Stress and Trauma Among Nurses in Development (STAND): A Descriptive Study.

BACKGROUND: Mental health conditions related to traumatic stress exposure are common in practicing nurses. Less is known about the impact of trauma on nursing students and how it affects their transition to practice. OBJECTIVES: The purpose of this study is to understand the experience of trauma exposure and resulting symptoms in undergraduate nursing students. DESIGN: This is an analysis of baseline data from a longitudinal study. Students in an undergraduate nursing program completed a survey with validated instruments to measure trauma exposure, risk and protective factors, and trauma symptoms. SETTINGS: The study took place in an undergraduate nursing program in the United States. PARTICIPANTS: A total of 248 nursing students participated in the study. RESULTS: The nursing students reported a higher number of adverse childhood experiences and post-traumatic stress disorder (PTSD) symptoms than the general population. Additionally, mental health symptoms and burnout symptoms increased over time. CONCLUSIONS: Nursing students are at high risk for PTSD and other mental health conditions due to cumulative trauma. Interventions are needed to address trauma in developing nurses.

Vaccine hesitancy and hesitant adoption among nursing students in Texas.

Background: As the state facing the second-largest nursing workforce shortage in the U.S. and low vaccination rates among residents early in the pandemic, Texas provided a unique opportunity to examine vaccine hesitancy and hesitant adoption among nursing students in an environment where state-level executive orders prohibited mandatory vaccinations. Methods: The purpose of this study was to describe the level of vaccine hesitancy and hesitant adoption among nursing students in the state of Texas. We used a convenient, opt-in, online survey of nursing students conducted between mid-April and mid-June 2022. The survey was distributed to all pre-licensure nursing programs in Texas. Results: The majority of survey respondents (n = 599) were between the ages of 18-28 (68 %), female (88 %) and white (57 %). Most received at least one dose of the COVID-19 vaccination (84 %). Of those receiving the vaccine, a high proportion (82 %) were identified as hesitant adopters. Respondents cited concerns about side effects (57 %) most frequently as the reason for vaccine hesitancy. Conclusion: Given the worldwide nursing shortage, factors potentially impacting the future workforce, such as vaccine hesitancy and hesitant adoption, must be closely monitored. More research is needed to understand the concerns of nursing students and the motivations of hesitant and non-hesitant adopters.

Anesthesiologists Have an Important Role in Preclinical Nurse Anesthesia Education.

Anesthesiologists do not participate regularly in the preclinical portion of nurse anesthesia training programs (NAPs). This practice is predicated on a historical separation of the early educational tracks of physicians and advanced practice nurses whose professions ultimately came to occupy overlapping niches within the field of anesthesia. The state of affairs has been bolstered by territorial friction between professional organizations, and by the lack of a perceived need for anesthesiologists to become involved at an early stage of nurse anesthesia education given the large number of qualified certified registered nurse anesthesia instructors available to perform this role. Anesthesiologists, however, have significant pedagogical assets to offer NAPs, including expertise in critical analysis and decision-making skills related to perioperative adverse events. In addition, introduction of anesthesiologists into preclinical NAP education has the potential to inject added academic rigor into NAPs currently transitioning to Doctor of Nursing Practice programs. Likewise, NAPs offer a professional haven for those anesthesiologists seeking new challenges in education, and a unique opportunity to shape the future of anesthesia. Most importantly, introducing anesthesiologists into the initial educational phases of the nurse anesthesia profession provides an opportunity to grow trust and understanding between these two professions that are critical for safe, healthy, and lasting partnerships in future years.

Factors affecting community participation in the CDTI program in Morogoro, Tanzania.

