Stress, depression, and anxiety among undergraduate nursing students in the time of a pandemic.

INTRODUCTION: Emerging literature reports on the challenges faced by nursing students internationally during the pandemic as they continue their education. The aim of this mixed methods study was to examine stress, depression, and anxiety among undergraduate nursing students at a Canadian university during the pandemic. THEORETICAL FRAMEWORKS: Stress and coping and trauma theories informed this study. METHODS: Mixed methods included an online questionnaire composed of the Depression Anxiety Stress scales (DASS), sociodemographic data, and quality of life items with open-ended questions. RESULTS: Sample included 280 participants. Mean scores for depression and stress were in the mild level, for anxiety in the moderate level; 24 , 37 and 23 % of the sample had scores of severe or extremely severe for depression, anxiety, and stress respectively. Written comments reflected the impact on participants' relationships, motivation, struggles with remote learning, perceived heavy workloads, and impact on health and self-care, while some described positive experiences, including improved study habits. DISCUSSION: Uncertainty, isolation, sudden and ongoing changes with program delivery and a variety of psychosocial losses, helped to explain the distress many shared. The disconnect between reported levels of use of mental health services and the higher levels of mental distress raises the question of access to and use of these services. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE: The importance of developing and maintaining effective coping, including a support system, and committing to healthy self-care during challenging times was reinforced. CONCLUSIONS: This difficult time for nursing students emphasized the need to ensure attention to student well-being and mental health during their foundational educational experiences.

Interpersonal Transphobia Within Nursing: A Critical Concept Exploration.

Transphobic perceptions negatively impact health care access and outcomes among transgender and gender-diverse people and challenge nurses' capacity to maintain ethical practice standards. The concept of transphobia has not been well defined in the literature or nursing. Using a critical realist lens, this concept exploration sought to define interpersonal transphobia through a review of purposefully selected literature. Attributes included discrimination and prejudice, while antecedents were cisnormativity, erasure, and stigma. Nurses can help reduce transphobia by seeking education and practicing gender-affirming care, including transgender people in research, and advocating for equitable policies and procedures. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A79 .

Clinical debriefing: A concept analysis.

AIMS AND OBJECTIVES: The purpose of this paper is to enhance nursing and collaborative practice by presenting a concept analysis of clinical debriefing and introducing an operational definition. BACKGROUND: Debriefing has taken many forms, using a variety of approaches. Variations and inconsistencies in clinical debriefing, and its related terms, still exist in the clinical setting. DESIGN: Concept analysis. METHODS: Walker and Avant's eight-step approach to concept analysis. RESULTS: The defining attributes of clinical debriefing identified in this analysis are described as the five E's: educated/experienced facilitator, environment, education, evaluation and emotions. Antecedents identified in this analysis include the critical event, the desire or need to review such an event and the organizational awareness to execute clinical debriefs. The consequences of clinical debriefings are primarily advantageous and positively impact involved nurses, healthcare teams, patients and organizations. Empirical referents of clinical debriefing are complex and multifactorial. The productivity of a clinical debrief can be enhanced through a series of proposed questions. Together, the defining attributes, antecedents and consequences shape a proposed operational definition of clinical debriefing. CONCLUSION: Clinical debriefing is a valuable tool within healthcare organizations. Debriefing can be a holistic, interprofessional, collaborative experience when all five defining attributes are present. Further investigation is required to standardise debriefing practices in clinical settings. RELEVANCE TO CLINICAL PRACTICE: A concept analysis on clinical debriefing promotes uniformity of debriefing practices, reflective practice among nurses and healthcare teams, and contributes to nursing science by creating a platform for the development of practice standards, research and theory development.

Mindfulness-based arts interventions for cancer care: A systematic review of the effects on wellbeing and fatigue.

OBJECTIVE: Upon receiving a cancer diagnosis, life irrevocably changes and complex experiences of emotional distress often occur. There is a growing interest in mindfulness-based arts interventions (MBAIs) to ameliorate the distress many patients experience. Our review objective was to synthesize the evidence on the effectiveness of MBAIs on psychological wellbeing and fatigue. METHOD: Relevant quantitative articles were identified through a systematic search of the grey literature and online databases including MEDLINE, CINAHL, Cochrane CENTRAL, Art Full Text, ART bibliographies Modern, PsycINFO, Scopus, and EMBASE. Two independent reviewers screened titles/abstracts against predetermined inclusion criteria, read full-text articles for eligibility, conducted quality appraisals of included articles, and extracted pertinent data with a standardized data extraction form. The heterogeneity of the included studies precluded a meta-analysis and a narrative synthesis of study outcomes was conducted. RESULTS: Our systematic search retrieved 4241 titles/abstracts, and 13 studies met our inclusion criteria (eight randomized controlled trials and five quasi-experiments). Most of the studies focused on patients with cancer (92.3%). There is a growing interest in MBAIs over time and significant heterogeneity in the types of interventions. A significant effect was found on several outcomes that are important in psychosocial oncology: quality of life, psychological state, spiritual wellbeing, and mindfulness. The effect on fatigue was equivocal. CONCLUSIONS: This novel intervention demonstrates promise for the psychosocial care of patients with cancer. These findings are an essential antecedent to the continued implementation, development, and evaluation of MBAIs in oncology.

