Assessing Tobacco Treatment Engagement in Assertive Community Treatment Programs.

OBJECTIVE: Despite high tobacco use prevalence among those with serious mental illnesses, few Assertive Community Treatment (ACT) programs provide tobacco treatment. Understanding the factors associated with the intentions to engage in tobacco treatment from both provider and consumer perspectives is important. The purpose was to examine ACT providers' intention to provide and consumer intention to engage in tobacco treatment. METHOD: A cross-sectional survey of ACT program providers (N = 51) and consumers (N = 43) from four community mental health centers. Multiple linear regression analyses were used to examine factors associated with the intentions to provide or engage in tobacco treatment from among attitudinal, subjective norms, and perceived behavioral control variables. RESULTS: Providers reported positive attitudes, high degree of perceived behavior control, and high intentions for delivering tobacco treatment, but poor perceptions of subjective norms. These results were like consumers' intentions to engage in tobacco treatment. In regression analysis, only subjective norms and perceived behavior control were significant predictors for providers' intentions to provide tobacco treatment, but there were no significant predictors of consumers' intentions to engage in tobacco treatment. Both providers and consumers endorsed poor implementation of evidence-based tobacco treatment. CONCLUSION: Poor engagement in tobacco treatment within ACT programs indicates the need for policymakers to support tobacco treatment within the services. This finding calls for training of mental and behavioral health providers while supporting tobacco-free initiatives in ACT treatment service settings.

The Relationship Between Trauma and Substance Use Among Healthcare Workers: A Cross-Sectional Analysis.

ABSTRACT: Trauma exposure is prevalent in the general population, but healthcare workers may be at greater risks for additional work-related trauma. Trauma is a known risk factor for substance use, particularly tobacco and risky alcohol use. Few studies have examined the relationship between trauma and substance use in healthcare workers. Among healthcare workers, the aims of our study were to examine (a) frequency of current tobacco use and risky alcohol use, (b) frequency and types of traumatic experiences, and (c) the associations between trauma experiences and current tobacco and risky alcohol use controlling for demographic factors. This study is a secondary analysis of cross-sectional survey data from healthcare workers (N = 850) in an academic medical center. Demographic and work-related variables, trauma experience, and substance use were examined. Multivariate logistic regression analysis examined associations between trauma exposure and tobacco and risky alcohol use controlling for demographic and work-related variables. Nearly 75% of respondents reported at least one lifetime traumatic experience, and one in 10 reported tobacco and risky alcohol use. When controlling for demographic and work-related variables, a dose-response relationship was observed such that the higher the number of traumatic experiences, there was a greater likelihood of reporting tobacco or risky alcohol use. Because healthcare providers have additional work-related trauma risk above the public, and greater trauma is associated with increased risk for substance use, it is important to screen for trauma and provide appropriate treatment resources to healthcare providers. Future research is needed to better delineate the relationship between specific traumas and risky substance use among healthcare providers.

Evaluating Simulation-Based Tobacco Treatment Scenarios for Providers Delivering Treatment for People Living With Mental Illnesses.