BACKGROUND: Up to 4 million people in Tanzania are at risk for the parasitic disease onchocerciasis. A treatment program, Community-Directed Treatment with Ivermectin (CDTI), has made significant gains in prevention and treatment. Understanding factors affecting participation could help boost treatment coverage and sustain gains made in controlling onchocerciasis in endemic areas. PURPOSE: To explore community-perceived factors related to participation in and sustainability of the CDTI program in southwest Tanzania. METHODS: Multilevel triangulation design using surveys, focus group discussions (FGDs), and semistructured interviews to collect data in two villages in the Morogoro Rural District of Tanzania. In total, 456 villagers participated in the survey and 42 in FDGs. Five community-directed distributors (CDDs) and three community health workers were interviewed. FINDINGS: High levels of awareness of onchocerciasis (90%) and methods of prevention and treatment (95%) were reported. Over 75% of participants knew how ivermectin was distributed and 74% have taken the drug. Over 90% of villagers knew that distribution of the drug was for treatment and prevention. Only 43% knew the cause of onchocerciasis. Through FGDs, villagers reported barriers to participation, including lack of comprehensive understanding of the disease, fears of medication, distrust of the method determining dose, lack of health education materials, insufficient CDD-resident communication, and inflexible drug distribution mechanisms. CONCLUSIONS: Sustaining programs without supporting growth of CDDs and reinforcing education of communities could lead to a decrease in treatment and an increase in the public health threat. This research uncovered a need for more effective community education and sensitization. CLINICAL RELEVANCE: Understanding barriers to participation in community-based programs can assist public health and community health nurses and key stakeholders including Ministries of Health and local and regional health systems in the development of education and support materials to enhance health literacy and encourage program participation.

Describing Spirituality at the End of Life.

Spirituality is salient to persons nearing the end of life (EOL). Unfortunately, researchers have not been able to agree on a universal definition of spirituality reducing the effectiveness of spiritual research. To advance spiritual knowledge and build an evidence base, researchers must develop creative ways to describe spirituality as it cannot be explicitly defined. A literature review was conducted to determine the common attributes that comprise the essence of spirituality, thereby creating a common ground on which to base spiritual research. Forty original research articles (2002 to 2012) focusing on EOL and including spiritual definitions/descriptions were reviewed. Analysis identified five attributes that most commonly described the essence of spirituality, including meaning, beliefs, connecting, self-transcendence, and value.

Spirituality and uncertainty at the end of life.

PURPOSE/OBJECTIVES: To examine the theoretical congruency between uncertainty and spirituality at the end of life (EOL). DATA SOURCES: Relevant empirical and theoretical articles using the key words spirituality, uncertainty, terminal illness, and similar derivatives were drawn from the databases of CINAHL®, MEDLINE®, PsycINFO, and SocINDEX. DATA SYNTHESIS: Spirituality and uncertainty were compared for theoretical congruency based on five general categories: prevalence, temporality, interpretation, quality, and directionality. The categories were drawn from the uncertainty literature and looked at the ability of spirituality and uncertainty to contribute to or detract from health. CONCLUSIONS: This article presents an innovative way of viewing how spirituality is experienced at the EOL. The likelihood that uncertainty and spirituality can coexist as a simultaneous and even blended construct that influences the EOL is supported and warrants additional exploration. IMPLICATIONS FOR NURSING: Health professionals must recognize the prevalence of spiritual uncertainty in the lives of their patients and understand the need to frequently assess for spiritual uncertainty. Specific recommendations are provided to guide professionals in addressing spiritual uncertainty with patients.

Caritas and job environment: a replication of Persky et al.

The purpose of this study was to replicate and expand on Persky, Nelson, Watson, and Bent (2008) study of characteristics related to nurses who were effective in Watson's Caritas framework. Previous research suggests that poorer work environments are associated with higher levels of caring. This surprising finding warrants further investigation. Registered nurses were recruited from a mid-sized community-based hospital in the Midwest portion of the United States of America (N = 20). Each completed the health environment survey (HES). Ten patients that had received primary care from the nurse completed the caring factors survey (CFS). Two hundred nurse/patient dyads were used to determine the relationship between the CFS and HES. Six of the 13 HES scales were positively associated with CFS scores. As nurses' positive perceptions of the work environment increased, patients' perceptions of caring increased. Our findings contrast Persky et al.'s. Further research is needed examining factors influencing the relationship between job environment and patient perceptions of caring.

Successfully recruiting, surveying, and retaining college students: a description of methods for the Risk, Religiosity, and Emerging Adulthood Study.

The selection of methods that purposefully reflect the norms of the target population increases the likelihood of effective recruitment, data collection, and retention. In the case of research among college students, researchers' appreciation of college student norms might be skewed by unappreciated generational and developmental differences. Our purpose in this article is to illustrate how attention to the generational and developmental characteristics of college students enhanced the methods of the Risk, Religiosity, and Emerging Adulthood study. We address the following challenges related to research with college students: recruitment, communication, data collection, and retention. Solutions incorporating Internet-based applications (e.g., Facebook) and sensitivity to the generational norms of participants (e.g., multiple means of communication) are described in detail.

