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.

Social-Ecological Resilience of Indigenous Adolescents in the United States and Canada: A Situation-Specific Nursing Theory.

For the past decade, resilience research with American Indian/Alaska Native and First Nations/Métis/Inuit adolescents has improved our understanding of how adolescents overcome mental health challenges. A new situation-specific theory is presented to guide nurses in applying the evidence to their practice with Indigenous adolescents in the United States and Canada. The social-ecological resilience of indigenous adolescents (SERIA) theory was derived from integrating ( a ) existing social-ecological frameworks by Bronfenbrenner, Ungar, and Burnette and Figley, ( b ) findings from a systematic review of 78 studies about resilience factors for mental health of Indigenous adolescents, ( c ) clinical experience, and ( d ) Indigenous knowledge.

Expanding the Health Belief Model for exploring inpatient fall risk perceptions: A methodology paper.

AIMS: Inpatient falls among older adults are a relentless problem, and extant inpatient fall prevention research and interventions lack the older adults' perspectives and experiences of their own fall risk in the hospital. Theory-guided research is essential in nursing, and the purpose of this paper was to describe the process of developing a theoretical framework for a phenomenological nursing study exploring older adults' lived experiences of being at risk for falling in the hospital. METHOD: Based on philosophical nursing underpinnings, the Health Belief Model (HBM) was selected as the theoretical model. The limitations of the model led to expansion of the model with established concepts associated with accidental falls among older adults. RESULTS: The HBM was selected as the guiding model due to its ability to capture a broad range of perceptions of a health threat. The HBM was expanded with the concepts of embarrassment, independence, fear of falling, dignity and positivity effect. The addition of these concepts made the theoretical framework more applicable to age-related developmental behaviours of older adult and more applicable to nursing research. CONCLUSION: The Expanded HBM theoretical framework may guide future nursing research to develop fall prevention interventions to decrease fall rates among hospitalized older adults. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Understanding the resilience of children living on an American Indian reservation: A mixed methods participatory study.

AIM: To explore the resilience of children, six to thirteen years old, living on a Northern Plains American Indian Reservation using a situation specific nursing theory. BACKGROUND: American Indian and Alaska Native children experience mental health inequities compared to their white peers, including substance use, suicide, depression, and anxiety. Resilience is a strength of children that can be leveraged to improve their mental health. DESIGN: A parallel convergent mixed methods design. METHODS: A community advisory board culturally adapted resilience instruments. During two weeks in summer 2022, forty-seven children/caregiver dyads completed surveys about the child's resilience. Descriptive statistics gave the scores of each child's personal, relational, and total resilience. A subset of 20 children participated in a semi-structured interview. RESULTS: Children scored high on overall resilience, and higher on the relational subscale than the personal subscale. Caregiver survey scores were not significantly correlated with their child's scores and were higher than the children's scores. Qualitative coding revealed six themes of resilience. Integration of data showed a concordance and expansion of the quantitative data across themes. CONCLUSION: The children reported high resilience supported by a strong ecosystem of relationships. Resilience, as explained through children's voices, corroborated with findings from the surveys. IMPLICATIONS FOR NURSING: Findings will help nurses across sectors of primary, secondary, and tertiary care create resilience-enhancing interventions and prevent mental health crises in this community. IMPACT STATEMENT: This findings from this study will inform local mental health interventions on the Reservation. The study provides a reproducible design to adapt to other Indigenous communities. PUBLIC CONTRIBUTION: A community advisory board was a partner in every stage of the study. Children and caregivers participated in data collection. CONTRIBUTION TO THE WIDER CLINICAL COMMUNITY: This research provides knowledge that will further social justice efforts within nursing to promote health equity across diverse populations.

The Effect of Physical Activity on Sleep Quality among Older Stroke Survivors: Secondary Analysis from a Randomized Controlled Trial.

