Themes of Liminality: Stories From Cancer Family Caregiver Narratives.

Cancer family caregivers dwell in an evolving landscape of ambiguity and in-betweenness, as "betwixt and between," in a space of unknowing. This space of unknowing exists within a transformational threshold of liminality, between what was known prior to the cancer and what will be known and embodied in the future. Theoretically grounded in Unitary Caring Science, this study used narrative inquiry alongside photo elicitation to cocreate cancer caregiver narratives and identify themes of liminality. Four thematic threads of liminality were identified as woven within and across the cancer caregiver narratives; stories of paradox, time warp, life disruption, and waiting in silence.

Characterizing Loss of Control Associated With Binge Eating in College-Age Men.

BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.) identifies key features of binge eating (BE) to include the consumption of a large amount of food and the perception of loss of control (LOC) over eating during a distinct episode. While earlier research has focused on food consumption, findings are now emerging on the role of LOC associated with the BE episodes, particularly in women. However, it is unclear that these findings are applicable to men without knowing how men experience LOC associated with BE. AIMS: This study examined how college-age men describe LOC associated with BE. METHOD: Previously collected qualitative data from a study examining BE in college age-students were used to examine responses from 53 men (mean age 19.9 ± 1.1 [SD] years). Respondents were asked about their individual experiences of LOC associated with BE episodes. Data were analyzed using content analysis. RESULTS: Four categories emerged from the data: (1) keep eating, (2) can't stop, (3) without thinking, and (4) food so good. CONCLUSIONS: Findings extend the current understanding of LOC associated with BE in men and point to potential gender differences, and/or weight influences, based on previous reports. Identified categories may be potentially targeted areas for tailored therapy to enhance awareness and self-regulation of BE behavior.

Mantram repetition and psychological distress: A systematic review and meta-analysis.

WHAT IS KNOWN ON THE SUBJECT?: Researchers have examined several interventions for psychological distress, mindfulness being a popular one. One intervention that fosters mindfulness is mantram repetition. Mantram repetition is an ancient traditional practice of repeating a sacred word/phrase at various times throughout the day and whenever needed. Psychologically, mantram repetition can mitigate immediate stressors. When used consistently, mantram repetition promotes resilience and deepens mindfulness, thereby promoting recovery from distress. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper examines the overall effect of mantram repetition on psychological distress symptoms (i.e., depression, anxiety and somatization). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The portable, cost-effective, mantram repetition intervention outperformed standard therapies. In people who are prone to psychological distress, practitioners might teach this technique, encouraging them to use it initially as they go through their day and then when they are experiencing distress. Mantram repetition can quiet the mind and pairs well with breathing exercises and routine activities such as walking or exercising, or during chores, thus, integrating the mantram into daily life. ABSTRACT: INTRODUCTION: Researchers have examined several interventions for psychological distress, mindfulness being a popular one. One mindfulness intervention is mantram repetition. Mantram repetition is an ancient traditional practice of repeating a sacred word/phrase at various times throughout the day and whenever needed. AIM: To examine the evidence of the effect of mantram repetition on psychological distress (i.e., depression, anxiety and somatization). METHOD: We searched 16 databases and retrieved 12 studies testing the effects of mantram repetition; only four of these measured aspects of psychological distress with comparison groups. RESULTS: All studies showed positive effects ranging from very mild (.08) to very strong (.71). The summary effect across all studies was small (.23, p = .015). Importantly, this small effect was found when compared to treatment as usual and even psychotherapy. DISCUSSION: The portable, cost-effective, mantram repetition intervention outperformed standard therapies. IMPLICATIONS FOR PRACTICE: In patients who are prone to psychological distress, practitioners might teach this technique, encouraging them to use it initially as they go through their day and then when they are experiencing distress. Mantram repetition could be practiced with breathing exercises, when walking or exercising, or during chores, integrating the mantram into daily life.

Lessons From the Field: Strategies for Success in Obtaining Grant Funding.

