Advanced Nurse Practitioners' (Emergency) perceptions of their role, positionality and professional identity: A narrative inquiry.

AIMS: To explore Advanced Nurse Practitioners' (ANP) (Emergency) perceptions of their role, positionality and professional identity. BACKGROUND: Advanced nursing practice was formally established in the Republic of Ireland in 2001 with 336 ANPs currently registered, projection increasing to a critical mass of 750 by 2021. Advanced practitioners (Emergency) give full emergency care for a specific cohort of clients with unscheduled, undifferentiated and undiagnosed conditions. DESIGN: Qualitative narrative inquiry using Bourdieu's concepts of habitus, field and capital as the theoretical framework was undertaken. METHODS: Data were collected in 10 in-depth interviews and thematic analysis applied. RESULTS: Five key themes emerged: participants' career pathways, personal and professional transitions, role dimensions and core concepts, and position in the organization and emergent professional identity. Role transitioning and a change in habitus, field and capital revealed the uniqueness of their nursing role. Minimizing waiting times, timely patient care and patient satisfaction were key performance indicators. A heightened awareness regarding higher-level decision-making, autonomy and accountability is integral to advanced practice. CONCLUSION: This study presents unique insights into the ANP role covering recruitment, organizational culture changes required and support to ease transition emerged. IMPACT: Better understanding the motivation to undertake the role, the transition experience and use of advanced practice skills sets will inform the targets for the future recruitment and retention of ANPs are met nationally and internationally. Dissatisfaction with previous management roles and wanting to be clinically close to patients were motivations to follow an advanced practice clinical career trajectory. Positionality and emergent professional identity are key enablers ensuring that advanced practitioners' roles demonstrate the attributes of advanced practice. Educators could use the findings to develop recruitment, retention and progression strategies. Disseminating the role and scopes of practice could positively influence collaborative models of service delivery and policy development.

The journey from nurse to advanced nurse practitioner: applying concepts of role transitioning.

The advanced nurse practitioner (ANP) role was established in Ireland in 2001 and represents an important nursing role development within Irish healthcare. Currently there are 336 ANPs registered with the Nursing and Midwifery Board of Ireland, working across 40 specialties. This number is increasing exponentially in response to emerging and anticipated future service needs and population demand projecting to a critical mass of 750 by 2021. Health service provision is enhanced by advanced practice performance outcomes. This article explores nurse to advanced nurse practitioner transitional journeys, a concept that has not previously been researched in depth from an Irish perspective. The theories of Benner, Woods, and Bourdieu are reviewed to explore whether an advance practice career trajectory results in unique nurse-to-ANP role transitioning. Contextualising possible personal, professional and educational transitions may enable the promotion of effective career 'scaffolding' to enhance a smooth transition for aspiring ANPs into advanced nursing practice roles.

Undergraduate mental health issues: the challenge of the second year of study.

BACKGROUND: Student mental health is a global issue. Macaskill reported that the second year was associated with the most significant increases in psychiatric symptoms in UK students. Qualitative data were collected to explore this further. METHOD: Twenty-three second-year undergraduate students were interviewed using a narrative interviewing method to explore their experience of their second year of study. They also completed the General Health Questionnaire-28. Students were grouped according to their psychiatric caseness scores, giving two groups, a well group with scores ≤5 and a clinical case group with scores ≥6 and their interview data were compared. RESULTS: Using thematic analysis, various themes and subthemes were identified. While both groups identified the same issues namely, the first-year concerns impacting on the second year, course issues, careers and future employability and student debt, the groups reported very different coping styles. CONCLUSION: There were shared anxieties across both groups. The majority related to institutional practices and the unintended impact they may be having on student mental health. While specialist interventions would help the clinical caseness group, arguably the anxiety levels of both groups would benefit equally from relatively easy to implement, inexpensive institutional changes and/or additions to current practices in universities.

Effectiveness of a health literacy intervention based on transformative learning and incorporating positive psychology on health behavior and well-being of Thai families with NCDs risk.

BACKGROUND: Thailand has a higher global NCD mortality rate in comparison to the rest of the world, accounting for 75% and 71% of all deaths. WHO focused increasingly on health literacy (HL) in order to decrease NCDs. This study aimed to assess the effectiveness of an HL intervention utilizing transformative learning and positive psychology with mindfulness training in terms of changing levels of HL, health behavior (HB), and health outcomes.   Design and methods: The study was a randomized control trial from May to September 2019.  The participants were a rural Thai population with low levels of HL, living in an area with high levels of NCDs. The 200 participants were cluster randomly allocated to an eight-week intervention, and the control group. The data were collected by Likert questionnaires and physical exams, and analyzed via ANOVA.  Results: The intervention group mean scores for HL, psychological capital, HB, and family well-being increased from baseline to post-intervention, but decreased during the follow-up but were still significantly higher than the control group and baseline scores. The increases in HL and HB were matched by improvements in physiological measurement. The BMI scores of the intervention group decreased in each phase, while the control group scores remained largely unchanged. An intervention group had significantly lower fasting blood sugar than the controls at the intervention and in the follow-up. There was no interaction between social support and any other variables. CONCLUSIONS: This program demonstrated improvements in HL, HB and the well-being of Thai families at risk of NCDs in rural communities.

Mindfulness interventions reduce blood pressure in patients with non-communicable diseases: A systematic review and meta-analysis.