Who will show up? Estimating ability and willingness of essential hospital personnel to report to work in response to a disaster.

Disaster planning in the healthcare setting requires consideration of surge capacity, specifically the community's ability to provide care for a rapid increase in numbers of patients having varied conditions. Adequate staffing is a key component of surge capacity. If fewer than anticipated healthcare personnel report to work in response to a disaster, safety and sustainability of the care provided may be jeopardized. In this article we discuss the need for essential personnel following a disaster, review the literature related to adequate disaster staffing, and share our study examining both the ability and willingness of healthcare personnel to report to work during a disaster and identified barriers to this reporting. We conclude by noting that healthcare personnel experience multiple barriers affecting ability and willingness to report to work during a disaster, with responsibility for children producing the greatest number of significant differences. Strategies for addressing these barriers are provided.

Depression and religiosity and/or spirituality in college: a longitudinal survey of students in the USA.

The aim of this study was to conduct a longitudinal test of an explanatory model of depression, where religiosity and/or spirituality (R/S) represents a potentially protective factor in college students in the USA. A Web-based survey was administered monthly to 214 students from religious and public colleges. At 1 month and 6 months, the measures of R/S, depression, stress, and cognitive vulnerability were administered. Between 2 and 5 months, only the measures of stress and depression were administered. The data were analyzed to test the hypothesis that R/S buffers the effect of stress on depression over time in the context of cognitive vulnerability. The results supported a direct and protective effect over time between R/S and depression, but a buffering effect on the relationship between stress and depression was not found. Although all aspects of R/S were demonstrated to protect the participants from depression, it did not appear that the relationship between R/S and stress or R/S and cognitive vulnerability explains this relationship. Nurses who are working with college students should take holistic approaches to their emotional difficulties, realizing the potentially beneficial effects of students' religiousness or spirituality.

Measuring religiosity/spirituality in diverse religious groups: a consideration of methods.

Minority religious groups continue to grow in the United States, and traditional religious groups are becoming more diverse. The purpose of this paper is to detail the methodology of the measure adaptation and psychometric phase of an ongoing study that is designed to describe the relationship between R/S, emotional extremes, and risk behaviors in Christian, Jewish, and Muslim high school students as they transition to college. Unique challenges associated with measurement, recruitment, and research team dynamics were encountered. These challenges and possible solutions are discussed in the context of conducting research that focuses on religious minority groups.

Clustering countries to evaluate health outcomes globally.

Clustering countries based on health outcomes is a useful technique for assessing global health disparities. However, data on country-specific indicators of health outcomes are inconsistent across databases from different sources, such as World Bank, WHO, and UNICEF. The new database on under-five child mortality from the Institute for Health Metrics and Evaluation advances information about child mortality by showing both country-level estimates and confidence intervals. We used the new database for child mortality and WHO data for HALE from 160 countries to identify country clusters through model-based clustering techniques. The four clusters in 2000 and six in 2003, within levels of uncertainty, showed nonlinear distributions of health outcomes globally, indicating that no single trajectory for progression is evident. We propose the use of country clusters in further study of societal conditions that contribute to health outcomes and changes over time.

A clinical evaluation of the cost and time effectiveness of the ASPAN Hypothermia Guideline.

It is known that perioperative hypothermia increases the cost of care and places surgical patients at increased risk for adverse outcomes. The American Society of PeriAnesthesia Nurses (ASPAN) developed the Clinical Guideline for the Prevention of Unplanned Perioperative Hypothermia to specify a systematic approach to the maintenance of normothermia in surgical patients, making use of newer active warming technologies as well as passive warming techniques. The purpose of this study was to test the cost and time effectiveness of the ASPAN Hypothermia Guideline as compared with usual care. Our findings indicate that the Hypothermia Guideline, which is known to employ practices effective for maintaining normothermia, is clinically feasible and can be implemented without significant increases in cost or time for an ambulatory surgical unit.

Religiosity, spirituality, and adolescent sexuality.

There are many individual, family, and cultural factors that influence the development of healthy sexuality in adolescents. One factor that is less often described but may play a role is religion/spirituality. Adolescents' religious/spiritual belief system or the cultural religious context within which they are raised may impact their attitudes or beliefs about having sex before marriage, decisions about the timing of coital debut, or contraceptive practices. In this article we will define the terms "religiosity" and "spirituality"; highlight the key scientific literature on the relationships between religiosity, spirituality, and adolescent sexual health outcomes (e.g., coital debut, contraceptive practices), including describing why religiosity/spirituality may be related to these outcomes; and briefly discuss programs/clinical implications for integrating these findings into clinical practice.

