Psychiatric mental health nurse practitioners experiencing therapeutic alliance while using tele-mental health: A phenomenological study.

BACKGROUND: Psychiatric mental health nurse practitioners have rapidly adopted and implemented tele-mental health in their practice; however it is unclear how this modality of care affects the experiential quality of therapeutic alliance, simply defined as the interpersonal working bond between provider and patient. OBJECTIVE: This study is the first to explore how psychiatric mental health nurse practitioners experience therapeutic alliance while using tele-mental health. DESIGN: Husserlian phenomenological qualitative study. PARTICIPANTS: A purposive, convenience sample of 17 American psychiatric mental health nurse practitioners who engaged in tele-mental health care were recruited online and interviewed. METHODS: Phenomenological interview transcripts recorded and later thematically coded in the qualitative software MaxQDA. RESULTS: From 1426 individual codes, five major themes and 16 subthemes were discovered. Overall, themes illuminated that psychiatric mental health nurse practitioners could build therapeutic alliance over tele-mental health using inherent interpersonal skills that had to be adapted to the technology. Adaptions included working with patient environmental factors, individual patient considerations, provider ambivalence, and technological observation shifting awareness and communication patterns. CONCLUSIONS: When adapting for the tele-mental health environment, psychiatric mental health nurse practitioners experienced building and sustaining therapeutic alliance with most patients. Unparalleled aspects of tele-mental health allowed for a fuller clinical picture and logistical convenience to see patients more often with ease for both the provider and patient. However, experiential aspects of therapeutic alliance created during in-person care could not be replaced with tele-mental health. In conclusion, participants concluded that a hybrid care model would enhance therapeutic alliance for most patients.

A Theoretical Framework for Conducting Psychiatric Mental Health Nursing Virtual Care & Research.

Despite rapid adoption and implementation, theoretical research considerations for virtual care (VC), defined simply as healthcare delivered using technology, are lacking across psychiatric mental health nursing (PMHN) scholarship. By adapting Hildegard Peplau's Interpersonal Relations Theory (IRT) and Media Richness Theory (MRT) using an intermodern and emancipatory knowing approach, a new framework was created for guiding modern PMHN VC research. Using this theoretical framework, readers can gain awareness of how the art and science of PMHN practice can be applied to VC scholarly endeavors in the modern healthcare space.

Clear integration of nursing and media theories to inform modern psychiatric mental health nursing virtual care and respective clinical vignetteDetails how the art and science of psychiatric mental health nursing can be applied to virtual care and researchFuture research applications regarding psychiatric mental health nursing virtual care are providedAmple review of interpersonal relations theory in psychiatric mental health nursing practice.

Development of an Intentional Telehealth Viewing Guide for Home-Based Patient Assessment.

Background: The increased use of telehealth to visit patients in their home permits greater access to care, and also increases the opportunity for whole-person assessments that improve individualized care. The videoconferencing camera is a proxy for home visit provider's eyes. However, cameras limit views, thereby reducing environmental cues. The Novice to Expert Theory of skill acquisition supports the use of an intentional viewing guide to assure a comprehensive patient assessment using telehealth in the home (CPATH). This study advances the development of a CPATH framework to guide providers to be intentional when using televideo technology. Methods: A quantitative content validity approach was used to determine the validity of a priori items within domains that were in the original protocol framework. A content validity determination requires 5-10 experts to rate agreement (range 1-5) on items within domains. Our sample was composed of seven expert home health providers. More than five experts had to agree to achieve statistical significance (p < 0.05) for validity. Results: Of the 15 items in the protocol, only 8 items had significant agreement for the sample size. These items were breathing, nonverbal gesturing, positioning, oxygen, safety, and types, dosages, and administration guidance of medication. Other items were added within the existing domains of Patient Characteristics, Treatment and Equipment Functioning, Medications and Environmental Quality, with the exception of Caregivers. Conclusion: The domains triggered considerations for existing or additional items that require assessment, thereby developing the intentional guide framework that permits individualization of a telehealth home-based visit.

Advanced Practice Registered Nurses Using Synchronous Telepsychiatry: An Integrative Systematic Review.

BACKGROUND: Despite wide-spread use, telepsychiatry use among psychiatric mental health advanced practice nurse practitioners (PMH APRNs) has not been systematically explored in the literature. AIMS: Systematically review the PMH APRN usage of live-time, synchronous telepsychiatry including audiovisual teleconferencing technology. METHOD: A comprehensive, systematic search was performed with no publication date restriction across CINAHL, the Cochrane Library, Embase, Google Scholar, PsycINFO, PubMed, Scopus, and Web of Science on July 30, 2019, by a medical librarian. Each citation was blinded and independently reviewed by three reviewers, and consensus was reached for inclusion. Eligible articles were peer-reviewed research or quality improvement articles available in full-text, written in English, including real-time, synchronous, audiovisual telepsychiatry services with PMH APRN providers. Discussion articles and literature reviews were excluded. Article quality and bias were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment tool. RESULTS: The search yielded a total of 342 articles, and only nine articles met full inclusion criteria. Overall, risk of bias was high in all studies, and the GRADE rating consisted of three "very low," five "low," and one "medium" quality article. However, considering the collectively positive outcomes from PMH APRN telepsychiatry use, the overall GRADE recommendation was to "probably do it" for seven studies and "do it" for two studies. CONCLUSIONS: Though existent literature is low quality and sparse, evidence supports that PMH APRNs can feasibly and successfully provide telepsychiatry services across a wide range of demographic patients and locations. PMH APRNs should contribute more original evidence to guide telepsychiatry implementation and adoption as the service expands.

