4 to 7 using Fitzpatrick and Whall's criteria. The existing literature strongly supports the availability of a drinking-related self-schema among moderate-to-heavy drinking samples, and suggests a positive relationship between elaboration and drinking behavior. The relationship between valenced content of the schema and drinking behavior remains unexplored. Identifying variation in the structural properties of drinking-related self-schemas could lay the foundation for future interventions.

Experiencing transformation: the case of Jordanian nurse immigrating to the UK.

AIMS AND OBJECTIVES: This study explored how Jordanian nurses experienced the transition from home to host country to illuminate the elements of transformation. BACKGROUND: Much research has been conducted on topics such as the current international nursing shortage and the recruitment of nurses from various countries. International nurses have unique needs with regard to adapting to new host cultures and workplaces; furthermore, the literature has revealed little evidence of nurses' professional and personal experiences related to migration. DESIGN: A qualitative study was conducted, collecting data via individual interviews. METHODS: Twenty-five face-to-face and telephone interviews with Jordanian migrant nurses. RESULT: This study showed that living and working in a host country changes the personal, social and professional attributes of migrant nurses. When nurses migrate, they encounter opportunities and significant challenges in their professional and personal lives. Although Jordanian nurses contributed their knowledge and skills to the UK healthcare system, they encountered enormous professional adaptation demands. Work setting discrepancies between source and host country are likely a major element behind the required nursing profession alteration. nurses' lives are transformed in terms of their personal and social networks in the host country. CONCLUSIONS: Social transformation is an integral and inseparable part of engagement with professional organisation(s) in the host community. Professional integration likely has far-reaching effects and consequences involving not only the individual but also their home and host country families and their professional networks. RELEVANCE TO CLINICAL PRACTICE: To provide high-quality nursing care, we must learn about the transformation experience, expand our sense of who we are and gain a degree of control over how we perform our nursing roles when we move away from our home.

Measuring Confidence in Nursing Graduates Within the Framework of the AACN Essentials.

: The American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education provide a framework for assessment of nursing programs. The purpose of this pilot study was to determine if there was a difference in self-perceived confidence in meeting the AACN essentials between senior students who completed a traditional clinical course and those in a preceptorship course. A descriptive, comparative design was used. The results indicate that students who completed both course models had similarly high levels of perceived confidence in meeting the majority of the AACN essentials.

Considering a relational model for depression in Navy recruits.

OBJECTIVE: Key variables that have influenced depression in previous research were examined in this study including adult attachment, perceived social support, sense of belonging, conflict in relationships, and loneliness for their relationships in a relational model for depression with U.S. Navy recruits in basic training. METHODS: This theory-testing analysis study was part of a larger cross-sectional cohort study that examined the factors associated with depression in Navy recruits. The sample for this study included 443 recruits. Structural equation modeling was used to test the fit of the theoretical model. RESULTS: The proposed model explained 49% of the variance in depressive symptoms with loneliness and sense of belonging as the strongest indicators of depression. CONCLUSIONS: The Navy should consider interventions that increase sense of belonging in high risk for depression recruits to decrease loneliness and depression and circumvent recruits not completing basic training. The assumption that recruits are in close quarters and contact with other people and therefore are not lonely and receive adequate social support is not supported. This article contributes to advancing the science of mental health in relation to depression by considering predictors that are amenable to intervention.

The development and testing of the nurses' cardiac triage instrument.

Rapid recognition and treatment of myocardial infarction (MI) reduces morbidity and mortality. Although emergency department (ED) nurses are often the first provider to evaluate individuals and are in a prime position to initiate MI guideline recommendations, no valid and reliable instrument was found to quantify their decision-making processes. The purpose of this study was to develop and test the psychometric properties of a new theoretically driven, empirically based instrument for measuring nurses' cardiac triage decisions. Using a descriptive research design, data were collected using a mailed survey. There were 158 ED nurses who completed a mailed questionnaire. Factor analysis revealed three factors (patient presentation, unbiased nurse reasoning process, and nurse action) with good internal consistency (Cronbach's alpha = .903, .809, .718) and sample adequacy (KMO = .758) of the 30-item instrument. The newly developed instrument has the potential to improve patient outcomes surrounding early MI identification and treatment.

Addressing psychosocial care using an interactive Web site for combat-wounded patients.