Nursing students' perceptions of and experiences coping with stress in clinical practice.

Objectives Clinical practice is a major component of nursing education wherein significant learning takes place. Nursing students experience stress in clinical practice which can have a negative impact on their learning. Guided by Lazarus and Folkman's theory of stress and coping, this study explored nursing students' perceptions of and experiences with coping with stress in clinical practice. Methods Semi-structured interviews were conducted with ten undergraduate nursing students. Qualitative content analysis was used to analyze the data. Results The themes of: Learning about self, Knowing self, Value of social support, and Relationships with clinical instructors reflect participants' descriptions of coping with stress. Students cognitive and behavioral strategies, including reflection, help them understand their stress and decide how to reduce its effects. Conclusions Supportive and respectful relationships are essential for a student to learn and cope effectively with stressful situations. Implications for improving the clinical instructor's role to enhance students' coping with stress in clinical practice are discussed.

Families' Experiences Living with Acquired Brain Injury: "Thinking Family"-A Nursing Pathway for Family-Centered Care.

The objective of this study was to examine families' experiences living with acquired brain injury (ABI) using a research approach that included both the affected individual family member and the family together as a family group. A narrative inquiry study, informed by the life-stage approach of Lieblich, Tuval-Mashiach, and Zilber, was used to obtain family stories. Families experiencing an ABI event were purposefully selected from different regions in a western Canadian province. Centered on the life stages of before the ABI event, now living with the ABI, and the future, thematic findings included: Families, a grounding force; Losses, individual and family; Family adaptive capacities; Experiences with the healthcare system-hospital to home; and A patchwork future-entering the unknown. Themes affirmed the significant impacts of ABI on individual and family members and acknowledged ABI as an ambiguous loss event. The findings also illuminated families' strengths and resiliencies in coping with living with ABI. The study results suggest by "thinking family" nurses can contribute towards a healthcare model that focuses on "family" as the central unit of care.

Navigating creativity within arts-based pedagogy: Implications of a constructivist grounded theory study.

BACKGROUND: Educators implement arts-based pedagogy with the hope that it will foster meaningful learning for students. However, nursing students have varied reactions to artistic assignments, and there is a need to further understand students' learning processes with this novel approach and the factors influencing their learning. This understanding could promote the more effective implementation of arts-based pedagogy into nursing education. OBJECTIVE: To develop a theoretical understanding of how and when undergraduate nursing students learn through arts-based pedagogy. DESIGN: Constructivist grounded theory. SETTINGS: Canadian baccalaureate nursing program. PARTICIPANTS: Thirty third-year undergraduate nursing students and eight of their nursing instructors. METHODS: Participants who had experienced arts-based assignments were recruited with purposive and then theoretical sampling. We collected four sources of data: a socio-demographic questionnaire, semi-structured interviews, photo/art elicitation, and field notes. The socio-demographic data were analyzed with descriptive statistics and all other data with constructivist grounded theory procedures. RESULTS: Our findings revealed that students had to navigate a creative process with arts-based assignments, which involved several iterative phases. This type of learning was unique within their program and somewhat constrained by the context of nursing education. There was notable variation in the students' experiences. Although many reported meaningful learning, approximately 20% of the students did not value the assignment. Our findings elucidated multi-level enabling and restraining factors that influenced students' engagement with and learning from this creative process. CONCLUSIONS: These findings provide insight into modifiable factors that influenced students' engagement and learning, and have important implications for making ABP accessible and meaningful for more students.

Putting on the Same Shoes: Lived Experiences of Women Who Are Reincarcerated.

