Posttraumatic growth in eating disorder recovery.

OBJECTIVE: To investigate posttraumatic growth in individuals recovering from an eating disorder. DESIGN: A convergent parallel mixed methods design was used. PARTICIPANTS: The sample consisted of 28 participants who completed the entire study and an additional 10 who completed only the quantitative portion of this mixed methods study. METHODS: The National Eating Disorders Association (NEDA) provided a link to the electronic survey via their website. Participants were asked to complete the Posttraumatic Growth Inventory (PTGI) and the Core Beliefs Inventory (CBI) in the quantitative strand. For the qualitative strand, participants were asked to describe any positive changes in their beliefs or life as the result of their eating disorder (ED). RESULTS: Participants reported a high amount of posttraumatic growth as indicated by their mean score on the CBI (30.39, SD 7.89) and (71.26, SD 16.58) on the PTGI. Qualitative categories included relating to others, personal strength, new possibilities, appreciation of life, and spiritual change. CONCLUSION: Participants described the transformation they experienced in the recovery process, with recovery from an eating disorder facilitating an opportunity for growth. Providing posttraumatic growth interventions may have the potential to help individuals with eating disorders find meaning in their pathway through recovery.

The restraint chair: A qualitative study of the patient experience.

Despite initiatives to eliminate restraint from acute psychiatric care, there remain times when violent episodes threaten the safety of patients and/or staff. The restraint chair may be used in these moments and provide an alternative to four-point restraint. The purpose of this study was to examine the patient experience of the restraint chair. Patients who had an episode of restraint in the restraint chair during their hospital stay were interviewed about the experience. Participants described the experience as "unpleasant," with the majority preferring the restraint chair to other methods of restraint they had experienced. Participants indicated they could "understand" why the restraint had occurred and felt staff were "helpful" and "create safety." Finally, participants stated the hospital experience was "positive." Although the goal remains to eliminate restraint, psychiatric settings may want to consider the restraint chair as an alternative to four-point restraint for situations requiring mechanical restraint. Nurses' presence and communication with patients during the restraint process is important to the patient experience. More research is needed to verify these results.

Ramifications of the COVID-19 Pandemic on Nursing Students' Transition to Practice.

As the COVID-19 pandemic altered the course of nursing education worldwide, it disrupted efforts to transition nursing students to professional practice. The investigators examined clinical nursing faculty members' assessment of senior students' practice strengths and challenges compared to graduates of prior years. Findings demonstrated COVID-19's wide-ranging impacts on nursing students' transition to practice and offered suggestions about the implications for nursing professional development practitioners.

Emergency Nurses' Care of Psychiatric Patients.

OBJECTIVE: The volume of patients with mental illness presenting to the emergency department (ED) has been increasing in recent years, yet many ED nurses hold stigmatized attitudes and behaviors about patients with mental illness, creating barriers to therapeutic care. At the same time, there has been an increase in workplace violence (WPV) against nurses. Fortunately, resilience helps nurses manage their response to WPV and continue to provide therapeutic care. Although research has considered many barriers to the therapeutic care of patients with mental illness in the ED, the variables of stigma, resilience, and the experience of WPV have not been considered in relation to behavioral care competence and work performance, which is the purpose of this study. METHODS: A survey consisting of the Brief Resilience Scale, the Individual Work Performance Questionnaire, the Behavioral Healthcare Competency (BHCC) survey, the Opening Minds Scale for Healthcare Providers, and open-ended questions about WPV were used to collect data. Independent t-tests were run between scale scores and categorical descriptive data. Correlations were run between scale scores and continuous descriptive data. RESULTS: Over half (60%) had experienced a personal injury from WPV. Higher behavioral competence scores were associated with lower stigma and higher contextual work performance. Nurses who experienced a WPV injury had higher mean BHCC and higher contextual work performance scores. CONCLUSIONS: WPV may be an impetus for nurses to improve their practice in behavioral health and working as part of a team.

Validating Psychometric Properties of a Revised Patient Version of the Combined Assessment of Psychiatric Environments (CAPE).

BACKGROUND: Measuring patient experience is an essential challenge in the inpatient behavioral health population. AIM: This initiative analyzed the psychometric properties of a revised version of the patient Combined Assessment of Psychiatric Environments (p-CAPE-R) survey. METHODS: The p-CAPE was revised to encompass the interdisciplinary treatment team and implemented on five inpatient psychiatric units at an academic medical center. A psychometric analysis was performed on the p-CAPE-R. RESULTS: Analysis of factor loadings with a large sample (n = 786) revealed a more coherent item structure under the "staff competency and engagement" and "treatment effectiveness" domains than presented in the original instrument development research. CONCLUSIONS: Although the p-CAPE-R reflects a more useful and psychometrically sound instrument than the original p-CAPE, further analysis and revision to reflect the entire interdisciplinary team is warranted.

