Stress First Aid for Health-care Workers: An Indicated Mental Illness Prevention Program for Nursing Education.

Spurred by a global pandemic, the incidence and prevalence of stress-related injury and illness continues to increase amid an overburdened nursing workforce that has remarkably and reliably performed on the frontlines of health care. Indicated mental illness prevention programs such as Stress First Aid for Healthcare Workers create an opportunity to target the acute and chronic expressions of stress experienced by nurses earlier through coordinated peer support with the goals of preserving life, preventing further harm, and promoting recovery. This article will describe how a Stress First Aid program was operationalized at a school of nursing at a private university.

How PMHNP Program Directors Facilitate Psychotherapeutic Skill Acquisition.

BACKGROUND: The use of psychotherapy has a long history within psychiatric-mental health nurse practitioner (PMHNP) practice. Underutilization of psychotherapy in practice has potentially led to a reduced emphasis in the PMHNP curriculum. To date, no national survey has solely evaluated how PMHNP programs ensure psychotherapy skill acquisition. AIMS: Survey the PMHNP programs within the United States on how psychotherapy skill acquisition is achieved, including (a) psychotherapeutic curricular content; (b) psychotherapy related clinical practicum hours, including simulation and preceptor-delivered hours; and (c) student interest in psychotherapy skills. METHOD: Three rounds of e-mail invitations were sent to all PMHNP programs within the United States. Descriptive statistics and reflective thematic analysis were used to examine survey content. RESULTS: There were 39 (27%) respondents, representing the U.S. regions equally. The most common forms of psychotherapy taught were cognitive-behavioral and motivational interviewing. The content was most often delivered through a hybrid program (65.8%). Psychotherapy clinical hours most often used in psychology and social work were varied (0-720, SD 132.9) and were usually (63.89%) separate from other clinical hours. Qualitative responses focused on increased emphasis on the use of psychotherapy within PMHNP programs and the need to develop competency checklists for psychotherapy skill acquisition to use with simulation. CONCLUSION: This survey reported on both similarities and differences in how PMHNP programs ensure student competency in the skill acquisition of psychotherapy. While this article focuses on what skills are needed in psychotherapy education, direction on how programs deliver this content to their students to ensure this skill will be retained in practice is a critical next step.

Evaluation of the Use of Telehealth Video Visits for Veterans With Chronic Pain.

BACKGROUND: Telehealth video visits are essential for delivering timely care while mitigating exposure during the COVID-19 pandemic. Telehealth video visits have the potential to improve missed appointments, reduce costs associated with Veterans Affairs (VA) travel reimbursement, and lead to positive patient and provider satisfaction. AIMS: This evidence-based improvement project sought to evaluate whether telehealth visits reduce the occurrence of missed appointments, determine cost savings associated with the VA travel reimbursement and assess patient and provider satisfaction with telehealth video visits. DESIGN: Evidence-based improvement project. SETTING: A retrospective chart review was conducted on military veterans with chronic pain who completed a telehealth video visit in the VA San Diego (VASD) pain clinic. METHODS: Missed appointment rates were compared from before (April 1, 2019-October 1, 2019) to after (April 1, 2020-October 1, 2020) implementation of the telehealth video visits. Estimated travel reimbursement for qualified patients was calculated per VA policy. Electronic satisfaction surveys were administered to patients and nurse practitioners to assess satisfaction with telehealth video visits. RESULTS: There was an 82.5% reduction in missed appointments from pre to post implementation of telehealth video visits. There was an estimated cost savings in travel reimbursements of $3,308.30. Overall, 93.62% of patients (n = 42) were satisfied with their video visits and there was a high degree of satisfaction in implementing video visits among the nurse practitioners (n = 3). CONCLUSIONS: The use of telehealth video visits during the COVID-19 pandemic reduced missed appointments, exhibited cost savings in VA travel reimbursement, and led to positive patient and provider satisfaction.

Symptom Trajectory among Formerly Abused Women: An Exploratory Study.

Women who have experienced intimate partner violence suffer from symptoms that persist long after the abuse has ended. However, the patterns and trajectory of these symptoms are poorly understood. The objective of this longitudinal research was to explore symptom trajectory typologies. A latent class growth analysis with multi-outcomes modeling was used to explore typologies based on women's (N = 30) trajectories over 4 months. Two distinct symptom typologies were identified: (1) consistently lessening symptom group (n = 16); (2) moderately worsening symptom group (n = 14). Women who experienced severe psychological vulnerability exhibited better symptom trajectories; a potential reflection of resilience in this population.

Voicing Jordanian Adolescents' Suicide.

