Confronting mental health stigma in Haitian Americans suffering from mental health challenges.

BACKGROUND: Haitian Americans have been disproportionately exposed to risk factors known to play a significant role in the development of mental illness. Yet despite the documented effectiveness of mental health treatment, a high proportion of Haitian Americans with mental health disorders have not received care. LOCAL PROBLEM: Internalized stigma of mental illness (ISMI) was reported as one of the primary reasons Haitian Americans do not seek help for mental illnesses, resulting in poor long-term outcomes for individuals and families in this community. This quality improvement project characterized ISMI among Haitian Americans, examined associated demographic factors, and tested the impact of a culturally relevant ISMI educational video intervention on willingness to seek mental health treatment. METHODS: Haitian Americans who self-reported mental illness ( N = 20) were recruited from a South Florida clinic. Descriptive statistics, correlations, and thematic analyses were completed to analyze the data. INTERVENTIONS: Participants completed the nine-item ISMI scale, watched an educational video about ISMI, completed a post-intervention survey, and engaged in conversations about mental health and ISMI. RESULTS: Sixty-five percent of participants reported mild levels of ISMI. Sex was significantly correlated with ISMI ( r = -0.458, p = .042); male participants experienced higher levels of ISMI. The educational video improved participants' knowledge of ISMI, and 85% indicated increased willingness to seek treatment. CONCLUSIONS: When caring for Haitian Americans with mental illnesses, nurse practitioners should initiate conversations about ISMI, consider gender differences in mental illness beliefs and attitudes, and provide culturally responsive psychoeducational interventions to promote more mental health treatment utilization.

Advanced nursing practice training: the reality of the United States and the first steps of Brazil.

This is a reflective theoretical essay, with the objective of reporting the experience of the United States and the first steps of Brazil in the training process of advanced practice nurses. The historical trajectory of two traditional graduate programs in the professional modality is described, one from Brazil and one from the United States. Both curriculum models highlight specific training disciplines of nursing practice, the thesis and DNP project, consisting of implementation studies. We concluded that both countries are still making progress in nursing education and practice and are working to collaborate to form the highest level of nursing education and practice.

Advanced nursing practice training: the reality of the United States and the first steps of Brazil / Prática avançada em enfermagem: a realidade dos Estados Unidos e os primeiros passos do Brasil / Enfermería de práctica avanzada: la realidad de los Estados Unidos y los primeros pasos de Brasil

ABSTRACT This is a reflective theoretical essay, with the objective of reporting the experience of the United States and the first steps of Brazil in the training process of advanced practice nurses. The historical trajectory of two traditional graduate programs in the professional modality is described, one from Brazil and one from the United States. Both curriculum models highlight specific training disciplines of nursing practice, the thesis and DNP project, consisting of implementation studies. We concluded that both countries are still making progress in nursing education and practice and are working to collaborate to form the highest level of nursing education and practice.

RESUMO Trata-se de um ensaio teórico reflexivo que busca relatar a experiência dos Estados Unidos e os primeiros passos do Brasil no processo de formação de enfermeiros de prática avançada. Descreveu-se a trajetória histórica de dois programas tradicionais de pós-graduação na modalidade profissional, um do Brasil e outro dos Estados Unidos. Ambos os modelos curriculares destacam as disciplinas específicas de formação da prática de enfermagem, a tese e o projeto DNP, composto por estudos de implementação. Concluiu-se que os dois países ainda estão progredindo e colaborando para formar o mais alto nível na educação e na prática de enfermagem.

RESUMEN Este es un ensayo teórico y reflexivo que pretende reportar la experiencia de los Estados Unidos y los primeros pasos dados por Brasil en el proceso de formación de enfermeros de práctica avanzada. Se describió la trayectoria histórica de dos programas tradicionales de posgrado en la modalidad profesional, uno en Brasil y otro en Estados Unidos. Ambos modelos curriculares destacan las asignaturas de formación específicas de la práctica de enfermería, la tesis y el proyecto DNP, compuesto por estudios de implementación. Se concluyó que los dos países presentan avances y colaboraciones para ofertar un alto nivel de educación y práctica de enfermería.

A Model to Guide Telehealth Research Quality Improvement, Practice and Education.

Telehealth is a means for providing care to our rural patients. This mode of healthcare delivery is not without challenges with technology, research, quality improvement, practice and education. Here we present the TRIP-E Meta Model. This model was derived from a two phased process. First, we performed a review of literature and from this developed the first attempt at model development. Second, we took student evaluations from a telehealth education program for Doctor of Nursing Practice students. Based on their feedback, we then further advanced the first model to the TRIP-E Meta Model. This model is a comprehensive guide to research, quality improvement, practice and education. As a meta model, the TRIP-E can have other theories applied for projects. This feature of meta models provide flexibility for the model. We invite others to test this model for its flexibility and usability.

Breaking new ground? The dual (PhD-DNP) doctoral degree in Nursing.

