Acquired Capability for Suicide: An Evolutionary Concept Analysis.

While virtually all suicide attempters experience ideations, not all who think about suicide will attempt or die by suicide. The ideation-to-action framework has led to new theories distinguishing suicide ideators from suicide attempters. The framework suggests that suicide progresses on a spectrum of thoughts and behaviors with different identifiers and explanations. The concept of acquired capability for suicide (ACS), conceptualized by the Interpersonal Psychological Theory of Suicide, is the first to explain the movement from ideation to action. This concept analysis of ACS is timely and relevant for greater clarification of the role ACS has in the movement from ideation to action. Rodgers' evolutionary concept analysis method is used. The six-step evolutionary method highlights the concept's attributes, antecedents, and consequences and provides a basis for further inquiry and development rather than a final definition.

Access to Palliative Care Services: Innovative Development of a Statewide Network.

In 2018, the Avera Sacred Heart Hospital and two partners were awarded a planning grant to improve palliative health care services in South Dakota (SD), United States, by assessing palliative care in rural SD communities. Through this effort, a newly formed South Dakota Palliative Care Network (SDPCN) convened statewide partners to develop a palliative care strategy for improving quality palliative care access for individuals with serious illness. Guided by a multidisciplinary governing board, the SDPCN completed needs assessments to (1) better understand the perception of palliative care in SD; (2) assess the palliative care landscape in the state; and (3) explore possible solutions to address the uneven access to palliative care. This article shares the process of network development, considers the future of the SDPCN, and provides a blueprint for improving palliative care in rural areas. The SDPCN sought first to inventory community-based palliative care resources and increase awareness of the need for services followed by addressing gaps identified through a comprehensive assessment. The SDPCN has engaged partners, captured data, and mapped a blueprint for sustaining accessible quality palliative care. Three years since its inception, the SDPCN secured additional funding to sustain the Network and to provide education on palliative care to providers and community members as a first strategic step toward improving overall palliative care in rural communities. The SDPCN currently serves rural SD patients by increasing knowledge of palliative care among health professionals (current and future), fostering Network member engagement, and maintaining an active governing board.

Navigating Disharmony: Nurse Experiences Providing End-of-Life Communication.

The purpose of this study was to describe nurses' experiences of communicating with patients and families at end of life (EOL). The COMFORT Communication Model guided this descriptive qualitative study. Participants from 1 major health care system located in the Great Plains completed an online survey, which consisted of Likert-type (N = 252) and open-ended questions (n = 201). This article reports the qualitative findings of this survey. Thematic analysis of the participants' narrative responses revealed an overarching theme of disharmony when caring for patients and families at EOL. We identified 3 themes within the overarching theme of disharmony: navigating denial, words matter, and knowledge deficit. Nurses express discomfort and a knowledge deficit when providing communication specific to primary palliative and EOL care. Nursing education has an obligation to ensure that new graduates are trained in and develop comfort with the communication principles of primary palliative and EOL care. This holistic approach may improve the quality of communication surrounding the EOL experience for patients, families, and nurses.

Embracing Emotional Pain: A Case Study of Adolescent Suicidality and Spirituality.

BACKGROUND: Suicidality continues to be the second leading cause of adolescent death. Nurses are in a prime position to address the emotional pain associated with adolescent suicidality but report skepticism and discomfort. Moreover, spirituality is identified as a protective factor against suicidality, yet a gap exists related to exploring spirituality within the context of the emotional pain associated with adolescent suicidality. Building awareness of adolescents' spirituality and emotional pain associated with suicidality is essential to address nurse skepticism and discomfort. AIMS: The purpose of this study was to explore young adults' experiences of suicide attempt(s) during adolescence in the context of spirituality using a case study application of participant narratives to Minton and Antonen's B.L.E.S.S. acronym. METHOD: A multiple-case study design was used to provide an alternative perspective for understanding adolescent suicidality from a spiritual context. Reed's theory of self-transcendence and the B.L.E.S.S. acronym guided the analysis and interpretation. Convenience online sampling resulted in six adult participants who provided email narratives of their adolescent experiences. Email data collection was guided by Fritz and Vandermause. Analysis of participant narratives followed the protocol of Baxter and Jack. RESULTS: Participant's narratives revealed self-transcendence that paralleled the five truths about emotional pain and spirituality inherent in the B.L.E.S.S. acronym. CONCLUSION: This case study provides nurses a guide for counteracting the barriers of skepticism and stigma to promote help-seeking behavior associated with adolescent suicidality. Further research is needed for the application of the B.L.E.S.S. acronym with other population samples.

