Use of a virtual environment to promote self-management and lifestyle changes in persons with bipolar disorder.

PURPOSE: Self-management and lifestyle interventions are a key factor in treatment outcomes for persons with bipolar disorder (BD). A virtual environment (VE), due to it's ability to provide flexibility of involvement in its platform, may be an alternative to face-to-face treatment to provide support for self-management. The purpose of this study is to explore how a VE, developed for chronic illness self-management, may be modified to promote self-management and lifestyle changes in those with BD. METHOD: This study used a qualitative description design with focus groups. Data were collected via minimally structured interviews and analyzed using thematic content analysis. A total of seven focus groups were conducted, and the sample consisted of 30 adults with BD. Age range was 21-77 years with 21 females, seven males, and two non-binary individuals. RESULTS: Five themes emerged from the findings: Self-management and lifestyle interventions with regards to (1) mental health; (2) holistic health; (3) role of peers; (4) involvement of the family; (5) technological aspects of the VE. CONCLUSIONS: Focus group participants suggested that the VE may be an efficacious way to enhance self-management and promote lifestyle interventions in those with BD. Research is needed to adapt such platforms to the need of the patients and examine its' effect on health outcomes.

Associations of Psychological Distress and Alcohol Use Patterns Among Older Adults of Sexual Minority Status and Heterosexual Peers.

BACKGROUND: There is limited research investigating sexual-orientation-related differences in older adults and their relationship with alcohol use. OBJECTIVE: The purpose of this study was to determine if sexual minority status moderates the relationship between psychological distress and alcohol drinking patterns. METHODS: This study was a secondary analysis of data from the 2017-2018 National Survey on Drug Use and Health. Health outcomes among lesbian, gay, and bisexual (LGB) older adults (N = 462) aged 50 years or older were compared with heterosexual (N = 16,856) peers using univariate analyses and logistic regressions. Interaction terms evaluated the influence of sexual orientation on psychological distress and alcohol consumption. RESULTS: Sexual orientation was a predictor of alcohol use in the past year, past month, and at any time (p < .001) but was not a predictor of alcohol dependence or misuse, binge drinking, or heavy drinking. Heterosexual older adults were less likely to consume alcohol than those who identified as LGB. Respondents not reporting psychological distress were less likely to engage in problematic drinking. However, there was no evidence that sexual minority status moderates the relationship between psychological distress and alcohol use. CONCLUSION: Limited evidence supports higher rates of alcohol use and alcohol-related problems among sexual minority persons than heterosexuals. Prediction models for alcohol use were not improved by using sexual orientation and psychological distress as interaction terms. Future research should examine the underlying causes of impaired health in the older LGB population. Those findings should be used to research methods of preventing and minimizing alcohol misuse.

The Impact of Bullying Victimization and Sexual Orientation on the Severity of Suicidal Behavior.

Background: Lesbian, gay, and bisexual youth face a disproportionate risk of suicidal ideation and attempt compared to heterosexual counterparts. Escalation from ideation to attempt can occur quickly, and youth who survive suicide attempts are likely to pursue subsequent, riskier attempts. This study examines the effects of bullying and sexual orientation on suicidal outcomes. Methods: Data came from the national, school-administered 2017 Youth Risk Behavior Survey (N = 14,765). Bivariate associations, binomial logistic regressions, and ordinal logistic regressions were performed. Results: Lesbian/gay, bisexual, and unsure youth reported greater odds of ideation and attempts compared to heterosexual youth. For ideation, increased effects were inconsistent across bullying types and significant interactions were found for bisexual youth who were bullied in school, and for lesbian/gay youth who were cyberbullied. Conclusion: These results underscore the need to understand bullying victimization for lesbian, gay, and bisexual youth. Awareness of increasing cyberbullying and creating school environments of no-bullying tolerance in the post-pandemic era are among the challenges ahead.

A nurse practitioner-led telehealth protocol to improve diabetes outcomes in primary care.