Compassion Fatigue Among RNs Working in Skilled Nursing Facilities.

Nurses employed in skilled nursing facilities (SNFs) are at risk for developing compassion fatigue. Compassion fatigue negatively impacts patient outcomes and is associated with decreased quality of care. Some nurses leave the profession due to compassion fatigue. There are no published studies in the United States focused on compassion fatigue among SNF nurses. The purpose of this interpretive phenomenological study was to identify the shared meanings of compassion fatigue among RNs caring for residents in SNFs. Shared meanings among participants were identified as: (1) I feel conflicted, which causes my compassion fatigue; (2) I feel physical and emotional manifestations of compassion fatigue; (3) Compassion fatigue is infused in every aspect of my life; and (4) We are trying to cope with compassion fatigue. Of paramount importance was the desire to make a difference in the lives of residents. Three participants sought employment outside the SNF setting due to compassion fatigue. Further research and education are needed to improve knowledge, policy, and practice. [Research in Gerontological Nursing, 13(6), 320-328.].

Knowledge Gaps About End-of-Life Decision Making Among Mexican American Older Adults and Their Family Caregivers: An Integrative Review.

INTRODUCTION: Mexican Americans (MAs) are the largest, fastest growing Latino subgroup in the United States, yet their use of hospice is limited. To better understand this disparity, the authors conducted an integrative review focused on MA caregiving families' end-of-life (EOL) care decisions. METHOD: In this literature review, the authors content analyzed results and discussions of 22 research studies focused on EOL decisions, which sampled MA adults at least 50 years old and/or families. The authors used Whittemore and Knafl's integrative review process, employing constructs from the Ethno-Cultural Gerontological Nursing Model. RESULTS: Topics included attitudes toward hospice, life-sustaining treatment, advance care planning, EOL decision making, perceptions of a good death, and life-limiting illnesses. EOL research for MA caregiving families is meager, largely atheoretical, and rarely validated by subsequent studies. DISCUSSION: Nursing research is needed to extend theory and policy in order to skillfully match EOL care with MA caregiving families' needs.

A model to evaluate data science in nursing doctoral curricula.

BACKGROUND: Building on the efforts of the American Association of Colleges of Nursing, we developed a model to infuse data science constructs into doctor of philosophy (PhD) curriculum. Using this model, developing nurse scientists can learn data science and be at the forefront of data driven healthcare. PURPOSE: Here we present the Data Science Curriculum Organizing Model (DSCOM) to guide comprehensive doctoral education about data science. METHODS: Our team transformed the terminology and applicability of multidisciplinary data science models into the DSCOM. FINDINGS: The DSCOM represents concepts and constructs, and their relationships, which are essential to a comprehensive understanding of data science. Application of the DSCOM identified areas for threading as well as gaps that require content in core coursework. DISCUSSION: The DSCOM is an effective tool to guide curriculum development and evaluation towards the preparation of nurse scientists with knowledge of data science.

Family Caregivers' Experiences of Within-Hospital Handoffs for Older Adults in Acute Care.

Family caregivers' experiences during within-hospital handoffs between acute care units are not well understood. Qualitative description methodology was employed to describe family caregivers' experiences during their loved ones' handoffs. Semistructured interviews were conducted with 10 caregivers of hospitalized older adults. Three themes emerged: Lack of care coordination, Muddling through handoffs alone, and Wariness toward the care delivery system. Findings can help clinicians shape their interactions with caregivers to maximize their involvement in post-hospital care.

Research in nursing informatics 2014.

This article reflects the work done in the third year of the Nursing Informatics Year in Review project. This project seeks to search and analyze articles written by nurses as first author on the subject of nursing informatics, published August 2013-August 2014. Each year we also seek recommended articles from our American Medical Informatics Association-Nursing Informatics Work Group (AMIA-NIWG) members that meet the same criteria as the search and most influenced their thinking and scholarship. Twenty-seven articles emerged from the literature review, and our AMIA-NIWG members recommended 32 articles. We analyzed the articles by journal of publication, country of first author, source of funding, research method, research setting, and area of focus. The purpose of this article was to present the results of this project for 2014.

Nursing education focus of nursing informatics research in 2013.

The Nursing Informatics Year in Review 2013 revealed an increase in publications associated with nursing education. Specifically, the articles addressed technology in nursing curricula, use of technology to teach nursing education, and use of technology to form collaborative relationships. In this article we present questions such as: how do these programs assist student nurses to transition to nurse providers where technology is infused into their work and workflow and what is the influence of the collaborative relationships with nurse educators, administrators, and informatics specialists increase patient safety and quality.