PURPOSE: Mindfulness based interventions (MBIs) are an emerging area of empirical study, not only in positive psychology, but also in clinical health care. This research aims to synthesize the evidence about whether MBIs reduce blood pressure (BP) in patients with non-communicable diseases (NCDs). METHODS: Relevant studies were identified via PubMed, the Cochrane Library, Embase and the CINAHL database between 2009 and 2019. The papers selected focused on mindfulness and the effect of these on the BP of patients with NCDs. The change in SBP and DBP were meta-analyzed, stratified by type of intervention (Breathing awareness meditation (BAM), Mindfulness Meditation (MM), and Mindfulness-based Stress Reduction (MBSR). RESULTS: Fourteen articles met eligibility criteria and were included in the final review. Among the studies using the type and duration of intervention, systolic BP was reduced after the mindfulness-based stress reduction for 8 weeks (-6.90 mmHg [95% CI: -10.82, -2.97], p < .050), followed by the breathing awareness meditation for 12 weeks (-4.10 mmHg [95% CI: -7.54, -0.66], p < .050) and the mindfulness-based intervention for 8 weeks (-2.69 mmHg [95% CI: -3.90, -1.49], p < .050) whereas diastolic BP was reduced after the mindfulness-based stress reduction for 8 weeks (-2.45 mmHg [95% CI: -3.74, -1.17], p < .050) and the mindfulness-based intervention for 8 weeks (-2.24 mmHg [95% CI: -3.22, -1.26], p < .050). CONCLUSION: MBIs can provide effective alternative therapies to assist in blood pressure reduction for patients with NCDs.

Multi-group Causal Model of Health Literacy and Behaviors on Family Well-being among Thai Adults at Risk of Non-Communicable Diseases (NCDs).

BACKGROUND: We aimed to develop a causal model of family well-being with health literacy (HL) as a mediator and to compare models between male and female spouses in urban and rural communities. STUDY DESIGN: A cross-sectional study. METHODS: The samples included 2000 spouses at risk of non-communicable diseases (NCDs) by stratified randomly sampled in 2018. Data were collected Likert questionnaires with reliability of 0.79-0.93, and analyzed via confirmatory factor analysis (CFA), and multi-group structural equation modeling (MSEM). RESULTS: A causal model for the overall group was consistent with the data. Causal factors had direct effects on health behavior including social norms, positive attitude toward health, psychological capital, and HL (ß=0.11, 0.14, 0.30, and 0.41, P<0.05 respectively). Health behavior and positive attitudes towards health had direct effects on family well-being (ß=0.36 and 0.42, P<0.05, respectively). All factors could predict health behavior and family well-being with variance of 70% and 50%. Invariance analysis of models showed no difference between male and female spouses. In addition, the mean comparison of latent variables showed that the positive attitudes towards health were lower in women than men. HL and positive attitudes towards health of spouses in urban were lower than in rural communities. CONCLUSION: Thai adult families in cities were at higher risk with NCDs. Therefore, health providers need to address HL and positive attitude toward health which were the main causal factors.

Review of Positive Psychology Applications in Clinical Medical Populations.

This review examines the application of positive psychology concepts in physical health care contexts. Positive psychology aims to promote well-being in the general population. Studies identifying character strengths associated with well-being in healthy populations are numerous. Such strengths have been classified and Positive Psychology Interventions (PPIs) have been created to further develop these strengths in individuals. Positive psychology research is increasingly being undertaken in health care contexts. The review identified that most of this research involves measuring character strengths and their association with health outcomes in patients with a range of different conditions, similar to the position in positive psychology research on non-clinical populations. More recently, PPIs are beginning to be applied to clinical populations with physical health problems and this research, although relatively scarce, is reviewed here for cancer, coronary heart disease, and diabetes. In common with PPIs being evaluated in the general population, high quality studies are scarce. Applying PPIs to patients with serious health conditions presents significant challenges to health psychologists. They must ensure that patients are dealt with appropriately and ethically, given that exaggerated claims for PPIs are made on the internet quite frequently. This is discussed along with the need for more high quality research.

The cognitive nature of forgiveness: using cognitive strategies of primary appraisal and coping to describe the process of forgiving.

The present study investigated forgiveness in a traditional cognitive model of stress appraisal and coping and in a more recent model that includes the construct of low control stressors. One-hundred sixty six men and 168 women completed measures of forgiveness, primary stress appraisals, and coping strategies. For men, forgiveness was found to be positively associated with the use of challenge appraisals, and negatively associated with the use of loss appraisals and emotion-focused coping. For women, forgiveness was found to be positively associated with emotion-focused coping and acceptance, and negatively associated with avoidance. The results for women indicate that when forgiveness situations are conceptualized as low-control stressors, we are able to explain the relationships between forgiveness, appraisal, and coping. The results for men are broadly in line with a more traditional model of coping, which does not consider the construct of low control. Crucial differences in the ways that men and women appraise and cope with situations involving forgiveness are discussed.

Defining forgiveness: christian clergy and general population perspectives.

The lack of any consensual definition of forgiveness is a serious weakness in the research literature (McCullough, Pargament, & Thoresen, 2000). As forgiveness is at the core of Christianity, this study returns to the Christian source of the concept to explore the meaning of forgiveness for practicing Christian clergy. Comparisons are made with a general population sample and social science definitions of forgiveness to ensure that a shared meaning of forgiveness is articulated. Anglican and Roman Catholic clergy (N = 209) and a general population sample (N = 159) completed a postal questionnaire about forgiveness. There was agreement on the existence of individual differences in forgiveness. Clergy and the general population perceived reconciliation as necessary for forgiveness while there was no consensus within psychology. The clergy suggest that forgiveness is limitless and that repentance is unnecessary, while the general population suggests that there are limits and that repentance is necessary. Psychological definitions do not conceptualize repentance as necessary for forgiveness, and the question of limits has not been addressed, although, within therapy, the implicit assumption is that forgiveness is limitless.