Department of Anesthesiology Skilled Peer Support Program Outcomes: Second Victim Perceptions.

BACKGROUND: Most anesthesia providers experience an adverse event during their training or career. Limited evidence suggests skilled peer support programs (SPSPs) reduce initial distress and support adaptive functioning and coping. This study evaluated second victim perceptions of a voluntary SPSP. METHODS: An SPSP was developed and implemented for all clinical and administrative personnel in the Department of Anesthesiology and Perioperative Medicine in three hospitals and six outpatient surgery centers in December 2017. The program incorporated the Scott Three-Tiered Interventional Model of Second Victim Support. Surveys were offered to clinicians in the department prior to implementation of the SPSP and again 18 months after implementation. Among the subset of respondents who experienced a serious adverse patient event, the authors used multiple logistic regression models that adjusted for role and number of night shifts per month to examine differences in perceived resource availability and post-event support received following implementation of the program. RESULTS: There were 94 surveys (83 complete; 11 partially complete) collected prior to implementation and 84 surveys (67 complete; 17 partially complete) collected after implementation. A total of 25 individuals took the survey at both pre and post (19 complete). After implementation, 62.5% of respondents indicated that institutional support had improved since the occurrence of their serious adverse patient event. Statistical models identified a significant improvement in the probability that a clinician agreed with the statement "I think that the organization learned from the event and took appropriate steps to reduce the chance of it happening again" at post vs. pre (adjusted odds ratio [aOR] 3.9, 95% confidence interval [CI] 1.01-15.1. A statistically significant increase from pre to post in the perceived availability of formal emotional support was identified (aOR 5.2, 95% CI 1.9-22.5). CONCLUSION: Implementation of a skilled peer support program within a large department of anesthesiology can improve institutional-based emotional support.

Multiple Informant Cluster Analysis Findings: Which Military-Connected Preschool Aged Children Are Doing Well and Why?

Informed by models of resilience in military families, we explored factors theorized to be associated with social-emotional resilience and risk among young military-connected children. Our secondary analysis of cross-sectional data from 199 military-connected families (n = 346 parents) with at least one preschool-age child in the home (n = 199) led to the empirical identification of two distinct clusters: families with children demonstrating healthy social-emotional functioning and those showing indicators of poor social-emotional functioning. We then identified factors associated with membership in each cluster to determine which deployment and parental wellbeing variables were salient for young child adjustment. Parent psychological health symptoms, parenting, child behavior, and parent-child relationships were measured by parent report and observed interaction. Children with healthier social-emotional functioning were found to be residing with families experiencing less stress and distress. The importance of maternal trauma history is highlighted in our study, as elevated maternal symptoms across all three posttraumatic stress disorder symptom domains were associated with child social-emotional risk. Basic family demographic characteristics did not contribute significantly to the cluster distinctions, nor did military service factors such as active duty, reserve or veteran status, military rank or parent deployment history. These findings are important as the results deemphasize the importance of military service characteristics and highlight the importance of parent wellbeing when considering social-emotional risk and resilience of young children within military families.

Hybrid delivery of behavioral health screening and prevention intervention for pediatric heart transplant recipients and families: A randomized pilot study.

BACKGROUND: A significant number of pediatric heart transplant recipients and their families experience post-traumatic stress symptoms following transplantation, which can impact recipient behavioral and medical health outcomes. Preventive behavioral health interventions may improve outcomes, especially if interventions can be delivered at a distance to decrease barriers to mental health care. This pilot study examined the acceptability and accessibility of an evidence-informed resilience training program delivered using a video telehealth platform. A secondary aim was to assess the preliminary efficacy of the intervention on recipient behavioral health outcomes, perceived barriers to recipient medication adherence, parent behavioral health outcomes, and family functioning. METHODS: Seventeen heart transplant recipients (8-18 years old) and their families were recruited and randomly assigned to a treatment as usual (n = 8) or an intervention group (n = 9). Baseline assessment data collected included demographic information and validated behavioral health measures. Follow-up assessments included the validated measures and acceptability and satisfaction ratings. RESULTS: The study demonstrated that the program has high acceptability by recipients and parents, and a positive impact on recipients and parents, including significant reductions in youth behavioral difficulties as well as parent depression and post-traumatic stress symptoms. CONCLUSIONS: Results of this study are promising and call for further evaluation of hybrid delivery models for behavioral health screening and prevention interventions for pediatric heart transplant recipients and their families.

