Mobilizing nurses to address the opioid misuse epidemic.

BACKGROUND: The opioid epidemic is a major health challenge in the United States. PURPOSE: Members from the American Academy of Nursing joined to write a consensus paper about nurses' role in the opioid epidemic. METHODS: The panel reviewed the history of the opioid epidemic and policies to care for patients with opioid use disorder (OUD) and how registered nurses (RNs) and advanced practice nurses (APRNs) could increase care for people with OUD. DISCUSSION: Recommendations are presented to advance policies that empower RNs and APRNs to abate the opioid epidemic. CONCLUSION: Recommendations include (a) advance legislation that supports RNs and APRNs full scope of practice and expands professional role in pain management and addiction prevention; (b) evaluate effective policies that promote RN and APRN care; support federal elimination of X-waiver with state law alignment; (c) sustain the use of nurses in telemedicine; (d) support nursing research on nurse involvement in all aspects of OUD.

American Academy of Nursing consensus recommendations to advance system level change for nurse well-being.

The COVID-19 pandemic has required close examination of workforce-related stressors that over decades have contributed to widespread burnout, negative health outcomes, including mental health outcomes, and the loss of the well-educated professionals who are the future of the nursing profession. In the United States and globally, evidence points to factors known to diminish well-being, including inequities, issues of minority status, persistent discrimination, and demanding work environments. The American Academy of Nursing (AAN), dedicated to organizational excellence, nursing leadership and evidence-based policy, develops statements reflecting its mission and those of its nursing affiliates and corporate member, The American Nurses Association. Within nursing, despite the efforts of its members toward advancement, professional fulfillment is often constrained by the systems in which nurses practice and workplace factors over which they have little control. Action by key organizations to initiate changes at systems levels in workplace safety, to increase professional mobility, and propel policies that increase access to health care resources could improve nurse well-being. This paper proposes recommendations from the AAN Expert Panels on Building Health Care System Excellence, Psychiatric Mental Health and Substance Use, and Global Health Expert Panels for the American Academy of Nursing to leverage related policy in the arenas of government and professional/healthcare organizations. Transforming health care work environments and advancing nurse well-being and equity can be accomplished through key, innovative policy changes. These will be achieved through collaboration among associations, organizations, nonprofit groups, and with the public and the media.

Case study of an adaptation and implementation of a Diabetes Prevention Program for individuals with serious mental illness.

The Diabetes Prevention Program (DPP) is an evidence-based lifestyle intervention developed to decrease the risk for type 2 diabetes and promote weight loss in individuals at risk for diabetes. Individuals with serious mental illness have a greater risk for developing diabetes compared with the general population. In this article, the authors provide a detailed description of the adaptation process of the DPP for individuals with serious mental illness (DPP-SMI). The adaptation process was based on a cultural adaptation framework for modifying evidence-based interventions. To assess the effectiveness of the DPP-SMI, 11 individuals from a community mental health residential agency completed a 22-session pilot study of the adapted program and provided physiological measures before and after the intervention. As primary outcomes, participants were expected to report decreased body weight and increased physical activity per week. Completers had an average weight loss of 19 lbs (8%) and their physical activity increased from 161 to 405 min per week. These preliminary results together with participants' feedback informed further refinement of the DPP-SMI. This case study supports that individuals with serious mental illness can benefit from the DPP-SMI, which is tailored to meet the unique needs of this population group.

Mentoring Interventions for Underrepresented Scholars in Biomedical and Behavioral Sciences: Effects on Quality of Mentoring Interactions and Discussions.

Mentors rarely receive education about the unique needs of underrepresented scholars in the biomedical and behavioral sciences. We hypothesized that mentor-training and peer-mentoring interventions for these scholars would enrich the perceived quality and breadth of discussions between mentor-protégé dyads (i.e., mentor-protégé pairs). Our multicenter, randomized study of 150 underrepresented scholar-mentor dyads compared: 1) mentor training, 2) protégé peer mentoring, 3) combined mentor training and peer mentoring, and 4) a control condition (i.e., usual practice of mentoring). In this secondary analysis, the outcome variables were quality of dyad time and breadth of their discussions. Protégé participants were graduate students, fellows, and junior faculty in behavioral and biomedical research and healthcare. Dyads with mentor training were more likely than those without mentor training to have discussed teaching and work-life balance. Dyads with peer mentoring were more likely than those without peer mentoring to have discussed clinical care and career plans. The combined intervention dyads were more likely than controls to perceive that the quality of their time together was good/excellent. Our study supports the value of these mentoring interventions to enhance the breadth of dyad discussions and quality of time together, both important components of a good mentoring relationship.

A Randomized Controlled Trial of Mentoring Interventions for Underrepresented Minorities.

