He knew more than we wanted him to know: Parent perceptions about their children's sense of pediatric cancer-related financial problems.

BACKGROUND: Treatment for pediatric cancer generates costs that place sizeable demands on family finances relative to household income. Little is known about whether children sense that their cancer has created financial problems for the family. The study purpose was to describe parents' perceptions about whether their child sensed that pediatric cancer created financial problems for their family. PROCEDURE: Family Communications Theory informed our study. We used descriptive statistics and content analysis to examine parents' (n = 417) responses to questions about the child's sense of pediatric cancer-related financial problems from a larger survey study. RESULTS: Approximately 56.2% of parents indicated that their child had no sense of the pediatric cancer-related financial problems and 44.1% indicated their child had some. Proportions of children perceived to sense these financial problems steadily increased with age grouping, while proportions perceived to have none declined. With content analysis, we identified cognitive capacity as the key child factor influencing children's sense of these problems. Influential context factors included social norms, observed changes in family routines and spending patterns, and overheard conversations between adults. Child psychological outcomes included guilt, anxiety about money, and feelings of being a burden. CONCLUSION: Pediatric oncology professionals and staff should be mindful of parent preferences about burdening children with sensitive financial information, and modify their behaviors and processes accordingly. They can also provide anticipatory guidance and psycho-education about psychological responses related to the effects of pediatric cancer on family finances and the role of cognitive development in the evolution of children's awareness of those effects.

Practice change: Social Media Screening Questionnaire to identify high-risk adult psychiatric patients.

PURPOSE: Include social media screening during initial psychiatric examination with new adult patients to increase psychiatric providers' awareness of the rate and impact of social media use in their patients. DESIGN AND METHODS: Plan-Do-Study-Act cycles were implemented to evaluate the effectiveness of psychiatric provider 5-question social media screening during the initial evaluation. FINDINGS: Screening for social medial usage (N = 136) improved providers' a wareness of the rate and impact of social media use on patients' distress levels. The process of screening influenced a conversation between provider and patient about healthy social media use. PRACTICE IMPLICATIONS: The inclusion of social media screening during initial psychiatric evaluation may aid in the assessment of risk factors for psychological distress.

Nonsuicidal Self-Injury: Management on the Inpatient Psychiatric Unit[Formula: see text].

BACKGROUND. Between 4% to 70% of inpatients engage in self-harming behaviors and effective interventions are needed to address this population. AIM. This article reviews literature from 2007 to 2017 to address treatment and management strategies specific for the treatment of nonsuicidal self-injury in the inpatient psychiatric setting. METHODS. Cochrane, PsycINFO, PubMed, and CINAHL were searched for relevant articles with 34 studies reviewed for applicability to the question, and 9 parsed into a summary of Findings table. RESULTS. Therapeutic approaches that show promise include cognitive behavioral therapy, dialectical behavior therapy, and mentalization as well as medications that act on the serotonergic, dopaminergic, and opioid systems. Effective models of care aim toward enhancing therapeutic relationships with staff, providers, and most important, encouraging the internal shift toward recovery within the patient. CONCLUSIONS. More research with controlled designs in the inpatient setting is needed, however, regardless of which approach is used, the impact of the individual caregiver on the patient's recovery is key.

Innovative Clinical Training Site for Psychiatric Mental Health Nurse Practitioner Students: Elementary School-Based Group Therapy (Manuscript ID UMHN-2017-0143).

The aim of this clinical training site innovation is to develop accessible pediatric mental health clinical training sites for psychiatric mental health nurse practitioner (PMHNP) students. Mental health services in school settings provide treatment in the child's community and create opportunities for innovation and collaboration with teachers, school counselors, and school psychologists. School settings provide opportunities for early recognition of anxiety symptoms and accessible treatment that can help close the gap in clinical training sites for this population. Mild and moderate symptoms of anxiety often go untreated and may affect academic performance negatively. Cognitive behavioral play therapy is an effective treatment modality provided by PMHNP students and supports the roles of school personnel.

Secondary Traumatization in Psychiatric Mental Health Nurses: Validation of Five Key Concepts.