OBJECTIVE: To summarize a preconference workshop that focused on how to be successful in obtaining funding by making one's scholarship innovative and significant. METHOD: In 2021, at the annual American Psychiatric Nurses Association (APNA) Conference, a panel of nurse scholars reflected on and discussed how to make grant proposals innovative and significant. Two moderators posed questions to five panelists at different stages in their research trajectories about four key research concepts: idea conception, framing for the funding agency, significance, and innovation. RESULTS: Conceptualizing an innovative, scholarly idea starts with a passion for the topic, a team of experts and scholarly community, and time to think and delve into the literature. For funding opportunities, start small, read the funding announcements thoroughly and carefully, and make sure it is the right fit. Strategies to illustrate significance include avoiding generalizations, maintaining objectivity, being clear about impact, and using strength-based language. Contemplate the many facets of innovation as well as balance innovation and feasibility. CONCLUSIONS: Inclusion of challenges in composing significance and innovation sections of grant proposals offers knowledge for psychiatric nurse researchers to add to their toolkits as they seek funding and conduct research and scholarship.

Effects of Transcendental Meditation on Blood Pressure: A Meta-analysis.

BACKGROUND: The World Health Organization estimates that 1.13 billion people worldwide have hypertension. Although pharmaceutical management of blood pressure is available, there are reasons why people prefer not to take medications including costs, adverse effects, and lack of access. Nonpharmacological healthy lifestyle methods are needed. One alternative method is transcendental meditation (TM). OBJECTIVE: The purpose of this study was to quantitatively synthesize the effects of TM on blood pressure. In addition, we examined the moderator effects of participant, methods, and intervention characteristics. METHODS: We searched 19 electronic databases without date restrictions to March 2021 including the gray literature and specific journals for primary studies evaluating TM to reduce blood pressure in adults and written in English. We coded primary studies for 5 categories (source, method, intervention, participant characteristics, and outcomes). RESULTS: Across 18 primary studies (N = 1207), TM mildly improved systolic blood pressure by -3.3 mm Hg (P = .025) and diastolic blood pressure by -1.8 mm Hg (P = .008) compared with comparison groups, but the effects waned after 3 months. Transcendental meditation reduced systolic blood pressure in samples that were 65 years and older significantly more than in samples that were younger than 65 years (-1.44 vs -9.87, P = .021) but showed no differential effect on diastolic blood pressure. CONCLUSIONS: Transcendental meditation mildly reduced blood pressure, but the effect waned after 3 months. Adults older than 65 years benefited more than younger adults. Transcendental meditation might be recommended as one aspect of a healthy lifestyle.

Facilitators and barriers to getting obstructive sleep apnea diagnosed: perspectives from patients and their partners.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is a prevalent and debilitating condition that is significantly underdiagnosed. The majority of adults sleep with someone-a partner. Partners can play a significant role in the patient's OSA diagnosis. The goal of this work is to describe facilitators and barriers to OSA diagnosis as discussed by patients with OSA and their partners. METHODS: This was a qualitative secondary analysis with results drawn from 20 dyadic interviews, conducted 1 couple at a time, in 20 newly diagnosed adult patients with OSA and their partners. Qualitative interview data were analyzed using conventional content analysis. RESULTS: Facilitators of OSA diagnosis were partners pushing patients to seek care, patients actively seeking care, and care providers identifying the patient's risk of OSA. Barriers to OSA diagnosis were patients' lack of serious attention to symptoms, patients' negative perceptual framing of diagnosis and treatment of OSA, and poor coordination of health care services. CONCLUSIONS: We recommend engaging partners in the OSA diagnosis and developing educational and behavioral interventions to raise public awareness about OSA. It is important to educate clinicians on atypical presentations of OSA. Further investigation is needed to evaluate the impact of health care services on OSA diagnosis. CITATION: Ye L, Li W, Willis DG. Facilitators and barriers to getting obstructive sleep apnea diagnosed: perspectives from patients and their partners. J Clin Sleep Med. 2022;18(3):835-841.

Binge Eating and Loss of Control in College-Age Women.

