Intrusive thoughts and memories in adolescents with major depressive disorder or post-traumatic stress disorder.

OBJECTIVES: Research in adults suggests that intrusive memories and intrusive thoughts (often referred to as intrusive cognitions) are common in members of the general population and are often seen in clinical disorders. However, little is known about the experience of intrusive cognitions in adolescents, particularly in adolescents with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The present study sought to gather fundamental data on these phenomena (i.e., frequency, characteristics and appraisals of intrusive cognitions) in adolescents with MDD and PTSD. METHODS: Adolescents aged 11-18 with MDD (n = 11), PTSD (n = 13) and a non-clinical control group (n = 25) completed structured interviews concerning their intrusive memories and thoughts. RESULTS: Intrusive thoughts were common in all three groups but were particularly frequently experienced in the MDD group. Intrusive memories were expectedly very common in the PTSD group but also experienced by over half of the adolescents with MDD. Both clinical groups reported more negative emotions in response to their intrusive thoughts or memories and appraised these cognitions more negatively than the non-clinical group. CONCLUSION: Intrusive memories and thoughts are common experiences in adolescents with MDD and PTSD. Emotions and appraisals relating to these cognitions may be targets for psychological intervention in this age group. However, small sample sizes limit the conclusions that can be drawn. Replication is needed with larger numbers of clinical participants.

Parental Anxiety and Posttraumatic Stress Symptoms in Pediatric Food Allergy.

OBJECTIVE: The purpose of this study was to explore anxiety, worry, and posttraumatic stress symptoms (PTSS) in parents of children with food allergies, and to evaluate whether these three psychological outcomes could be predicted by allergy severity, intolerance of uncertainty, and food allergy self-efficacy. METHODS: Participants were 105 parents who reported their children to have medically diagnosed food allergies. Participants were recruited to a study on parent wellbeing through an allergy clinic and social media advertisements. Participants completed online questionnaires assessing anxiety, worry, PTSS, intolerance of uncertainty, food allergy self-efficacy, and demographic and allergy information. RESULTS: In this sample, 81.0% of parents reported clinically significant worry, 42.3% met the clinical cut-off for PTSS, and 39.1% reported moderate-extremely severe anxiety. Greater intolerance of uncertainty and lower food allergy self-efficacy were associated with poorer psychological outcomes, with mixed results for allergy severity. However, intolerance of uncertainty was the only variable to consistently account for unique variance within regression models. CONCLUSIONS: This study highlights the need for greater awareness of mental health in parents of children with food allergy. The study also indicates that factors impacting on parents' perception of threat may be most strongly predictive of psychological outcomes, warranting further research. Finally, the study indicates that intolerance of uncertainty may be a promising target for psychological interventions within this population.

The Psychosocial Patient-Reported Outcomes of End of Pathway Cleft Surgery: A Systematic Review.

OBJECTIVE: To identify and review the literature on the psychosocial patient-reported outcomes (PROs) of surgery at the end of the cleft treatment pathway. DESIGN: A systematic literature search was performed using electronic databases (Medline, PubMed, EMBASE, PsycInfo, Web of Science, and Science Direct) from database inception to September 2017, to identify studies measuring and reporting the psychosocial PROs of end of pathway cleft surgery. RESULTS: Of 263 identified papers, 22 studies were eligible for inclusion. Apart from one randomized controlled study, studies were largely observational and adopted a cross-sectional or retrospective design. The majority (n = 16) were small-scale studies. The methodological quality was variable in terms of what, how, and when psychosocial outcomes were measured and reported. None of the studies utilized a psychosocial PRO measure validated in the cleft population, and few studies measured outcomes prospectively. A high proportion of studies utilized bespoke measures of patient satisfaction. Taken together, findings from the included studies are tentative but seem to suggest patients derive some benefit from undergoing end of pathway cleft surgery, in terms of increased satisfaction, quality of life, social interactions, and decreased appearance-related distress. CONCLUSIONS: Due to methodological challenges and the heterogeneity of what, how, and when outcomes are measured and currently reported, it is difficult to determine the psychosocial PROs of end of pathway cleft surgeries. Consequently, this review advocates the conduct of well-designed, longitudinal studies using cleft-sensitive tool/s to capture the psychosocial PROs of end of pathway cleft surgery at various time points.