BACKGROUND: Women are discharged daily from correctional institutions across the world. Many of these women cycle in and out of jail and experience the "revolving door syndrome," characterized by release, reimprisonment, and subsequent rerelease into the community. Although many factors contribute to this phenomenon, there is limited understanding of its impact on imprisoned women, including their perceptions of returning to community life. PURPOSE/OBJECTIVE: This phenomenological study examined the lived experiences of women who were imprisoned, released to the community, and returned to custody. METHOD: Twelve women, nine of whom were Indigenous were interviewed at the Women's Correctional Centre in Manitoba. Individual, face-to-face, in-depth interviews were employed using a woman-centered conversational approach. Qualitative thematic analysis, informed by van Manen's approach, was used to inductively arrive at themes. FINDINGS: Themes and subthemes organized around van Manen's existentials (temporality, spatiality, relationality, and corporeality) highlight the barriers and challenges women face as they try to sustain change in their lives to avoid the revolving door. Threaded through their accounts are experiences of personal and historical trauma, painful childhoods, difficult relationships, and ineffective or absent personal and systemic supports. CONCLUSION: This study highlights the need for trauma-informed comprehensive health care and programing sensitive to women's experience of trauma in their complex lives. Nurses need to partner with service providers and policy makers to address the social/economical inequities that impede the positive life changes these women need to make to prevent reimprisonment.

The arts as a catalyst for learning with undergraduate nursing students: findings from a constructivist grounded theory study.

Background: There is a growing interest in arts-based pedagogy (ABP) to promote the wide range of competencies needed for professional nursing. The aim of this study was to develop a theoretical understanding of how students learn through ABP in undergraduate nursing education. Methodology and Methods: We used a constructivist grounded theory methodology which incorporated art-elicitation interviews. Thirty nursing students and eight nurse educators shared about their ABP experiences. Data were analyzed with grounded theory procedures. Results: The arts as a catalyst for learning emerged as the core category and elucidates how the unique quality of the arts created powerful pedagogical processes for many students. When students engaged with these processes, they resulted in surprising and transformative learning outcomes for professional nursing. Conclusions: These findings provide insight into why and how students learned through ABP, and can inform the effective implementation of ABP into healthcare education.

Feasibility and efficacy of a hospital-based violence intervention program on reducing repeat violent injury in youth: a randomized control trial.

OBJECTIVES: To determine feasibility and efficacy of an Emergency Department Violence Intervention Program (EDVIP) to reduce violence related injuries in youth. METHODS: One hundred and thirty youth aged 14-24 presenting to an emergency with violence related injury were randomized in parallel to receive EDVIP for 1 year (n = 65) or a waitlist control (n = 65). The primary outcome was to determine feasibility. Secondary outcomes are incidence, number/severity of repeat violence related injury, justice and education systems interactions, substance misuse and mental health presentations, and ED length of stay (LOS). RESULTS: This study established feasibility in recruitment, outcomes collection and safety. Fidelity and adherence measures required optimization during the study. Efficacy analysis of EDVIP vs. the control group demonstrates an absolute decrease of 10.4% in repeat violence related injury (13.7% vs. 24.1%) (p = 0.15), reduction in new interactions in the justice system (OR = 0.36 (0.07-1.77)), improved engagement in education (11.8% EDVIP vs. 7.6% control, p = 0.42) and no change in repeat visits for substance or mental health. LOS decreased by 59.5 min (p = 0.21). CONCLUSIONS: This program is feasible for ED implementation and for completion of a future RCT to measure effectiveness.

Effectiveness of mindfulness-based arts interventions on psychological wellbeing and fatigue in adults with a physical illness: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to synthesize evidence on the effectiveness of mindfulness-based arts interventions on psychological wellbeing and fatigue in adults with a physical illness.

Young women's experiences of psychotic illness: a systematic review of qualitative research.