Compassion Satisfaction and Burnout Are Related to Psychiatric Nurses' Antipathy Towards Nonsuicidal Self-Injury (NSSI).

OBJECTIVE: Many psychiatric patients engage in nonsuicidal self-injury (NSSI). Despite this, studies show that psychiatric nurses display a stigma toward patients who engage in self-harm, often due to the fact that nurses report a lack of understanding about the behavior. In addition, nurses can struggle with professional quality of life (ProQOL). The purpose of this study was to provide an educational intervention on NSSI and measure its effects on antipathy as well as to determine if ProQOL has an impact on overall antipathy. METHODS: A sample of psychiatric nurses was recruited and randomly assigned to either the educational intervention or control group. Both groups took the Self-Harm Antipathy Scale (SHAS) and ProQOL-V; the intervention group was asked to repeat the SHAS immediately following an educational video, and the control was asked to repeat the SHAS at least 2 weeks later. Qualitative data were also collected. RESULTS: The ProQOL-V CS subscale and pretest SHAS total scores (n = 23, r = -0.432, p = .039) and SHAS Needs Function (NF) (n = 23, r = -0.454, p = .029) showed a significant moderate negative correlation. There was also a significant moderate positive correlation between the ProQOL-V Burnout subscale and SHAS NF pretest scores (n = 23, r = 0.483, r = 0.02). CONCLUSIONS: A relationship between high compassion satisfaction and low antipathy, as well as between high burnout and high antipathy, particularly in the area of understanding the reasons patients self-harm (NF) was found. Educating nurses on the reasons for NSSI may reduce their antipathy. It may also be beneficial to support nurses to prevent burnout.

I Get by With a Little Help From My Peers: Mindfulness and Peer Support for Doctor of Nursing Practice Students.

ABSTRACT: Graduate nursing students faced numerous stressors while pursuing their education during the COVID-19 pandemic, with many working clinically while studying. The purpose of this pilot was to explore support strategies and decrease stress in first-year students enrolled in a doctor of nursing practice program during a time of uncertainty and crisis. Graduate students were assigned to practice a three-minute mindfulness activity and connect with a fellow student for a month. Students reported mindfulness benefits and social support. Modeling healthy practices is critical to support mastery of skills that will promote positive reactions to challenges in their future practice settings.

Preparing for the Impact of COVID-19 on the Mental Health of Youth.

The COVID-19 pandemic is continuing to have long-term and global effects that the vaccine may not ease. Children and adolescents endured unprecedented periods of loneliness, social isolation, financial stressors, in-home conflicts, changes in living circumstances, and variable access to healthcare, resulting in increased mental health sequelae. Timely recognition of students' anxiety, depression, and disruptive behaviors will allow appropriate interventions to de-escalate these feelings and prevent suicidal ideations and attempts. As youth return to school, their mental health needs will not subside. School nurses and the multidisciplinary team have a vital role in impacting this population's already surging increase of mental and behavioral health disorders.

Breastfeeding During a Pandemic: The Influence of COVID-19 on Lactation Services in the Northeastern United States.

BACKGROUND: Pandemic-related restrictions have limited traditional models of lactation support. RESEARCH AIMS: The primary aim of this study was to determine changes to breastfeeding support services during the coronavirus-2019 pandemic according to trained lactation providers. The secondary aim was to assess strengths and limitations of telehealth services. METHODS: A prospective survey was conducted entirely online using the Qualtrics platform during June 2020. Gatekeepers at Connecticut agencies and breastfeeding networks were forwarded an anonymous survey link to distribute to eligible lactation staff. RESULTS: A variety of participants (N = 39) completed the survey and the majority (69.2%; n = 27) were providing only telehealth services. More than half (58.1%; n = 18) of the participants who conducting telehealth in any form, found that virtual lactation support was moderately effective compared to in-person support. Weakness of virtual support included technical and logistical difficulties, challenges assisting with latching or reading body language over the phone or online, and accurately assessing infant growth. Strengths related to virtual support included the flexibility and convenience of home-based support, expanded communication strategies, and safety from virus exposure. Further, visits with a lactation professional decreased significantly during the pandemic. Limited in-hospital and pediatrician support were also noted, particularly among groups without access to telehealth resources. CONCLUSIONS: As a result of the pandemic and associated shifts in lactation services, breastfeeding disparities may be further exacerbated among those without equitable access to lactation support. Challenges and innovations in virtual support may influence adaptive options in the field moving forward.

Caffeine and high energy drink use and knowledge by nurses in three countries.