PURPOSE: To conduct a randomized controlled trial to evaluate the effects of different mentoring interventions on the basic psychological need satisfaction of underrepresented minorities and women in academia. METHOD: Participants were 150 mentor/protégé dyads from three academic medical centers and eight other colleges and universities in western and central New York, randomized from 2010 to 2013 into mentor training (using principles of self-determination theory); peer mentoring for protégés; mentor training and peer mentoring for protégés combined; or control/usual practice. Protégé participants were graduate students, fellows, and junior faculty who were from underrepresented groups based on race, ethnicity, gender, or disability.The primary analysis was a comparison of intervention effects on changes in protégés' satisfaction of their basic psychological needs (competence, autonomy, and relatedness) with their mentor. They completed a well-validated, online questionnaire every two months for one year. RESULTS: There was no significant effect at the end of one year of either mentor training or peer mentoring on protégés' psychological basic need satisfaction with mentor specifically or at work in general. Exploratory analyses showed a significant effect of the mentor-based intervention on the protégés' overall psychological need satisfaction with their mentor at two months, the time point closest to completing mentor training. CONCLUSIONS: This randomized controlled trial showed a potential short-term effect of mentor training on changing basic psychological need satisfaction of underrepresented scholars with their mentors. Despite the lack of sustained effect of either mentor training or peer mentoring, these short-term changes suggest feasibility and potential for future study.

Evaluation of a theory-based education program to motivate nursing students to intervene with their seriously mentally ill clients who use tobacco.

Tobacco dependence is a major health problem for persons with a serious mental illness (SMI). Nurses working with psychiatric clients often lack the knowledge, ability, and confidence to offer their clients meaningful, effective help to quit smoking. The purpose of this study was to evaluate the effects of a tobacco education program on the perceived competence and motivation of baccalaureate nursing students (BSN) to intervene with SMI clients who use tobacco. The education program significantly improved the competence and motivation of BSN students to deliver cessation interventions to this vulnerable population of smokers.

Making a case for systematic integration of theory-based tobacco education into graduate psychiatric/mental health nursing curriculum.

Tobacco use and dependence is a serious public health issue that disproportionately affects the mentally ill client population. Mental health professionals, including psychiatric/mental health advanced practice nurses (PMHAPNs), are disinclined to integrate tobacco cessation interventions into their practice, due in part, to a general lack of tobacco-related knowledge (C. Essenmacher, C. Karvonen-Gutierrez, J. Lynch-Sauer, & S. A., Duffy, 2008; A. J. Molina, T. Fernandez, D. Fernandez, M. Delgado, S. de Abajo, & V. Martin, 2012; L. Sarna, L. L. Danao, S. Chan, S. Shin, L. Baldago, E. Endo, & M. E. Wewers, 2006); D. Sharp, S. Blaakman, R. Cole, & J. Evinger, 2009). This paper provides an in-depth literature review of tobacco education in nursing curricula and proposes the systematic integration of theory-based tobacco content into psychiatric/mental health graduate nursing programs.

Report from a national tobacco dependence survey of psychiatric nurses.

BACKGROUND: Persons with mental illness smoke proportionately more cigarettes and die earlier than the general population. Yet compared with other clinicians, psychiatric professionals have intervened slowly with smoking patients. To assess psychiatric nurses' perspectives concerning tobacco dependence interventions, the American Psychiatric Nurses Association (APNA) Tobacco Dependence Task Force surveyed email-accessible APNA members (N = 1,365). OBJECTIVES: This paper reports survey results and implications for psychiatric nursing. STUDY DESIGN: Cross-sectional analysis of a 29-item online survey conducted in early 2008. RESULTS: Most nurses asked if patients smoked but fewer advised against smoking, referred to cessation resources, or delivered intensive interventions. Nurses referred to resources if they felt motivated, knowledgeable, and/or confident in their skills and rated highly their patients' ability and/or motivation to quit smoking. Workplace characteristics were related to nurses' behaviors. Nursing curricula lack tobacco dependence content. CONCLUSIONS: Findings will guide efforts to support nurses in reducing/eliminating smoking by their patients through practice, education, research, and policy initiatives.

A review of research by nurses regarding tobacco dependence and mental health.