PURPOSE: The aims were to examine military nurses and combat-wounded patients' evaluation of a cognitive behavioral intervention Web site called Stress Gym. DESIGN AND METHODS: The use of the intervention was a proof-of-concept design with 129 military nurses and combat-wounded patients in military medical treatment facilities (MTFs). The nurses and patients logged on to Stress Gym, reviewed the nine modules available, and completed a short evaluation of the Web site. FINDINGS: The evaluation of the military nurses and patients was high. There were no significant differences in the evaluation based on military services, sex, deployment, and education levels. PRACTICE IMPLICATIONS: The strength of Stress Gym is that it enables all military members to learn about and get help with problems such as stress, anxiety, anger, and depressive symptoms anonymously and in private. CLINICAL RELEVANCE: Stress Gym is a versatile tool that can help nurses address the psychosocial needs of their patients by encouraging its use and including it in treatment protocols.

The need for reform of human subjects protections in military health research.

A number of factors currently hinder the ability of researchers to conduct military-funded research studies successfully in a timely fashion, including low-risk, psychosocial and behavioral, multisite studies. Our experiences and a review of the literature highlight examples of delays and wide variations in military and civilian Institutional Review Board (IRB) approvals. This article describes the specific experiences from a program of research over a 15-year period, required documents unrelated to protection of human subjects, onsite study principal investigators, examples from other research, and participant recruitment. Concern is raised about significant resources committed to nonstudy interventions, some described as "training," which fall outside of IRB review and its human subject protections. A broad initiative for evidenced-based research, particularly psychosocial and behavioral research, could become marginalized with limited resources redirected to technology-focused quick fixes and data collection during training. Possible solutions and initiatives are proposed that emphasize the need to reform IRB oversight and associated paperwork that is required to undertake military research.

Applying the nursing theory of human relatedness to alcoholism and recovery in alcoholics anonymous.

Alcohol misuse is a global health risk, and Alcoholics Anonymous (AA) is the largest and most popular mutual-help program for individuals with alcohol-related problems. In recent years, researchers and clinicians have become increasingly interested in specific mechanisms of action that may contribute to positive outcomes through involvement with this 12-step program for recovery, yet few have applied a theoretical framework to these efforts. We examined the phenomena of alcoholism and recovery in AA, using the nursing Theory of Human Relatedness (THR). THR addresses a pervasive human concern: "establishing and maintaining relatedness to others, objects, environments, society and self." The theory describes four states of relatedness (connectedness, disconnectedness, parallelism, and enmeshment) and four relatedness competencies (sense of belonging, reciprocity, mutuality, and synchrony). Both alcoholism and recovery in AA can be viewed primarily in terms of relatedness. In active alcoholism, an individual's involvement with alcohol (enmeshment) can limit, impair, or preclude healthy or adaptive relatedness toward virtually all other referents, including self. As a program of recovery, each of the 12 Steps of Alcoholics Anonymous addresses an individual's relatedness to one or more identified referents while simultaneously enhancing and expanding each of the four relatedness competencies. THR provides a theoretical framework to help direct patient care, research, and education and has the potential to serve as a unifying theory in the study of alcoholism and recovery in AA.

Design element alternatives for stress-management intervention websites.

Typical public and military-sponsored websites on stress and depression tend to be prescriptive. Some require users to complete lengthy questionnaires. Others reproduce printed flyers, papers, or educational materials not adapted for online use. Some websites require users to follow a prescribed path through the material. Stress Gym was developed as a first-level, evidence-based, website intervention to help U.S. military members learn how to manage mild to moderate stress and depressive symptoms using a self-help intervention with progress tracking and 24/7 availablility. It was designed using web-based, health-management intervention design elements that have been proven effective and users reported they prefer. These included interactivity, self-pacing, and pleasing aesthetics. Users learned how to manage stress by accessing modules they choose, and by practicing proven stress management strategies interactively immediately after login. Test results of Stress Gym with Navy members demonstrated that it was effective, with significant decreases in reported perceived stress levels from baseline to follow-up assessment. Stress Gym used design elements that may serve as a model for future websites to emulate and improve upon, and as a template against which to compare and contrast the design and functionality of future online, health-intervention websites.

Military nurses and combat-wounded patients: a qualitative analysis of psychosocial care.

PURPOSE: The aims were to explore the lived experience of combat-wounded patients and the military nurses who care for them. DESIGN AND METHODS: The study was a qualitative phenomenological design, and focus groups were conducted with 20 nurses and 8 combat-wounded patients. FINDINGS: Themes common to nurses and patients were coping, shared experiences, finding meaning, psychosocial nursing care, families, and bureaucratic structure. Thematic differences were the patients' perspectives "changed self" while nurses described "professional boundaries." PRACTICE IMPLICATIONS: The importance of finding meaning presents ideas that could help nurses and patients cope better with stressful situations regardless of the setting.