AIM: The purpose of this study was to examine nurses' use and knowledge of caffeine and high energy drinks (HED) in three countries. METHODS: Nurses in each country completed a survey on caffeine and HED use and knowledge. RESULTS: In a sample of 182 nurses, caffeine use was high with 92% of nurses in Korea, 90.8% in Italy and 88.1% in the United States (US) having at least one cup of coffee a day while 64% of Koreans and 11.9% of those in the US had at least one HED per day. In Korea 68% of nurses (Italy 63.1% and 35.8% US) had at least one cup of caffeinated tea per day. Most agreed there is a need to educate nurses about HED, which contain high amounts of caffeine. Over half of nurses in Korea (58%) and the US (56.7%) said their colleagues consume HED at work. CONCLUSION: Findings of this study indicate many nurses are consuming caffeine at work and there is a need for education. It is unclear how caffeine affects nurses' clinical performance, which raises the issue of patient safety. Further research is needed regarding safe amounts of caffeine while nurses are on the job as well as an understanding of how HED additives may affect the well-being and clinical care of nurses.

The Development of Trauma and Resilience Competencies for Nursing Education.

BACKGROUND: Trauma and its consequences have been identified as a high-priority public health risk. A growing body of research reveals the devastating long-term consequences from common and widespread adverse events across the life span. In addition, recent research links medical procedures and medical illnesses with posttraumatic stress disorder. Nurses too are at risk and suffer vicarious trauma. Nurses must be able to recognize and assess for early trauma symptoms and assist in enhancing resilience in order to prevent and care for those with trauma. However, there is a lack of trauma-informed and trauma-specific training in nursing education. Given the ubiquity of traumatic events, the pervasive physical and emotional sequelae of trauma, and the existence of evidence-based treatment for trauma; there is a critical need to develop core competencies for nursing education and practice. AIM: The purpose of this study was to develop and validate Trauma and Resilience Competencies for Nursing Education. METHOD: An expert panel of 16 nurses met in 2018 to develop Trauma and Resilience Competencies for undergraduate and graduate nursing programs, and for psychiatric mental health nurse practitioner education. Following the Expert Panel's work and approval from the institutional review board, a modified e-Delphi survey was sent to experts in trauma and resilience to validate this work. RESULTS: The competencies were validated and edited to 88 competencies through two rounds of a Delphi survey. CONCLUSIONS: Implications for education, practice, and research are discussed. The Trauma and Resilience Competencies for Nursing Education will be disseminated widely through publications and are available online.

Incorporating Future of Nursing Competencies Into a Clinical and Simulation Assessment Tool: Validating the Clinical Simulation Competency Assessment Tool.

AIM: The purpose of the study was to evaluate the validity of the Clinical Simulation Competency Assessment Tool (ClinSimCAT). BACKGROUND: The 2011 Future of Nursing report encouraged nursing programs to move toward a competency-based approach to education. As no tool was found to holistically evaluate nursing student competency in clinical and simulation settings, we developed the ClinSimCAT based on the Institute of Medicine recommended competencies. METHOD: A Delphi study with three rounds was conducted. A national sample of nursing education and simulation leaders was used to achieve consensus about the competencies. RESULTS: The process resulted in a set of 20 competencies across eight domains (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, informatics, professionalism, and systems-based practice). CONCLUSION: The ClinSimCAT has demonstrated evidence of content validity and can be used for evaluation of clinical and simulation across a variety of undergraduate nursing courses.

Nurses' resilience levels and the effects of workplace violence on patient care.

Nurses experience high rates of violence on the job, which is a significant stressor. Stress can alter nurses' care of patients, but stress can be mitigated by resilience. The purpose of this study was to examine the relationship between nurses' resilience levels and their reports of patient care following episodes of workplace violence. Six themes emerged from nurses' (n = 57) responses to workplace violence: vigilance, cautious yet individualized with care, part of the job, growth, jaded, and no effect. Low resilience levels were found in nurses with themes of feeling jaded, cautious yet individualized with care, and vigilance. High resilience levels were found in nurses with themes of no effect, growth, cautious yet individualized with care, and vigilance. Nurses' resilience scores were related to their patient care descriptions after episodes of workplace violence. Raising nurses' resilience levels through training might help them to positively overcome the effects of workplace violence, limiting impacts to patient care.

Determinants of Cycling Performance: a Review of the Dimensions and Features Regulating Performance in Elite Cycling Competitions.

BACKGROUND: A key tenet of sports performance research is to provide coaches and athletes with information to inform better practice, yet the determinants of athletic performance in actual competition remain an under-examined and under-theorised field. In cycling, the effects of contextual factors, presence of and interaction with opponents, environmental conditions, competition structure and socio-cultural, economic and authoritarian mechanisms on the performance of cyclists are not well understood. OBJECTIVES: To synthesise published findings on the determinants of cyclists' behaviours and chances of success in elite competition. METHODS: Four academic databases were searched for peer-reviewed articles. A total of 44 original research articles and 12 reviews met the inclusion criteria. Key findings were grouped and used to shape a conceptual framework of the determinants of performance. RESULTS: The determinants of cycling performance were grouped into four dimensions: features related to the individual cyclist, tactical features emerging from the inter-personal dynamics between cyclists, strategic features related to competition format and the race environment and global features related to societal and organisational constraints. Interactions between these features were also found to shape cyclists' behaviours and chances of success. CONCLUSION: Team managers, coaches, and athletes seeking to improve performance should give attention to features related not only to the individual performer, but also to features of the interpersonal, strategic, global dimensions and their interactions.