BACKGROUND: Studies focusing on adolescent suicide in Arab countries are particularly scarce, with the few available undertaken from within an epidemiological paradigm. OBJECTIVE: This study aimed to understand Jordanian adolescents' perceptions, beliefs, and attitudes toward suicide. METHODS: A qualitative design using 12 dual-moderator focus group discussions was conducted in public schools. Participants were selected from the three main regions of the country (rural southern, urban central, and suburban northern). Participants included Jordanian adolescent boys and girls, aged 14-17 years, who reported experiencing mild to moderate depressive symptoms. A relational content analysis approach was used for coding data, and a content analysis was used to identify salient thematic categories. Data were analyzed using NVivo software. RESULTS: Four themes emerged, including perceived risk factors, perceived protective factors, active and passive suicidal ideations, and e-games and Internet influences. Main risk factors were depression; anxiety; stigma, shame, and isolation; family issues; life pressures; and guilt. Conversely, religiosity, perceived positive family functioning, and availability of long-term goals seemed to confer resilience to adolescents' suicidal ideation and behavior. Passive suicidality (having death wishes without any plans to complete suicide) was noticed most among participants who feared jeopardizing the family's reputation if they committed suicide. Several boys with active suicidal ideations used the Blue Whale Challenge e-game to learn how to complete suicide and relinquish their problems. DISCUSSION: Suicide is a multifactorial problem requiring multimodal strategies. Evidence from this research suggests that those most passionate about the outcome of interest are encouraged to redouble efforts to reduce modifiable risk factors, enrich protective factors, target the underlying psychiatric illness that informs suicidal ideations and behavior, and research the effect of social media and Internet activity more deeply. Parents are advised to monitor the online activities of their children and familiarize themselves with the digital applications they use.

Early Experience of a Multidisciplinary Group Pain Program with Cognitive Behavioural Strategies, Physiotherapy and Peer Support for Patients with Chronic Noncancer Pain.

BACKGROUND: Chronic non-cancer pain affects about 20% of the population worldwide. The effect of medical treatment in isolation is often limited. A multidisciplinary approach has been strongly advocated to help manage patients' pain more effectively. AIMS: The primary purpose was to reduce pain severity, pain interference on patients'daily activities and improve their levels of self-efficacy despite pain. The secondary aim was to evaluate the possible changes in patients' depression, anxiety, and stress symptoms after amultidisciplinary group pain program. The program content and structure were also evaluated. DESIGN: This scholarly project used within-subject pre- and post-test design. SETTINGS/SUBJECTS: Fifty-six patients were recruited from the project center pain clinic. METHODS: An evidence-based eight-hour multidisciplinary group pain program was implemented. Data was collected before and 3 months after the program. INTERVENTIONS: The program covered pain physiology, cognitive behavioural strategies, demonstration of various exercises, self-management skills, medication management, and peer support. RESULTS: Three months postprogram, there was a statistically significant improvement in patients' pain severity (ß = -0.9, 95% CI: -1.73 to -0.14, p = .023) and self-efficacy (ß = 5.6, 95% CI: 0.85 to 10.41, p = .023). Pain interference on their daily activities was also significantly reduced (ß = -2.0, 95% CI: -2.90 to -0.83, p = .001). Patients provided positive and encouraging feedback about the program. CONCLUSION: Initial improvements in patients' ability to cope with pain and to perform daily activities were demonstrated following participation in the brief multidisciplinary group pain program. Future randomized controlled trials are needed to confirm that the results are due to patients' participation in the program.

Buddy Care, a Peer-to-Peer Intervention: A Pilot Quality Improvement Project to Decrease Occupational Stress Among an Overseas Military Population.

INTRODUCTION: Occupational stress can have a direct influence on worker safety and health. Navy medical professionals are known to neglect self-care, putting them at risk for deteriorations in psychological health that can lead to adverse patient outcomes. To support medical professionals, a peer-to-peer intervention called Buddy Care, embedded in Navy Medicine's Caregiver Occupational Stress Control (CgOSC) program, was evaluated. Strategies to prevent and better manage occupational stress are vital to improve the health care providers' abilities to cope with day-to-day stressors, which is crucial to maintaining mission readiness. The overarching aim of this quality improvement pilot project was to implement and evaluate Buddy Care and to provide context as an evidenced-based peer intervention and leadership tool at a military hospital in Guam. This project is the first to implement and evaluate Buddy Care intervention for an active duty U.S. Navy population stationed overseas. MATERIALS AND METHODS: A convenience sample of 40 Navy active duty assigned to three inpatient units were offered Buddy Care intervention, which was introduced by conducting a Unit Assessment. A pre-test and 3- and 6-month post-test intervention design used a self-administered, 79-item CgOSC Staff Wellness Questionnaire which included five validated measures to assess the independent variable: (1) Response to Stressful Experience Scale, (2) Perception of Safety, (3) Horizontal Cohesion, (4) Perceived Stress Scale, and (5) Burnout Measure, short version. This project was determined as exempt by the Department of Navy Human Research Protection Program and did not require further review by the Institutional Review Board. RESULTS: Of the 40 questionnaires collected, 39 were partially completed. Paired sample t-tests were conducted between designated time-points to maximize the sample size and retain the repeated measures nature of the outcome variables. The small sample size allowed for statistical comparisons; however no statistically significant differences were found across the time-points. There was a large effect size for Perceptions of Safety and a medium effect size for Burnout Measure from baseline to 3 months, with both lowered at the 6 months. Although the sample size was too small to achieve statistical significance, the effect size analysis suggested that significance might be obtained with a larger sample. CONCLUSION: The small number of participants and missing data significantly limited the ability to identify reliable changes across time-points. Despite the lack of statistically significant findings, there was an unintended positive result. The Unit Assessment piqued the interest of other departments, and during the project period, 11 departments requested a Unit Assessment. Although there were no requests for Buddy Care intervention from the targeted sample, it was occurring an average of 40 times per month throughout the command. Replication of this project in a similar setting is encouraged so that Buddy Care can be further evaluated. Understanding the effectiveness of well-mental health programs that promote early intervention and prevention efforts may contribute to a psychologically tougher medically ready force. Shortly after project completion, a CgOSC Instruction was approved by the Navy Surgeon General, highlighting the importance of CgOSC and Buddy Care on the operational readiness of Navy Medicine.

