Childhood trauma differentially impacts depression and stress associations with reintegration challenges among post-9/11 U.S. veterans.

BACKGROUND: Post-9/11 veterans exhibit high prevalence of deployment stress, psychological conditions, and traumatic brain injury (TBI) which impact reintegration, especially among those with a history of interpersonal early life trauma (I-ELT). The relative importance of each risk factor is unclear. PURPOSE: We examined major deployment and clinical exposures of reintegration challenges among veterans with and without I-ELT. METHOD: We analyzed cross-sectional data of 155 post-9/11 veterans from the Translational Research Center for TBI and Stress Disorders study. FINDINGS: Depression severity had the strongest association with reintegration challenges, followed by posttraumatic stress disorder (PTSD) severity, post-deployment stress, and deployment safety concerns. Deployment safety concerns had a stronger, significant association among veterans with I-ELT. In nearly every model, PTSD and depression severities were weaker for veterans with I-ELT, compared to those without. DISCUSSION: Clinicians should consider the relative risk of concurrent clinical conditions and trauma histories when considering veterans' reintegration needs.

A Theoretical and Clinical Perspective on Social Relatedness and the Patient With Serious Mental Illness.

BACKGROUND: A therapeutic relationship forms the basis of care of patients in psychiatric mental health nursing. However, individuals with schizophrenia have difficulty participating in these relationships. Recent research in the area of social cognitive psychology offers that deficits in this area affect the flow of perceiving and relating in interpersonal relationships. This literature has not been applied to nursing. OBJECTIVE: The objective of this article is to review the theories underpinning therapeutic relationships from a nursing and psychological perspective, including the newest research from social cognitive psychology. DESIGN: The article presents a literature review of the theories of nursing, psychology, and social cognitive science. Two patient case studies are used as examples of application of the theories. RESULTS: This article incorporates new knowledge about the components of social cognition to inform nurses as they build therapeutic relationships with patients with chronic and persistent mental illnesses. CONCLUSIONS: The science of social cognitive psychology offers nursing a new perspective on the evolving therapeutic nurse-patient relationship with patients with chronic and persistent mental illnesses. It has implications for clinicians, educators, and nurse scientists.

Clinically relevant correlates of accurate perception of patients' thoughts and feelings.

The goal was to explore the clinical relevance of accurate understanding of patients' thoughts and feelings. Between 2010 and 2012, four groups of participants (nursing students, medical students, internal medicine residents, and undergraduate students) took a test of accuracy in understanding the thoughts and feelings of patients who were videorecorded during their actual medical visits and who afterward reviewed their video to identify their thoughts and feelings as they occurred (Test of Accurate Perception of Patients' Affect, or TAPPA). Participants' accuracy scores were then correlated with participants' attitudes toward patient-centered care, clinical course background, recall of clinical conversation, evaluations of clinical performance made by preceptors, evaluations of interpersonal skill made by standardized patients in clinical encounters, and independent coding of behavior in a clinical encounter. Accuracy in understanding patients' thoughts and feelings was significantly correlated with nursing students' clinical course experience, clinicians' favorable attitudes to psychosocial discussion, standardized patients' evaluations of medical students' interpersonal skill, independent coding of medical students' patient-centered behavior while taking a social history, and undergraduates' more accurate recall of what an actor-physician said on video. Accuracy in perceiving patients' thoughts and feelings can be objectively measured and is a skill relevant to clinical performance.

The Test of Accurate Perception of Patients' Affect (TAPPA): an ecologically valid tool for assessing interpersonal perception accuracy in clinicians.

OBJECTIVE: A clinician's ability to infer patients' thoughts and feelings is a critical component of high quality care. The goal of this article is to present a new test to measure this ability in clinicians, called the Test of Accurate Perception of Patients' Affect (TAPPA). METHODS: Audiovisual clips were taken from patients' actual medical visits. The patients reviewed the videotape after the visit to identify their thoughts and feelings during the visit. This information was used to extract short audiovisual clips for which the correct answer was the patient's report of the thought or feeling associated with that clip. The TAPPA contains 48 audiovisual clips, each responded to in a multiple choice format. RESULTS: The TAPPA showed good psychometric properties (optimal mean and good variance, adequate internal consistency, and strong re-test reliability) and convergent validity with other tests of emotion recognition. In addition, the test showed predicted better performance by female than male participants. CONCLUSION: The TAPPA promises to be a valuable tool for research and education on provider-patient relationships and quality of care. PRACTICE IMPLICATIONS: A tool for testing clinicians' understanding of patients' thoughts and feelings may contribute to better quality of care and to improved selection and training.

Client-nurse interaction with individuals with schizophrenia: a descriptive pilot study.

Individuals with schizophrenia have difficulty forming social relationships. New research has identified deficits in social cognition. These findings have not been applied to studying the nurse-client relationship. The aim of this pilot study is to describe the verbal and nonverbal communication between a psychiatric clinical nurse specialist and clients with schizophrenia through assessment of their videotaped interactions. Clients showed differing levels of ability to respond to the voice and body/facial features of the nurse. The data obtained can be used as a basis for further investigations regarding the interactions between nurses and those clients with severe and persistent mental illnesses.