Advance Care Planning Engagement Strategies for Primary Care Providers Seeing Diverse Patient Populations: A Scoping Review.

Diverse patients are less likely than Whites to have advance care planning. The primary purpose of this scoping review was to summarize recent evidence about advance care planning engagement interventions for primary care providers working with diverse patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) Checklist was followed. Peer-reviewed articles published in English since 2000 reporting the results of studies testing intervention programs in primary care to improve advance care planning with adult, racially diverse populations were included. Searches were conducted in 5 online databases and yielded 72 articles. Gray literature yielded 23 articles. Two authors independently reviewed the abstracts of 72 articles determining that 9 articles met the aim of this review. These studies were analyzed by communication tools and other resources, population, intervention, primary outcomes, instruments, and primary findings and organized into 3 categories: ( a ) provider-focused interventions, ( b ) patient-focused interventions, and ( c ) multilevel interventions. Improvement in advance care planning outcomes can be achieved for racially diverse populations by implementing targeted advance care planning engagement interventions for both providers and patients. These interventions can be used in primary care to increase advance care planning for diverse patients. More research is needed that evaluates best practices for integrating advance care planning into primary care workflows.

Effects of a 12-Session Symptom Self-Management Course on Forensic Psychiatric Inpatients' Auditory Hallucinations and Anxiety.

The purpose of this clinical dissemination project was to evaluate changes in intensity of unpleasant auditory hallucinations (AH) and level of anxiety after forensic psychiatric inpatients attended an evidence-based symptom self-management course. The course was taught twice to patients with schizophrenic disorders. Data were collected using five self-rating measures. Seventy percent of participants reported reduced AH and anxiety; 100% reported helpfulness of being with others with similar symptoms; 90% would recommend the course to others. The course facilitator reported: improved communication, comfort, and effectiveness working with people with AH, plans to teach the course again and recommend it to colleagues.

Selecting a journal for your manuscript: A 4-step process.

BACKGROUND: Identifying the most appropriate journal for a manuscript can be challenging for both experienced and novice nurse authors. Several factors should be considered when selecting a journal (e.g., peer-reviewed, target audience, type of manuscripts accepted, type of copyright and publishing model used). Selecting the most appropriate journal can save time for both authors and publishers. PURPOSE: The purpose of this article is to provide nurses, particularly those new to scholarly publishing, with clear, plain language guidance on the processes and considerations involved in selecting a journal for publication. METHODS: A librarian and a nurse educator collaborated to develop an innovative 4-step process to help authors select the most appropriate journal for their manuscript. RESULTS: A case study is used to illustrate the process, and a worksheet is provided to guide the reader through the selection of an appropriate journal for their manuscript. CONCLUSIONS: This manuscript can be used by individual nurse authors to find the most appropriate journal for their manuscript, as a teaching tool for nurse educators, and for others mentoring nurse authors who are new to publishing.

Critical Appraisal Tools and Reporting Guidelines for Evidence-Based Practice.

BACKGROUND: Nurses engaged in evidence-based practice (EBP) have two important sets of tools: Critical appraisal tools and reporting guidelines. Critical appraisal tools facilitate the appraisal process and guide a consumer of evidence through an objective, analytical, evaluation process. Reporting guidelines, checklists of items that should be included in a publication or report, ensure that the project or guidelines are reported on with clarity, completeness, and transparency. PURPOSE: The primary purpose of this paper is to help nurses understand the difference between critical appraisal tools and reporting guidelines. A secondary purpose is to help nurses locate the appropriate tool for the appraisal or reporting of evidence. METHODS: A systematic search was conducted to find commonly used critical appraisal tools and reporting guidelines for EBP in nursing. RATIONALE: This article serves as a resource to help nurse navigate the often-overwhelming terrain of critical appraisal tools and reporting guidelines, and will help both novice and experienced consumers of evidence more easily select the appropriate tool(s) to use for critical appraisal and reporting of evidence. Having the skills to select the appropriate tool or guideline is an essential part of meeting EBP competencies for both practicing registered nurses and advanced practice nurses (Melnyk & Gallagher-Ford, 2015; Melnyk, Gallagher-Ford, & Fineout-Overholt, 2017). RESULTS: Nine commonly used critical appraisal tools and eight reporting guidelines were found and are described in this manuscript. Specific steps for selecting an appropriate tool as well as examples of each tool's use in a publication are provided. LINKING EVIDENCE TO ACTION: Practicing registered nurses and advance practice nurses must be able to critically appraise and disseminate evidence in order to meet EBP competencies. This article is a resource for understanding the difference between critical appraisal tools and reporting guidelines, and identifying and accessing appropriate tools or guidelines.