PURPOSE: 1) Provide background information on the PhD-DNP dual doctoral degree, specifically historical perspectives and existing programs; 2) Describe one PhD-DNP program as an exemplar to illustrate program data challenges and solutions; and 3) Discuss the national landscape of the dual doctoral degree program. PRINCIPAL RESULTS: PhD-DNP dual doctoral degree programs have existed for 10 years; there are five known programs nationally. Reported here for one dual doctoral degree program are data collected from the program's inception (2010) through 2019. These data include demographic program characteristics, time to degree, and achievements during and after the program. Challenges pertaining to mentorship, progression to degree, socialization and student productivity also are described. Strategies for moving the dual degree forward nationally depend on a collaborative effort for data generation and collection from existing PhD-DNP programs. These data can be instrumental for seeking funding for dual doctoral degree programs. CONCLUSIONS: The dual PhD-DNP degree has not yet gained a foothold nationally. There is demand for the program by nursing doctoral students and availability of these programs is slowly increasing. National nursing leaders and organizations can consider developing metrics and collecting data that will lend support to future funding initiatives for the dual degree.

Introducing telehealth skills into the Doctor of Nursing Practice curriculum.

ABSTRACT: Telehealth training was important for nurse practitioner (NP) students prior to the COVID-19 pandemic, but now it is essential. Training in telehealth allows access to health care for vulnerable populations in rural health areas and beyond. As the future of health care delivery changes, providers will be required to use this technology. Therefore, it is imperative that such training become part of NP education to prepare students to be technologically competent providers in the 21st century. The objective of this educational pilot project was to educate Doctor of Nursing Practice nurse practitioner students to conduct patient interviews and provide interprofessional collaboration using telehealth. The project addressed a gap in the literature on planning for simulations from varying NP specialties and provided feedback from standardized patients on their experiences. A total of 83 students from four specialty tracks received telehealth education. Students then interviewed simulated patients and provided a collaborating report. The students and patients were asked to complete questionnaires to assess the modules and the experience itself. Quantitative descriptive data were gathered, and qualitative themes were obtained from open-ended questions. Both the students and simulated patients indicated that they appreciated the ease and convenience of interviewing patients through technology. Both struggled with issues related to the technology and the need to have backup systems available. The students demonstrated that they were very capable of using telehealth and were generally very positive about the experience.

Development of an Innovative Tool to Appraise Big Data for Best Evidence.

BACKGROUND: Datum from electronic sources has accumulated and resulted in the establishment of big data and data science. Big data consists of data sets that are larger than traditional data processing applications can manage. Data science is the research method used to analyze big data. Researchers are applying research methods to harness large and complex data sets to increase our understanding of population health by creating predictive models of patients using a variety of key variables or characteristics. Evidence-based practice relies on the appraisal of research to ensure rigor prior to implementation in clinical settings. Consistent with other research methods, papers based on data science should be subject to appraisal for determination of best evidence. The purpose of this paper is to present a tool that can be used to appraise research papers based on large data sets and data science research methods. METHODS: The following approach was used to develop the Data Science Appraisal Tool (DSAT). Despite an exhaustive search, we were unable to locate an appraisal tool for papers based on data science research methods. We then synthesized the extant literature to form the tool. The tool is based on the common characteristics of big data: (a) verification that the data set is representative of big data; (b) preparation of the data for analysis; (c) methodology used for data analysis; (d) results; and (e) theoretically based. LINKING EVIDENCE TO ACTION: Appraisal tools currently exist for traditional and well-known research methods. The DSAT provides a method to appraise papers based in data science for best evidence.

Type 2 diabetes and depression in the African American population.

BACKGROUND AND PURPOSE: Type 2 diabetes mellitus (T2DM) affects 30.3 million people (9.4%) in the United States. African Americans are twice as likely to be diagnosed with diabetes and have two to four times the rates of T2DM-associated complications. Depression has long been associated with poor outcomes of diabetic self-management and glycemic control. Comorbidity of T2DM and depression worsen effective self-management of these conditions in the African American population. The purpose of the study was to synthesize the literature with practice recommendations of care related to T2DM and depression in the African American population. METHODS: A literature search was conducted using PRISMA in June 2018 with PubMed, Google Scholar, Cochrane, Scopus, Embase, and PsycINFO databases using the years from 2008 through 2018. The following terms and combination of terms were used to identify articles for the review: (a) diabetes mellitus, type 2, (b) diabetes type 2 and depression, and (c) diabetes mellitus type 2, depression, African America. CONCLUSIONS: The overall prevalence of depression with T2DM in African Americans is about 25%. The quality of care received by African Americans is lower when compared with non-Hispanic Whites, resulting in more emergency department visits and fewer physician visits per year. African Americans require supportive and trusting collaboration with providers for the ongoing optimal management of these complex conditions. IMPLICATION FOR PRACTICE: Culturally relevant education on lifestyle modification may help mitigate barriers to management of T2DM and depression in the African American population. Using the diabetes self-management education/support to help empower African Americans may be essential for effective self-management strategies of T2DM and depression.

Anxiety Disorders in Primary Care Settings.