Poor sleep quality constitutes one of the most common difficulties faced by stroke survivors. Physical activity has been shown to improve sleep quality among healthy adults. The study objective was to examine the effect of physical activity on sleep outcomes in community-dwelling stroke survivors previously enrolled in a randomized clinical trial (RCT). Secondary analysis of data collected in the RCT was used to examine the effects of physical activity (PA) on sleep outcomes using the Pittsburgh Sleep Quality Index (PSQI), compared to usual care (controls). Unadjusted and adjusted mixed effects models were used to model changes in sleep quality between groups. At baseline, poor sleep quality (PSQI > 5) was reported by about half of the participants (PA group = 48.5%, n = 47/97; controls = 56.3%, n = 27/48). Results from the unadjusted and adjusted models for sleep quality were similar and showed no statistically significant differences between groups (p > 0.05). In the unadjusted model, the difference between groups (change from baseline to 24 weeks) showed that the PA group had better sleep quality than the controls (difference= -1.02 points, 95% CI -2.12, 0.07, p = 0.07). In the model adjusted for age, social support, and marital status, the difference between groups (change from baseline to 24 weeks) showed that the PA group had better sleep quality than the controls (difference= -1.07 points, 95% CI -2.19, 0.05, p = 0.06). PA did not significantly improve sleep quality in older community-dwelling stroke survivors. Further research is needed to confirm or refute these findings.

Examining the Associations between Post-Stroke Cognitive Function and Common Comorbid Conditions among Stroke Survivors.

A considerable complication for stroke survivors is the subsequent development of cognitive decline or dementia. In this study, the relationship between the inflammation-centered comorbidity burden on post-stroke cognitive function among community-dwelling stroke survivors capable of independent living was examined. Data for this secondary analysis were collected from stroke survivors (n = 97) participating in a randomized clinical trial. Participants provided baseline responses, regarding cognitive function (mini-mental status exam, MMSE; Montreal cognitive assessment, MoCA), history of stroke comorbid conditions, and the Stroke Prognosis Instrument-II (SPI-II), an index of stroke comorbidity and recurrent stroke risk within the next two years. Relationships and differences between groups were tested for significance using Spearman's correlation, Kruskal-Wallis, or Mann-Whitney U tests. Most stroke survivors (69%) had multiple comorbidities. Total SPI-II scores were negatively correlated to both MoCA and MMSE scores (r = -0.25, p = 0.01; r = -0.22, p = 0.03, respectively), and differences in MoCA scores among SPI-II risk groups (low, medium, high) were evident (p = 0.05). In contrast, there were no differences in MoCA or MMSE scores when comorbid conditions were examined individually. Lastly, no gender differences were evident in cognitive assessments. Our data support the premise that comorbidity's burden impacts post-stroke cognitive decline, more than a single comorbid condition. Inflammation may be an important component of this comorbidity burden. Future studies that operationalize this concept will better illuminate the complex phenomenon of post-stroke cognitive decline for improved clinical rehabilitation modalities.

Relying on myself: The lived experience of being at risk for falling in the hospital among older adults.

Inpatient fall rates have not significantly decreased the last decade. Older adults have an estimated 50% greater inpatient fall rate than younger adults. How older adults perceive their own fall risk affects their adherence to fall prevention recommendations. The aim of this phenomenological study was to understand the lived experiences of being at risk for falling in the hospital among older adults. Nine participants (N=9) aged 65 years and older (female=55%) were interviewed twice using online video-conferencing after hospital discharge, and interview data was analyzed using van Manen's interpretive phenomenological method. Five major interpretive themes emerged: Relying on Myself, Managing Balance Problems in an Unfamiliar Environment, Struggling to Maintain Identity, Following the Hospital Rules, and Maintaining Dignity in the Relationships with Nursing Staff. Hospitalized older adults employed their self-efficacy to manage balance problems in the hospital. Additional fall prevention interventions supporting hospitalized older adults' self-management of fall risk are needed.

Selecting a theoretical framework for chronic cardiovascular disease self-management among rural dwelling adults.

A paucity of research has examined the factors and perceptions of self-management among individuals living rurally with chronic cardiovascular disease (CCVD). Exploration of this population is prudent as CCVD continues to be the leading cause of mortality within the United States (US). As the US population ages, increased rates of CCVD and the process of managing the disease will continue to challenge patients and the health care system. Rural dwelling adults are faced with additional complexities to manage a chronic disease, resulting in higher rates of chronic disease as compared to urban dwellers. It is essential for nurses working with adults living with CCVD in rural areas to promote self-management strategies derived from a theoretical perspective. The purpose of this paper is to examine theories and models that facilitate self-management of CCVD among rural dwelling adults. Three established self-management theories and models from psychology and public health were evaluated using Walker and Avant's framework for theory analysis. Social cognitive theory was selected as a best fit for self-management of CCVD among rural dwelling adults, due to the symbiosis of chronic disease, and applicability of ruralness within the triadic reciprocal causation of person-behavior-environment of the model.

Recruiting African American parents of school-aged children in a physical activity study: Lessons learned.