BACKGROUND: Diabetes-related complications contribute to a costly health burden in the United States. Telehealth (TH) is a tool that can increase access to care and offer ongoing support for chronic disease self-management. LOCAL PROBLEM: A primary care practice in Texas needed a method to manage an influx of patients with uncontrolled diabetes and improve type 2 diabetes outcomes using nurse practitioner (NP) TH appointments. METHODS: Thirty patients meeting inclusion criteria participated in monthly TH check-ins and followed monthly for 3 months. Baseline and postintervention diabetes laboratory studies (hemoglobin A1c [HbA1c], estimated glomerular filtration rate, and microalbumin) were collected. INTERVENTIONS: During each monthly TH visit, an NP-led diabetes TH QI protocol was implemented. The Telehealth Usability Questionnaire was administered to patients after the 3-month intervention. RESULTS: The TH QI protocol resulted in an overall ∼1% reduction in HbA1c. Over 73% of participants experienced various reductions of HbA1c, of which 2.3% achieved a postintervention HbA1c <7%, indicating controlled diabetes. Kidney function indicated by eGFR improved by 7 ml/min/1.73 m2 in 83% of participating patients. At the end of the 3-month intervention, 84% of participants expressed overall satisfaction with TH appointments. CONCLUSIONS: Interventions using TH to improve chronic disease may be useful in diabetes outcomes and self-management. Monthly TH visits can improve patient outcomes, reduce complications, and enhance the patient-provider relationship. Preventive self-care activities and long-term use of TH visits for self-management are implications for future studies.

Siblings' experience during pediatric intensive care hospitalization.

PURPOSE: The impact on children who visit an ill sibling in the pediatric intensive care unit (PICU) is unknown. The aim of this study was to describe the experiences of siblings of acutely critically ill or injured children hospitalized in the PICU. DESIGN AND METHODS: A qualitative approach using one-to-one interviews was conducted to gain an understanding of the experience of 9- to 17-year-old children who visited their siblings in the PICU. Thematic analysis was used to develop a description of the experiences of the siblings. FINDINGS: Sixteen siblings (mean age, 12.5 years) indicated that visiting their critically ill sister or brother in the PICU can cause negative reactions. The data revealed two major themes within the overall sibling experience-stressors, coping-and nine subthemes. Predominant sibling stressors included pre-illness stressors, the PICU environment, the appearance of the ill child, uncertainty, and parental stress. Siblings coped mainly via distractions, social support, and spirituality and by reflecting on the sibling relationship. Support from friends, family members, and the community was reported to be helpful. CONCLUSIONS: Siblings visiting the PICU may experience a broad range of physical, emotional, and social responses. PRACTICE IMPLICATIONS: Future research should fully incorporate the sibling perspective when designing interventions to mitigate the potentially distressing effects of PICU visitation on the family.

Psychoeducation for caregivers of patients with bipolar disorder-Lessons learned from a feasibility study.

INTRODUCTION: The purpose of this study was to test the feasibility and potential efficacy of a 7-week psychoeducation intervention implemented in a group setting. The intervention was based on Miklowitz's (2008) psychoeducation component of Family-Focused Therapy. METHOD: This was a feasibility randomized controlled trial study using a 2-group design (intervention and wait-list control). Twelve adult family members of those with bipolar disorder were randomized to receive 7 psychoeducation sessions immediately or after a 7-week waiting period. Outcomes were caregiver burden, depression, mental-well being, health status, and cortisol and interleukin-6 (IL-6) levels. Frequencies and percentages were used to calculate feasibility measures. The Wilcoxon Signed Rank Test was used to assess change over time during treatment. RESULTS: Twelve participants were recruited out of a projected sample size of 40. Feasibility rates included the following: 85% retention rate, 100% data collection rate, 94% attendance rate. The mean satisfaction score was 17.25, with potential scores of 4-20. There were trends in improvement in some of the variables (caregiver burden, mental well-being, IL-6) from pre-to post-intervention. LIMITATION: The study lacked a sufficient sample size. CONCLUSION: Although some feasibility results were positive and the participants were satisfied with the intervention, recruitment was challenging. The study setting was near downtown in a sprawling urban area. Also, potential participants often assume multiple role responsibilities. They often lacked the time to physically attend the sessions. Future studies could incorporate teleconference or virtual environment platforms.

Associations of meaning of illness with psychosocial, clinical, and immunological characteristics in patients with Leptomeningeal metastasis.