Background: People living with mental illnesses (PMI) experience elevated tobacco use and related morbidity and mortality. Despite the availability of effective and safe tobacco treatments along with evidence that PMI are motivated and able to quit successfully, few Mental and behavioral healthcare providers (MHPs) engage PMI in such treatment. MHPs may lack the confidence or skills to engage their clients in tobacco treatment. Currently, there are limited training modalities to prepare MHPs in delivering tobacco treatment for PMI. However, animated scenario-based simulated encounters can bridge this gap to effectively provide tailored MHP training to enhance treatment delivery. Hence, the purpose of this study was to evaluate simulated tobacco treatment education scenarios tailored to MHPs. Methods: For this evaluation, we used a pretest-posttest design to assess changes in MHPs tobacco treatment knowledge and behavioral intentions after viewing simulated treatment encounters. We developed four animated scenarios, using brief tobacco treatment interventions, simulating treatment encounters with PMI. MHPs were primarily recruited from mental or behavioral healthcare facilities and were asked to complete a web-based questionnaire. Their knowledge, views, and experiences in providing tobacco treatment were assessed prior to viewing the animated scenarios. Participants were then asked to evaluate the desirability, acceptability, and applicability of the animated scenarios; and thereafter, their knowledge of and intentions to provide evidence-based tobacco treatment (i.e., ASK, ADVISE, ASSESS, ASSIST, ARRANGE) were again assessed. Results: Participants (N = 81) were on average 41.0 years of age, mostly female (79.0%), and non-Hispanic White (86.4%). Nearly a quarter endorsed current tobacco use and few had tobacco treatment training (14.8%). Overall knowledge of tobacco treatment scores significantly increased before and after viewing the videos (M = 3.5 [SD = 1.0] to M = 4.1 [SD = 1.0], p < 0.0001). After viewing the simulated scenario videos, participants endorsed moderate to high mean scores (ranging from 4.0-4.2 on a 0 to 5 scale) on the desirability, acceptability, and applicability of the different animated scenarios. In addition, after viewing the scenarios the proportion of participants who endorsed that they intended to occasionally/very often engage clients in evidence based tobacco treatment were high for ASK (94.9%), followed by ADVISE and ASSESS (84.7% each), followed by ASSIST (81.4%), and ARRANGE (74.6%). Evaluation scores significantly differed by type of animated scenario and participants' work settings and discipline. Conclusions: These findings suggest that the use of brief animated scenarios may be a useful modality to enhance MHPs knowledge acquisition and treatment delivery intentions. Such approaches may be integrated into tobacco treatment trainings for MHPs.

Factors associated with posttraumatic growth among healthcare workers at an academic-medical center: A correlational study.

PURPOSE: Posttraumatic growth (PTG) can occur after experiencing traumatic events. Our purpose was to examine factors associated with PTG experiences of healthcare workers within an academic-medical center. DESIGN AND METHODS: A correlational study was conducted using a convenience sample of 479 healthcare workers at a large academic-medical center. FINDINGS: Having children living at home, serving the pediatric population, longer duration of alcohol abstinence, and having received treatment for trauma were significantly associated with greater PTG scores. Compared to nondirect care staff, advance practice providers, nursing staff, social work/psychologists, and pharmacy staff had significantly lower PTG scores. PRACTICE IMPLICATIONS: Understanding the positive psychological changes that occur in workers after trauma experiences may provide insight to guide interventions that promote healthcare worker wellbeing.

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress Among Nursing Staff at an Academic Medical Center: A Cross-Sectional Analysis.

BACKGROUND: Although several studies have recently described compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in nurses, few to date have examined these issues across nursing specialties. Such examination is needed to inform future nursing-subspecialty tailored interventions. AIMS: To examine (1) differences in CS, BO, and STS across nursing specialties and (2) differences associated with demographic, work-related, and behavioral factors among nurses. METHOD: A secondary analysis of survey responses from nurses (N = 350) at an academic medical center. Demographic, behavioral, work-related, and professional quality of life variables were analyzed using hierarchical regression analyses. RESULTS: CS, BO, and STS scores significantly varied across specialties with emergency nurses experiencing significantly elevated rates of BO and STS, and lowest rates of CS; scores were also differentially associated with demographic, work-related, behavioral, and workplace violence variables. CONCLUSIONS: Key differences in CS, BO, and STS by nursing specialty suggests the importance of tailoring BO and STS mitigative interventions. BO and STS risk factors should be assessed in nurses (e.g., behavioral health problems and poor sleep quality) and specialty-specific interventions (e.g., reducing workplace violence exposure in emergency settings) may be considered to improve CS while reducing BO and STS among nurses.

Correlates of post-traumatic growth among nursing professionals: A cross-sectional analysis.