OBJECTIVES: To describe the recruitment strategies and lessons learned when enrolling African American parents/caregivers of school-aged children (ages 6-12 years) in an online survey of physical activity. With physical activity serving as a modifiable behavioral risk factor for several chronic diseases (obesity and cardiovascular diseases), little is understood regarding the influences on African Americans' physical activity participation to develop culturally appropriate physical activity interventions. Gaining a better understanding of physical activity influences is possible through research, yet recruiting and enrolling African Americans in health research is a challenge. METHODS: Over a three-month period, a multidimensional approach (distribution of flyers, community partnerships, network sampling, African American researcher, effective communication, and data collection procedures) was used for study recruitment. RESULTS: We exceeded our recruitment goal of 105 participants. A total of 127 African American parent/caregivers of school-aged children enrolled, which included both females/mothers (n = 87, 69%) and males/fathers (n = 40, 31%). Network sampling was the single most effective recruitment strategy for reaching this population. Lessons learned in this study includes considering participant burden and their comfort with technology, as well as gaining community trust. DISCUSSION: Lessons learned in recruiting African American parents provides a guide for future research. Efforts are needed to further increase the representation of African American males in health research.

Older adults' perceptions of their fall risk in the hospital: An integrative review.

AIMS AND OBJECTIVES: The objectives of this review are to determine what is currently known about older adults' perceptions of their own fall risk in the hospital and associated factors and explore how perceived fall risk in the hospital is assessed. BACKGROUND: Every year, up to one million patients suffer an accidental fall in the hospital. Despite research efforts during the last decade, inpatient fall rates have not significantly decreased, and about one third of inpatient falls result in injuries. Limited evidence suggests that assessing hospitalised patients' perceptions of their fall risk and engaging them in their own fall prevention can reduce inpatient falls. DESIGN: An integrative review. METHODS: An electronic literature search was conducted in the Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Embase, Google Scholar, OpenGrey, ProQuest Dissertations & Theses Global, PsycINFO and PubMed. Data extraction and quality assessments were independently performed by two reviewers. PRISMA guidelines were followed for reporting this review. RESULTS: Twenty-two studies met the inclusion criteria. The findings suggest that hospitalised older adults inadequately estimate their own fall risk. Most participants did not perceive themselves as at risk for falling in the hospital. Educational and motivational interventions can change the patients' perceptions of their own fall risk in the hospital and engage them in fall prevention. The desire to remain independent and feeling vulnerable were associated with fall risk, and the relationship with nursing staff may affect how hospitalised patients perceive their own fall risk. CONCLUSIONS: Hospitalised adults, and specifically older adults, do not adequately estimate their own fall risk. Factors associated with these perceptions must be further explored to develop assessment tools and interventions to decrease inpatient fall rates. RELEVANCE TO CLINICAL PRACTICE: Nurses' understanding and assessment of hospitalised adults' perception of their own fall risk is important to consider for reducing inpatient falls.

Barriers and facilitators for adopting a healthy lifestyle among Latina cancer survivors: A qualitative descriptive study.

PURPOSE: Cancer is the leading cause of death among Hispanics/Latinos in the USA. Latina cancer survivors experience higher symptom burden than other cancer survivors. A healthy lifestyle can decrease recurrent cancer risk, increase well-being, and may decrease symptom burden in cancer survivors. The purpose of this study was to explore the barriers and facilitators for adopting healthy lifestyle behaviors among Latina cancer survivors. METHODS: Using the Health Belief Model as the theoretical framework, qualitative descriptive methodology was used for secondary analysis of data from a previously conducted randomized clinical trial. Transcripts from the telephone health coaching calls, analyzed in the original language (English or Spanish), were used for this qualitative analysis. RESULTS: Intervention telephone call transcript data from Latina cancer survivors (n = 14) were analyzed. Major themes were as follows: Perceived susceptibility to other chronic illnesses, perceived benefits of a healthy lifestyle, and perceived barriers and facilitators of adopting a healthy lifestyle. Lack of knowledge about healthy lifestyle behaviors could prevent participants from adopting a healthy lifestyle; gaining new knowledge about healthy lifestyle behaviors was a facilitator for changing lifestyle. Family responsibility and wearable technology could both prevent and motivate the participants to adopt a healthy lifestyle. CONCLUSION: Developing culturally appropriate interventions for Latina cancer survivors is vital to decrease symptom burden and health risks, as well as improve health outcomes in this population.