Perceptions of Palliative Care: Voices From Rural South Dakota.

OBJECTIVES: This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery. METHODS: Six focus groups were conducted over two months. Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants. RESULTS: Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged: Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results: Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents.

Psychometric analysis of the Comfort with Communication in Palliative and End-of-Life Care (C-COPE) instrument.

BACKGROUND: Nurses must be comfortable facilitating palliative and end-of-life communication with patients and their families. AIM: A validated instrument measuring the comfort of nurses with conducting end-of-life communication is essential for meeting the goals and wishes of patient care. This study aimed to develop and conduct a psychometric evaluation of the Comfort with Communication in Palliative and End-of-Life Care (C-COPE) instrument. METHODS: Face, content, and construct validity, including test-retest reliability, were conducted. RESULTS: Four experts subjectively confirmed face content validity and the quantitative item content validity index (I-CVI) ranged from 0.67 to 1 and scale content validity index (S-CVI/Ave) was 0.98. Principal axis factoring with Promax rotation yielded a five-factor solution accounting for 66.2% of the variance. The items loading on the five factors ranged from 0.46-0.96 (factor 1), 0.67-0.93 (factor 2), 0.49-0.86 (factor 3), 0.68-0.79 (factor 4), and 0.24-0.96 (factor 5). Internal consistency reliability (coefficient a) was 0.90 for the total C-COPE, and above 0.75 for each factor. The five factors are 'cultural/spiritual considerations,' 'team considerations,' 'addressing decision-making,' 'addressing symptomatology,' and 'deliberate awareness.' Test-retest reliability yielded an intraclass correlation coefficient (ICC) of 0.87 (CI 95%, 0.82-0.91). CONCLUSIONS: The C-COPE is a reliable and valid instrument measuring nurse comfort with palliative and end of-life care communication, yet requires testing in more diverse samples.

Nurse Comfort With Palliative and End-of-Life Communication: A Rural and Urban Comparison.

Communication is a key component of palliative and end-of-life care. Little is known about comfort with palliative and end-of-life communication among nurses working in rural and urban settings. We assessed this comparison using the 28-item (including 2 ranked items) Comfort with Communication in Palliative and End-of-Life Care instrument. Descriptive analyses of the sample (N = 252) identified statistically significant results differences for age and experience; rural nurses were older and more experienced. Urban nurses reported less comfort than did rural nurses based on composite score analysis (P = .03) and reported less comfort than did rural nurses in talking with patients and families about "end-of-life decisions" (P < .05). Overall, years of experience were significant for more comfort with end-of-life communication. Our instrument could be used within academic settings to establish baseline awareness of comfort with palliative and end-of-life communication and in institutional settings to provide a continuing education bridge from prelicensure through licensure. Moreover, experienced nurses are integral in mentoring new graduates in initiating and sustaining difficult conversations.

Midcareer Faculty Needs Identified by the Midwest Nursing Research Society Midcareer Scholars Task Force.

The midcareer academic period is largely unexplored despite its lengthy duration and challenging career expectations at academic institutions. The Midwest Nursing Research Society (MNRS) formed a Midcareer Scholars Task Force to address this gap. All active members of MNRS were invited to participate in a cross-sectional survey, of which 286 members completed. The most frequently perceived institutional support for midcareer scholars was for conference attendance followed by librarian assistance. Most assistant and associate professors perceived mentoring as a critical MNRS organizational activity to advance their research and careers; however, full professors saw MNRS's responsibility in mentoring midcareer scholars differently. Existing academic institutions were perceived as limited in their support and success in midcareer scholar mentorship efforts. There are considerable needs for midcareer scholar support and mentoring, and professional organizations can play an important role to fill this gap. Targeted mentoring and professional development initiatives are needed to better support midcareer faculty.

End-of-Life Communication: Nurses Cocreating the Closing Composition With Patients and Families.

