American Academy of Nursing Expert Panel Consensus Statement on leveraging equity in policy to improve recognition and treatment of mental health, substance use disorders, and nurse suicide.

Rates of nurse mental health and substance use disorders are high. Heightened by the COVID-19 pandemic, nurses are challenged to care for patients in ways that often jeopardize their own health and increase risks for their families. These trends exacerbate the epidemic of suicide in nursing underscored by several professional organization clarion calls to nurses' risk. Principles of health equity and trauma-informed care dictate urgent action. The purpose of this paper is to establish consensus among clinical and policy leaders from Expert Panels of the American Academy of Nursing about actions to address risks to mental health and factors contributing to nurse suicide. Recommendations for mitigating barriers drew from the CDC's 2022 Suicide Prevention Resource for Action strategies to guide the nursing community to inform policy, education, research, and clinical practice with the goals of greater health promotion, risk reduction, and sustainment of nurses' health and well-being are provided.

Measures of Personality Pathology, Levels of Functioning, and Physical Health in an Urban Primary Care Sample.

Integrative approaches in the primary care setting have grown in favor over the past few decades, with many interesting findings about the influence of personality disorders on physical health and functioning; however, less is known about how specific pathological personality traits impact patient-provider assessments of physical and mental health. Using the DSM-5 Levels of Personality Functioning Questionnaire-Short Form (DLOPFQ-SF) and Personality Inventory for DSM-5-Brief Form, these relationships were evaluated in a sample of 50 inner-city, low-income patients in a primary care clinic. Point-biserial correlations revealed significant correlations between physical and mental health morbidities, as well as personality pathology and patient response to treatment. Our findings lend further support to describing the relationships between personality pathology, medical comorbidities, and patient response to treatment.

Medical Cannabis and Psychiatric Disorders: Implications for Psychiatric Nurses.

OBJECTIVE: Cannabis use for medical condition has significantly increased over the past 20 years with 33 states and the District of Columbia passing laws legalizing medical cannabis. Five qualifying psychiatric disorders have been identified. The objective of this review article is to present a brief history of medical cannabis, the evidence for the qualifying psychiatric conditions, and to discuss the implications for psychiatric nurses. METHOD: A review of the literature on the five qualifying psychiatric disorders was conducted. Databases searched included CINAHL, PubMed, Cochrane Library, MedLine Plus, and EMBASE. Keywords were cannabis, medical cannabis, delta-9-tetrahydrocannabinaol, cannabidiol, and psychiatric disorders. RESULTS: The evidence that medical cannabis or cannabinoids is an effective treatment for the qualifying psychiatric disorders (e.g., posttraumatic stress disorder, agitation in Alzheimer's disease and other dementias, Tourette's syndrome, anxiety, and obsessive-compulsive disorder) is too weak and of low quality to recommend as an intervention at this time. A discussion of the implications of these findings for psychiatric nurses is offered based on the published guidelines by the American Nurses Association and National Council of State Boards of Nursing. CONCLUSION: There is a significant gap between evidence supporting the effectiveness of medical cannabis for psychiatric disorders and patient interest and use of cannabis for such conditions as well as other psychiatric symptoms. There are tremendous opportunities for psychiatric nurses to make an impact both clinically and be conducting research in this emerging field. We need to educate ourselves and our patients about the benefits and risks of medical cannabis and to help patients make informed decisions about their health care.

The Transition From Spousal Caregiver to Widowhood: Quantitative Findings of a Mixed-Methods Study.

BACKGROUND: The number of persons diagnosed with dementia is projected to triple to 14 million by 2050. The significance of these projections is particularly relevant to older women (>65 years), who are more likely to provide dementia caregiving for a husband than vice versa. Research has identified consistent themes around the impact of caregiving during the caregiving experience, yet there is limited research exploring the ongoing impact during the transition to widowhood. Moreover, there is a paucity of research examining differences between rural and urban spousal dementia caregivers. AIMS: The aims were to compare differences between older rural and urban spousal caregivers on physical and mental health factors affecting the transition from caregiver to widow and to identify resources the women used during this transition over 12 months. METHOD: This mixed-methods longitudinal study recruited 13 urban and nine rural female spousal caregivers. Participants were interviewed three times over 12 months. The dependent variables were depression (measured using Center for Epidemiologic Studies Depression Scale), physical and mental functioning (measured using the 12-item Medical Outcomes Study-Short Form Health Survey Version 2). RESULTS: No statistically significant differences were detected between rural and urban female caregivers on the dependent variables. However, rural caregivers scored higher on depression and lower on both physical and mental functioning compared to their urban counterparts. CONCLUSIONS: The findings have clinical and research implications. Psychiatric nurses are well positioned to provide education related to dementia information deficits; implement interventions that facilitate bereavement, resilience, self-care, and identity; advocate for additional services; and conduct larger scale studies with a more diverse sample of female spousal caregivers.

