Undergraduate Nursing Student Reflections on Academic Service Learning Experiences - A Qualitative Study.

The provision of nursing care has shifted toward integrated primary care (provision of community health services by an interprofessional team), requiring that nurse educators take steps to ensure students have opportunities to learn and practice the leadership and professional skills required to function as members and leaders of interdisciplinary teams. We developed the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) program for undergraduate nursing students to facilitate this learning. During clinical immersion, students participated in academic service learning (ASL) activities consisting of a minimum of 25 h of clinical agency service each semester. This descriptive qualitative design captures recurring themes in the ASL reflections of eight nursing students participating in the inaugural TRIP cohort. Three themes were identified (1) "Embracing the Nursing Profession" (2) "Utilizing the Professional Skills of Nursing" and (3) "I Am A Nurse". We urge our faculty colleagues to consider incorporating ASL experiences into their undergraduate activities. We believe the effort to initiate, develop and sustain these partnerships will pay handsome dividends in terms skill and confidence enhancements for our undergraduate nursing students.

Regional Comparison of Diabetes Psychosocial Comorbidities Among Americans With Type 1 Diabetes During the COVID-19 Pandemic.

PURPOSE: The purpose of this study was to compare diabetes psychosocial comorbidities among adults with type 1 diabetes (T1D) across the United States during the onset of COVID-19 pandemic. METHODS: Adults with T1D from 4 main US geographic regions including South (n = 367), West (n = 234), Northeast (n = 250), and Midwest (n = 247) completed a cross-sectional online survey between April and June 2020. Data collection was done on psychosocial measures, glycemic variability, sociodemographic characteristics, and various challenges related to the COVID-19 pandemic. Chi-square, Fisher's exact, Kruskal-Wallis tests, ordinary least squares, proportional odds, and ordinal logistic regression methods were used for data analysis. RESULTS: In the South, 51.2% of participants had moderate to high levels of diabetes distress, and this was significantly (P = .03) higher than other regions. Northeast region had the lowest prevalence of moderate to severe diabetes burnout (19.8%), but this was not significantly different compared to the other regions. Participants in the South had also the highest mean score on the 8-item Patient Health Questionnaire, with 30.3% of them reporting moderate to severe depressive symptoms. However, there were no significant differences in depressive symptoms among the regions. Glycemic control, demographic characteristics, and COVID-19-related challenges were associated with different psychosocial comorbidities in different regions. CONCLUSIONS: When providing information and support to individuals with diabetes in time of crisis like the COVID pandemic, providers should consider psychosocial aspects of diabetes care. Diabetes disparities and contextual factors vary geographically in the United States; these factors may impact the psychosocial comorbidities of diabetes in each region.

Quality of Life in Psychogenic Nonepileptic Seizures: An Evolutionary Concept Analysis.

Psychogenic nonepileptic seizures (PNES) pose a serious threat to quality of life (QOL) in patients who battle the disorder. As psychological treatment options have progressed, improvement in QOL has become a more common desired outcome. Despite its relevance in PNES research and treatment, QOL has not been defined in the PNES population. Rodgers' Evolutionary Method of concept analysis was used to analyze 47 articles and clarify the concept of QOL in PNES. QOL in PNES is subjective, multidimensional, associated with symptoms, and dynamic in nature. This conceptualization of QOL in PNES may be useful in future PNES research and treatment.

Integrated Education Reduces Negative Attitudes Toward Persons with Substance Use Disorders: A Pilot Study.

Educational practices to reduce negative attitudes toward persons with substance use disorders (SUD) are urgently needed for undergraduate nursing students, but few studies have examined their long term effectiveness. In this pilot, consenting students completed the Drug and Drug Problems Perception Questionnaire (DDPPQ) anonymously online, before and 1 year after integrated curricular content about SUD. Pretest scores were significantly higher than posttest, indicating higher negative attitudes toward persons with SUD before the integrated content. Time main effect was statistically significant. To our knowledge, this is the first report examining long-term effects of an educational intervention with reinforcement in multiple courses over time upon the attitudes of undergraduate nursing students toward persons with SUD.

Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life: A National Study.

Children, who enroll in hospice, have complex mental and behavioral health (MHBH) problems. There is limited literature on patterns of these problems among children at their end of life. Using the national database of 6195 children enrolled in hospice between January 1, 2011, and December 31, 2013, and latent class analysis, this study identified 4 distinctive classes of children. Neurodevelopment and anxiety class (26.5% of the sample) had 41.3% of children of 15 years or older, who had an average of 1.4 MHBH comorbidities and took 17 medications; 29.1% had physical health comorbidities, and 23% were dependent on technology. In the Behavior and Neurodevelopment class (20%), 53.1% of the children were between ages 6 and 14 years, who had an average of 2 MHBH comorbidities and took 17 medications. In the Physiology class (43.4%), 65.5% of children were younger than 5 years, had 1 MHBH comorbidity, and took 19 medications. In the Mood, Behaviors, and Anxiety class (10.2%), more than 90% of children were older than 6 years, had 4 MHBH comorbidities, and took 30 medications. In the latter 3 classes, approximately half of the children either had physical health comorbidities or were technology dependent. These findings highlight the importance of end-of-life care that accounts for the likely presence of complicated patterns of MHBH conditions.

In Our Own Words: Baccalaureate Nursing Students Describe Academic Service Learning Experiences.

INTRODUCTION: Service learning integrates community service, didactic and student self-reflection while at the same time striving to identify and meet needs of the community partnership agencies involved. Project Descriptions. In this manuscript, two baccalaureate nursing students describe their service learning experiences while embedded in an integrated primary care community partner site for two years. In project one, students designed and conducted an educational group for mental health clients in a rural day treatment program. In project two, the student revised a diabetic clinic educational form to reduce client burden.Project management and outcomes: Projects were designed in collaboration with community partners and faculty. Project one resulted in increased knowledge of coping mechanisms in a majority of group participants. Three months after implementation of the revised form designed in project two, a majority of diabetic clients served in the clinic had A1c reductions. DISCUSSION: Lessons learned by students during the experiences include communication skills such as developing rapport with specific client groups, steps of change management, professional team interactions and increased civic engagement. CONCLUSION: To our knowledge, this is the first manuscript wherein baccalaureate nursing students add their voice to the literature describing the benefits of academic service learning. Our next step is an online follow up 9 months post-graduation, to examine whether benefits and skills are maintained.

Mental health and developmental disabilities in US children admitted in hospice care.

BACKGROUND: Of the 40 000 children who die annually in the US, thousands are admitted to hospice care. Little is known about the mental health and developmental disabilities of these children. AIMS: To describe the mental health and developmental disabilities of children who are admitted to hospice care and compare this across age groups. METHODS: The 2011 to 2013 US Medicaid files were used. The sample included 6195 children with a diagnosis of a mental health and/or developmental disability. Comparisons were calculated using the Pearson chi-square test. RESULTS: Mental health conditions, including anxiety (31.0%), depression (33.1%), behavioural disorders (33.9%) and affective disorders (34.8%), were highest among children aged between 15 and 20 years. Developmental delays were common in children under a year, while intellectual disabilities were highest in the 15 to 20 years age group. CONCLUSIONS: Nurses have an important role in understanding the mental health and developmental disabilities of children admitted to hospice care.

Transforming RN roles using an academic-practice partnership to improve healthcare access for underserved populations.

There is a national call to improve healthcare access for underserved populations by preparing BSN students to practice at the full scope of their license in community-based, integrated primary care settings upon graduation. In response to this call, a robust academic-practice partnership-using interprofessional education and practice and primary care and leadership development- is preparing BSN students to practice in community-based integrated primary care settings where culturally diverse rural and urban underserved populations receive care. In this article, academic-practice partners describe the implementation, lessons learned, and initial outcomes of a grant-funded program that is transforming nursing education and practice. All partners viewed communication, collaboration, and flexibility as key to a successful partnership. Our work serves as a template to help others shift nursing culture to create a sustainable RN workforce prepared to improve the health and wellbeing of underserved populations.