Communication is imperative for end-of-life decision-making; however, descriptions of key strategies used by nurses are missing. A phenomenological approach was used to interpret interviews from 10 hospice/palliative nurses. The overarching pattern is the closing composition. Key communication strategies/patterns include establishing context, acknowledging through attentive listening, making it safe for them to die, planning goals of care, and being honest. Essential is the awareness that nurse, patient, and family all hold expertise in the subject matter. It is imperative that pre-/postnursing licensure curriculum be expanded to include training in mutual influence communication practices and mentoring in the skill of orchestration.

A willingness to go there: Nurses and spiritual care.

AIMS AND OBJECTIVES: To describe rural and urban palliative/hospice care nurses' communication strategies while providing spiritual care for patients and families at end of life. BACKGROUND: Nurses aim to provide holistic care consisting of physical, psychological and spiritual components. However, it is well documented that spiritual care is largely missing from nursing care. Internationally, spiritual care is a growing topic of interest, yet many nurses feel unprepared to deliver spiritual care. DESIGN: This qualitative study used Braun and Clarke's thematic analysis method. METHODS: As part of a larger multimethod study, this study shares the narrative descriptions from 10 experienced palliative/hospice care nurses. Individual, face-to-face interviews were conducted and lasted 45-60 minutes. Each interview started with the same lead-in questions, was audio-recorded and was transcribed verbatim. The research team used an inductive analysis approach and met several times reviewing and analysing the detected themes until reaching consensus. RESULTS: The primary theme, sentience includes the capacity to act, a willingness to enter into the unknown and the ability to have deep meaningful conversations with patients regardless of the path it may yield. Subthemes include: (i) Willingness to Go There, (ii) Being in "A" Moment and (iii) Sagacious Insight. CONCLUSION: Nurses are integral in the provision of spiritual care for patients/families across the lifespan and at end of life. Nurses must feel confident and competent before they are willing to enter uncomfortable spaces with patients/families. Nursing curriculum must include purposeful engagement and focused debriefing in spiritual assessment and care. RELEVANCE TO CLINICAL PRACTICE: There is a dire need to prepare undergraduate and graduate students to assess and support a patient's spiritual needs. Addressing spiritual care content as a clinical and educational priority will promote a patient-centred approach for spiritual care and can further shape nursing curricula, policies, guidelines and assessment tools.

A Multi-faceted Approach to Improving Breast Cancer Outcomes in a Rural Population, and the Potential Impact of Patient Navigation.

UNLABELLED: The mastectomy rate in rural areas of the Northern Plains of the U.S. was 64 percent from 2000 through 2005. We implemented a breast cancer patient navigation (BPN) program in May 2007 to increase breast conservation (BC) rates. METHODS: We analyzed mastectomy and BC rates among our 1,466 patients with either ductal carcinoma in situ (DCIS) or stage I/II invasive breast cancer treated from 2000 through 2012. We used interrupted time series (ITS) to compare rates in treatment following implementation of BPN. In addition, breast conservation rates were compared to population data from the Surveillance, Epidemiology, and End Results (SEER) database. RESULTS: The BC rates were 56 percent for navigated patients versus 37 percent for non-navigated patients (95 percent CI for difference: 14.8 to 25.6 percent). There was a consistent annual increase in treatment with BC versus a mastectomy (+2.9 percent/year, p-trend < 0.001). The BC rate of 60 percent in 2012 now mirrors those observed in the SEER database. The ITS did not find that the change in BC rates over time was significantly attributable to implementation of the BPN. Other secular trends may have contributed to the change in BC rates over time. CONCLUSIONS: A number of factors may have contributed to an increase of BC rates over time, including physician and patient education, more radiation therapy options, and possibly a dedicated breast cancer PN program. This analysis demonstrates that overall breast cancer care among this rural and medically-underserved population is improving in our region and now parallels other regions of the country.

Prayer and the Registered Nurse (PRN): nurses' reports of ease and dis-ease with patient-initiated prayer request.