Spousal Dementia Caregiving to Widowhood: Perceptions of Older Urban and Rural Widows.

Older widows might experience poor health outcomes following their spousal dementia caregiving experience. Widows from rural areas with fewer resources may have worse health outcomes. Serial, qualitative interviews were conducted at baseline, 6-months and 12-months with 13 urban and nine rural older widows who cared for husbands with dementia. Perceptions of caregiving, widowhood, and resources were examined. Major themes were 24/7 Care, Watch the Man Go Down, Build a Network, Spiritual Support, No Regrets/Some Regrets, Time for Me Now, Loneliness, and Keep Reaching In. Compared to urban widows, rural widows had fewer emotional and tangible resources. All widows desired more support during spousal dementia caregiving and in their transition to widowhood. Nurses need to continue to support the transition from spousal dementia caregiving to widowhood and to test interventions unique to meeting the needs of urban and rural older women.

The Aftermath of Suicide: A Qualitative Study With Guyanese Families.

INTRODUCTION: The suicide rate in Guyana was five times higher than the world average in 2014 (WHO) which puts Guyana at the top of the list with 44.2 per 100,000 people, the highest suicide rate in the world. For every completed suicide, there are survivors who experience high levels of psychological, physical, and social distress, and report feelings of guilt, shame, social stigma, and search for meaning. AIM: The aim of this qualitative study was to explore how family members coped and understand the suicide of their loved one, and to determine what resources were available to help them during this transition. METHOD: Ten family members were recruited to participate in a focus group. The focus group lasted approximately 90 min and was recorded. The audio recordings were later transcribed. RESULTS: Four overarching themes emerged from the data: (1) perceived causes of suicide, (2) perceived solutions, (3) barriers to helping persons who are suicidal, and (4) personal and community reactions to suicide. IMPLICATIONS FOR PRACTICE: Nurses in Guyana are uniquely positioned to take a leadership role in creating and implementing postvention programs for suicide survivors that are culturally and ethnically relevant. Opportunities to partner with schools of nursing in higher income countries are explored.

The Effective Use of Psychiatric Mental Health Nurses in Integrated Care: Policy Implications for Increasing Quality and Access to Care.

In the last ten years primary care providers have been encouraged to implement integrated models of care where individuals' medical and mental health needs are addressed holistically. Many integrated models use Psychiatric Mental Health (PMH) nurses as case managers and select exemplars use PMH Advanced Practice Nurses (APNs) as providers. However, the potential value of PMH nurses in integrated health care remains unrealized by health care planners and payers, limiting access to services for the populations most in need of comprehensive care approaches. This current situation is partially fueled by insufficient knowledge of the roles and skill sets of PMH nurses. In this paper, the PMH RN and APN skill sets are detailed, demonstrating how effective use of these nurses can further the aims of integrated care models. Finally, outlined are barriers and enabling factors to effective use of PMH RNs and APNs and attendant policy implications.

Confronting Compassion Fatigue: Assessment and Intervention in Inpatient Oncology
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BACKGROUND: A notable variation among patient satisfaction scores with nursing care was identified. Contributing factors were examined and revealed significant negative correlations between the unit death rate and surviving patients' satisfaction scores. Compassion fatigue (CF) was hypothesized to be a major contributing factor.
. OBJECTIVES: The objective was to address CF in RNs and oncology care associates (assistive personnel) by developing an intervention to provide bereavement support to staff after patient deaths.
. METHODS: A mixed-methods sequential design was used. Instruments included the Professional Quality of Life scale and Press Ganey survey results. Univariate descriptive statistics, frequencies, an independent t test, and an analysis of covariance were used for data analysis.
. FINDINGS: The preintervention results revealed average compassion satisfaction and secondary traumatic stress scores and low burnout scores. No significant difference was noted between pre- and postintervention CF scores. Patients' perception of nurses' skills improved significantly in the second quarter of 2015.

