My Patient Died: A National Study of Nursing Students' Perceptions After Experiencing a Patient Death.

AIM: The purpose of this study was to examine, on a national level, nursing students' perceptions after experiencing a patient death. BACKGROUND: Death is a highly stressful experience for nursing students. Debriefing, which routinely occurs with a patient's demise in the simulation setting, typically does not happen in actual death situations. METHOD: A mixed-methods design using quantitative and qualitative questions as part of an anonymous survey was sent to the membership of the National Student Nurses' Association. Of approximately 55,000 members, 2,480 responded to the survey. RESULTS: Experiencing a patient death as a student occurred for 41 percent of participants in the nationally representative sample. Of those who experienced a patient death, 64 percent did not receive any debriefing. CONCLUSION: Most nursing students did not feel prepared to care for a dying patient and the patient's family. Students need and want more education on end-of-life nursing care.

Nursing Students' Clinical Experience With Death: A Pilot Study.

Although debriefing in simulation settings is routine in nursing education, debriefing does not routinely take place in clinical settings with nursing students after a patient has died. This pilot study sought to explore nursing students' perceptions of their first experience with the death of a patient. Students reported emotional distress and feelings of inadequacy with regard to communicating with and supporting the family of the dying patient. Only half the students sampled reported debriefing by their clinical instructor or staff. Nurse educators must include debriefing and student support following a patient death in the clinical setting.

The nurse's role in primary care antidepressant medication adherence.

Depression remains one of the most common conditions seen in primary care settings. Antidepressant medications (ADMs) are considered standard treatment for moderate to severe depression, and in some instances, for minor depression. When ADM adherence is low, patients are at risk for treatment failure and poor quality of life. Nurses may be key in ensuring the success of ADM therapy; however, little is known about the interventions nurses use or the consequent patient outcomes. The objectives of this article were to identify studies in which nurses managed ADM adherence and to collect evidence about the efficacy of these interventions. A systematic literature review of clinical trial studies was conducted, which specifically included the role of the nurse. Nurse interventions identified were: patient care management, medication monitoring, depression education, and referrals to specialty providers. Nurses use a range of interventions to manage ADM adherence. In most studies, these approaches, including collaborative care, were efficacious.

Developing positive attitudes toward geriatric nursing among Millennials and Generation Xers.

Despite the increase of the older adult population, there exists a shortage of health care professionals trained to help this population remain independent as long as possible. Ageism, common among younger adults, affects the capacity building of health care for older adults. Research has indicated that increased knowledge about older adults, as well as exposure to the elderly, may alter nursing students' attitudes regarding careers in gerontological nursing. However, questions remain as to what are the most effective ways to provide gerontological content in nursing programs and enhance attitudes toward older adults.With the understanding that younger adults see a need to balance work and play, a baccalaureate nursing program provides examples of ways to accomplish this through integration of courses, simulations, positive images of aging, and learning activities that enhance empathy for both frail and healthy older adults.

Factors associated with antidepressant medication adherence and adherence-enhancement programmes: a systematic literature review.

Medication adherence is critical to the efficacy of available treatment for depression in primary care settings. This review identifies factors associated with adherence and what is known about the effectiveness of adherence-enhancement programmes. A comprehensive systematic review of English language publications from January 2002 to October 2011 was conducted using the following databases: PUBMED/MEDLINE, PsycINFO and the Cochrane database. Twenty-one studies met the inclusion criteria for adherence-enhancement evaluations. Eleven of the studies evaluated demonstrated significantly positive effects on adherence; the remaining 10 reported mixed or no effects. Similar to previous literature reviews, factors shown to be associated with adherence were multifactorial and in this analysis were grouped as patient, condition and comorbidities, therapy or treatment, patient-provider relationship and healthcare system level. Adherence improved most notably in studies that included sustainable system and patient-targeted changes. Evaluating adherence-enhancement interventions is key to promoting successful approaches; however, a number of gaps exist between intervention and implementation: (1) the cost in resources and time to implement and sustain these programmes is unknown, (2) specific details about which subgroups of patients are best helped with such programmes is not clear, and (3) what specific processes or content are critical to programme success is still to be identified. There are sufficient data supporting the substantial need for planning and implementing adherence interventions despite reported mixed results. Primary care providers are often positioned to impact patients' adherence; however, practice constraints can limit their implementation.

Practical considerations in establishing sustainable international nursing experiences.

An understanding of global health and the development of cultural competence are important outcomes of today's baccalaureate nursing programs. Thoughtfully designed international experiences can provide excellent opportunities to achieve those outcomes. Based on 16 years of providing international experiences within a baccalaureate curriculum, components are identified that contribute to the development of a sustainable international program. Areas addressed in the article are evaluating the fit with university and college mission, establishing the program within the university operational structure, selecting faculty and students, developing sites, designing a course, and program evaluation.

Healthcare system use by risky alcohol drinkers: A secondary data analysis.

PURPOSE: To examine the effects of at-risk alcohol use on patterns of healthcare use and health outcomes. DATA SOURCES: Using the National Health Interview Survey and the Medical Expenditures Panel Survey, a total sample of 4449 adults, mean age 45 (SD 15), were grouped according to responses to the question: "In the past year, on how many days did you have 5 or more drinks of any alcoholic beverage?" CONCLUSIONS: Three categories of respondents were grouped as follows: not at-risk group = 0 days of 5+ drinks/day (n = 2991, 67%); the low at-risk group = 1-11 days of 5+ drinks/day (n = 796, 18%); and the high at-risk group = 12-365 days of 5+ drinks/day (n = 662, 15%). The level of risky alcohol use did not predict healthcare use or healthcare outcomes; high at-risk alcohol drinkers were less likely to use the healthcare system than other drinkers. When divided by rural versus urban living, rural high at-risk alcohol drinkers reported more emergency department visits and all rural living groups reported poorer physical and mental health than their urban counterparts. IMPLICATIONS FOR PRACTICE: Risky alcohol use, defined as drinking above low-risk guidelines, affects 3 out of 10 adults, and risky drinking plays a role in over 60 chronic health conditions. Nurse practitioners encounter risky alcohol users in multiple practice settings. It may be difficult to identify the underlying alcohol issues, particularly in those living in rural settings; however, identification of at-risk drinkers is essential for prompt intervention in the potential progression from risky alcohol use to an alcohol use disorder.