AIMS: Among nursing professionals, our aims were to examine (a) self-reported traumatic experiences, (b) differences in post-traumatic growth (i.e. positive psychological growth after experiencing a traumatic event) by nursing professional level and (c) demographic, work-related, behavioural and traumatic experience covariates of post-traumatic growth. BACKGROUND: Trauma experience among nursing professionals is higher than observed in the general population. Due to the nature of their work environment, workplace trauma rates are particularly alarming. Understanding post-traumatic growth among nursing professionals may guide interventions to enhance well-being. METHOD: A secondary analysis of cross-sectional survey data from nursing professionals (N = 299). Demographic, work-related, behavioural, trauma experience categories and post-traumatic growth variables were examined. RESULTS: Advanced practice nurses and clinical nurses reported higher rates of workplace trauma, as compared to nursing assistants. Higher post-traumatic growth scores were associated with having a postgraduate degree, serving the paediatric population and lower frequency of alcohol use. Lower post-traumatic growth scores were associated with being married/widowed, being an advanced practice provider or clinical nurse, working in the intensive care unit and reporting workplace, family/personal stress and undisclosed trauma. CONCLUSIONS: Nursing professionals have several demographic, work-related, behavioural and traumatic experience-related variables associated with and that explain variances in post-traumatic growth. IMPLICATION FOR NURSING MANAGEMENT: Targeted screening and individualized treatment based on nursing professional level should be considered to support trauma recovery and post-traumatic growth.

Factors Associated With Burnout in Trauma Nurses.

BACKGROUND: Burnout is a psychological syndrome resulting from repeated stressors experienced in the workplace that centers on emotional exhaustion, detachment from the job, and a sense of ineffectiveness. It has been previously demonstrated that burnout exists in the health care workforce, but there has been limited investigation of burnout in nurses who primarily provide care for patients who have been traumatically injured. The purpose of this study was to explore factors associated with burnout reported by trauma nurses. METHODS: This was a secondary analysis of a cross-sectional survey distributed at a large, academic Level I trauma center that serves both adult and pediatric patients. For this analysis, only the Burnout subscale of the Professional Quality of Life scale Version 5 (ProQOL) was used. Multivariate hierarchical regression was used to determine factors associated with burnout reported by trauma nurses. RESULTS: Protective factors included being female, being married, and better quality of sleep. Risk factors included having a mental health diagnosis and working with adult populations. CONCLUSIONS: These results provide an important contribution to the burnout risk profile for trauma nurses and may provide insight into future investigations as well as development and testing of tailored interventions to mitigate burnout in trauma nurses.

Assessing opinions and barriers to providing evidence-based tobacco treatment among health care providers within an in-patient psychiatric facility.

Background: Tobacco-related morbidity and mortality is high among people with mental illnesses (PMI); yet tobacco treatment (TT) is often not provided by mental health care providers (MHPs). Studies that examine barriers to TT for people with MI are critical in addressing this disparity.Aims: To determine factors associated with MHPs' opinions of, self-efficacy in, barriers to and training needs for providing TT by job role.Methods: 205 MHPs in a psychiatric facility were surveyed using a standardized questionnaire on demographics and opinions, self-efficacy, barriers and needs to providing TT. Descriptive and multivariate regression analyses examined factors associated with the main outcomes.Results: MHP's gave high ratings to both the appropriateness of delivering evidence-based TT and their confidence in providing TT medications. In regards to perceived barriers to providing TT, MHP's further endorsed that patients should be provided nicotine replacement therapy and be motivated to engage in TT. Key needs were for training in cessation counseling, cessation materials and community support for TT.Conclusions: Based on our findings, future studies are needed to address providers' biases and concerns, eliminate system-barriers and determine effective provider training. Moreover, these findings may guide research, practice and policies toward enhancing TT in PMI.

Reasons for Tobacco Use and Perceived Tobacco-Related Health Risks in an Inpatient Psychiatric Population.