Military Service-Related Post-traumatic Stress Disorder: Finding a Way Home.

Mental illness and injury, including post-traumatic stress disorder, represents a significant source of disability and morbidity among military and veteran populations. This article explores the pathophysiology, identification, and treatment of military service-connected trauma-related and stressor-related disorders. Particular attention is given to trauma informed care, evidence-based practice recommendations, and the sequencing of psychotherapy and pharmacotherapy in pursuit of optimal patient outcomes.

Concordant Actions in Suicide Assessment Model.

This article offers an alternative conceptualization from which a health care provider can consider and respond to client-based suicidal ideation and behavior. Pragmatically explored through the prism of locus of control, Rogerian psychotherapy principles, Peplau's theory of interpersonal relations, and the work of Kay Redfield Jamison, the Concordant Actions in Suicide Assessment (CASA) model frames clinical decision making along a continuum defined by concordant and state-based action. Therein, cognitive reframes are offered to illustrate how to apply the CASA model in clinical practice.

Using Simulation in a Psychiatric Mental Health Nurse Practitioner Doctoral Program.

The use and effectiveness of simulation with standardized patients in undergraduate and graduate nursing education programs is well documented. Simulation has been primarily used to develop health assessment skills. Evidence supports using simulation and standardized patients in psychiatric-mental health nurse practitioner (PMHNP) programs is useful in developing psychosocial assessment skills. These interactions provide individualized and instantaneous clinical feedback to the student from faculty, peers, and standardized patients. Incorporating simulation into advanced practice psychiatric-mental health nursing curriculum allows students to develop the necessary requisite skills and principles needed to safely and effectively provide care to patients. There are no documented standardized processes for using simulation throughout a doctor of nursing practice PMHNP curriculum. The purpose of this article is to describe a framework for using simulation with standardized patients in a PMHNP curriculum. Students report high levels of satisfaction with the simulation experience and believe that they are more prepared for clinical rotations. Faculty feedback indicates that simulated clinical scenarios are a method to ensure that each student experiences demonstrate a minimum standard of competency ahead of clinical rotations with live patients. Initial preceptor feedback indicates that students are more prepared for clinical practice and function more independently than students that did not experience this standardized clinical simulation framework.

Evolving the PICOT Method for the Digital Age: The PICOT-D.

BACKGROUND: Many articles written about the PICOT (Population, Intervention, Comparison, Outcome, Time) method for developing research questions focus on searching the existing evidence base to review the impact of interventions. The PICOT method evolved to craft questions that yield operative search terms. Currently, the PICOT method falls short in its utility for health care and doctoral education. For example, the Doctor of Nursing Practice scholarly practice projects evaluate the existing evidence base and compare the current real-world state with the evidence base, for which the current conceptualization of the PICOT method has limited applicability. METHOD: The PICOT-D adds digital data (D) components to the traditional PICOT, allowing for the explicit identification of data measures that form the basis of the evaluation of an intervention. RESULTS: the PICOT-D has the potential to improve student efficiency, efficacy, and confidence in the development of truly answerable questions that fully support improved patient care and systems-level change. CONCLUSION: This article demonstrates the need for the evolution of the PICOT format to the PICOT-D format.

Military Culture Implications for Mental Health and Nursing Care.

With over 13 years of war and military combat operations, the number of veterans, military families, and service members with mental health needs continues to increase across civilian and federal healthcare services. Knowledge about severe battle wounds, traumatic brain injury, and traumatic stress has influenced the delivery of healthcare. The invisible wounds of war associated with brain injury and traumatic stress will increase clinical care challenges into the foreseeable future. The purpose of this article is to describe two interrelated concepts, military cultural competence and stress injuries. The authors also differentiate stress reactions versus stress injury. Nurses with military cultural competence and knowledge about stress injuries will be better able to deliver patient-centered care to patients with military culture experiences.