The Relationship between DNA Methylation and Antidepressant Medications: A Systematic Review.

Major depressive disorder (MDD) is the leading cause of disability worldwide and is associated with high rates of suicide and medical comorbidities. Current antidepressant medications are suboptimal, as most MDD patients fail to achieve complete remission from symptoms. At present, clinicians are unable to predict which antidepressant is most effective for a particular patient, exposing patients to multiple medication trials and side effects. Since MDD's etiology includes interactions between genes and environment, the epigenome is of interest for predictive utility and treatment monitoring. Epigenetic mechanisms of antidepressant medications are incompletely understood. Differences in epigenetic profiles may impact treatment response. A systematic literature search yielded 24 studies reporting the interaction between antidepressants and eight genes (BDNF, MAOA, SLC6A2, SLC6A4, HTR1A, HTR1B, IL6, IL11) and whole genome methylation. Methylation of certain sites within BDNF, SLC6A4, HTR1A, HTR1B, IL11, and the whole genome was predictive of antidepressant response. Comparing DNA methylation in patients during depressive episodes, during treatment, in remission, and after antidepressant cessation would help clarify the influence of antidepressant medications on DNA methylation. Individuals' unique methylation profiles may be used clinically for personalization of antidepressant choice in the future.

The restraint chair: A qualitative study of nurses' experience with the restraint chair versus four point restraint.

Restraint and seclusion continues to be a challenging topic in psychiatric nursing care. While there is a movement toward reduction and elimination of restraint, emergency situations still arise that require intervention for the safety of patients and staff. In addition to traditional methods of restraint (physical holds, four-point restraint, seclusion), the restraint chair has been introduced at some hospitals as an alternative to four-point restraint. The restraint chair allows the patient to be upright in a seated position during the restraint process. Little research on the restraint chair currently exists. The purpose of this study was to examine the nurses' experience with the restraint chair compared to four-point restraint. Results indicate nurses feel the restraint chair is easier to use, more humane, less traumatic, comforting, and enhances the therapeutic relationship compared to four-point restraint. Based on the reports of nurses in this study and prior quantitative work on the restraint chair (Castillo, Coyne, Chan, Hall, & Vilke, 2011; Visaggio et al., 2018), the restraint chair appears to be a safe and effective alternative to traditional four-point restraint. More research verifying these results at other hospitals in the United States and abroad is warranted.

Nursing Student Interprofessional Simulation Increases Empathy and Improves Attitudes on Poverty.

Poverty is increasing and it has adverse effects on health. Nurses need to understand how to help patients in poverty meet health goals within interprofessional teams. Nursing students and Veteran's Affairs employees, consisting of patient care and support staff, were recruited for an interprofessional poverty simulation. Prior to and directly following the simulation, participants were asked to complete the Attitudes about Poverty and Poor People (APPP) scale, the Toronto Empathy Questionnaire (TEQ), and the Self Reflection and Insight Scale (SRIS). Scores on the APPP and TEQ improved. The SRIS results had no significant changes. Interprofessional simulation positively impacts attitudes toward poverty and empathy in nursing students and health professionals.

Practices and Attitudes of Nursing Students Toward Patients With Disordered Eating Behaviors.

Disordered eating (DE) behaviors are associated with obesity and eating disorders. This study describes practices and attitudes of nursing students toward patients exhibiting DE and how personal DE behaviors affect practices and attitudes. Most respondents had a mental health rotation (74.7 percent) and DE education (68 percent); however, only 34.7 percent felt prepared to screen for DE, and only 44 percent were taught to screen. Those scoring high for DE behaviors (n = 7) indicated greater rates of feeling prepared to screen. This knowledge can help nurse educators design curricula to increase the preparation of nurses to address DE behaviors.

The relationship of body mass index (BMI) to job performance, absenteeism and risk of eating disorder among hospital-based nurses.

Obesity has been linked to job absenteeism and decreased job performance. Additionally, shift work may be related to abnormal eating in nurses. This study examines the relationship between body mass index, job performance, absenteeism, and eating disorder risk among nurses. Registered Nurses (n = 63) participated in a survey that included the Work Limitations Questionnaire and the Eating Attitudes Test. Most participants were either overweight or obese. Significant correlations were noted between body mass index and job performance, and body mass index and risk of eating disorders. An understanding of how increased body mass index can affect a nurse's job performance and wellness warrants continued attention from the nursing profession.