Suicide in Guyana: Nurses' Perspectives.

Guyana, an English-speaking country on the north coast of South America, has the highest suicide rate in the world. Nurses are an integral part of the healthcare team working with patients experiencing psychological distress and are uniquely qualified to add to the discourse on factors contributing to the high suicide rate in Guyana. The purpose of this study was to explore the attitudes and experiences of nurses and nurse assistants in Guyana related to suicide. Nine registered nurses and nurse assistants who worked at a private hospital in Georgetown, Guyana, were recruited to participate in a focus group. The focus group lasted approximately 70 minutes and was recorded. The audio recordings were later transcribed word for word. Four themes emerged from the data: family issues as they relate to the high suicide rate, suicide attempts as a cry for help, lack of support, and coping mechanisms used by nurses when caring for victims of attempted suicide. Nurses are uniquely positioned to intervene with families in crisis, whether it be suicide, suicide attempts, or the underlying factors of family dysfunction, child maltreatment, poverty, or alcoholism. Establishing forensic nursing as a specialty in Guyana would validate this important role through education and certification of nurses.

Depression in Home-Based Care: The Role of the Home Health Nurse.

Depression is a major health issue among older adults receiving home-based services yet is underdiagnosed and undertreated, which can result in negative health outcomes. Despite the recognized need for improved mental health services, significant gaps and barriers exist that contribute to less than optimal home-based depression management interventions. Home healthcare clinicians are well positioned to drive this effort for improving depression care with enhanced learning. Thus, the purpose of this article is to provide guidelines on improving depression care in homebound older adults based on four clinical functions central to home healthcare: screening, assessment, medication management, and patient/family education.

Depression and Diabetes in a Primarily African American Female Population.

Depression is one of the most serious mental health comorbidities associated with diabetes. In this pilot study, we describe the associations identified via a cross-sectional survey among demographic variables, depression, self-efficacy, and glycemic control in a primarily minority population (mean age = 57.9 years; n = 30) with diabetes mellitus. Descriptive, bivariate, and correlation analyses were conducted. A significant inverse relationship was detected between depression and self-efficacy; however the relationship between depression and A1C was not significant. The implications of these findings include the need for interventions that regularly screen for depression and self-efficacy in persons diagnosed with diabetes mellitus, especially in the earlier years of diagnosis.

The Relationship Between Male Patients' Antihypertensive Medication Beliefs and Erectile Function.

There was no association between the demographic variables of age, race, marital status, and education and respondents' medication beliefs or erectile function in this pilot study.

The impact of a lifestyle change program on the mental health of obese under-served African American women.

BACKGROUND: Obesity is a critical social and health issue, adversely impacting life expectancy, quality of life, and mental health. Minorities are disproportionately impacted by obesity with African Americans experiencing the highest prevalence among minority groups. PURPOSE: The aim of this study was to determine if a lifestyle program that integrated chair exercises, nutrition and educational counseling, and scripture readings would help under-served obese African American women make lifestyle changes that would positively impact their quality of life, especially mental health. METHODS: A repeated measures intervention study was conducted (24-weeks). Weeks 1-12 involved meeting twice a week for a total of 4h with participants engaged in chair exercises, educational counseling, and scripture readings. During weeks 13-24, the participants were "on their own" but were encouraged to exercise and eat healthy. Focus groups were held at 12 and 24-weeks. Participants were recruited from a nurse managed center and a primary care clinic for the uninsured. Mental health data were collected at baseline, 12, and 24-weeks. The Medical Outcomes Study Short Form Version 2 (SF-36v2) was used to measure changes in mental health. Higher scores indicate better perceived health status. Group scores less than 47 indicate impaired functioning. FINDINGS: 55 women had complete data for all three data collection points, with a mean age of 50 and a mean BMI of 41.2. Repeated ANOVAs detected significant differences on the mental component summary of the SF-36v2: this score improved from baseline (M=44.1) to 12-weeks (M=50.7) but decreased at 24-weeks (M=47.9) (p=.000). The four domains (vitality, social functioning, role emotional, mental health) were also significantly different over the three data collection points. IMPLICATIONS: The findings have significant implications for psychiatric nurses in terms of education, clinical practice, and future research. The study contributed to the participants' mental health through the various group activities including scripture readings, socialization with "like minded" women and structured exercises. These findings offer psychiatric nurses additional tools for effective care.

