How Should Suicide Prevention and Healing Be Expressed as Goals of Inpatient Psychiatric Unit Design?

Inpatient psychiatric units' policies and restrictions for suicide prevention can exacerbate harm rather than promote wellness. This commentary on a case examines ethics concerns about prevention policies that overly rely on liberty restriction, as expressed in the design of inpatient psychiatric unit structures and spaces. Person-centered approaches to design are key to promoting healing and preserving dignity.

Sleep, mental health, and access to health care of women truck drivers.

BACKGROUND: The numbers of women in trucking are growing steadily, yet because they represent a minority group, little is known about their health issues. Most studies of truck drivers have focused on the mental and physical health, sleep, and health care access of male truck drivers. PURPOSE: The purpose of this study was to characterize chronic stress, sleep, and mental health service and overall access to care among women truck drivers. METHODOLOGY: Twenty-five female truck drivers were a subsample of participants from a larger parent study of truck drivers. After approval from the institutional review board, participants completed a 59-item Qualtrics survey; data were transferred from Qualtrics to SPSS v. 24 for analysis. RESULTS: No acute sleepiness or excess daytime sleepiness was observed, but participants only slept 6 hr per night, and all experienced poor sleep quality. Although 28% of participants met or exceeded the threshold score for posttraumatic stress disorder (PTSD), only 8% sought care for feelings of upset or distress. Also, 80% of the women had health insurance, yet there were those who did not seek care because of job-related conflicts. CONCLUSION/IMPLICATIONS: Participants were sleep deprived and experienced poor-quality sleep. Mental health and other health services utilization was low. Implications for practice include consideration of telehealth services to improve health care access and screening and referral as needed to mental health care providers by Department of Transportation medical examiners. Future research should include younger women truck drivers to determine the potential contribution of perimenopause/menopause to some of the health issues experienced by this group of workers.

Experiences of Mental Health Practitioners With Empathy Computer Games.

Several learning games designed for nursing training exist. Yet, there is a gap in understanding what makes learning games efficacious. The current study examined the reactions of 12 mental health nurses, therapists, social workers, and counselors during and after playing four computer games designed to induce empathy for persons with mental health disorders. Thematic analysis revealed that games accurately embodied emotional and cognitive experiences of the intended disorders. Analysis also indicated shortcomings, including games falling short in their usefulness for understanding depicted disorders. Participants indicated that the games changed their attitudes and beliefs. Findings suggest that learning games can be useful for nursing students and trainees, as well as patients' friends and family members. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 25-31.].

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

Twenty years of the brazilian psychiatric reform: meanings for psychiatric and mental health nursing / Veinte años da ley de reforma psiquiátrica en brasil: significados para la enfermería psiquiátrica y en salud mental / Vinte anos da lei da reforma psiquiátrica brasileira: significados para a enfermagem psiquiátrica e em saúde mental

ABSTRACT Objective to develop arguments supporting Psychiatric and Mental Health Nursing as a baseline force of qualified and indispensable work in the evolution of mental health care and policies. Method argumentation of a reflective nature, considering the path of Psychiatric and Mental Health Nursing over the twenty years of the legal framework of the Psychiatric Reform, as well as the publications pertinent to discussion of the topic in vogue. Results two topics emerged, namely: From Psychiatric Nursing to Mental Health Nursing: a change of paradigm; and Mental Health Nursing: a new praxis. Conclusion Psychiatric and Mental Health Nursing presents itself as a resilient and sustainable practice despite the crises caused by institutionalizing policies implemented at the governmental level. The profession, increasingly politicized and attentive to the relevant guidelines of the Unified Health System, struggles and reinvents itself in its way of caring, in line with the reform guidelines, not subjected to stigmatizing regressions or outside the community territory.

RESUMEN Objetivo desarrollar una argumentación que sustente a la Enfermería Psiquiátrica y en Salud Mental como una fuerza base de trabajo calificado e indispensable para la evolución de la atención y las políticas de salud mental. Método argumentación de carácter reflexivo, considerando el trayecto de la Enfermería Psiquiátrica y en Salud Mental a lo largo de los veinte años de vigencia del marco legal de la Reforma Psiquiátrica, al igual que las publicaciones pertinentes al debate del tema en boga. Resultados se presentaron dos temas: de la Enfermería Psiquiátrica a la Enfermería en Salud Mental: un cambio de paradigma; y Enfermería en Salud Mental: una nueva praxis. Conclusión la Enfermería Psiquiátrica y en Salud Mental se presenta como una práctica resiliente y sustentable con respecto a las crisis originadas por políticas institucionalizantes implementadas al nivel gubernamental. La profesión, cada vez más politizada y atenta a las pautas relevantes del Sistema Único de Salud, lucha y se reinventa en su forma de ofrecer atención, alineada con las directrices de la reforma y no sujeta a regresiones de carácter estigmatizante o fuera del territorio comunitario.

