The therapy relationship with lesbian and gay clients.

This study investigated the role of therapy practices and the therapy relationship on lesbian and gay clients' feelings about their current therapist. Participants were 76 lesbian and 40 gay male clients ranging in age from 19 to 69 years. The real relationship was found to predict an additional 8% of variance in clients' positive feelings about their therapist above and beyond months in therapy, therapy practices, and the working alliance. However, therapy practices did not add significance in predicting lesbian and gay clients' feelings about their therapist beyond the working alliance and the real relationship. Fifty-three of the participants responded to a question about their current experiences in therapy, and the data were analyzed using consensual qualitative research-modified (CQR-M; Spangler, Liu, & Hill, 2012). Thirty percent of clients indicated a preference for a lesbian or gay therapist, or gay-friendly therapist. Only 25% found that their therapist lacked knowledge about lesbian and gay issues, but 21% indicated that their therapist was dismissive of and/or viewed their sexual orientation as a problem. More than two-thirds of the participants indicated they had a positive therapy relationship with their therapist. Results highlight the important role that therapy practices and the therapy relationship play in lesbian and gay clients perceptions' of their therapist. The findings also provide support for heterosexual therapists' ability to develop a positive therapy relationship and be effective with lesbian and gay clients.

The development and initial validation of the dating attitudes inventory: a measure of the gender context of dating violence in men.

The development and initial psychometric investigation of the Dating Attitudes Inventory (DAI) is reported. The DAI was created, to fill a gap in the literature and to measure specific masculine ideology and traditional gender attitudes that rationalize the abuse of women. Using a sample (n = 164) of male college students, a 20-item measure was developed consisting of two subscales (Rationalization of Abuse and Dominance and Control) and a total score. The 20-item DAI and other measures used for validation were completed by 216 male college students. The DAI correlated in theoretically expected ways with measures of propensity for abusiveness, relational dominance, and masculine gender role stress. A confirmatory factor analysis supported the two theorized factors of the DAI. Results of the present study offer initial support for the validity and reliability of the DAI. The authors discuss the importance of measuring masculine gender role attitudes and beliefs that support and rationalize dating violence.

The real relationship inventory: development and psychometric investigation of the client form.

The development and validation of a client version of the Real Relationship Inventory (RRI-C) is reported. Using a sample of clients (n = 94) who were currently in psychotherapy, a 24-item measure was developed consisting of two subscales (Realism and Genuineness) and a total score. This 24-item version and other measures used for validation were completed by 93 additional clients. Results of the present study offer initial support for the validity and reliability of the RRI-C. The RRI-C correlated significantly in theoretically expected ways with measures of the client-rated working alliance and therapists' congruence, clients' observing ego, and client ratings of client and therapist real relationship on an earlier measure of the real relationship (Eugster & Wampold, 1996). A nonsignificant relation was found between the RRI-C and a measure of social desirability, providing support for discriminant validity. A confirmatory factor analysis supported the two theorized factors of the RRI-C. The authors discuss the importance of measuring clients' perceptions of the real relationship.

Predoctoral interns' nondisclosure in supervision.

In interviews with 14 counseling center predoctoral interns regarding a significant nondisclosure in supervision, eight interns reported good supervisory relationships and six indicated that they experienced problematic supervisory relationships. Nondisclosures for the interns in good supervisory relationships related to personal reactions to clients, whereas nondisclosures for interns in problematic supervisory relationships related to global dissatisfaction with the supervisory relationship. In both groups, interns mentioned concerns about evaluation and negative feelings as typical reasons for nondisclosure. Additional reasons for nondisclosure for interns in problematic supervision were power dynamics, inhibiting demographic or cultural variables, and the supervisor's theoretical orientation. Both groups described negative effects of nondisclosure on themselves and their relationships with clients. Interns in problematic supervision also reported that nondisclosures had negative effects on the supervisory relationship.

Second language learning in a family nurse practitioner and nurse midwifery diversity education project.

PURPOSE: To describe the Clinical Communication Program developed to integrate second language learning (L2), multimedia, Web-based technologies, and the Internet in an advanced practice nursing education program. DATA SOURCES: Electronic recording devices as well as audio, video editing, Web design, and programming software were used as tools for developing L2 scenarios for practice in clinical settings. CONCLUSIONS: The Clinical Communication Program offers opportunities to support both students and faculty members to develop their linguistic and cultural competence skills to serve better their patients, in general, and their students who speak a language other than English, in particular. The program provided 24 h on-demand access for using audio, video, and text exercises via the Internet. IMPLICATIONS FOR PRACTICE: L2 education for healthcare providers includes linguistic (listening, speaking, reading, and writing) experiences as well as cultural competence and practices inside and outside the classroom environment as well as online and offline the Internet realm.