The prevalence of tobacco use and dependence among those with psychiatric and/or substance use disorders is exceptionally high, contributing to significant morbidity and mortality. The purpose of this review is to discuss the findings conducted by nurses regarding smoking and mental health. A search of the available literature since 1950 resulted in a review of 17 studies authored or coauthored by nurses. Most study designs were descriptive with only one investigator reporting the results of a small clinical trial. In addition to documenting smoking patterns in this population, investigators found that many psychiatric nurses assessed their clients for tobacco use and advised them to stop smoking but few intervened intensively to aid cessation. Psychiatric nurses reported low efficacy for delivering interventions and considerable doubt about their clients' abilities and motivation to stop smoking. Although some desired additional training in tobacco dependence interventions, nurses reported feeling ethically conflicted about, and were inconsistently supportive of, system level interventions such as tobacco free health care settings. It is likely that these findings, as well as the paucity of tobacco dependence studies, reflect the relatively small number of psychiatric nurses conducting research as well as the inattention, until recently, of mental health leaders, policy makers, and funders to the importance of tobacco dependence research in this clinical population. As tobacco dependence treatment for those with mental illnesses and/or addictive disorders becomes more of a public health priority, opportunities abound for nurse researchers to contribute to the growing evidence in this often neglected area.

A self-determination multiple risk intervention trial to improve smokers' health.

BACKGROUND: Little is known about how interventions motivate individuals to change multiple health risk behaviors. Self-determination theory (SDT) proposes that patient autonomy is an essential factor for motivating change. OBJECTIVE: An SDT-based intervention to enhance autonomous motivation for tobacco abstinence and improving cholesterol was tested. DESIGN: The Smokers' Health Study is a randomized multiple risk behavior change intervention trial. SETTING: Smokers were recruited to a tobacco treatment center. PATIENTS: A total of 1.006 adult smokers were recruited between 1999 and 2002 from physician offices and by newspaper advertisements. INTERVENTIONS: A 6-month clinical intervention (4 contacts) to facilitate internalization of autonomy and perceived competence for tobacco abstinence and reduced percent calories from fat was compared with community care. Clinicians elicited patient perspectives and life strivings, provided absolute coronary artery disease risk estimates,enumerated effective treatment options, supported patient initiatives,minimized clinician control, assessed motivation for change, and developed a plan for change. OUTCOME MEASURES: Twelve-month prolonged tobacco abstinence, and change in percent calories from fat and low-density lipoprotein-cholesterol (LDL-C) from baseline to 18 months. RESULTS- Intention to treat analyses revealed that the intervention significantly increased 12-month prolonged tobacco abstinence (6.2% vs 2.4%; odds ratio [OR]=2.7, P=.01, number needed to treat [NNT] =26), and reduced LDL-C (-8.9 vs -4.1 mg/dL; P=.05). There was no effect on percent calories from fat. CONCLUSIONS: An intervention focused on supporting smokers'autonomy was effective in increasing prolonged tobacco abstinence and lowering LDL-C. Clinical interventions for behavior change may be improved by increasing patient autonomy and perceived competence.

Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial.

A longitudinal randomized trial tested the self-determination theory (SDT) intervention and process model of health behavior change for tobacco cessation (N = 1006). Adult smokers were recruited for a study of smokers' health and were assigned to intensive treatment or community care. Participants were relatively poor and undereducated. Intervention patients perceived greater autonomy support and reported greater autonomous and competence motivations than did control patients. They also reported greater medication use and significantly greater abstinence. Structural equation modeling analyses confirmed the SDT process model in which perceived autonomy support led to increases in autonomous and competence motivations, which in turn led to greater cessation. The causal role of autonomy support in the internalization of autonomous motivation, perceived competence, and smoking cessation was supported.

A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research.

A. Bellg, B. Borrelli, et al. (2004) previously developed a framework that consisted of strategies to enhance treatment fidelity of health behavior interventions. The present study used this framework to (a) develop a measure of treatment fidelity and (b) use the measure to evaluate treatment fidelity in articles published in 5 journals over 10 years. Three hundred forty-two articles met inclusion criteria; 22% reported strategies to maintain provider skills, 27% reported checking adherence to protocol, 35% reported using a treatment manual, 54% reported using none of these strategies, and 12% reported using all 3 strategies. The mean proportion adherence to treatment fidelity strategies was .55; 15.5% of articles achieved greater than or equal to .80. This tool may be useful for researchers, grant reviewers, and editors planning and evaluating trials.

Examples of implementation and evaluation of treatment fidelity in the BCC studies: where we are and where we need to go.

Treatment fidelity plays an important role in the research team's ability to ensure that a treatment has been implemented as intended and that the treatment has been accurately tested. Developing, implementing, and evaluating a treatment fidelity plan can be challenging. The treatment fidelity workgroup within the Behavior Change Consortium (BCC) developed guidelines to comprehensively evaluate treatment fidelity in behavior change research. The guidelines include evaluation of treatment fidelity with regard to study design, training of interventionists, delivery and receipt of the intervention, and enactment of the intervention in real-life settings. This article describes these guidelines and provides examples from four BCC studies as to how these recommended guidelines for fidelity were considered. Future work needs to focus not only on implementing treatment fidelity plans but also on quantifying the evaluations performed, developing specific criteria for interpretation of the findings, and establishing best practices of treatment fidelity.