Gender and students' vocational choices in entering the field of nursing.

As the demand increases for nursing professionals, existing theories borrowed from the field of industrial psychology may help employers and recruiters to identify appropriate candidates, train, hire and promote nurses in a more effective manner. An important component of these theories is understanding an individual's motivation to choose a certain profession. This preliminary study examined gender differences in motivations to enter the field of nursing. Two theoretical points of view were offered to account for the differences: Holland and Row's models of person-job congruence and Maslow's hierarchy of needs. One hundred and sixty (24 men and 136 women) freshmen from 3 nursing programs were asked to report their motivations to enter nursing. A new instrument based on the models mentioned above and representing 2 basic motivations, self-actualization and survival needs, was developed for the purposes of this study. While both genders mentioned self-actualization as their main motivation for entering nursing, men tended to give survival needs more weight than women did. The motivation patterns as well as the gender differences are discussed in light of recent trends in nursing and within the framework of personnel selection and training.

Methodological pitfalls in the study of religiosity and spirituality.

The number of studies demonstrating a relationship between religiosity and spirituality and physical and psychological health have increased rapidly during the past decade. There are significant disputes in the literature regarding the methodological quality of research in this area. Despite nursing scholars' interest in this area, no thorough review of the methodological critiques is available. The purpose of this study is to review areas of methodological difficulty in the study of religiosity and spirituality by identifying contemporary methodological critiques, critically evaluating the critiques and the underlying issues, and making suggestions for methodological advancement in the field. Three main areas of methodological critique exist: construct measurement, study design, and data analysis. Research in this area should aim for conceptual clarity, deliberate design, and appropriate analysis. Considerations of these critiques are instructive for nursing research done in the area of religiosity and spirituality.

The relationship between depression and emerging adulthood: theory generation.

Depression during the transition from late adolescence to young adulthood is a major mental health concern. Developmental theories addressing this transition, also called emerging adulthood, are few, and fewer yet are theories addressing mental health or psychopathology during this period. This article establishes the legitimacy of emerging adulthood as a unique developmental period and attempts to generate directions for theory development by merging theories of depression and development at the point of emerging adulthood. This article concludes with a theoretical discussion and application of this process in research and practice.

TPL-KATS-card sort: a tool for assessing structural knowledge.

The study of how individuals organize knowledge has been a popular endeavor for several decades. As a result, techniques have been developed to assess how individuals represent and organize knowledge internally. Although several conceptual knowledge elicitation methods have been developed and used to assess the organization of knowledge, their use is often labor intensive and time consuming. Presented here is a software tool that was developed to reduce the problems associated with manually administering the conceptual knowledge elicitation technique, or card sorting. The TPL-KATS-card sort software not only simplifies the administration of the task, but also adds features to the card-sorting task such as media insertion, time stamping, and instructorless administration. In the present article, an introduction to the card-sorting technique is provided, the new software tool is described, and the advantages of the software are detailed.

Does religious psychotherapy improve anxiety and depression in religious adults? A review of randomized controlled studies.

Nurses in mental health settings are expected to provide insightful, wholistic, and effective care. Many patients in mental health settings have concerns or needs related to spiritual or religious dimensions. Unfortunately, many of these concerns are not addressed. Religious psychotherapy (RPT) is an approach to therapy that attempts to recognize and utilize the religious beliefs of clients in treatment for the purposes of reducing mental health difficulties. The purpose of this paper is to review the current randomized and controlled research (RCT) on the utilization of RPT in adult populations with anxiety and depressive disorders and to make recommendations for practice and future research. A search of the literature yielded four studies. A critical review of the studies yielded the following findings: (1) The findings across studies consistently demonstrate that RPT is as effective as standard treatment; (2) the results in each study were statistically significant and appeared to qualify as being clinically significant; and 3) the studies reviewed, although varying in quality, were true experiments marked by intervention, randomization, and control groups or comparison with standard treatment groups. There is warrant for greater consideration of the religious beliefs of depressed and anxious clients in outpatient settings. Nurses should be aware of the potential for the reduction of distressing symptomology through the consideration of clients' belief systems as they effect clients' perceptions of their own mental health.