People with mental illness (MI) have a disproportionate tobacco-related disease burden and mortality. Tobacco-use rates in people with MI are nearly twice that of the general population. Reasons for tobacco-use in this population may be a result of diminished tobacco-related disease risk perceptions. The purpose of this study was to examine the reasons for tobacco-use and perceived tobacco-related health risks among psychiatric inpatients. A correlational design was employed to survey a convenient sample of 137 patients from a psychiatric facility in central Kentucky. Information obtained from participants included demographics, psychiatric diagnoses, tobacco-use and exposure history, medical illness history, reasons for tobacco-use, and tobacco-related illness risk perceptions. The primary reasons participants endorsed for tobacco-use were for stress reduction, followed by addiction, then boredom, psychiatric symptom control, social, and negative mood. In addition, about 72% of participants used tobacco to cope with MI symptoms and 52% to manage the side effects of their medications. Participants were most likely to endorse that tobacco-use caused lung disease (83.2%), heart disease (79.6%), cancer (77.4%), and premature mortality (79.6%) but were less likely to admit that it may cause addiction to other drugs (39.4%) or MI (23.4%). Given the high endorsement of tobacco-use for stress reduction and psychiatric symptom control, it is important for mental health nurses to properly educate consumers on tobacco addiction and evidence of its effects on mental health. Strategies to incorporate our study findings into routine mental health services may address the tobacco-use disparities experienced by people with MI.

A cross-sectional examination of factors associated with compassion satisfaction and compassion fatigue across healthcare workers in an academic medical centre.

Compassion satisfaction (CS) among healthcare professionals is a sense of gratification derived from caring for their suffering patients. In contrast, compassion fatigue, often a consequence of burnout (BO) and secondary traumatic stress (STS), is detrimental to healthcare professionals' productivity and patient care. While several studies have examined CS, BO, and STS among healthcare professionals, the majority have assessed samples in specific disciplines. However, the comparative differences in these factors by discipline or work setting are not well known. The aims of this study were to examine the differences in CS, BO, and STS by discipline and work setting, and to assess demographic, work-related, and behavioural factors associated with these outcomes. An electronic survey was administered (N = 764) at a large academic medical centre in the southeast United States. Questions elicited demographic variables, work-related factors, behavioural/lifestyle factors, experience with workplace violence, and the Professional Quality of Life Scale. Findings of the study determined that the rates of CS, BO, and STS vary across healthcare disciplines and work settings. Demographic, work-related, behavioural, and work setting (i.e., experience of workplace violence) factors were differentially associated with experiences of CS, BO, and STS. The results of the study suggest two potential areas for research, specifically workplace violence and sleep quality as a means of further understanding reduced CS and increased BO and STS among healthcare workers. These findings have important implications for future research and policy interventions to enhance healthcare workers' health and safety.

Factors Associated with the Initial Sensations of Smoking among Smokers with Mental Illness.

People with mental illnesses (MI) have a disproportionate smoking prevalence and associated disease burden. Smoking initiation among people with MI is poorly understood. However, the sensations experienced during smoking initiation predict continued smoking and nicotine dependence. Yet, few studies have examined the initial experiences of smoking among people with MI. Thus, the aim of this study was to explore factors associated with the initial sensations of smoking in people with MI. Smokers in an inpatient psychiatric facility (n = 123) were surveyed. Data obtained included information on demographics, smoking and secondhand smoke (SHS) exposure, psychiatric diagnoses, and sensations of initial smoking. Spearman correlations explored associations among initial smoking sensation variables; and binary logistic regression analyses examined the associations between study variables and groupings derived from initial sensations (i.e., "pleasant + buzz," "unpleasant + buzz," and "all" sensations). The most frequently reported initial smoking sensation was feeling dizzy (87%) and there were low to moderate correlations between unpleasant (e.g., cough, sick, nervous) and pleasant (e.g., good, relaxed) sensations. In logistic regression analyses, having higher perceived SHS exposure was significantly associated with the "pleasant + buzz" sensation grouping; and lower past week SHS exposure was associated with the "unpleasant + buzz" sensation grouping; but, no variables were associated with "all" sensation group. Initial smoking sensations are an uncharted avenue of exploration in understanding smoking initiation among people with MI. SHS exposure may be an important factor associated with the report of both unpleasant and pleasant initial sensations. Future studies are needed to further explore initial sensations in relation to the context of smoking initiation among people with MI.

Correlates of Tobacco Use and Consumption Among Hospitalized Psychiatric Patients.