BACKGROUND: The relationship between young adulthood, women and psychosis was the focus for this systematic review. Age and gender are factors that can influence responses to illness. Research indicates that there are differences in how young men and women are affected biologically and psychosocially, including the presentation of a constellation of symptoms, response to anti-psychotic medications and how they assess their life circumstances. Yet in literature that examines experiences of young people with psychosis, the specific needs of young women are usually not presented separately. To better understand and address young adult women's healthcare and social service needs, a synthesis of evidence addressing the relationship between young adulthood, women and psychosis is needed. OBJECTIVES: The aim of this systematic review was to synthesize the best available evidence on the experiences of young adult women (aged 18-35 years) living with a psychotic illness in the community. Specifically, the review question was:What are the experiences of young adult women living with a psychotic illness? INCLUSION CRITERIA TYPES OF PARTICIPANTS: Participants were young women between 18 and 35 years of age who were living with a psychotic illness in the community. PHENOMENA OF INTEREST: The phenomenon of interest was the experiences of living with a psychotic illness of women aged 18-35 years in the community. Experiences were defined broadly as and inclusive of perceptions and experiences with health and social systems. CONTEXT: The context for this review was the community setting. TYPES OF STUDIES: The current review included studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, feminist research and the qualitative component of mixed methods studies. SEARCH STRATEGY: A three-step search strategy was used to locate both published and unpublished studies. The search was limited to studies published from 1995 to the search date of May 13, 2015. METHODOLOGICAL QUALITY: Two reviewers independently appraised the nine included studies using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) assessment tool. DATA EXTRACTION: Data were extracted from included papers using the standardized data extraction tool from JBI-QARI. DATA SYNTHESIS: Two reviewers independently reviewed the extracted findings to identify potential categories to pool similar findings. A third member of the team met with the reviewers to collaboratively review these derived categories to create a meta-synthesis that reflected a comprehensive set of synthesized findings. RESULTS: Based on the thematic findings from nine qualitative studies, two synthesized findings were identified: (1) the complexity of living with psychosis and finding health, and (2) the presence of harming and healing relationships in young women's lives. The included studies explored a range of experiences relevant for women within the broader phenomenon of experiences of living with a psychotic illness, including experiences within healthcare and social systems. CONCLUSION: The systematic exploration of the literature resulted in identification of nine studies of moderate-to-high methodological quality that met the inclusion criteria. The ConQual evaluation of the level of evidence resulted in synthesized finding 1 (the complexity of living with psychosis and finding health) rated as moderate and synthesized finding 2 (the presence of harming and healing relationships in young women's lives) rated as low. Practitioners can use these findings to guide practice. Further research exploring other experiences relevant for this population is needed.

Examining Associations of Functional Deficits and Mood States With Empathic Responses of Stroke Family Caregivers.

BACKGROUND: Stroke is one of the most prevalent chronic illnesses worldwide. Family caregivers can make a significant contribution toward patients' recovery. However, the patient's functional deficits and the caregiver's mood states can impact the caregiver's motivation to engage in empathic responses toward patients. Clinicians need help in recognizing patients at risk for not receiving empathic responses from family caregivers who are pivotal in long-term help and emotional support. OBJECTIVE: The aim of this study was to examine possible associations of family caregiver perceptions of functional deficits of patients who are poststroke and caregiver mood states with their empathic responses toward patients who are poststroke. METHODOLOGY: As guided by Davis' organizational model on empathy, we conducted a correlational descriptive study of associations among patient functional deficits, caregiver mood states, and caregiver empathic responses toward patients who are poststroke. Participants were requested to complete four questionnaires. RESULTS: Caregiver fatigue was the only mood state significantly associated with their empathic responses toward patients who are poststroke. CONCLUSIONS: The results of the current study contribute to the current state of the literature on poststroke care at home by highlighting the impact of caregiver mood states, particularly caregiver fatigue, on their empathic responses toward patients who are poststroke. Recommendations for clinical practice and future studies were made based on this study's results.

Effectiveness and experience of arts-based pedagogy among undergraduate nursing students: a mixed methods systematic review.

BACKGROUND: To develop well rounded professional nurses, educators need diverse pedagogical approaches. There is growing interest in arts-based pedagogy (ABP) as the arts can facilitate reflection, create meaning and engage healthcare students. However, the emerging body of research about ABP needs to be systematically examined. OBJECTIVES: To synthesize the best available evidence on the effectiveness of ABP in enhancing competencies and learning behaviors in undergraduate nursing education and to explore nursing students' experiences with art-based pedagogy. INCLUSION CRITERIA TYPES OF PARTICIPANTS: The review considered studies that included participants who are undergraduate nursing students. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: The qualitative (QL) component considered studies investigating nursing students' experiences of ABP, and the quantitative (QN) component considered studies evaluating the effectiveness of ABP in undergraduate nursing education. TYPES OF STUDIES: The QL component considered QL studies including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. The QN component considered studies that examined the effectiveness of ABP including designs such as randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, analytical cross-sectional studies, case series, individual case reports and descriptive cross-sectional studies. OUTCOMES: The following QN outcomes of ABP were assessed: knowledge acquisition, level of empathy, attitudes toward others, emotional states, reflective practice, self-transcendence, cognitive/ethical maturity, learning behaviors and students' perspectives of ABP. SEARCH STRATEGY: An extensive three-step search strategy was conducted for primary research studies published between January 1, 1994 and April 7, 2015. The strategy included searching CINAHL, MEDLINE, ERIC, PsycINFO, Academic Search Complete, Arts and Humanities Citation Index, Art Full Text, Scopus, ProQuest Dissertations and Theses, A&I, and gray literature. Only studies published in English were included. METHODOLOGICAL QUALITY: Two reviewers assessed all studies for methodological quality using appropriate critical appraisal checklists from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) or the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION: Data were extracted from included articles using the standardized data extraction tool from JBI-QARI or JBI-MAStARI. DATA SYNTHESIS: Qualitative studies were pooled through a meta-synthesis. Data from the QN studies were combined using a narrative synthesis as a meta-analysis was not possible. The researchers used a segregated mixed methods approach to integrate the QL and QN components. RESULTS: Twenty-one QL studies of high methodological quality were included. The two synthesized findings revealed that art forms could create meaning and inspire learning in undergraduate nursing education and that ABP can develop important learner outcomes/competencies for professional nursing. These synthesized findings received a moderate ConQual rating. Fifteen experimental/quasi-experimental studies of moderate methodological quality were included. The narrative synthesis suggested that ABP improved nursing students' knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. In five cross-sectional studies, the majority of students had a positive perspective of ABP. When the QL and QN findings were interpreted as a whole, ABP appeared to facilitate learning in the cognitive and affective domains and may be especially useful in addressing the affective domain. CONCLUSION: Nurse educators should consider using ABP as students found that this approach offered a meaningful way of learning and resulted in the development of important competencies for professional nursing. The QN studies provide a very low level of evidence that ABP improved students' knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. Although the QN findings can inform future research, the evidence is not robust enough to demonstrate improved outcomes.