Psychological services for food allergy: The unmet need for patients and families in the United Kingdom.

Research over the past 20 years has demonstrated the significant impact food allergy can have on quality of life and mental health of patients and their families, yet there is a paucity of psychological services to support families in coping with this condition. This paper provides a short overview of the psychological impact of food allergy, followed by a discussion of the use of paediatric psychological services for long-term conditions. To our knowledge, few paediatric allergy clinics in the UK have funding for dedicated clinical psychology services. Two such services are based at Southampton General Hospital and the Evelina London Children's Hospital. This paper includes descriptions of these services and how they are currently being used by patients and families. This is followed by an allergy clinician's perspective on the use of psychological services. Recommendations are made for allergy services to work with hospital psychology services to develop, integrate and deliver psychological services for all patients with allergy and their families who are in need. Future research also needs to focus on the efficacy of psychological therapies and group interventions in food allergy.

Stakeholder views on the design of National Health Service perinatal mental health services: 360-degree survey.

AIMS AND METHOD: At the start of a new community perinatal mental health service in Scotland we sought the opinions and aspirations of professional and lay stakeholders. A student elective project supported the creation of an anonymous 360-degree online survey of a variety of staff and people with lived experience of suffering from or managing perinatal mental health problems. The survey was designed and piloted with trainees and volunteer patients. RESULTS: A rich variety of opinions was gathered from the 60 responses, which came from a reasonably representative sample. Respondents provided specific answers to key questions and wrote free-text recommendations and concerns to inform service development. CLINICAL IMPLICATIONS: There is clear demand for the new expanded service, with strong support for provision of a mother and baby unit in the North of Scotland. The digital survey method could be adapted to generate future surveys to review satisfaction with service development and generate ideas for further change.

Development of a Collaborative Online International Learning (COIL) Activity.

Global mobility has made global health a priority within nursing curricula and health care organizations. A collaborative online learning activity could promote international perspectives of health care delivery. Including a collaborative online international learning activity in continuing education for practicing nurses is a viable strategy that is consistent with the internationalization at home movement. Use of a qualitative descriptive evaluation approach when teaching prelicen-sure nursing students and educating practicing nurses provides effective international collaboration, promotes a global mindset, and provides an exemplar for professional development specialists to teach practicing nurses. [J Contin Educ Nurs. 2024;55(5):220-223.].

Nineteenth-Century Nurses and Midwives in Three Canadian Cities, 1861-1891.

This paper focuses on nurses and midwives in Montreal, Halifax, and Saint John in the decades leading up to the introduction of trained nurses. Self-employed (private) nurses are compared with those in hospitals. Overwhelmingly of the working-class, predominantly women, and frequently widows, the nurses were not formally trained, though some midwives were. Comparisons are made between nurses and midwives in Montreal, Halifax, Saint John, and their counterparts in Toronto. The changing fortunes of midwives during the era are also discussed.

Pet therapy: dogs de-stress students.

Research supports the efficacy of the human-animal bond and pet therapy in a variety of settings. At nursing students' request at one school, the author began offering pet therapy prior to examinations. Anecdotal evidence of a study with the author's Golden Retriever, Goldilocks, demonstrates that pet therapy can reduce test anxiety and improve nursing student performance.

The effectiveness of an educational intervention to enhance undergraduate nursing students' competence with interprofessional collaboration.