Advanced health assessment in nurse practitioner programs: follow-up study.

The increase in advanced practice graduate programs and the inclusion of content and skills related to advanced health assessment as a core competency for practice served as the impetus for a 5-year follow-up study to track the changes, methodologies, and integration of technology into practitioner programs. The questionnaire was mailed to the faculty/schools listed as current members in the National Health Service Corps Nurse Practitioner Faculty Advocate Network. The number of responding schools was 135 (44%). The family nurse practitioner program continues to be the most offered advanced practice nursing program. Nearly all institutions offer a post-master's program and an advanced health assessment course to their clinical graduate students. Health assessment is usually taught concurrently or as a prerequisite for clinical experiences; there continues to be a strong emphasis on the physical examination component. Ethnic and cultural assessment and gerontological assessment content increased since the original study. Both class and laboratory class sizes decreased. Qualitative data that centered on differences in graduate versus undergraduate health assessment revealed a shift in focus in several areas: differential diagnoses, abnormals, and the inclusion of advanced skills. There was an emergence of more creative strategies: the use of standardized patients, online coursework, videotaping, "live" patients, and simulations.

Evaluation of a tobacco cessation curricular intervention among acute care nurse practitioner faculty members.

BACKGROUND: In 2002, a report indicated that tobacco-related curricular content in educational programs for acute care nurse practitioners was insufficient. To provide healthcare professionals with the necessary knowledge and skills to intervene with patients who smoke tobacco, the Summer Institute for Tobacco Control Practices in Nursing Education was implemented at Georgetown University in Washington, DC. OBJECTIVE: To evaluate the impact of a train-the-trainer program in which the Rx for Change: Clinician-Assisted Tobacco Cessation curriculum was used among faculty members of acute care nurse practitioner programs. METHODS: Thirty faculty members participated in the 2-day train-the-trainer program. Surveys were administered at baseline and 12 months after training to examine perceived effectiveness for teaching tobacco content, the value of using an evidence-based national guideline, and the number of hours of tobacco content integrated in curricula. RESULTS: The percentage of faculty members who devoted at least 3 hours to tobacco education increased from 22.2% to 74.1% (P<.001). Perceived effectiveness in teaching tobacco cessation also increased (P < .001), as did mean scores for the perceived value of using an evidence-based national guideline (P<.001). CONCLUSIONS: Use of the Rx for Change train-the-trainer program can enhance the level of tobacco education provided in acute care nurse practitioner programs. Widespread adoption of an evidence-based tobacco education in nursing curricula is recommended to help decrease tobacco-related morbidity and mortality.

Quality of life and psychological status of patients with implantable cardioverter defibrillators.

BACKGROUND: Implantable cardioverter defibrillators reduce mortality in patients at high risk for sudden cardiac death and in patients with heart failure. Patients with defibrillators often experience psychological distress and poor quality of life, which can potentiate pathological processes that increase the risk for sudden cardiac death. To achieve the full benefits of the defibrillators, patients must maintain their psychological status and quality of life. OBJECTIVES: To review the research on psychological status and quality of life of patients with implantable cardioverter defibrillators and suggest nursing interventions to improve the patients' health. METHOD: Searches of PubMed were used to find articles on depression, anxiety, and quality of life in patients with implantable cardioverter defibrillators. RESULTS: Poor quality of life is associated with anxiety and depression in patients with implantable cardioverter defibrillators. Discharges of the devices have adverse consequences for patients' psychological status and quality of life. Younger patients are at highest risk for psychological distress and poor quality of life after implantation. Longitudinal research would facilitate determining the course of the changes in psychological status and quality of life during the time patients have the defibrillators. More intensive intervention may be necessary for the most vulnerable recipients: patients who are young, have experienced shocks, and are in psychological distress. CONCLUSIONS: Poor quality of life and depression are common in patients with implantable cardioverter defibrillators. Nursing interventions to reduce psychological distress and improve quality of life may reduce morbidity and mortality in these patients. Additional research is needed to determine effective interventions.

Using the Rx for Change tobacco curriculum in advanced practice nursing education.

In today's health care system driven by quality outcome indicators and performance care measures, it is essential for nurses to know how to intervene with tobacco-dependent patients. This article discusses pilot results from the "Rx for Change: Clinician Assisted Tobacco Cessation Curriculum" intervention conducted at Georgetown University School of Nursing and Health Studies using advanced practice students. The results reveal that 6 hours of tobacco-cessation training can increase knowledge and self-efficiency scores.

Caught in the middle: experiences of tobacco-dependent nurse practitioners.