AIMS: To explore nurse comfort with patient-initiated prayer request scenarios. BACKGROUND: Spiritual care is fundamental to patient care evidenced by Joint Commission requirement of a spiritual assessment on a patient's hospital admission. Prayer is an assessment component. Patients may seek solace and support by requesting prayer from the bedside nurse, the nurse may lack confidence in responding. Absent in the literature are reports specific to nurses' comfort when patients initiate prayer requests. DESIGN: Cross-sectional mixed methods study. METHODS: Data were collected in early 2014 from 134 nurses in the USA via an online survey using QuestionPro. The qualitative results reported here were collated by scenario and analysed using thematic analysis. RESULTS/FINDINGS: The scenario responses revealed patterns of ease and dis-ease in response to patient requests for prayer. The pattern of ease of prayer with patients revealed three themes: open to voice of calm or silence; physical or spiritual; can I call the chaplain. For these nurses, prayer is a natural component of nursing care, as the majority of responses to all scenarios demonstrated an overwhelming ease in response and capacity to pray with patients on request. The pattern of dis-ease of prayer with patients distinguished two themes: cautious hesitancy and whose God. These nurses experienced dis-ease with the patient's request no matter the situation. CONCLUSION: Educators and administrators must nurture opportunities for students and nurses to learn about and engage in the reflective preparation needed to respond to patient prayer requests.

Palliative and end-of-life care in South Dakota.

BACKGROUND: Geographical disparities play a significant role in palliative and end-of-life care access. This study assessed availability of palliative and end of life (hospice) care in South Dakota. METHODS: Grounded in a conceptual model of advance care planning, this assessment explored whether South Dakota health care facilities had contact persons for palliative care, hospice services, and advance directives; health care providers with specialized training in palliative and hospice care; and a process for advance directives and advance care planning. Trained research assistants conducted a brief telephone survey. RESULTS: Of 668 health care eligible facilities, 455 completed the survey for a response rate of 68 percent (455 out of 668). Over one-half of facilities had no specific contact person for palliative care, hospice services and advance directives. Nursing homes reported the highest percentage of contacts for palliative care, hospice services and advance directives. Despite a lack of a specific contact person, nearly 75 percent of facilities reported having a process in place for addressing advance directives with patients; slightly over one-half (53 percent) reported having a process in place for advance care planning. Of participating facilities, 80 percent had no staff members with palliative care training, and 73 percent identified lack of staff members with end-of-life care training. Palliative care training was most commonly reported among hospice/home health facilities (45 percent). CONCLUSIONS: The results of this study demonstrate a clear need for a health care and allied health care workforce with specialized training in palliative and end-of-life care.

Carrying the pain: the journey from suffering to transformation-perspectives from Shakespearean tragedy and pastoral care.

This paper proposes an admittedly difficult thesis that emotional pain and suffering can be good news. Rather than denying and running from emotional pain and suffering, we suggest embracing and carrying the pain. Through academic and spiritual writings, an observation of Hamlet's tragic suffering, an examination of pastoral care case study data, and a B.L.E.S.S. acronym, this paper proposes that within the experience of suffering lies the transformative potential for meaning and fullness.

The first anniversary: stress, well-being, and optimism in older widows.

The first anniversary for older widows (n = 47) has been explored during Months 11, 12, and 13. Concurrent correlations show that optimism inversely correlates with psychological (intrusion and avoidance) stress as measured with the Impact of Event Scale (r = -.52 to -.66, p < .005) and positively correlates with well-being (physical: r = .36 to .46, p < .025; psychosocial: r = .58 to .72, p < .005; spiritual: r = .50 to .69, p < .005). Lagged correlation patterns suggest that higher levels of optimism at a given time are associated with higher life satisfaction and spiritual well-being at later times. Psychological stress is higher at Month 12 when compared to Month 13, t(43) = 2.54, p = .01, but not when compared to Month 11, t(43) = 1.49, p > .10. There are no significant differences in physiologic stress (salivary cortisol) or well-being during the first anniversary of spousal bereavement.

Spousal bereavement assessment: a review of bereavement-specific measures.

The death of a spouse represents a common form of bereavement among adults and is associated with significant distress and adaptation. This 10-year review of the bereavement literature highlights 12 tools used to assess bereavement in spousally bereaved samples. Pertinent measurement foci and psychometric properties of each tool are presented. Applicability of each tool within the spousal bereavement process is discussed, and aspects of the spousal bereavement process not currently addressed or under-addressed provide direction for future tool development.