Psychoanalytic Perspectives on Moral Injury in Nurses on the Frontlines of the COVID-19 Pandemic.

OBJECTIVE: To raise awareness of the potential for moral injury in nurses working on the frontlines of COVID-19 patient care and to present aspects of mental functioning that may increase the likelihood of psychological distress. Approaches that draw on psychoanalytic thinking to support frontline nurses' mental health are explained. METHOD: This article draws on recent work that is available from multiple sources, including published journal articles on moral injury, recent reports from news services highlighting the crisis state of the pandemic and effects on nurses, established literature on the structural model of the mind, and recent webinars and online lectures addressing mental health crisis interventions. The author draws on expertise from years of training in the Adult Psychoanalytic Training Program at the Michigan Psychoanalytic Institute and graduation as an academic analyst. RESULTS: How nurses navigate moral hazards inherent in the current state of frontline health care may depend on their existing ego strengths and levels of self-blame and guilt from a harsh superego. CONCLUSIONS: Mental health professionals need to be aware of the mental minefields that frontline nurses must navigate when providing care that, due to circumstances beyond their control, may be morally ambiguous. Educating nurses about the meaning of their own emotional and psychic responses amid the realities in the field may help to decrease the damaging effects of moral injury.

Informatics Experience Can Help Predict Doctor of Nursing Practice Student Mastery of Informatics Competencies.

With information technology increasingly guiding nursing practice, Doctor of Nursing Practice students must be prepared to use informatics to optimize patient outcomes despite their varied experience and education. Understanding how students' baseline experience affects their mastery of informatics competencies could help faculty design Doctor of Nursing Practice course content. Therefore, the aim of this retrospective descriptive study was to evaluate whether Doctor of Nursing Practice students' baseline informatics experience affected their mastery of four competencies: meaningful use, datasets, e-health, and clinical support systems. Participants were Doctor of Nursing Practice students (n = 55) enrolled in an online informatics course. Participant experience was compared to competency mastery using χ tests. Logistic regression was performed to assess the effect of experience and highest degree obtained on competency mastery. Analysis revealed that participants with meaningful use experience were significantly more likely to master the meaningful use competency than were those without it. Relevant experience did not predict mastery of dataset competencies. Participants with e-health experience were significantly more likely to master the e-health competency (applying e-health resources to vulnerable patients' learning needs). While not significant, a greater percentage of students with clinical support systems experience mastered the clinical support systems competency. Informatics courses might need to be designed to address students' needs based on their experience.

Evaluation of Doctor of Nursing Practice Students' Competencies in an Online Informatics Course.

BACKGROUND: Doctor of Nursing Practice (DNP) programs have experienced rapid growth across the United States. With the expansion of electronic health records, DNP students are expected to acquire the knowledge and skills needed to manage data and apply informatics concepts. However, little information exists to help faculty evaluate student competency in these areas. METHOD: This retrospective analysis evaluated the competencies of a convenience sample of DNP students enrolled in an online informatics course. Two areas were assessed in this study: acquisition of informatics skills, and analysis or application of informatics concepts. RESULTS: Regarding informatics skills, postbaccalaureate students performed better than post-master's students. In analysis and application of informatics concepts, post-master's students performed better than postbaccalaureate students. CONCLUSION: Different educational strategies may need to be created to meet the varying needs of postbaccalaureate and post-master's students in DNP programs. [J Nurs Educ. 2017;56(6):364-367.].

Assessing sustainability of InSHAPE participants' fitness activities in a community mental health setting.

InSHAPE (Self Help Action Plan for Empowerment), an exercise and nutrition wellness program, is gaining national recognition for its success in helping individuals with serious mental illness (SMI) improve physical fitness and dietary habits. Although gains have been reported in objective measures of fitness as participants progressed through the year-long program, there is little information about what happens with participants after program completion. To address this gap in knowledge, the authors conducted a longitudinal qualitative study in which 11 InSHAPE participants were interviewed both near the end of their year in the program and 9 months later. Participants identified the trainer's ability to contain their initial feelings of distress and form a working alliance as factors that contributed to their exercise persistence. Current findings suggest that individuals with SMI may need a longer period of time working closely with fitness trainers to sustain physical activity levels achieved during the program.

Moving toward health and fitness: a collaborative academic and community mental health services partnership.

For individuals with serious mental illness, physical fitness is a health imperative. This article describes the progression of an ongoing interprofessional partnership formed between a university's school of health professions and a community mental health services agency to find ways to improve the physical health status of individuals served by the agency. Clinical and research initiatives involving nursing and physical therapy faculty and students have contributed to the establishment of a growing physical fitness and health promotion program championed by agency administrators, staff, and service users. The groundwork has been laid for future collaborative efforts. More needs to be done to turn the tide on the chronic disease tsunami that prematurely takes the lives of people struggling with mental disorders.

Facilitating students' success with their own research projects.

With a study template and adaptable plan, students were given opportunities in an introductory research course to complete small-group, original research studies from beginning to end in 1 semester. This "hands-on" assignment merges research with clinical experiences, makes use of computers and software applications in the classroom, and addresses 2 important components of the American Association of Colleges of Nursing's Baccalaureate Essentials.

Social problem solving training for African Americans: effects on dietary problem solving skill and DASH diet-related behavior change.