PURPOSE: To explore how tobacco-dependent nurse practitioners (NPs) describe their experiences with health promotion and disease prevention practices with patients who smoke. DATA SOURCES: Twelve NPs who completed a graduate level NP program of study participated in face-to-face interviews and/or online chat room interviews. CONCLUSIONS: Participants' responses revealed three themes relevant to their experience as tobacco-dependent clinicians with health promotion responsibilities. These themes centered around (a) living as an insider in the world of tobacco addiction, (b) having the outside-in view of living with a tobacco addiction, and (c) being caught in the middle of a tobacco addiction. IMPLICATIONS FOR PRACTICE: All of the tobacco-dependent participants described limited smoking-cessation interventions with their patients. A barrier to implementation of more aggressive interventions, perhaps, is the provider's own tobacco addiction. With increasing evidence that tobacco-dependent health care professionals are not adequately intervening with tobacco-dependent patients, effective strategies are needed to assist and/or support not only tobacco-dependent patients but providers as well.

Leadership to reduce health disparities: a model for nursing leadership in American Indian communities.

Health disparities can be especially dramatic for American Indians because of a variety of powerful forces that include poverty, isolation, low educational achievement, and a unique political relationship that dictates the design of special healthcare delivery mechanisms. The challenge facing nursing leaders in these setting is addressed with consideration to culture, an examination of why leadership is needed to change the forces that lead to health disparities, the role of leadership in reducing ethnic disparities in health outcomes, as well as an examination of the most productive ways to mobilize nurses and nursing leadership to address the problems. A model for nursing leadership in Native American communities is proposed and a case study that illustrates how culturally diverse leadership in a public health setting can maximize results is presented.

Health risk behaviors in smoking and non-smoking young women.

PURPOSE: To compare the health, health risk behaviors and stress levels of college female smokers and non-smokers. DATA SOURCES: Forty-one college women, ages 18-21 years, participated in an interview and completed a health survey and the Derogatis Stress Profile. CONCLUSIONS: The smokers perceived themselves to be more overweight (Chi square, p = < .001). Smokers used more marijuana (Chi square, p = < .003) and had higher scores on depression [t (39) = 2.29, p = .028], hostility [t (39) = 2.562, p = .014] and perceived quality of health [t (39) = 2.72, p = .01]. In the interview, smokers identified social situations involving alcohol as the time they would most likely smoke. Smokers did not smoke when ill and all were interested in quitting. The non-smoking women support smoking cessation for their peers. IMPLICATIONS FOR PRACTICE: College alcohol and substance use prevention and treatment programs should address tobacco cessation. The majority of college women are not smokers and could be resources to encourage smoking cessation among their peers. Smoking cessation at this age has dramatic implications for future health.

The ABCs of psychopharmacology.

The forgoing represents an attempt to reduce psychopharmacology to a presynaptic neuron-synapse-post-synaptic neuron event. Obviously other strategies might be employed resulting in equal or perhaps greater clarity. Limitations of this approach include the lack of discussion about neuronal modulation, second messenger systems (which most NTs discussed here use), expansion of the ion channel discussion, and the implications of excitatory vs. inhibitory physiological effects. Nonetheless, we find this template for understanding psychotropic drug mechanism of action a fruitful lens through which to guide further study of these drugs. We feel like we are moving toward a silver dollar-size circle.

Tobacco dependence curricula in acute care nurse practitioner education.

BACKGROUND: Tobacco dependence is the leading preventable cause of death in the United States, yet healthcare professionals are not adequately educated on how to help patients break the deadly cycle of tobacco dependence. OBJECTIVE: To assess the content and extent of tobacco education in the curricula of acute care nurse practitioner programs in the United States. METHODS: A survey with 13 multiple-choice items was distributed to the coordinators of 72 acute care nurse practitioner programs. The survey was replicated and modifiedfrom previous research on tobacco dependence curricula in undergraduate medical education. RESULTS: Fifty programs (83%) responded to the survey. Overall, during an entire course of study, 70% of the respondents reported that only between 1 and 3 hours of content on tobacco dependence was covered. Seventy-eight percent reported that students were not required to teach smoking-cessation techniques to patients, and 94% did not provide opportunities for students to be certified as smoking-cessation counselors. Sixty percent reported that the national guidelines for smoking cessation were not used as a curriculum reference for tobacco content. CONCLUSIONS: The majority of acute care nurse practitioner programs include brief tobacco education. More in-depth coverage is required to reduce tobacco dependence. Acute care nurse practitioners are in a prime position to intervene with tobacco dependence, especially when patients are recovering from life-threatening events. National recommendations for core tobacco curricula and inclusion of tobacco questions on board examinations should be developed and implemented.