The TEA transcription factor Tec1 confers promoter-specific gene regulation by Ste12-dependent and -independent mechanisms.

In Saccharomyces cerevisiae, the TEA transcription factor Tec1 is known to regulate target genes together with a second transcription factor, Ste12. Tec1-Ste12 complexes can activate transcription through Tec1 binding sites (TCSs), which can be further combined with Ste12 binding sites (PREs) for cooperative DNA binding. However, previous studies have hinted that Tec1 might regulate transcription also without Ste12. Here, we show that in vivo, physiological amounts of Tec1 are sufficient to stimulate TCS-mediated gene expression and transcription of the FLO11 gene in the absence of Ste12. In vitro, Tec1 is able to bind TCS elements with high affinity and specificity without Ste12. Furthermore, Tec1 contains a C-terminal transcriptional activation domain that confers Ste12-independent activation of TCS-regulated gene expression. On a genome-wide scale, we identified 302 Tec1 target genes that constitute two distinct classes. A first class of 254 genes is regulated by Tec1 in a Ste12-dependent manner and is enriched for genes that are bound by Tec1 and Ste12 in vivo. In contrast, a second class of 48 genes can be regulated by Tec1 independently of Ste12 and is enriched for genes that are bound by the stress transcription factors Yap6, Nrg1, Cin5, Skn7, Hsf1, and Msn4. Finally, we find that combinatorial control by Tec1-Ste12 complexes stabilizes Tec1 against degradation. Our study suggests that Tec1 is able to regulate TCS-mediated gene expression by Ste12-dependent and Ste12-independent mechanisms that enable promoter-specific transcriptional control.

The course council: an example of student-centered learning.

To promote student-centered learning, a course council was established in a beginning undergraduate nursing course. A student representative was selected by peers to attend a monthly course council meeting with faculty. Representatives were asked to query classmates in their section of eight students regarding opinions, questions, and concerns about the course and then bring those views to the council. In this monthly, small group, open dialogue setting, students spoke freely about experiences in the classroom, laboratory, and clinical settings. The stage was set for reflection, problem solving, and decision making involving students and faculty. Student input led to meaningful course changes, provided opportunities for students to learn from one another, and fostered critical thinking and professional responsibility. The course council approach was successful and has been expanded to include other nursing courses.

Rurality and mental health treatment.

Diversity within rural areas renders rural-urban comparisons difficult. The association of mental health treatment rates with levels of rurality is investigated here using Rural-Urban Continuum Codes. Data from the 1996-1999 panels of the Medical Expenditure Panel Survey are aggregated to provide annual treatment rates for respondents reporting mental health problems. Data show that residents of the most rural areas receive less mental health treatment than those residing in metropolitan areas. The adjusted odds of receiving any mental health treatment are 47% higher for metropolitan residents than for those living in the most rural settings, and the adjusted odds for receiving specialized mental health treatment are 72% higher. Findings suggest rural community size and adjacency to metropolitan areas influence treatment rates.

Rurality, gender, and mental health treatment.

Mental health problems are common and costly, yet many individuals with these problems either do not receive care or receive care that is inadequate. Gender and place of residence contribute to disparities in the use of mental health services. The objective of this study was to identify the influence of gender and rurality on mental health services utilization by using more sensitive indices of rurality. Pooled data from 4 panels of the Medical Expenditure Panel Survey (1996-2000) yielded a sample of 32,219 respondents aged 18 through 64. Variables were stratified by residence using rural-urban continuum codes. We used logistic and linear regression to model effects of gender and rurality on treatment rates. We found that rural women are less likely to receive mental health treatment either through the general healthcare system or through specialty mental health systems when compared to women in metropolitan statistical areas (MSA) or urbanized non-MSA areas. Rural men receive less mental health treatment than do rural women and less specialty mental health treatment than do men in MSAs or least rural non-MSA areas. Reported mental health deteriorates as the level of rurality increases. There is a considerable unmet need for mental health services in most rural areas. The general health sector does not seem to contribute remarkably to mental health services for women in these areas.

Differential regulation of Tec1 by Fus3 and Kss1 confers signaling specificity in yeast development.

Transcriptional regulation by mitogen-activated protein (MAP) kinase signaling cascades is a major control mechanism for eukaryotic development. In budding yeast, Fus3 and Kss1 are two MAP kinases that control two distinct developmental programs-mating and invasive growth. We investigated whether signal-specific activation of mating and invasive growth involves regulation of the transcription factor Tec1 by Fus3 and Kss1. We present evidence that, during mating, Fus3 phosphorylates Tec1 to downregulate this invasive growth-specific transcription factor and its target genes. This function of Fus3 is essential for correct execution of the mating program and is not shared by Kss1. We find that Kss1 controls the activity of Tec1 mainly during invasive growth by control of TEC1 gene expression. Our study suggests that signaling specificity can arise from differential regulation of a single transcription factor by two MAP kinases with shared functions in distinct developmental programs.