Although anxiety disorders are extremely prevalent in primary care settings, barriers such as a lack of knowledge, time constraints, and lack of common presentation can lead to misdiagnosis and ineffective treatment. Optimal treatment of anxiety disorders includes both pharmacologic and behavioral interventions. The purpose of this article is to assist primary care providers in quick identification of anxiety disorders so that proper treatment can be initiated and appropriate referrals can be made.

Considerations for the Care of Transgender Individuals.

Transgender individuals are at an increased risk of experiencing health inequalities, such as anxiety, depression, and HIV. It is important that providers and staff in the health care setting are prepared to care for this population to ensure best patient outcomes. An understanding of transgender terminology and the experience of gender dysphoria is key. In addition, a transinclusive environment should be created to reduce the likelihood of transgender-related discrimination. Developing an understanding of potential gender-affirming treatments and surgeries also optimizes patient care. Improving the quality care will reduce health disparities commonly faced by the transgender population.

Bridging the Gap of Mental Health Inequalities in the Transgender Population: The Role of Nursing Education.

The transgender population experience mental health disparities as a result of numerous environmental, sociocultural and personal factors. Health care-related discrimination plays an unfortunate role in these disparities. The institutional and informational erasure of transgender individuals in health care actively contributes to this discrimination. The lack of preparation of health care professionals to care for this population is a significant factor. There is an absence of education on transgender topics in nursing school and a lack of nursing research on this population. An awareness through education of culturally competent transgender terminology is crucial to ensure a transinclusive environment is created. The creation of a transinclusive environment in the mental health care setting will ultimately lead to improved patient outcomes.

An Overview of Munchausen Syndrome and Munchausen Syndrome by Proxy.

Munchausen syndrome and Munchausen syndrome by proxy are complex diseases that are difficult to diagnose and treat. To assist in this process, an overview of diagnostic criteria with common characteristics and red flags are discussed, with case studies illustrating identification and diagnosis of these disorders. Treatment options are addressed within the context of each of these complex syndromes. The provider's knowledge of diagnostic criteria and treatment options for Munchausen syndrome and Munchausen syndrome by proxy promotes better outcomes for patients. Without an early diagnosis and intervention, the patient is at high risk for severe complications, including organ failure and mortality.

Pharmacogenetic Testing: Application in Mental Health Prescribing.

BACKGROUND: Despite extensive scholastic and professional training, medication management in psychiatry is often relegated to trial-and-error prescribing. Pharmacogenetic testing (PGT) may expedite identification of medications with maximal efficacy and minimal side effects by recognizing individual genetic variability in drug response. OBJECTIVES: This article outlines the background of PGT, explains drug metabolism, and evaluates the impact of PGT. DESIGN: A review of the literature since 2010 found 42 articles regarding PGT in clinical nursing settings on PubMed and ProQuest. RESULTS: Despite continuing rises in health care costs, new biotechnology has led to a decrease in the cost of genetic sequencing and application of PGT to practice. CONCLUSION: As PGT becomes increasingly prevalent, nurses should be knowledgeable of its purpose, possibilities, and potential limitations to provide accurate and up-to-date patient information.

Street Level Prostitution: A Systematic Literature Review.

The aim of this study was to synthesize research on female street level prostitutes for application in mental health practice and identification of future research needs. The data were from reports conducted in Westernized countries on female street level prostitutes between the years 2000 and 2014. Street level prostitutes are at high risk for HIV/STIs, chronic and acute physical/mental health problems, and violence, but there is a paucity of research on resilience and coping skills. We conclude that street level prostitutes suffer severe health disparities, yet they do not seek health care on a consistent basis. It is important for mental healthcare providers to offer women a safe, non-judgmental environment while providing assessment and referral. Future research on mental health consequences as well as resilience and coping skills would support effective interventions that address the women holistically.

Developing schools' capacities to respond to community crisis: the Tennessee initiative.

TOPIC: The development and implementation of a statewide initiative addressing mental health issues within schools postcrisis. PURPOSE: The potential for a community crisis occurs every day. After a crisis, schools are practical, logical, and effective places to help students recover from a tragedy. If crisis-related trauma is not addressed adequately, it can impact academic outcomes such as reading achievement, grade point average, and overall academic performance. For these reasons, it is imperative that school administrators support students in the aftermath of a crisis. CONCLUSIONS: This ongoing project continues in an effort to support students, faculty, and staff after a traumatic event within the Tennessee public school system.

Dialectical behavior therapy group skills training in a community mental health setting: a pilot study.

Effective and affordable therapies are needed for treating people with severe and persistent mental illness in a community mental health setting. In this pilot study, we evaluated the effectiveness of a modified dialectical behavior therapy (DBT) protocol for improving symptoms and functioning in a cohort of persons with severe and persistent mental illness. We provided six months of weekly DBT skills training in a group setting. Depression symptoms decreased significantly after treatment. There was a wide range of number of sessions attended, with a minority of the participants completing the full course of treatment. Increased attendance was correlated with improvements in depression symptoms, overall symptoms, quality of life, and community functioning. The study findings suggest that the group skills training component of DBT can be successfully implemented in a community mental health center and that further research to determine its efficacy in comparison to other treatments is warranted.