BACKGROUND: Interprofessional collaboration and teamwork have been identified as priorities for delivering quality client care. Improved teamwork, communication, and collaboration among healthcare professionals improve client outcomes. Nurse professionals are challenged to be equally engaged with other healthcare professionals to develop a culturally competent client-centered plan of care. PURPOSE: The purpose of the current project was to examine the effectiveness of a multifaceted educational intervention on prelicensure nursing students' development of interprofessional competencies with teams and teamwork, communication, roles and responsibility, values, and ethics. METHODS: Metrics used included the Interprofessional Collaboration Competency Attainment (ICCAS) and the Assessment of Collaborative Environments (ACE-15) surveys. RESULTS: The results support practical and statistical significance in the students' self-reported collaborative competence across all items of the ICCAS at p < 0.000 level, and across each individual item. CONCLUSIONS: The multifaceted educational strategy effectively engaged prelicensure nursing students with other healthcare disciplines to develop a client-centered plan of care and achieve interprofessional competencies.

Promoting nursing students' transcultural self-efficacy to care for Burmese refugees using a set of educational strategies.

BACKGROUND: Educators must respond to changing societal demographics with revised curricula that facilitate student transcultural self-efficacy to care for diverse client populations. PROBLEM: A Midwest University was situated in a community wherein the Burmese Chin refugees were predominant arrivals, and the least known. OBJECTIVES: This project examined the change in mean scores for transcultural self-efficacy for nursing cohorts following their engagement in educational strategies focused on the Burmese Chin culture. METHODS: The project was a pre-post design. The Transcultural Self-Efficacy Tool (TSET) was used to measure students' self-efficacy. INTERVENTIONS: Nursing students completed a set of educational strategies intentionally staged over 5 weeks of a semester. RESULTS: There was a significant increase in mean change from pre- to post for each of the three domains of the TSET, cognitive (1.3), practical (1.4), and affective (0.7) (p < 0.0001). There was a marginally significant mean change in the practical (p = 0.0573; p < 0.05) domain with the accelerated students in comparison with the traditional students. The group differences in mean change TSET scores remained marginally significant after adjusting for age.

A Multisite Study Demonstrates Positive Impacts to Systems Thinking Using a Table-top Simulation Experience.

BACKGROUND: Systems thinking (ST) is the ability to recognize, understand, and synthesize interactions and interdependencies in a set of components designed for a purpose. Systems thinking has been shown to improve systems and decrease error. Despite these benefits, ST has not yet been consistently integrated into all health care education programs. PURPOSE: This study examined the impact of Friday Night at the ER (FNER), a table-top simulation designed to teach ST to a variety of prelicensure and postlicensure health care students. METHODS: A multisite study was conducted in 5 academic institutions targeting both graduate and prelicensure students enrolled in nursing, medicine, physical therapy, public health, psychology, and pharmacy programs. RESULTS: The FNER simulation was followed by statistically significant improvements in ST scores. CONCLUSIONS: The FNER table-top simulation was found to improve ST in a wide variety of health-related majors.

Results of a clinician-led evidence-based task force initiative relating to pressure ulcer risk assessment and prevention.

Integration of research findings into clinical practice is essential for achieving cost-effective, quality patient outcomes. Data confirm that nursing care in most settings is "empiric" and is based largely on untested assumptions, as opposed to being evidence-based. Process improvement efforts must engage clinicians in initiatives that promote the integration of research into clinical practice and acceptance of shared professional accountability for sustaining needed change. A clinician-led task force was assembled to identify and apply current evidence to clinical practice in the areas of risk assessment and prevention of hospital-acquired pressure ulcers in the inpatient setting. Data collected prior to and following our process improvement project demonstrated significant improvement in patient outcomes.

An Educational Strategy to Inform Legislators and Nurses About the Professional Nursing Role.

Nurses provide an informed perspective to influence decision making with health care-related legislation. This article describes a strategy that can inform legislators about the contemporary nursing role and its influence on patient safety, as well as raise nurse awareness of the professional responsibility for political advocacy and how to engage in this role. [J Contin Educ Nurs. 2019;50(4):150-152.].

The prevalence of intrusive memories in adult depression: A meta-analysis.