Hybrid Delivery of Mindfulness Meditation and Perceived Stress in Pediatric Resident Physicians: A Randomized Clinical Trial of In-Person and Digital Mindfulness Meditation.

Physicians are experiencing epidemic levels of work-related stress and burnout. Determine efficacy of mindfulness meditation delivered as a hybrid (in-person and digital) format to reduce perceived stress in pediatric residents. Pediatric residents (n = 66) were block randomized to a hybrid Mindful Awareness Practices (MAPs) intervention, comprised of one in-person 60-min session and 6-week access to a digitally delivered MAPs curriculum (n = 27) or wait-list control (n = 39). Perceived Stress Scale (PSS) was administered at baseline and post-intervention as the primary outcome measure. A priori secondary outcomes were measured using the Abbreviated Maslach Burnout Inventory-9, Beck Depression Inventory, Beck Anxiety Inventory, UCLA Loneliness Scale, and Pittsburgh Sleep Quality Index. After the first session, 58% participated at least one digital session (M = 2.0; SD = 1.3). MAPs participants showed significant decrease in PSS compared to controls, with between-group mean difference of 2.20 (95% CI 0.47-3.93) at post-intervention (effect size 0.91; 0.19-1.62). No secondary outcome group differences were detected. Exposure to a hybrid mindfulness intervention was associated with improvement in perceived stress among pediatric residents.Trial Registration: NCT03613441.

End-of-Life Care in Patients with Cancer 16-24 Years of Age.

PURPOSE OF REVIEW: To present new findings in order to aid in the provision of high-quality symptom management and psychosocial care for adolescents and young adults with advanced cancer at the end of life. RECENT FINDINGS: Behavioral health providers support patients by teaching them symptom control skills, building legacies, and making meaning of their lives. Integration of cultural values is essential for comprehensive assessment and decision-making. Effective management of physiological symptoms and psychological distress begins with accurate communication about prognosis and goals of care that focus on patient preferences and priorities. Oncology teams promote quality of life and the successful management of fatigue, pain, decreased mobility, poor appetite, and dyspnea with the early inclusion of palliative care. While provision of end-of-life care in a young person with cancer presents challenges, multidisciplinary teams can effectively accompany patients in this journey by prioritizing patient and family preferences to promote quality of life.

Psychological Outcomes in Fathers of Critically Ill Children in the Pediatric Intensive Care Unit: A Systematic Review.

Systematically review evidence of psychological distress in fathers of children admitted to the pediatric intensive care unit (PICU). Two reviewers independently reviewed 24 published articles that studied fathers during and closely following a PICU admission. Results are presented for psychological outcomes of stress, PTSD, anxiety and depression, family functioning, and other forms of distress. Potential moderators of distress are also presented. Although methodological variance and inconsistent findings make it difficult to draw definitive conclusions, mothers and fathers appear to experience similar levels of distress and psychiatric symptoms during and after a PICU admission. Fathers' distress may be characterized by feelings of helplessness and often manifests after discharge, later than for mothers. More research is needed to understand gender differences in the expression of parental distress during and after a PICU admission as this will serve to inform interventions designed to improve family functioning.

Ethical Issues in Providing End-of-Life Cancer Care for Transitional-Aged Youth.