BACKGROUND: Loss of control (LOC) over eating is a cardinal feature of the DSM-5 definition of binge eating (BE). While this behavior is frequently reported in college-age women, there is limited research on descriptions of loss of control from first-person accounts from individuals reporting LOC associated with BE. OBJECTIVE: The objective of this study was to investigate descriptions of LOC associated with BE episodes in college-age women who reported recent BE behavior. STUDY DESIGN: A secondary analysis of previously collected qualitative data on BE behaviors in college students was conducted. Two hundred and twenty-one college-age women's (age = 19.77 ± 1.03) comments regarding the experiences of LOC associated with BE episodes were analyzed using conventional content analysis. Codes were inductively generated allowing categories to emerge from the data codes. RESULTS: Three major overarching descriptive categories were identified: (1) LOC over eating, (2) feelings associated with the LOC, and (3) cognitive dispositions (thoughts) associated with LOC during a BE episode. DISCUSSION: The findings of this study expand the current literature on LOC over eating and provide a number of potential targets for intervention with college-age women who report BE behaviors.

Spiritual Knowing: Another Pattern of Knowing in the Discipline.

Fundamental patterns of knowing in nursing have historically served to clarify the substance and structure of the discipline, significantly contributing to nursing's body of knowledge. In this article, we continue the scholarly conversation on patterns of knowing in nursing by advancing spiritual knowing as a pattern of knowing that helps advance nursing's agenda toward universal well-being and critical during this time toward interdisciplinarity. Implications for nursing are explored in relation to enduring and new questions that require our attention related to human beings, their environments, and healing.

Realizing the Focus of the Discipline: Facilitating Humanization in PhD Education: A Student Exemplar Integrating Nature and Health.

Doctorally prepared nurses must be able to represent the unique nursing perspective within interdisciplinary teams to address contemporary health challenges. This article provides a student exemplar applying the unifying focus of facilitating humanization as described by Willis, Grace, and Roy to science on nature and health. As scientific knowledge becomes more complex, nurses must be skilled in translating information through the nursing lens to support individuals in realizing meaning, choice, quality of life, and healing in living and dying. In order for doctoral students to shepherd the discipline, they must first integrate nursing's philosophical underpinnings into their practice.

"It's Changed Everything": Voices of Veterans in the Veteran-Directed Home and Community Based Services Program.

The purpose of this study was to understand the value and impact of the Veteran-Directed Home and Community Based Services program (VD-HCBS) on Veterans' lives in their own voices. Focus groups and individual interviews by telephone were conducted to elicit participant perspectives on what was most meaningful, and what difference VD-HCBS made in their lives. Transcripts were analyzed using content analysis. The sample included 21 Veterans, with a mean age of 66±14, enrolled in VD-HCBS an average of 20.8 months. All were at risk of institutional placement based on their level of disability. Five major categories captured the information provided by participants: What a Difference Choice Makes; I'm a Person!; It's a Home-Saver; Coming Back to Life; and Keeping Me Healthy & Safe. Participants described the program as life changing. This study is the first time that Veterans themselves have identified the ways in which VD-HCBS impacted their lives, uncovering the mechanisms underlying positive outcomes. These categories revealed new ways of understanding VD-HCBS as an innovative approach to meeting the person-centered needs of Veterans wishing to remain at home, while experiencing quality care and leading meaningful lives, areas identified as priorities for improving long term services and supports.

Review and application of the National Academies of Sciences, Engineering, and Medicine bullying or cyberbullying recommendations for screening and lesbian, gay, bisexual, and transgender youth.

Bullying has been long seen as a natural part of childhood and adolescence. However, a growing body of evidence suggests bullying and now cyberbullying may inflict harm or distress on targeted youth including physical, psychological, social, or educational harm. The purpose of this paper is to endorse the National Academies of Sciences, Engineering, and Medicine statement, summarize the report, and apply the recommendations to screening lesbian, gay, bisexual and transgender youth related to bullying and cyberbullying; line 11 change exemplified to discussed. Screening for bullying against youth; lesbian, gay, bisexual, and transgender youth as a high-risk group for bullying victimization; and implications to address bullying against youth are exemplified. Nurses need to promote policies that foster inclusive, supportive, safe, and healthy schools and environments for youth.

Towards Changing the Long Term Care (LTC) Paradigm: Explicating the Concept of Thriving in Older Adults Living in LTC.