BACKGROUND: Intrusive memories have typically been associated with post-traumatic stress disorder (PTSD) but some studies have suggested they can also occur in depression-alone. OBJECTIVE: This meta-analysis aimed to estimate the prevalence of intrusive memories in adult depression and to explore methodological and other factors that may moderate this prevalence. METHOD: The databases PsycINFO, PsycARTICLES, MedLine, PubMed, CINAHL and Embase were searched for relevant articles, published up to and including July 2016. Studies measuring point prevalence of intrusive memories in adults aged 18 years or above with depression were included and assessed for quality. Meta-analysis was completed under a random effects model. RESULTS: Seven studies measuring point prevalence of intrusive memories in adult depression were included. The overall pooled prevalence estimate calculated was 76.0% (95% CI 59.4-89.4%), reducing to 66.0% (95% CI 51.0-79.5%) when restricted to intrusive memories experienced within the week prior to assessment. Heterogeneity was high. Between-groups analyses indicated that adults with depression are as likely to experience intrusive memories as adults with PTSD, and more likely to experience intrusive memories than healthy controls (risk ratio of 2.94, 95% CI 1.53-5.67). LIMITATIONS: The strength of conclusions is limited by the small number of studies included. Consideration of the relationship between depression, intrusive memories and trauma exposure is required. CONCLUSIONS: Intrusive memories are experienced by a large majority of adults with depression and may therefore be an important target for cognitive intervention. Larger scale measurement of clinical outcome is needed with identification of individual factors predicting treatment response.

The relationship between maladaptive appraisals and posttraumatic stress disorder: a meta-analysis.

Cognitive models of post-traumatic stress disorder (PTSD) suggest maladaptive appraisals play a central role in the aetiology of this disorder. The current meta-analysis sought to provide a comprehensive, quantitative examination of the relationship between maladaptive appraisals and PTSD. One-hundred and 35 studies met study inclusion criteria and were subject to random effects meta-analysis. A large effect size was found for the relationship between appraisals and PTSD (r = 0.53, 95% CI = 0.51-0.56, k = 147), albeit with significant heterogeneity. In studies using only the Posttraumatic Cognitions Inventory or Child Post-traumatic Cognitions Inventory, the effect size remained large (r = 0.56; k = 104). In adults, appraisals about the self had a large effect size (r = 0.61), appraisals about the world had a medium effect size (r = 0.46) and self-blame appraisals had a small effect size (r = 0.28). In child/adolescent studies, large effect sizes were found for both 'fragile person in a scary world' and 'permanent and disturbing change' appraisals (r = 0.54 and r = 0.60, respectively). The effect size remained large in prospective longitudinal studies up to one year after trauma. There was no moderation effect for civilian vs military populations, questionnaire vs interview measures of PTSD, single vs multiple trauma exposure, or intentional vs unintentional trauma. The main effect size estimate was robust to sensitivity analyses concerning statistics used, study quality and outliers. These findings are consistent with the strong role for maladaptive appraisals in the aetiology of PTSD proposed by cognitive models. In particular, the role of self-appraisals in adults was highlighted. Avenues for future research include more studies in child, multiple trauma and military populations and longer-term follow up studies.