Piloting the Transforming RN Roles in Community-Based Integrated Primary Care (TRIP): Student Responses.

In this manuscript, we report the pilot results of the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) undergraduate nursing curriculum. Junior nursing students participated in TRIP didactic, simulation and clinical activities and completed a focus group at the midpoint and conclusion of year one. Focus group themes addressed recruitment, understanding or primary care, connections between clinical and didactic, and team based care. TRIP offers the first comprehensive community based integrated primary care training for students in our region. Overall, the TRIP curriculum enhanced student learning and promoted leadership.

Team Development Measure in Interprofessional Graduate Education: A Pilot Study.

A faculty team developed the 4-week Recovery-Based Interprofessional Distance Education (RIDE) rotation for graduate students in their disciplines. The evaluation team identified the Team Development Measure (TDM) as a potential alternative to reflect team development during the RIDE rotation. The TDM, completed anonymously online, was piloted on the second student cohort (N = 18) to complete the RIDE rotation. The overall pretest mean was 60.73 points (SD = 11.85) of a possible 100 points, indicating that students anticipated their RIDE team would function at a moderately high level during the 4-week rotation. The overall posttest mean, indicating student perceptions of actual team functioning, was 72.71 points (SD = 23.31), an average increase of 11.98 points. Although not statistically significant, Cohen's effect size (d = 0.43) indicates an observed difference of large magnitude. No other published work has used the TDM as a pre-/posttest measure of team development. The authors believe the TDM has several advantages as a measure of student response to interprofessional education offerings, particularly in graduate students with prior experience on health care teams. Further work is needed to validate and extend the findings of this pilot study. [Journal of Psychosocial Nursing and Mental Health Services, 56(4), 18-22.].

Transforming Health Care Through Interprofessional Graduate Education.

PURPOSE: We provide an overview of the Recovery-based Interprofessional Distance Education (RIDE) rotation for graduate students in psychiatric mental health (PMH) nursing, pharmacy, nutrition, and exercise physiology, with faculty from the four professions represented. CONCLUSIONS: Interprofessional education can enhance team concepts in these professions and is viewed positively by students and faculty. PRACTICE IMPLICATIONS: Interprofessional learning opportunities prepare graduates to contribute to team-based care. We urge colleagues to join us in providing meaningful IPE experiences to students at all levels, with the goal of optimizing health care for all persons with mental health treatment needs.

Recovery-Based Interprofessional Distance Education (RIDE): Graduate Student Responses.

Graduate student attitudes (n = 28) were assessed before and after participation in interprofessional practitioner education (IPE). Twenty-eight graduate students participated (14 mental health nursing, 6 pharmacy, 4 nutrition, 4 exercise physiology); most had at least some health care experience. Posttest scores indicated gains on a majority of constructs measured. These results suggest that online-blended IPE content yields gains in team skills and attitudes. This study adds to a very small body of literature on IPE in graduate programs. More research is needed in examining online versus face-to-face delivery.

Effect of a Telephone Intervention on Measures of Psychiatric and Nonpsychiatric Medication Adherence in Outpatients With Schizophrenia Spectrum Disorders.

Telephone intervention may address the need for problem-solving interventions to improve medication adherence in patients with schizophrenia spectrum disorders (SSDs). The current randomized controlled trial examined the effect of weekly telephone intervention problem solving (TIPS) on quantitative measures of psychiatric and nonpsychiatric medication adherence over 6 months in 105 stable outpatients with SSDs. Independent samples t test revealed no significant differences in psychiatric or nonpsychiatric pill count adherence between groups at 6 months; however, 54.7% of experimental participants versus 32.7% of controls had serum antipsychotic levels within therapeutic range at 6 months (χ2 = 5.2, df = 1, p = 0.023). The current study extends the literature on adherence in patients with SSDs by describing a clinical sample of stable outpatients over 6 months and examining adherence to psychiatric and nonpsychiatric medications. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 29-36.].