RESUMO Objetivo desenvolver argumentação sustentando a Enfermagem psiquiátrica e em saúde mental como força-base de trabalho qualificado e indispensável na evolução da assistência e políticas em saúde mental. Método argumentação de natureza reflexiva, considerando o percurso da Enfermagem psiquiátrica e em saúde mental ao longo dos vinte anos do marco legal da Reforma Psiquiátrica, bem como as publicações pertinentes à discussão do tema in voga. Resultados apresentam-se dois tópicos: da Enfermagem Psiquiátrica à Enfermagem em saúde mental: mudança de paradigma; e, Enfermagem em saúde mental: uma nova práxis. Conclusão a Enfermagem psiquiátrica e em saúde mental se apresenta como prática resiliente e sustentável a despeito das crises originadas por políticas institucionalizantes implementadas em nível governamental. A profissão, cada vez mais politizada e atenta às pautas relevantes do Sistema Único de Saúde, luta e se reinventa na sua forma de cuidar, alinhada às diretrizes da reforma, não estando sujeita a regressões de caráter estigmatizante ou fora do território comunitário.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Value-Based Payment: What Does It Mean for Nurses?

Among the many lessons that have been reinforced by the SARS-COVID-19 pandemic is the failure of our current fee-for-service health care system to either adequately respond to patient needs or offer financial sustainability. This has enhanced bipartisan interest in moving forward with value-based payment reforms. Nurses have a rich history of innovative care models that speak to their potential centrality in delivery system reforms. However, deficits in terms of educational preparation, and in some cases resistance, to considering cost alongside quality, has hindered the profession's contribution to the conversation about value-based payments and their implications for system change. Addressing this deficit will allow nurses to more fully engage in redesigning health care to better serve the physical, emotional, and economic well-being of this nation. It also has the potential to unleash nurses from the tethers of a fee-for-service system where they have been relegated to a labor cost and firmly locate nurses in a value-generating role. Nurse administrators and educators bear the responsibility for preparing nurses for this next chapter of nursing.

Gender Differences in Medical Cannabis Use: Symptoms Treated, Physician Support for Use, and Prescription Medication Discontinuation.

Background: Medical cannabis (MC) utilization continues to expand in the United States, as a growing body of evidence supports the use of cannabis and cannabinoids in the treatment of a range of chronic conditions. To date, gender-related differences in MC use are not widely reported, and little is known regarding physicians' support of patients' use of MC to address symptoms associated with chronic conditions. Materials and Methods: We conducted a cross-sectional online survey of MC users in Illinois (n = 361). We summarized participants' qualifying conditions, symptoms treated with MC, perceived physician support for MC use, use of MC and prescription medications, then analyzed differences by participant gender. Results: Bivariate analyses indicate that men report higher levels of support for MC use from both specialist and primary care physicians. Women were significantly more likely to increase use of cannabis after acquiring an MC card, and to discontinue prescription medications through MC use. Multivariable analyses indicate that being a woman, using MC to treat multiple symptoms, and reporting higher levels of support for MC use from a primary care provider significantly increased the likelihood of discontinuing prescription medication through MC use. Discussion: Women are more likely to report decreased use of prescription medications to treat symptoms, and report lower levels of support from physicians for MC use. Future research on gender differences in this population may benefit from more detailed data related to symptomology, utilization, dosing, and outcomes associated with MC, and interactions with the health care system to extend these findings.

Perceived Efficacy of Medical Cannabis in the Treatment of Co-Occurring Health-Related Quality of Life Symptoms.

For persons living with chronic conditions, health-related quality of life (HRQoL) symptoms, such as pain, anxiety, depression, and insomnia, often interact and mutually reinforce one another. There is evidence that medical cannabis (MC) may be efficacious in ameliorating such symptoms and improving HRQoL. As many of these HRQoL symptoms may mutually reinforce one another, we conducted an exploratory study to investigate how MC users perceive the efficacy of MC in addressing co-occurring HRQoL symptoms. We conducted a cross-sectional online survey of persons with a state medical marijuana card in Illinois (N = 367) recruited from licensed MC dispensaries across the state. We conducted tests of ANOVA to measure how perceived MC efficacy for each HRQoL symptom varied by total number of treated symptoms reported by participants. Pain was the most frequently reported HRQoL treated by MC, followed by anxiety, insomnia, and depression. A large majority of our sample (75%) reported treating two or more HRQoL symptoms. In general, perceived efficacy of MC in relieving each HRQoL symptom category increased with the number of co-occurring symptoms also treated with MC. Perceived efficacy of MC in relieving pain, anxiety, and depression varied significantly by number of total symptoms experienced. This exploratory study contributes to our understanding of how persons living with chronic conditions perceive the efficacy of MC in treating co-occurring HRQoL symptoms. Our results suggest that co-occurring pain, anxiety, and depression may be particularly amenable to treatment with MC.

Mindfulness, sleep, and post-traumatic stress in long-haul truck drivers.