Integrating Anxiety Reduction into an Existing Self-Management of Auditory Hallucinations Course.

High levels of anxiety were found to interfere with voice hearers' ability to benefit from a 10-Session Behavioral Management of Auditory Hallucinations Course. The 10-session course was revised, adding anxiety reduction strategies to the first four classes and reinforcing those strategies in the remaining eight classes. A multi-site study (N = 27) used repeated measures to determine whether the new 12-session course would significantly reduce anxiety. Ten course leaders were trained and taught the course six times at three different outpatient mental health sites. Three measures of anxiety were used. The 12-session course was found to significantly reduce anxiety after the first four classes with further reduction at the end of the course. Eighty-eight percent of course participants reported the course was moderately to extremely helpful. They also reported that being in a group with others with similar symptoms was valuable. Course leaders reported learning about the prevalence and importance of treating voice hearers' anxiety. [Journal of Psychosocial Nursing and Mental Health Services, 55(5), 29-39.].

Auditory hallucinations interview guide: promoting recovery with an interactive assessment tool.

The Auditory Hallucinations Interview Guide (AHIG) is a 32-item tool that helps psychiatric-mental health (PMH) nurses assess past and current experiences of voice hearers so they can provide more individualized care. The AHIG was developed as a research tool but has also been found to be clinically useful in both inpatient and outpatient settings to help voice hearers and nurses develop a shared terminology of auditory hallucinations (AH). Using the AHIG, voice hearers are able to tell their stories in a structured and safe environment, thus encouraging recovery. Through respect and active listening, PMH nurses can communicate unconditional acceptance, caring, and hope for recovery, which helps develop rapport and promote trust in the nurse-patient relationship. Once trust is developed, voice hearers and PMH nurses can work together to find effective strategies for managing AH, including commands to harm self and others.

Disseminating an evidence-based course to teach self-management of auditory hallucinations.

This multi-site project extended course dissemination of the 10-session Behavioral Management of Auditory Hallucinations Course to U.S. Department of Veterans Affairs (VA) mental health outpatient settings. The VA Quality Enhancement Research Initiative (QUERI) model and Rogers' theory of diffusion of innovations served as the theoretical framework. The course was taught to mental health professionals using teleconferencing, electronic media, and monthly conference calls across 24 VA mental health outpatient sites. Twenty course leaders provided feedback. One hundred percent reported being better able to communicate with patients about their voices and 96% reported improved understanding of the voice-hearing experience. Thirty-three course participants provided feedback. Ninety-four percent would recommend the course, 85% reported being better able to communicate with staff about their voices, and 66% reported being better able to manage their voices. Facilitators and barriers to course implementation are described.

Self-management of unpleasant auditory hallucinations: a tested practice model.

Individuals who experience auditory hallucinations (AH) frequently report hearing unpleasant voices saying disturbing things to them, making derogatory remarks about them, or commanding them to do something, including harming themselves or someone else. The Self-Management of Unpleasant Auditory Hallucinations Practice Model was developed to help psychiatric-mental health nurses in both inpatient and outpatient settings implement evidence-based nursing care for voice hearers who are distressed by unpleasant voices. The model's utility extends to nursing education, administration, and research. The model is comprised of three parts: (a) Assessment of Voice Hearer's Experience, (b) Nursing Interventions, and (c) Voice Hearer's Expected Positive Outcomes. These three parts of the model describe nursing assessments conducted with an interview guide and two self-report tools, nursing interventions that teach strategies to manage unpleasant AH in a 10-session course or individually, and evaluation of voice hearer outcomes with two self-report tools.

Responding to command hallucinations to harm: the unpleasant voices scale and harm command safety protocol.

Command hallucinations are relatively common in voice hearers and are taken seriously because of the potential threat to self and others. Many variables mediate the relationship between hearing commands and acting on them. This article describes the implementation of the Harm Command Safety Protocol and the Unpleasant Voices Scale to respond to command hallucinations to harm in the context of the dissemination of a multisite, evidence-based behavioral management course for patients with auditory hallucinations.

Comprehensive evidence-based program teaching self-management of auditory hallucinations on inpatient psychiatric units.

Patients hearing command hallucinations to harm whose only self-management strategies are to obey these commands, can represent serious safety concerns on inpatient psychiatric units. A comprehensive evidence-based program teaching self-management of auditory hallucinations on inpatient psychiatric units is described that includes five components: suggestions for staff education; patient self-assessment tools; an interview guide and safety protocol; a course to teach strategies for managing distressing voices and commands to harm; suggestions to improve staff communication; and a plan to extend the program from inpatient care settings into the community by sharing materials with community case managers and caregivers when patients are discharged.