Using a cross-sectional analysis, we assessed correlates of tobacco use and tobacco consumption from inpatient records (N = 2,060) from a state psychiatric hospital. We used multivariate logistic regression analyses to examine correlates of tobacco use in the total sample and multivariate linear regression to examine correlates of tobacco consumption among tobacco users. Tobacco-use associated variables in the total sample were being male, being White, lower education, having a substance-use disorder/treatment, having an externalizing or psychotic disorder, being from a rural county, being younger, and shorter length of hospital stay. Among tobacco users (n = 1,153), correlates of amount of tobacco consumption were being male; being White; lower education; having an internalizing, externalizing, and psychotic disorder; using cigarettes; and living in a county without a smoke-free policy. Psychiatric patients should be screened for specific associative variables as part of tobacco-use assessments. Future research may expand on the current findings to develop strategies to enhance tobacco treatment among psychiatric patients.

Which Types of Tobacco Treatment Interventions Work for People with Schizophrenia? Provider and Mental Health Consumer Perspectives.

People with schizophrenia and other psychotic disorders (PWS) consume tobacco at high rates, resulting in disproportionate tobacco-related morbidity and mortality. Conventional tobacco treatment (TT) approaches may not adequately address unique affective, cognitive, and social challenges of PWS during cessation. This study sought to obtain provider and mental health consumer perspectives on effective, desirable, applicable, and acceptable components of TT for PWS. This convergent mixed-method study used structured interviews and a cross-sectional survey to obtain data. Eighteen mental health consumers and six mental health providers were engaged in face-to-face or telephone interviews. The qualitative data were analyzed using content analysis and theme identification and descriptive statistics were used for the analysis of quantitative data. In the qualitative analysis, consumers endorsed education, counseling, social support, and pharmacotherapy as key TT components. Consumers further stressed the need for flexible interventions that are available at any point in a quit attempt. Both providers and consumers endorsed targeting TT interventions to consider learning needs, potential cognitive issues, and motivation for behavioral change. Providers encouraged a recovery-driven TT framework with peer support and health promotion activities. Quantitative findings mirrored the qualitative findings with support sessions, relapse prevention, and skills training having the highest desirability, applicability, and acceptability TT component scores. Providers and consumers agreed on components of an effective TT program targeted to PWS. Given these findings, it is crucial to further investigate successful TT approaches for PWS and to test whether targeted or tailored programs are more effective than conventional approaches.

Associations Between Secondhand Tobacco Smoke Exposure and Nicotine Dependence and Smoking Cessation Attempts Among Adult Tobacco Users With a Psychiatric Disorder.

INTRODUCTION: Secondhand smoke exposure (SHSe) is predictive of greater nicotine dependence (ND) and poor smoking cessation (SC) outcomes. SHSe and its impact on ND and SC attempts in people with psychiatric disorders (PD) remain poorly understood. Hence, the objectives of this study were to (1) quantify SHSe, (2) examine the association of SHSe with ND, and (3) assess the association between SHSe and SC among tobacco users with PD. METHOD: A cross-sectional survey of 118 tobacco users in an inpatient psychiatric facility was conducted. Data on demographics, tobacco use and SHSe history, motivation to quit smoking, ND, and SC attempts were obtained. Participants' environmental and psychosocial sources of and perceived SHSe were described. Multivariate linear regression analyses were used to examine the associations between SHSe and ND, while logistic regression analyses were used to assess the associations between SHSe and SC. RESULTS: The primary sources of environmental SHSe were from the car (63.6%) and home (51.7%); primary sources of psychosocial SHSe were close friends (67.8%) and parents/grandparents (65.3%); and mean perceived SHSe was 6.2 ( SD = 3.5). Although perceived SHSe was significantly associated with ND (ß = .39, p < .0001) in multivariate analyses, no SHSe variable was associated with SC. However, scores on items measuring motivation to quit smoking were associated with SC attempts. DISCUSSION: Patients with PD reported high levels of SHSe, which was associated with higher ND. Routine screening for SHSe should be implemented as part of health assessments in this population to address ND treatment options. Moreover, targeted interventions and policies should be considered toward reducing SHSe in this vulnerable population.