Los modelos cognitivos del trastorno de estrés postraumático (TEPT) sugieren que las valoraciones desadaptativas desempeñan un rol central en la etiología de este trastorno. El presente metanálisis buscó proporcionar un examen exhaustivo y cuantitativo de la relación entre las valoraciones desadaptativas y el TEPT. Ciento treinta y cinco estudios cumplieron con los criterios de inclusión y fueron sujeto de un metanálisis de efectos aleatorios. Se encontró un gran tamaño del efecto para la relación entre las valoraciones y el TEPT (r = 0,53, IC del 95% = 0,51-0,56, k = 147), aunque con una heterogeneidad significativa. En los estudios que utilizaron solo el Inventario de Cogniciones Postraumáticas o el Inventario Infantil de Cogniciones Postraumáticas, el tamaño del efecto se mantuvo grande (r = 0.56; k = 104). En adultos, las valoraciones sobre el sí mismo tuvieron un tamaño de efecto mayor (r = 0,61), las valoraciones sobre el mundo tuvo un tamaño de efecto medio (r = 0,46) y las valoraciones auto-culpables tuvieron un tamaño de efecto pequeño (r = 0,28). En estudios con niños/adolescentes, se encontraron mayores tamaños de efecto para las valoraciones de 'persona frágil en un mundo aterrador' y 'cambio permanente y perturbador' (r = 0.54 y r = 0.60, respectivamente). El tamaño del efecto se mantuvo grande en estudios longitudinales prospectivos hasta un año después del trauma. No hubo efecto de moderación para las poblaciones civiles frente a las militares, las medidas de cuestionario versus a la entrevista del trastorno de estrés postraumático, la exposición trauma individual versus la exposición múltiple o el trauma intencional versus al no intencional. La estimación del tamaño del efecto principal fue robusta para los análisis de sensibilidad relativos a las estadísticas utilizadas, la calidad del estudio y los valores atípicos. Estos hallazgos son consistentes con el fuerte papel de las valoraciones desadaptativas en la etiología del TEPT propuesto por los modelos cognitivos. En particular, se destacó el papel de las autovaloraciones en adultos. Las vías para futuras investigaciones incluyen más estudios en niños, traumas múltiples y poblaciones militares y estudios de seguimiento a más largo plazo.

Using a Role-Play Simulation Game to Promote Systems Thinking.

Learning is a dynamic process where the learner discovers new knowledge and constructs new insights. The "Friday Night in the ER"© role-play simulation game facilitates system thinking, data-based decision making, and collaboration. Nurse educators in academe and health care settings can use this game to practice the essential skills of nurse professionals. J Contin Nurs Educ. 2018;49(1):10-11.

Strategies for Integrating Global Awareness and Engagement Into Clinical Practice.

Nurse educators are faced with the challenge of educating learners about global health for clinical practice, particularly as cultural diversity increases in their own communities. This third article in the four-part Teaching Tips series focuses on active teaching-learning strategies for global health awareness and engagement in clinical practice using interprofessional education global health competencies and evidence-based interactive teaching strategies. Tips and topic ideas are offered for integrating global awareness and engagement in both the academic and practice settings to prepare today's nurses for systems-based culturally competent care in clinical practice. J Contin Nurs Educ. 2018;49(5):203-205.

Age-related eye diseases and recommendations for low-vision AIDS.

As the number of people older than 65 years in the United States increases, the home care population will increase as well. Many of these patients will have several chronic diseases, including those related to vision loss. Home healthcare clinicians are in a position to promote patient safety by educating these patients about the devices available for those with decreased vision. This article provides guidance on the most appropriate methods for communicating with patients who have limited vision. The 4 major causes of vision loss in this population are briefly reviewed. Low-vision aids are described and sources for these products are identified.

Creating a faculty community that values curricular assessment and improvement: one DNP program's experience.

Developing faculty ownership of ongoing curricular improvement presents educational and management challenges for schools of nursing, yet little has been published about which components help build a faculty community that values curricular assessment and improvement. The purpose of this case study was to describe key features of and faculty satisfaction with one school of nursing's doctor of nursing practice curricular assessment process, with a description of key considerations for developing an ePortfolio-supported curricular assessment process. ePortfolio matrices were used as a curricular organizing structure for mapping and scoring each completed student assignment to an American Association of Colleges of Nursing Essential descriptor using a rubric that measured evidence of student learning. Faculty satisfaction with the process was also evaluated. First-year results indicated high levels of faculty satisfaction with the assessment process. The initial findings led to four actions for curricular improvement and agreement to continue the assessment process biannually. The curricular assessment was successful in generating faculty satisfaction, identifying needed areas to improve the curriculum, and obtaining faculty agreement to continue the process. A faculty community supportive of curricular assessment is essential to a transformational learning environment that prepares future nursing leaders.

Student stakeholders impact redesign for management practicum.

Healthcare educators are continually challenged to respond to societal needs as they engage in the dynamic and ongoing process of curriculum redesign. The expectations of a group of stakeholders in the process, our students, were obtained through a survey process over time and led to change in the management and leadership practicum. The authors describe the survey process and its outcomes.