Behavioral management of auditory hallucinations.

A 10-session behavioral course for self-management of auditory hallucinations in patients with schizophrenia has demonstrated positive outcomes. This article evaluates both the course's implementation and benefits to patients attending the course. Teleconferencing, electronic media, and 26 monthly conference calls were used to educate six advanced practice nurses (APNs) at six sites about the course implementation. Thirty-two patients within the U.S. Department of Veterans Affairs participated in the course. All of the APNs reported course helpfulness, improved communication with patients about voices, and improved harm assessment. Of the patients, 96% found the course helpful: 67% no longer heard voices to harm self or others, and 60% had improved auditory hallucination intensity scores. The project demonstrated successful implementation and practice integration with APNs' activities corresponding to Rogers' stages of innovation adoption. Facilitators and barriers to implementation are also described.

Behavioral management of command hallucinations to harm in schizophrenia.

The study objective was to evaluate changes in prevalence of command hallucinations to harm self or others, characteristics and intensity of auditory hallucinations, and levels of anxiety and depression after attendance at a 10-session course teaching behavioral strategies for managing persistent auditory hallucinations to adult outpatients with schizophrenia. Prevalence of command hallucinations to harm self or others was measured at baseline, end of course, and 1-year post-course. Pre-course scores on the Characteristics of Auditory Hallucinations Questionnaire, Unpleasant Voices Scale, tension-anxiety subscale of Profile of Mood States, and Beck Depression Inventory-II were compared with scores immediately post-course and 1 year later. The prevalence rate of command hallucinations to harm self of 44% at baseline decreased to 24% immediately after attending the 10-session course and remained at 24% 1-year post-course. The prevalence rate for command hallucinations to harm others of 21% at baseline decreased to 16% at end of course and 17% 1-year post-course. People who attended the course perceived it as helpful, and improvement was seen in all seven characteristics of auditory hallucinations, intensity of auditory hallucinations, and anxiety and depression immediately after the course and 1-year post-course.

A conceptual framework for a clinical nurse leader program.

Developing a map to guide the design of a novel educational program for nursing students can assist educators in piecing together identified conceptual variables in a logical and reasonable manner. We developed a conceptual model for a clinical nurse leader (CNL) program to present to a school of nursing faculty and a state board of nursing for approval and adoption. The concept map was created following a literature review and analysis of the American Association of Colleges of Nursing description of the CNL. Following the identification of certain variables, such as theories underpinning nursing practice, clinical processes, and education, each team member researched identified variables of the conceptual diagram, wrote a thoughtful explanation of the components, and frequently met with the others to discuss each element of the model and the relationships among the variables. Over time, an emerging model developed and was adopted by the school of nursing and approved by the state board of nursing. An explanation of the components of the conceptual framework and their relationship to the CNL role may assist educators in developing and implementing other emerging CNL programs.

Collaboration versus competition: results of an academic practice alliance.

In 2002, a Community Academic Practice Alliance (CAPA) was forged between Marin County, Department of Health and Human Services (DHHS), and local bachelor of science in nursing (BSN) nursing programs. This alliance has increased opportunities for DHHS to recruit new baccalaureate registered nurses, eliminated competition among universities for community health nursing (CHN) placements, enriched experiences for BSN students, and enhanced service to the community. This article describes the development process and examines preceptor, faculty, and student satisfaction. It also describes students' attitudes toward CHN and public health nursing, which increased significantly (p < .001, 95% confidence interval of 1.11-2.14). Process evaluation (17 Likert items, on a scale ranging from 1 [low] to 4 [high]) revealed a mean of 3.30 with a standard deviation of 0.328 suggesting CAPA members' satisfaction with the process. This project was presented at the American Public Health Association 131st annual meeting, San Francisco, California, November 2003.

Long-term effects of teaching behavioral strategies for managing persistent auditory hallucinations in schizophrenia.

1. Attendance at a 10-week class designed to teach behavioral management strategies to people with schizophrenia was effective in reducing some of the negative characteristics of auditory hallucinations for 12 months and in reducing anxiety for 9 months after completion of the class. 2. The sustained improvement experienced by class participants was characterized by their voices being less frequent and more mumbled and the participants feeling more in control, less distractible, and less anxious. 3. Participants recommended that other mental health consumers take similar classes to learn how to better manage their voices. 4. Monthly support groups may help participants maintain gains lost during the follow-up period.