A phenomenon of interest for nursing is the facilitation of humanistic health care experiences and quality of life (Willis, Grace, & Roy, 2008 ). Inquiry into the concept of thriving as it manifests in the older adult residing in long-term care aligns with this interest. Thriving has been described by scholars in various disciplines but no context-specific definition for the LTC resident currently exists. Contrary to the generally held negative view of LTC, there is emerging evidence that older adult LTC residents "do well" or thrive in this environment.

Couples' experiences with continuous positive airway pressure treatment: a dyadic perspective.

OBJECTIVE: The majority of adults sleep with a partner, making sleep a dyadic experience. However, interventions to improve sleep have primarily focused on individuals. This qualitative analysis used a dyadic approach to identify facilitators and barriers to successful treatment of one of the most common sleep disorders, obstructive sleep apnea, with continuous positive airway pressure (CPAP). METHODS: Twenty joint qualitative interviews were conducted with couples, one couple at a time, with a sample of 20 patients with obstructive sleep apnea and their partners to develop an understanding of couples' experiences with CPAP use. Interviews were audio recorded and transcribed. Conventional qualitative content analysis was used to analyze the interview data. RESULTS: Facilitators of CPAP use were the following: the partner aiding diagnosis and treatment, couples working together using CPAP, the perceived benefits of CPAP for both partners, the patient being motivated to use CPAP for the benefit of the partner, and various types of support provided by the partner to encourage CPAP use. Major barriers to CPAP use were the following: anxiety related to CPAP use particularly in the beginning of therapy, bothersome equipment causing disruptions in sleep and bedtime routine, interruptions to intimacy, and concern about image change while wearing CPAP. CONCLUSIONS: Findings from this study suggest that couple-directed interventions that advocate for a mutually engaging perspective and promote supportive relationships and positive dyadic coping may be targets for improving CPAP adherence. Further research evaluating the potential of couple-focused interventions to improve sleep health is warranted.

"A Very Steep Climb": Therapists' Perspectives on Barriers to Disclosure of Child Sexual Abuse Experiences for Men.

Recent studies indicate that men experience unique barriers to disclosure of child sexual abuse. Blind spots held by mental health providers and social service agencies may inadvertently help produce and sustain these barriers. However, therapists who specialize in treating this population may also hold important insights into the barriers clients face. Because delayed and nondisclosure of child sexual abuse have been associated with negative mental health outcomes for adult survivors, understanding these barriers is critical to improve clinical practice and facilitate help-seeking. Using conventional content analysis, this study examined the perceptions of nine therapists who specialize in the treatment of men who were sexually abused in childhood, many of whom are considered pioneers in the field. Analyses identified nine types of barriers, which were organized into three categories: intrapersonal experience (difficult feelings, lack of language, and self-engagement), social milieu (internalized social stigma, negative responses, social loss or judgment, and masculine identity dissonance), and health care environment (structural barriers, relational challenges with therapists, and unhelpful therapeutic strategies). Implications for future research, clinical training, and clinical practice are discussed.

Developing Abilities to Navigate Through the Grey Zones in Complex Environments: Nurses' Reasons for Applying to a Clinical Ethics Residency for Nurses.

BACKGROUND AND PURPOSE: Nurses face complex ethical issues in practice and have to determine appropriate actions. An inability to conceptualize or follow a preferred course of action can give rise to moral uncertainty or moral distress. Both moral uncertainty and moral distress are problematic for nurses and their patients. A program designed to increase nurse confidence in moral decision making, the clinical ethics residency for nurses (CERN), was offered selectively to nurses affiliated with two academic medical centers. This is a report of the analysis of their application essays. DESIGN: Over a 3-year period, 67 application essays were analyzed using conventional content analysis. Applicants comprised one third advanced practice nurses (APNs) and two thirds staff nurses. They were asked to describe their reasons for interest in the CERN and how they would apply the knowledge gained. METHODS: For conventional content analyses, no theoretical presumptions are used; rather, codes are identified from the data in an iterative manner and eventually collapsed into themes. Initially, broad themes were identified by the CERN team. Subsequently, in-depth and recursive readings were completed by a subset of three members, resulting in refinement of themes and subthemes. FINDINGS: The overarching theme identified was "developing abilities to navigate through the 'grey zones' in complex environments." Three subthemes were: (a) nurses encountering patients who are chronically critically ill, culturally diverse, and presenting with complex circumstances; (b) nurses desiring enhanced ethics knowledge and skills to improve quality of care, understand different perspectives, and act as a resource for others; and (c) nurses supporting and facilitating patient-centered ethical decision making. CONCLUSIONS: Findings are consistent with those appearing in the international literature but provide a more cohesive and comprehensive account than previously, and hold promise for the development of educational and policy strategies to address moral distress and uncertainty. CLINICAL RELEVANCE: This study is relevant to clinical practice in its verification of the need nurses have for ethics knowledge, skill refinement, and application through communication. These findings affirmed the challenge that nurses feel in communicating their ethical concerns in an effective and engaging way and their commitment to advocacy and improvement in the quality of care for patients.