Emergency department triage nurses' self-reported adherence with American College of Cardiology/American Heart Association myocardial infarction guidelines.

BACKGROUND AND OBJECTIVE: Mortality from acute coronary syndromes has decreased. This achievement is based on the rapid recognition of possible acute coronary syndrome, obtaining an electrocardiogram for diagnosis, and the prompt initiation of therapy, including aspirin, oxygen, thrombolytics, and cardiac catheterization. The importance of rapid diagnosis and therapy is emphasized by American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines. However, these goals are not always met, and their failure leads to increased mortality. The purpose of this study was to determine the frequency emergency department nurses report guideline-related activities when triaging patients for complaints suggestive of myocardial infarction. SUBJECTS AND METHODS: As part of a larger study examining nurses' cardiac triage decisions, 158 emergency department nurses who belonged to the Emergency Nurses Association responded to a mailed questionnaire, which asked how frequently certain nursing practice activities were performed that would facilitate the attainment of ACC/AHA myocardial infarction guidelines and goals. Responses were measured on a 5-point Likert-type scale from "none of the time" to "all of the time." RESULTS: Not a single one of the 9 goals was met "all of the time" by all of the nurse participants. "All of the time" ranged from 52% for giving analgesics to 87% asking about chest pain. Only 81% of participants had a goal of obtaining electrocardiogram within 10 minutes of arrival, and only 27% of participants met all 9 goals "all of the time." The likelihood of nurses meeting goals was not associated with their age, experience, educational level, or certification status. CONCLUSIONS: We recommend tailored educational interventions be developed to improve nurses awareness of the importance of complying with the ACC/AHA standard of care practice goals and the necessity of achieving these goals all of the time as a path to improving patient outcome.

Stress Gym: Feasibility of deploying a web-enhanced behavioral self-management program for stress in a military setting.

Stress and depression can adversely impact the performance of military personnel. Cognitive-behavioral (CBT) interventions for managing stress are efficacious in traditional face-to-face formats, but the Internet supports a broader reach of these programs. This study reports on the feasibility of using an Internet-based self-help stress-management intervention in military personnel. There were 142 officers/enlisted sailors at a Naval Medical Center who completed the program. Evaluation of the program titled "Stress Gym" was positive for the user interface, content, feasibility, and satisfaction. Positive evaluation was not influenced by rank/status, sex, or previous deployment. Stress ratings also decreased significantly while using the program. These data support Stress Gym as being an online CBT-based self-help intervention that is feasible to deploy, accepted by the intended end users, and demonstrates the intended goal of reducing stress.

Evaluation of the ACT intervention to improve nurses' cardiac triage decisions.

Emergency department (ED) nurses are in a key position to initiate life-saving recommendations for myocardial infarction, which include a physician-read electrocardiogram (ECG) within 10 min of ED arrival. Using a quasi-experimental, one-group pretest-posttest design, the authors evaluated the preliminary effectiveness of the Aid to Cardiac Triage (ACT) intervention to improve ED nurses' cardiac triage decisions. Charts of all women who received an ED ECG 3 months before ( n = 171) and after (n = 184) the intervention and who were at least 18 years of age were reviewed. A 1-hr educational session was conducted to improve nurses' (n = 23) cardiac triage decisions. Postintervention, the proportion of women receiving an ECG within 10 min of ED arrival improved, as did the odds of women receiving a timely ECG. Preliminary evaluation of the ACT intervention indicates its effectiveness at improving ED nurses' cardiac triage decisions and obtaining a 10-min physician-read ECG.

The feasibility and utility of the aid to cardiac triage intervention to improve nurses' cardiac triage decisions.

BACKGROUND: Despite the benefits of prompt treatment of myocardial infarction, gender disparities exist in emergency department (ED) nurses' cardiac triage decisions. OBJECTIVE: To determine the feasibility and utility of the aid to cardiac triage (ACT) intervention designed to improve ED nurses' cardiac triage decisions for women with myocardial infarction. METHODS: A prospective, exploratory design was used. To determine feasibility, we evaluated the 1-hour time allocated for the intervention and ED nurses' participation rates. Twenty-three participants completed a utility questionnaire at the completion of the 1-hour intervention, and 18 participants completed the questionnaire 3 months post-intervention. RESULTS: The ACT intervention was delivered within 30 to 40 minutes, allowing 20 minutes for questions and discussion. ED nurses viewed the ACT intervention as a useful, helpful, and practical tool for improving their cardiac triage decisions at both intervention completion and 3 months later. CONCLUSION: The evaluation supports the feasibility and utility of the ACT intervention.