Stroke Survivors' Personal Efficacy Beliefs and Outcome Expectations of Tai Chi Exercise: A Qualitative Descriptive Study.

Prior qualitative research conducted among stroke survivors to explore the potential benefits and challenges of participating in tai chi exercise during stroke recovery is limited to those without depression. A qualitative descriptive approach was used. Social Cognitive Theory and Complex Systems Biology provided the theoretical framework, with focus group interview data collected from stroke survivors after participation in a tai chi intervention. Due to COVID-19, the focus group interview was conducted via online video conferencing. Content analysis of the de-identified transcript was conducted with a-priori codes based on the theoretical framework and inductive codes that were added during the analysis process. Lincoln and Guba's criteria were followed to ensure trustworthiness of the data. Community-dwelling stroke survivors (n = 7) participating in the focus group interviews were on average 68 years old, mainly retired (71%, n = 5), married women (57%, n = 4) with >13 years education (86%, n = 6). The three major themes were: personal efficacy beliefs, tai chi intervention active ingredients, and outcome expectations. Social Cognitive Theory underscored stroke survivors' personal efficacy beliefs, behavior, and outcome expectations, while Complex Systems Biology highlighted the active ingredients of the tai chi intervention they experienced. Participation in the 8-week tai chi intervention led to perceived physical, mental, and social benefits post stroke.

The Feasibility of Tai Chi Exercise as a Beneficial Mind-Body Intervention in a Group of Community-Dwelling Stroke Survivors with Symptoms of Depression.

Depression is prevalent among one-third to two-thirds of acute and chronic stroke survivors. Despite the availability of pharmacotherapies and/or psychotherapies, depression persists, even for 5-10 years after stroke, reflecting limited treatment responses and/or adherence to this conventional care. Mind-body interventions are commonly used among adults to ameliorate depressive symptoms. Thus, the feasibility of Tai Chi, alongside conventional care, to manage poststroke depression was investigated using a single-group pre-post intervention design. Recruitment and retention, intervention adherence, safety, acceptability, and fidelity were assessed. Symptoms of depression, anxiety, and stress were assessed using standardized questionnaires, objective sleep was assessed via a research-grade triaxial accelerometer, and blood samples were taken to measure oxidative stress, inflammatory markers, and a neurotrophic growth factor using commercially available kits per manufacturer's protocol. Pre-post intervention changes were assessed using paired t-tests. We enrolled stroke survivors (N = 11, mean age = 69.7 ± 9.3) reporting depression symptoms. After the intervention, we observed significant reductions in symptoms of depression (-5.3 ± 5.9, p=0.01), anxiety (-2.2 ± 2.4, p=0.01), and stress (-4.6 ± 4.8, p=0.01), along with better sleep efficiency (+1.8 ± 1.8, p=0.01), less wakefulness after sleep onset (-9.3 ± 11.6, p=0.04), and less time awake (-9.3 ± 11.6, p=0.04). There was a 36% decrease in oxidative stress (p=0.02), though no significant changes in the other biomarkers were found (all p values >0.05). Tai Chi exercise is a feasible intervention that can be used alongside conventional care to manage poststroke depression, aid in reducing symptoms of anxiety and stress, and improve sleep.

The Effect of Tai Chi Chuan on Emotional Health: Potential Mechanisms and Prefrontal Cortex Hypothesis.

Deep involvement in the negative mood over long periods of time likely results in emotional disturbances/disorders and poor mental health. Tai Chi Chuan (TCC) is regarded as a typical mind-body practice combining aerobic exercise and meditation to prevent and treat negative mood. Although there are an increasing number of TCC studies examining anxiety, depression, and mental stress, the mechanisms underlying these negative emotions are not fully understood. This review study examined TCC studies related to emotional health from both clinical patients and healthy individuals. Next, several potential mechanisms from physiological, psychological, and neurological perspectives were evaluated based on direct and indirect research evidence. We reviewed recent functional magnetic resonance imaging studies, which demonstrated changes in brain anatomy and function, mainly in the prefrontal cortex, following TCC practice. Finally, the effects of TCC on emotion/mental health is depicted with a prefrontal cortex hypothesis that proposed "an immune system of the mind" indicating the role of the prefrontal cortex as a flexible hub in regulating an individual's mental health. The prefrontal cortex is likely a key biomarker among the multiple complex neural correlates to help an individual manage negative emotions/mental health. Future research is needed to examine TCC effects on mental health by examining the relationship between the executive control system (mainly prefrontal cortex) and limbic network (including amygdala, insula, and hippocampal gyrus).