Effect of a Telephone Intervention Upon Self-Reported Medication Adherence and Self-Efficacy in Outpatients With Schizophrenia Spectrum Disorders (SSDs).

We conducted a randomized controlled trial to determine the effect of weekly telephone intervention upon self-reported medication adherence, medication adherence self efficacy, and symptom levels in 140 stable outpatients with SSDs for three months. To our knowledge, this is the first study examining medication adherence self efficacy in persons with SSDs. Study measures were administered in a private office by trained study staff immediately following the granting of informed consent, and again after three months. Participants ranged in age from 19-71 years with an average age of 46.1 years (SD 12.9). A majority were males (n = 80, 57.1%) with schizoaffective disorder (n = 94, 67.1%). Symptoms were lower and self-reported medication adherence was higher in experimental participant after three months, but differences were not statistically significant. Medication adherence self efficacy was essentially unchanged over the three month follow up period. This study extends the literature on adherence in SSDs by describing a clinic-based sample of stable outpatients, and is the first investigation to measure medication adherence self efficacy in this group. Our next project will examine the effectiveness of TIPS upon objectively measured medication adherence in this group over 6 months of follow up.

Descriptions and Correlates of Medication Adherence, Attitudes, and Self-Efficacy in Outpatients With Schizophrenia Spectrum Disorders (SSDs).

The problem of medication adherence in schizophrenia spectrum disorders (SSDs) has challenged researchers and clinicians for decades. Few investigations have examined non-psychiatric adherence in this group. We conducted a descriptive correlational investigation of adherence and related factors in 185 stable outpatients with SSDs. Fifty-seven percent of participants had antipsychotic medication levels within therapeutic range and 42% had levels below therapeutic range. Pill count percentage adherence to antipsychotic medications ranged from 0-100% with a mean of 70% and SD 34.9. Mean non-psychiatric medication adherence ranged from 0 to 100 with a mean of 61% and SD 31.8. The following characteristics were not significantly associated with adherence: age, diagnosis, gender, race, living arrangement, educational level, typical versus atypical antipsychotic medication. Level of symptoms was correlated negatively and significantly with self-reported medication adherence and medication adherence self-efficacy. Our next project will examine the effectiveness of a telephone-delivered intervention designed to support adherence in this group.

Understanding the perspectives of family members on telephone intervention for individuals with schizophrenia: results of a focus group.

The current study explored the perspectives of family members of individuals with schizophrenia to identify family needs. Six family members from the National Alliance on Mental Illness participated in a 90-minute focus group to share their perspectives on treatment needs and delivery options and to provide suggestions on needs that might be met using telephone-based treatment. Traditional atheoretical content analysis was performed. Five major themes emerged from the data: (a) isolation, (b) negative emotions, (c) recognition of illness, (d) communication with providers, and (e) problem solving. Findings indicate that families perceive needs that could potentially be met using telephone-based treatments. More research is needed to determine family responses to telephone-based treatment initiatives.

Descriptions and correlates of salivary cotinine in individuals with schizophrenia spectrum disorders.

The purpose of this study was to describe the procedure and results of salivary cotinine testing and to examine correlations between cotinine levels, self-reported smoking behavior, and other demographic variables in outpatients with schizophrenia spectrum disorders (SSDs). Twenty-one participants completed salivary cotinine measures. Sixteen reported smoking cigarettes (mean = 1.2 packs per day; SD = 0.8; range = 0.25 to 3.0) for a mean of 27.4 years (SD = 16.3 years, range = 1 to 46 years). Age was significantly positively correlated with self-report of packs smoked per day (r = 0.52; p = 0.04) and years smoked (r = 0.63; p = 0.02). There was no clear pattern of relationship between salivary cotinine level and self-reported smoking behavior. This pilot study adds to a small body of literature describing salivary cotinine measures in individuals with SSDs, yet further investigation is warranted to definitively determine the utility of this objective measure of nicotine use.