Failing Clinical Practice & the Unsafe Student: A New Perspective.

Students who fail clinical courses is a long standing issue in nursing education. Although faculty intuitively "know" a student is in clinical difficulty, the research literature is limited to delineating and describing characteristics of these students. A retrospective analysis of students' files in which there was at least one clinical failure was conducted to identify clinical failure indicators. Files included students who were successful, required to withdraw, or voluntarily withdrew. This study integrates these characteristics in a manner not discussed in the literature. Two themes emerged that characterize student practices: (i) How students are in practice and (ii) Aspects of practice. A third theme surfaced as clinical teachers responded to these students by labelling the practice unsafe and increasing vigilance. A model was developed that shows the relationship between these characteristics and unsafe student practice.

Examining the Relationship Between Family Caregivers' Emotional States and Ability to Empathize with Patients with Multiple Sclerosis: A Pilot Study.

BACKGROUND: Multiple sclerosis (MS) is the most common nontraumatic cause of disability affecting young adults in Canada. Caregivers of patients with MS are highly psychologically burdened. Empathy and helping behaviors are hallmarks of quality care, but when they are challenged, suboptimal patient care can result. We aimed to evaluate the prevalence of negative emotional states among primary caregivers of people with MS; the association between the caregiver's empathy-related behavior and the physical and cognitive impairment of the person with MS; and the association between the caregiver's emotional status and his or her empathy-related behaviors. METHODS: We conducted a descriptive, cross-sectional pilot study with family caregivers of noninstitutionalized individuals living with MS. We used univariate linear regression models for each potential predictor. The Kruskal-Wallis test was conducted to compare differences in caregiver empathic responses depending on Profile of Mood States subscale scores. RESULTS: Thirty percent of caregivers had elevated or very elevated mood scores, and such elevated scores were associated with greater functional impact of MS on the person with MS. Patient severity of cognitive impairment was not associated with caregiver mood scores. Caregiver mood state was not associated with empathy-related behaviors. Empathy-related behaviors were less frequent when levels of anger and hostility were higher, but this association did not reach statistical significance. CONCLUSIONS: Given the elevated levels of fatigue, depression, and anger observed among caregivers in this study, clinicians need to be aware of the potential impact of caregiving and to assess the needs of caregivers.

Development of an Emergency Department Violence Intervention Program for Youth: An Integrated Knowledge Translation Approach.

BACKGROUND: Violent interpersonal injury is a common presentation to emergency departments (EDs) and is increasingly being treated as a preventable condition. Given the complexity of the issue, it is key to ensure interventions are feasible and acceptable within the communities that are affected by violence. Our team consists of ED staff, community members who work with youth affected by violence, people who were affected by violence in their youth, and researchers. OBJECTIVES: We describe how an integrated knowledge translation (KT) process was used to develop an ED violence intervention program (EDVIP) for youth affected by violence. METHODS: We used the Canadian Institutes of Health Research Guidelines for integrated KT (iKT) to develop an EDVIP. Specifically, we report the Knowledge to Action process which involves both knowledge creation and an action cycle. RESULTS: Our team determined the research question, the research approach, assessed feasibility and determined outcomes for our study. Using the iKT approach facilitated initiation of a funded trial that is now active. CONCLUSIONS: This paper highlights the benefit of including community experts at the beginning of and throughout the research process.