OBJECTIVE: Hypertension continues to take its toll on millions of African Americans. Adhering to an eating plan called Dietary Approaches to Stop Hypertension (DASH) can significantly lower blood pressure. This study examined whether problem solving training in addition to education on DASH is more effective than education alone to help African Americans in an urban community college setting solve their own dietary problems and change eating behaviors that could affect blood pressure. METHODS: A randomized, two groups, multiple post-test design was used. All participants (N=78, 59% female) completed a Problem Solving Instrument immediately post-intervention and a follow-up Telephone Interview 2 weeks later. RESULTS: Fewer than half had normal blood pressure on screening. The Experimental Group identified and implemented significantly higher quality solutions to the second of their two problems than the Control Group. The intervention effect was the greatest for participants with blood pressure screenings above normal. CONCLUSION: Problem solving training combined with nutrition information may help African Americans to deal more effectively with dietary problems especially when the problems are complex or less well-defined. PRACTICE IMPLICATIONS: Dietary interventions that include a focus on everyday problem solving as well as knowledge acquisition can be developed in clinical, community health, school, and worksite settings.

Using Web sites on quality health care for teaching consumers in public libraries.

More and more consumers are searching the Internet for health information. Health Web sites vary in quality, though, and not all consumers are aware of the need to evaluate the information they find on the Web. Nurses and other health providers involved in patient education can evaluate Web sites and suggest quality sites for patients to use. This article describes a project we implemented in 2 public libraries to educate consumers about quality health care and patient safety using Web sites that we had evaluated earlier. Participants (n = 103) completed resources on health care quality, questions patients should ask about their diagnoses and treatment options, changes in Medicare and Medicare options or ways to make their health benefits work for them, and tips to help prevent medical errors. Most consumers were highly satisfied with the Web sites and the information they learned on quality care from these resources. Many participants did not have Internet access at home or work and instead used the library to search the Web. Information about the Web sites used in this project and other sites on quality care can be made available in libraries and community settings and as part of patient education resources in hospitals. The Web provides easy access for consumers to information about patient safety initiatives and health care quality in general.

Internet education of African American consumers on quality of care.

This article describes a study using the Internet to teach African American consumers about quality of health care. By reading information on quality of care, consumers can learn ways to assess the care they are receiving, develop strategies needed to participate effectively in communicating with their health care providers, and make informed decisions in their own best interests. We developed an educational intervention using 5 Internet documents on quality of care and evaluated its effectiveness on learning, value of the information, and satisfaction with the instruction between consumers who read the information alone and those who read the information and interacted with a nurse. Participants indicated they learned a great deal from the information at the Web sites and reported that it would be helpful in assessing their own health care. They more frequently described quality care in terms of health outcomes, self care behaviors, and patient education after the Internet instruction, reflecting important concepts contained in the documents.

Use of MindMapper software for research domain mapping.

The application of concept mapping software to facilitate the first steps of the research review process is discussed in relation to other software programs currently used for research synthesis. MindMapper software was used to develop a strategy for organizing the results of a comprehensive literature search into discrete categories with relationships among concepts graphically displayed to reveal the structure of the research domain. A Mind Map was developed for the scholarly literature on Web-based consumer health information. A second Mind Map examined the subconcept of barriers to consumer use of the Internet for health information. MindMapper has many features that facilitate description of the breadth and depth of literature in a domain of inquiry. It also facilitates identification of the number and nature of studies underpinning mapped relationships among concepts, thus laying the groundwork for systematic research reviews and meta-analyses.

Directory of Internet documents for consumers on quality of care.

Healthcare professionals have an important role in helping patients and families understand the concept of healthcare quality and gain access to available information on quality care. Information about quality of healthcare is available from many reputable sources on the Internet. A resource directory that leads consumers to these sites would be a useful tool for patient education. This article describes (a) the process of retrieving and evaluating Web site documents on quality care, using criteria developed by the Health Information Technology Institute, and (b) the method of organizing them into a logical structure using Mind Map software. The 32 documents that make up the directory are included in a table under subheadings developed with concept mapping.

Using the Internet to teach consumers about quality care.

BACKGROUND: The Internet is an important source of health information for consumers. Patients can learn about their diagnoses, review treatments and medications, and locate other health information for themselves and their families. Information about quality care can also be found on the Internet. Few consumers, though, use these Web sites for learning about quality care. SEARCH FOR WEB SITES ON QUALITY CARE: In 2000 the investigators searched the Internet and generated a list of approximately 90 relevant Internet documents under the broad heading of quality health care. They then pared the list to 34, by using the Health Information Technology Institute (HITI) criteria. TESTING OF INTERNET DOCUMENTS BY CONSUMERS: In the second phase of the project, 5 of the 34 Internet documents were tested by a convenience sample of 32 consumers. Most of the participants had experience in using the Internet, although generally not in the area of quality care. They found the Web sites easy to use and indicated that the Internet resources would help them assess the quality of care they receive from physicians, nurses, and others. DISCUSSION: Web sites need to be evaluated to ensure that the information they provide is accurate and current, among other criteria. All patients should understand their health benefits and the importance of making informed decisions about their health care, as well as how quality care is measured, how to use quality reports, how to choose providers and hospitals, how to assess the quality of their own care and be more involved in it, and what they should do when faced with new diagnoses.