PURPOSE: The purpose of this study was to validate five concepts central to secondary traumatization (ST) using narratives of psychiatric mental health advanced practice nurses. DESIGN AND METHODS: The study was designed as a directed content analysis of narrative notes (N-30). FINDINGS: Consistency was found between narrative notes and the concepts. This study revealed that exposure and vulnerability precede empathic engagement, reaction, and alteration/transformation. The bidirectional outcome of alteration/transformation suggested that conditions leading to ST could have a positive outcome. PRACTICE IMPLICATIONS: Failure to recognize symptoms of ST and provide reflective supervision may compromise the nurse's ability to maintain a work-life balance and provide quality patient care.

Using Animal-assisted Therapy to Enrich Psychotherapy.

Animal-assisted therapy (AAT) has been shown to be effective in the treatment of many psychological disorders, including autism spectrum disorders, depression, anxiety, and posttraumatic stress disorder (PTSD). AAT can be used as an adjunct to other forms of psychotherapy. With AAT, the animal becomes a part of the treatment plan. Outcomes for clients that are associated with the use of AAT include (1) increased sense of comfort and safety, (2) increased motivation, (3) enhanced self-esteem, (4) increased prosocial behaviors, and (5) decreased behavioral problems. AAT provides a bridge for the therapist to develop a therapeutic relationship with a client, and the animal can provide supportive reassurance for the therapist. The amount of data that supports the benefits of AAT for the treatment of those with mental illnesses is growing, but evidence-based research that supports its use is lacking. Further research is needed.

Reflective Prompts to Guide Termination of the Psychiatric Clinical Student Nursing Experience.

The average length of stay on psychiatric inpatient units has decreased in the past 40 years from 24.9 to 7.2 days. Inpatient psychiatric nurses are challenged to meet the standards and scope of practice despite the changing circumstances of their work environment. The amount of time student nurses spend with a given patient has been affected by changes in acute psychiatric inpatient care and decreased length of stay; however, opportunities exist for effective termination of the nurse-client relationship. Facilitation of students' awareness and understanding of the dynamics inherent in the termination process is an important teaching task for psychiatric nursing clinical instructors. In the current article, a clinically focused learning activity using structured prompts to guide and promote psychiatric nursing students' experiences with the process of termination is described and teaching strategies are discussed.

Ahead of the game: the use of gaming to enhance knowledge of psychopharmacology.

Experiential teaching strategies have the potential to more effectively help students with critical thinking than traditional lecture formats. Gaming is an experiential teaching-learning strategy that reinforces teamwork, interaction, and enjoyment and introduces the element of play. Two Bachelor of Science in Nursing students and a clinical instructor created a Jeopardy!(®)-style game to enhance understanding of psychopharmacology, foster student engagement in the learning process, and promote student enjoyment during clinical postconference. The current article evaluates the utility, relevance, and effectiveness of gaming using a Jeopardy!(®)-style format for the psychiatric clinical setting. Students identified the strengths of this learning activity as increased awareness of knowledge deficits, as well as the reinforcement of existing knowledge and the value of teamwork.

Cyberbullying: implications for the psychiatric nurse practitioner.

PURPOSE: The purpose of this article is to inform and educate psychiatric nurse practitioners about the pervasiveness of the rapidly increasing problem of cyberbullying. REVIEW OF LITERATURE: As more children and adolescents obtain access to the Internet, mobile devices, and social networking sites, the exposure to bullying in the virtual format increases. Cyberbullying is a growing public health concern and can affect mental health and school performance. Cyberbullying often results in a range of psychiatric symptoms and has been linked to suicide attempts and completions. CONCLUSIONS: The psychiatric nurse practitioner is uniquely prepared to provide a range of interventions for patients, families, and communities who have experienced cyberbullying.

Customized role play: strategy for development of psychiatric mental health nurse practitioner competencies.

PURPOSE: To discuss the teaching/learning strategy of customized role play to enhance psychiatric mental health nurse practitioner (PMHNP) students' entry level competency. CONCLUSIONS: Customized role play facilitates application of new content, understanding of the patient's experience, and assessment of skill deficits. PRACTICE IMPLICATIONS: New PMHNP graduates have entry level proficiency across the life span with a range of psychotherapeutic interventions.