Background: Leptomeningeal metastasis (LM) creates symptoms related to both the disease within the nervous system and treatment toxicities. Biologic processes, such as inflammation and behavioral processes, such as the meaning ascribed to illness (Meaning of Illness: MoI), can impact physical and psychosocial symptoms. The aim of this study was to understand the relationships among MoI, physical and psychosocial symptoms, and inflammation in patients with LM. Methods: Thirty enrolled participants completed the MD Anderson Symptom Inventory-Brain Tumor with spine experimental symptoms added. Meaning of illness, quality of life (QoL), and depression were captured by validated instruments. Interleukin (IL)-6 and tumor necrosis factor (TNF)-α in serum and cerebrospinal fluid (CSF) were measured by ELISA. Correlations were performed to assess relationships among the variables. Results: Participants were primarily white (73%), female (63%). Median age was 54 years (34-83). Breast (50%) and lung (20%) were most common diagnosis. Higher MoI scores were associated with better QoL (p < .01) and fewer depressive symptoms (p < .01). All CSF samples contained IL-6 and all but one sample had elevated IL-6. Higher levels of IL-6 in the CSF were associated with greater symptom burden (p < .01) and interference of symptoms in daily life (p = .02) but not MoI. Conclusions: MoI was associated with QoL and depression. High levels of IL-6 in the CSF were associated with more severe symptoms. This study provides the groundwork for future research, including interventional studies to improve QoL in patients with LM.

Prevention Strategies for Neonatal Skin Injury in the NICU.

PURPOSE: The purpose of this article was to determine specific skin injury prevention interventions for neonates in the NICU. DESIGN: The design was a systematic review. SAMPLE: PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, and Scopus were systematically searched to identify quantitative studies identifying skin injury preventions for neonates in the NICU. OUTCOMES: The outcomes included skin integrity or skin condition. RESULTS: Nineteen studies were included in the review. Twelve studies included a randomized design. Barriers were the main interventions for the prevention of pressure injury, medical adhesive skin injury, diaper dermatitis, and general skin condition. The types of barriers included hydrocolloids, polyurethane-based dressings, film-forming skin protectant, or emollients. Nonbarrier interventions included rotation between a mask and nasal continuous positive airway pressure (NCPAP) interfaces, utilization of prescribed guidelines to decrease pressure injuries, and use of a lower concentration of chlorhexidine gluconate as a disinfectant.

Blood biomarkers for physical recovery in ischemic stroke: a systematic review.

Stroke is a common cause of physical disability. Biomarkers have been used to predict prognosis in ischemic stroke, but studies linking biomarkers to physical recovery from ischemic stroke have not been systematically evaluated since 2011. The purpose of this paper is to report the findings of a systematic review of the intervening literature to identify potential predictive biomarkers for recovery of physical function following ischemic stroke. The PubMed, Embase, and CINAHL databases were searched for studies reported between January 1, 2011, and September 18, 2018. Search criteria were adult ischemic stroke patients, blood sample collection within 24 ± 6 hrs of stroke onset, and outcome measures, including physical function. Identified from 18 studies and representing four biological classifications, 34 biomarkers were significantly associated with physical recovery after ischemic stroke: (1) immune response (15, 44%); (2) lipids/metabolism (4, 12%); (3) neuronal function (4, 12%); and (4) blood vessel/circulation (11, 32%). Of the predictive biomarkers associated with 1-month recovery, 60% (6 of 10) was classified into blood vessel/circulation; 54% (14 of 26) of the biomarkers associated with 3-6 month physical recovery involved the immune response. Blood biomarkers might provide useful information to improve the prediction of physical outcome after ischemic stroke. The data suggest that biomarkers from four biological classifications may predict physical recovery in patients after ischemic stroke.

Understanding the role of m-health to improve well-being in spouses of patients with bipolar disorder.