Social Support, Postpartum Depression, and Professional Assistance: A Survey of Mothers in the Midwestern United States.

Transition into motherhood is generally a joyful life event; for some women, however, it is marked by emotional turmoil. Lack of support can be associated with postpartum depression and can compromise both the mother and infant. A descriptive, cross-sectional study (N = 61) was conducted to explore the relationship between social support and postpartum depression and to determine whether mothers overwhelmed with childcare, or overwhelmed with life in general since becoming a mother, sought professional help. The results revealed that screening for depression alone may not be sufficient, that mothers are willing to contact a professional for help in the postpartum period, and that assessments after birth should include a broader assessment of life's difficulties rather than focusing on childcare responsibilities alone.

Vitamin d, depression and coping self-efficacy in young women: longitudinal study.

Depression is a significant health issue in young women with few assessment strategies for early detection. It has been suggested that self-efficacy and vitamin D levels can predict and prevent depression. The authors examined the relationship between vitamin D levels, coping self-efficacy and depression in 77 college age women over three seasons. The results of the repeated measures analysis showed that a strong, inverse relationship existed between self-efficacy and depression but not vitamin D levels. These findings were consistent across the three data collection points. The results implied that strengthening perceived coping self-efficacy may be useful in order to maintain the mental health of young college age women.

The prevalence and patterns of substance abuse among nurse anesthesia students.

The purpose of this study was to assess the prevalence, demographic factors, outcomes, and preventative measures for substance abuse among nurse anesthesia students over a 5-year period from 2008 to 2012. An electronic survey was sent to 111 program directors of accredited nurse anesthesia programs in the United States. Twenty-three programs (response rate = 21.7%) reported data related to 2,439 students. Sixteen incidents of substance abuse were reported for a 5-year prevalence of 0.65%. Opioids were the most frequent drug of choice (n = 9). The programs identified no predisposing risk factors in 50% of the incidents. For the students, reported outcomes included voluntary entry into treatment (n = 10), dismissal from the program (n = 7), loss of nursing license (n = 2), and 1 death. Pre-enrollment background checks and drug testing for cause were the most commonly reported screening practices. The most frequently reported prevention strategy was wellness promotion education. The prevalence was lower among student registered nurse anesthetists, as compared with certified registered nurse anesthetists. Although additional studies are necessary to verify this finding, an opportunity might exist for programs to be proactive in assessing risk postgraduation. Future studies evaluating the effectiveness of wellness promotion efforts might lead toward a standardized, best practice approach to risk reduction strategies.

Depression screening and treatment in uninsured urban patients.

BACKGROUND: Depression has been widely studied in primary care settings, yet studies of medically uninsured populations are lacking. We sought to determine whether depression screening and treatment improved depression scores of a medically uninsured, mostly African American primary care population. METHODS: The study was a prospective repeated-measures design that recruited uninsured patients. Patients were screened for depression, and the rate of depression diagnosis was compared with baseline. Patients who were diagnosed and accepted treatment were randomized to 1 of 4 treatment arms: (1) usual care; (2) usual care and psychotherapy; (3) usual care and education and psychotherapy; and (4) usual care and education. Patients were then reevaluated at 8, 12, and 24 weeks. RESULTS: A total of 674 patients participated. Depression prevalence was significantly higher among those screened (38%) than at baseline (16%). All treatment groups showed a significant reduction in depression scores over a 6-month period, from a mean score of 15 at baseline to 8.3 at 24 weeks (P < .005). All treatment interventions were equally effective. CONCLUSION: Screening improves the rate of diagnosis of depression in an uninsured, primarily African American population, and subsequent treatment significantly reduces the burden of depression.

Development of a doula intervention for postpartum depressive symptoms: participants' recommendations.

PROBLEM: About 10-15% of women experience postpartum depression (PPD). Doulas provide support and education about PPD. METHODS: This qualitative study used focus groups with mothers, doulas, and doula trainers to develop educational materials for doulas to help mothers identify symptoms of depression and seek treatment. FINDINGS: All participants preferred materials that use simple language and avoid psychiatric jargon. Three themes emerged: someone to talk to, flexibility, and interactivity. Materials developed include tri-fold brochure and content for an application for smartphones and digital tablets. CONCLUSIONS: Doulas can use these interactive materials to provide supportive, relationship-based care that complements nursing care.