Psychometric Properties of the Translated Tai Chi Exercise Self-Efficacy Scale for Chinese Adults with Coronary Heart Disease or Risk Factors.

Tai Chi is an effective exercise option for individuals with coronary heart disease or its associated risk factors. An accurate and systematic assessment of a Mandarin-speaking adults' self-efficacy in maintaining Tai Chi exercise is lacking. Mandarin Chinese has the most speakers worldwide. This study aimed to translate the Tai Chi Exercise Self-Efficacy scale and examine its psychometric properties. The 14-item Tai Chi Exercise Self-Efficacy scale was translated from English into Mandarin Chinese using a forward-translation, back-translation, committee approach, and pre-test procedure. Participants with coronary heart disease or risk factors (n = 140) enrolled in a cross-sectional study for scale validation. Confirmatory factor analysis indicated a good fit of the two-factor structure (Tai Chi exercise self-efficacy barriers and performance) to this sample. The translated scale demonstrated high internal consistency, with a Cronbach's α value of 0.97, and good test-retest reliability, with an intra-class correlation coefficient of 0.86 (p < 0.01). Participants with prior Tai Chi experience reported significantly higher scores than those without (p < 0.001), supporting known-group validity. A significant correlation was observed between the translated scale and total exercise per week (r = 0.37, p < 0.01), providing evidence of concurrent validity. The Mandarin Chinese version of the Tai Chi Exercise Self-Efficacy scale is a valid and reliable scale for Chinese adults with coronary heart disease or risk factors.

National Internet-Based Survey of the Use, Barriers, Reasons and Beliefs of Mind-Body Practices During the Early Months of the COVID-19 Pandemic.

The purpose of this study was to learn about the use, barriers, reasons and beliefs regarding mind-body practices among adults living in the United States during the beginning months of the 2019 novel coronavirus disease (COVID-19) pandemic. An on-line survey was developed following the Checklist for Reporting Results of Internet e-Surveys (CHERRIES) guidelines and using the online survey software program, Qualtrics®XM, platform. Pilot testing of the survey was conducted for usability and functionality. The final 24-item survey was distributed via email and social media. A total of 338 adults responded to the survey, with 68.8% indicating that they participated in mind-body activities since the start of the pandemic. Physical activity was the most frequently (61.5%, n = 227) used mind-body practice. Further, 2 of the common barriers to engaging in mind-body practices were lack of motivation and wandering mind. Frequently listed reasons for using mind-body practices were to promote health, reduce stress and relaxation. Respondents believed that mind-body practices resulted in less stress. These findings may be applicable for reducing psychological stress related to the pandemic, as the pandemic continues to impact many areas of the United States.

Health Benefits of Tai Chi Exercise: A Guide for Nurses.

Tai chi is an ancient Chinese internal martial art that has increased in popularity across the United States over the past 2 decades. Tai chi combines gentle physical movement, mental imagery, and natural, relaxed breathing. There is increasing scientific evidence showing the impact of tai chi exercise on multifaceted areas of health and well-being, including positive effects on cognition, depression, anxiety, sleep, cardiovascular health, and fall prevention. A review of the health benefits of tai chi exercise is presented, as well as recommendations for nurses seeking to answer patient questions about tai chi.

Selecting a theoretical framework to explore the social and cognitive uncertainty that hepatitis C treatment represents for people who inject drugs.

Emerging research models for hepatitis C eradication suggest a social network-based treatment approach among people who inject drugs. It is essential for nurses to critically examine the influence of these social networks among people who inject drugs and the impact on their hepatitis C treatment decisions. The purpose of this paper is to describe the process of selecting a theoretical framework to guide a mixed methods study exploring the perceived uncertainty of individual hepatitis C treatment behaviors existing within the social networks of people who inject drugs. Using Walker and Avant's framework for theory analysis, four established theories and models from nursing science and psychology were reviewed. Aspects of both the Social Cognitive Theory and Uncertainty in Illness Theory were combined to form a theoretical framework, the Socio-Cognitive Uncertainty Model. This new theoretical framework describes the social and cognitive uncertainty that hepatitis C virus treatment represents for people who inject drugs. Taken together, social influence and social selection can inform the nurse's understanding of hepatitis C treatment acceptability among this high-risk social network- an important consideration in the pursuit of disease eradication.