OBJECTIVES: Spouses and partners of individuals with bipolar disorder (BD) experience significant burden. As there are some limitations to standard psychosocial caregiver interventions, mobile health technology (mHealth) may be a way to reduce burden and improve well-being in these caregivers. The purpose of this study was to explore how the well-being of spouses or partners of patients with BD can be improved through mHealth technology. METHODS: Using a qualitative design, we conducted five focus groups and one in-depth individual interview to collect information from participants about what they would expect from such a device. The sample consists of thirteen participants (eleven spouses and two partners). The age range was 29-65, with eight females and five males. Data were collected using minimally structured interviews and independently analyzed by the authors using content analysis. RESULTS: Results indicated that the mHealth device many be helpful in at least six areas: reduction of stressors, decreased social isolation, improving communication in the relationship between the spouses, speaking with children about the illness, managing medications, and providing information on resources. CONCLUSION: Mobile health technology may be a feasible, available, and cost-effective support tool for spouses and partners of individuals with BD, especially in reducing caregiver stress. Future research is needed to develop the application and test its effectiveness on health outcomes in a larger trial.

Treatment recidivism in adolescents with mental illness: A focused applied medical ethnography.

PROBLEM: Treatment recidivism, described as frequent unplanned relapse readmissions, is a national problem predominant in adolescents with mental illness. Because the main triggers of treatment recidivism are not fully understood, the purpose of this study was to explore treatment recidivism (i) to better understand treatment recidivism from the perspectives of recidivist adolescents with mental illness, (ii) to describe major factors that contribute to treatment recidivism and how best to minimize them from the perspectives of these adolescents, and (iii) to describe their interaction with the medical culture. METHODS: A focused applied medical ethnography was used to study 16 purposively selected adolescents. Interviews were conducted together with unobtrusive unit observation of the participants and collection of demographic and clinical information. FINDINGS: The participants were nearly unanimous in identifying the "additional stressors" of problematic parental relations and school bullying as the main triggers of treatment recidivism over and above their "routine stressors" of adolescence and mental illness. They had mixed perceptions of treatment recidivism and described their interaction with the medical culture as positive. CONCLUSION: Further research is needed to determine the impact of parental relations and school bullying on recidivism in adolescents with mental illness.

Ethical issues of incorporating spiritual care into clinical practice.

AIMS AND OBJECTIVES: The aim of this article was to analyse the scholarly discourse on the ethical issues of incorporating spirituality and religion into clinical practice. BACKGROUND: Spirituality is an important aspect of health care, yet the secularisation of health care presents ethical concerns for many health providers. Health providers may have conflicting views regarding if and how to offer spiritual care in the clinical setting. DESIGN: Discursive paper. RESULTS: The discourse analysis uncovered four themes: ethical concerns of omission; ethical concerns of commission; conditions under which health providers prefer to offer spiritual care; and strategies to integrate spiritual care. Ethical concerns of omission of spiritual care include lack of beneficence for not offering holistic care. Ethical concerns of commission are coercion and overstepping one's competence in offering spiritual care. Conditions under which providers are more likely to offer spiritual care are if the patient has a terminal illness, and if the patient requests spiritual care. Strategies for appropriate spiritual care include listening, and remaining neutral and sensitive to spiritual issues. CONCLUSIONS: Health providers must be aware of both the concerns of omission and commission. Aristotle's golden mean, an element of virtue ethics, supports a more moderate approach that can be achieved by avoiding the imposition of one's own personal beliefs of a religious persuasion or beliefs of extreme secularisation, and focusing on the beneficence to the patient. Relevance to clinical practice. Key components for health providers in addressing spiritual concerns are self-reflection, provision of individualised care, cultural competency and communication.

Spiritual practices in self-management of diabetes in African Americans.

In this qualitative study, African Americans described 3 orientations about spiritual practices and diabetes self-management: Spiritual practice as effort toward self-management; spiritual practice and self-management as effort toward healing; and spiritual practice as effort toward healing. Spiritual practices may influence diabetes self-management in African Americans and be a resource in care.

Spirituality: a cultural strength for African American mothers with HIV.

The purpose of this study was to describe how spirituality affected the lives of African American mothers with Human Immunodeficiency Virus (HIV) in the context of coping. This qualitative descriptive study used secondary data of interviews from a larger longitudinal study of parental caregiving of infants seropositive for HIV. Participants were 38 African American mothers with HIV. Data from longitudinal semi-structured interviews were analyzed using content analysis. The women dealt with the stresses of HIV through a relationship with God. Two domains explain this relationship: God in control and God requires participation. The benefits of their relationship with God were a decrease in stress and worry about their own health and that of their infants. It is important for nurses working with mothers with HIV to acknowledge their spirituality and assess how spirituality helps them cope with and manage their illness.