BACKGROUND: The high stress culture and demands associated with long-haul truck driving place truckers at risk for mental health and sleep disorders, and thereby, increased risk for accidents, injuries, and fatality. Hours-of-service regulations have proven insufficient as a stand-alone intervention to protect the welfare of long-haul truckers, impacting those working in the industry and those sharing our nation's roads. Interventions to increase mindfulness have been used across occupational and personal domains to improve sleep quality, mental health, awareness of the environment, and reaction time. OBJECTIVE: The purpose of this study was to examine the relationships between sleep, mental health, health care utilization, and mindfulness in long-haul truck drivers in the United States. METHODS: Participants (N = 140) were recruited to complete a web-based survey. Descriptive statistics, bivariate analysis, and regression analysis were used to examine variables of interest. RESULTS: Post-traumatic Stress Disorder (PTSD) symptomology and daytime sleepiness predicted mental health care utilization in the past year. Mindfulness was inversely correlated with PTSD symptomology, however in the full regression model, mindfulness failed to predict mental health care utilization. CONCLUSIONS: Occupational health professionals should utilize mindfulness screenings as an adjunctive component to traditional mental health screenings and refer drivers for advanced care as appropriate.

Self-Efficacy in Researching and Obtaining Medical Cannabis by Patients With Chronic Conditions.

Background. Due to the increasing availability of medical-grade cannabis for treatment of chronic conditions, we examined how prospective users navigate the process of researching, procuring, and using cannabis. Given the barriers prospective users experience, self-efficacy may be a factor for those who incorporate cannabis into treatment. Aims. The purpose of this study was to identify behaviors associated with self-efficacy in the context of researching, procuring, and using cannabis. We analyzed narratives of patients who obtained legal medical cannabis in the currently complex medical, legal, and social landscape. Method. Data were collected through 30 telephone interviews utilizing a semistructured interview protocol, which were analyzed using inductive coding. The protocol emphasized four topics: (a) symptom management/pain reduction, (b) provider communication about chronic conditions/cannabis, (c) perspectives on medicinal cannabis and stigma, and (d) views on recreational cannabis. Results. Participants demonstrated self-efficacy in three contexts: (a) self-directed experimentation with cannabis strains, dosages, and administration methods; (b) managing care by selecting and educating their providers; and (c) information-seeking and research behaviors. Discussion. High self-efficacy may be an important factor in navigating the medical cannabis process. Results suggest that providers who are not prepared to partner with patients as they seek information about medical cannabis may be replaced by dispensaries and websites with expertise in cannabis but without understanding of patients' medical conditions and individual needs. Conclusion. Patients with higher self-efficacy may engage in various activities to investigate, procure, experiment with, and incorporate medical cannabis into their condition management outside the purview of their providers.

Advocates' Experiences With Media and the Impact of Media on Human Trafficking Advocacy.

The present qualitative study explores advocates' opinions of misinformation about human trafficking in the media and describes advocates' strategies to counter the misinformation presented by the media. Thus, 15 advocates who work against human trafficking in Chicago-based nonprofit organizations participated in semistructured interviews about their opinions and strategies. Data were analyzed using thematic content analysis. The present study identifies specific misperceptions of human trafficking in the media, highlights advocates' opinions of this misinformation, and discusses advocates' strategies to counteract inaccurate media, adding support to the role of media advocacy. Advocates note how media images shape and perpetuate stereotypes of trafficking through glamorizing sex work and sensationalizing stories that are most often international depictions of trafficking. Advocates report media generally shares only a piece of the story, simplifying the stories of survivors and the issue of human trafficking. Advocates critique media perpetuating these misperceptions for how they may contribute to policies and programs which fail to address structural factors that create vulnerabilities to be trafficked and the multisystem needs of survivors. However, advocates also note misperceptions can be counteracted by producing sensitive, informed media through social platforms. Advocates share their strategies counteracting misinformation through engaging in informative conversations, utilizing social media to educate, and promoting media messages of survivor agency. Research, clinical, and policy implications are also discussed. The present study emphasizes the importance of decision makers and service providers being critical consumers of media and to assess how media portrayals may (or may not) inform their understanding and response to the issue.

Referral to Digital Parent Training in Primary Care: Facilitators and Barriers.

Objective: Parent training (PT) programs for parents of preschool-aged children promote effective parenting practices and reduce the risk for the development of child behavior problems. Digital platforms and self-administered formats can expand access to preventive PT and complement traditional behavioral services. Primary care provides an ideal environment to refer patients to prevention-focused PT; however, effective integration of a referral process requires an understanding of implementation facilitators and barriers. The current study is a secondary analysis of facilitators and barriers to the implementation of a referral to ezParent, a self-administered, digital PT program, in four primary care clinics from the perspective of clinic personnel. Method: Personnel from participating clinics took part in semi-structured group interviews to share their experiences of referral to ezParent. Researchers extracted themes using the Consolidated Framework for Implementation Research. Results: Clinic personnel support preventive PT, but time, workflow, and organizational barriers impede consistent referral implementation. Conclusions: The authors discuss recommendations for harnessing facilitators for referring primary care patients to digital PT using the strengths of multidisciplinary clinical teams and organizational structures.