Parents Caring For Adult Children With Serious Mental Illness.

BACKGROUND: Parents often become the caregivers for their adult children with serious mental illness (SMI) due to the chronic and debilitating course of the illness and shortages in funding for community mental health services and residential placements. OBJECTIVE: To examine parents' management styles when caring for adult children with SMI and parents' perspectives on what type of community-based mental health interventions would support and/or enhance overall family functioning. DESIGN: A qualitative descriptive study using semistructured interviews with parents caring for adult children with SMI. The study was undergirded by Knafl and Deatrick's Family Management Style Framework. RESULTS: Four major themes emerged from the data describing prolonged and difficult phases that parents and the family undergo in caring for an adult child with SMI. CONCLUSIONS: Successful management of these phases must include increasing access to mental health information, mental health screening, early interventions, and violence prevention for adult children and their families.

Exercising Nursing Essential and Effective Freedom in Behalf of Social Justice: A Humanizing Model.

This article expands upon previous work by the authors to develop a model of nursing essential and effective freedom to facilitate nursing action in behalf of social justice. The article proposes that while social justice is rooted in nursing's ontological, epistemological, and moral foundations, the discipline's social justice mandate is constrained by its historical and contemporary location within an institutionalized medical paradigm. We present a model of nursing "essential" and "effective" freedom based on the philosophy of Bernard Lonergan to illustrate how nursing can transcend these barriers. This humanizing model is illustrated through personal narratives of the authors.

Using Liberating Structures to Increase Engagement in Identifying Priorities for the APNA Research Council.

BACKGROUND: In 2015, the Co-Chairs and Steering Committee of the Research Council members recognized the need to reevaluate the council's priorities. OBJECTIVE: To determine the top priorities for the Research Council. DESIGN: Use of liberating structures: Impromptu Speed Networking, 1-2-4-all, and Crowd Sourcing. RESULTS: Identified Research Council priorities included the following: efforts to increase psychiatric mental health (PMH) research funding; serve as a connector to bring researchers together; foster research through state chapters; increase collaboration between PhDs and DNPs; and develop models for organizational support for PMH staff nurse involvement in research. CONCLUSIONS: The liberating structures used are valuable strategies for engaging groups of people to identify what matters most to the group. Through the use of these novel techniques, the American Psychiatric Nurses Association Research Council has identified priorities for the work of the council. This has led to actions planned for the coming future with the intent to move PMH nursing research forward.

Distinguishing Features and Similarities Between Descriptive Phenomenological and Qualitative Description Research.

Scholars who research phenomena of concern to the discipline of nursing are challenged with making wise choices about different qualitative research approaches. Ultimately, they want to choose an approach that is best suited to answer their research questions. Such choices are predicated on having made distinctions between qualitative methodology, methods, and analytic frames. In this article, we distinguish two qualitative research approaches widely used for descriptive studies: descriptive phenomenological and qualitative description. Providing a clear basis that highlights the distinguishing features and similarities between descriptive phenomenological and qualitative description research will help students and researchers make more informed choices in deciding upon the most appropriate methodology in qualitative research. We orient the reader to distinguishing features and similarities associated with each approach and the kinds of research questions descriptive phenomenological and qualitative description research address.