The aim of the study is to examine the salient ethical factors that arise in caring for transitional-aged cancer patients at the end of life (EOL). This article reviews significant clinical, ethical, and legal considerations relevant to psychologists working in oncology. Transitional-aged youth (TAY, ages 16-24) with cancer face a number of challenges when navigating treatment options at the EOL. Changes in treatment roadmaps, lapses in effective provider-patient communication, disagreements with parents, and developmental and disease-based changes in capacity all become salient in palliative care. Psychologists should be aware that both physician and patient factors influence the types of treatments proposed as well as the extent of EOL discussions. Psychologists are urged to bear in mind the ethical principles of respect for people's rights and dignity and nonmaleficence to best aid families and multidisciplinary teams navigate this difficult time and promote quality of life and the patient's wishes.

Betrayal Trauma: Impact on Health Professionals.

"Second victims" are clinicians who are traumatized after an unanticipated adverse patient event, medical error, or patient-related injury. Less recognized is the profound sense of betrayal and trauma that can occur in the context of patient deception. The implicit patient-healthcare provider contract assumes that patients are truthful with providers so they may obtain accurate diagnoses and effective treatments. Betrayal by deception can feel like a traumatic death; not of a person, but of a previously intimate and trusting relationship. Healthcare professionals are no better at detecting lies than the lay public and hold inaccurate beliefs about detectable signs of deception. Thus, healthcare professionals may be more vulnerable to betrayal by deception than they realize. The 2 clinical cases presented here reveal the ease with which healthcare providers can be misled, emotionally manipulated by individuals who superficially appear to be psychologically healthy and traumatized by betrayal by deception.

Evaluation and Management of Factitious Disorder Imposed on Another.

Munchausen by proxy refers to an individual who abusively and compulsively falsifies physical, psychiatric or developmental disorders in a child or adult victim in order to satisfy a psychological need. Factitious disorder imposed on another refers to the psychopathology in the abuser. Psychologists in medical settings may: (1) identify patients they come to suspect as being victims or perpetrators of MBP, (2) conduct or assist in clinical or forensic evaluations; (3) offer recommendations for clinical case management, and/or (4) provide treatment or referrals. The purpose of this paper is to provide guidance to psychologists and other mental health professionals in medical settings who may encounter individuals with this potentially lethal form of psychopathology.

Communicating with Youth about Pain: Developmental Considerations.

BACKGROUND: Pain experiences can negatively impact children and adolescents, leading to trauma symptoms and nonadherence to important health behaviors. Developmentally-tailored communication strategies may mitigate this risk. METHODS: This article reviews cognitive and linguistic developmental factors, within the familial and cultural context, that are important to consider when communicating with youth about acute, procedural, and/or chronic pain. RESULTS: Youth undergoing acute or procedural pain benefit from pain education, truthful information about the procedure, and advance preparation. The use of analogies may be particularly helpful for patient understanding of chronic pain development, maintenance, and treatment. Youth with developmental disabilities may express pain differently than their normative peers, requiring adaptation of communication strategies. CONCLUSION: Developmentally-tailored pain communication is an important tool for caregivers and healthcare providers that may foster adaptive functioning in youth who experience pain.

Meaning, Joy, and Critical Care Nurse Well-Being: A Call to Action.

Healthy nurses are essential for optimizing population health, patient care experiences, and health care cost-efficiency. Critical care nurses are at increased risk of developing physical and psychological symptoms due to their high-stress work environment and exposure to traumatic events. There is growing recognition for the value of implementing nurse-centered, team-based, and organizational-wide levels of intervention designed to mitigate the impact of high work stress and trauma on health professionals. The central assertion of this article is that meaning and joy in nursing practice are contributors to professional well-being and part of the solution for achieving the quadruple aim.

Implementing an emotional support and mental health response plan for healthcare workers during the COVID-19 pandemic.

Institutions across the world are working to develop initiatives aimed at supporting the well-being of healthcare workers (HCWs) facing the psychological impacts of the novel coronavirus (COVID-19) pandemic. This Commentary identifies risks that HCWs are experiencing, reviews sources of fear and stress, and describes the implementation of a three-tiered model for the provision of emotional support and mental health services for clinical and nonclinical HCWs. The model recognizes the fluid, ever-evolving nature of the COVID-19 pandemic and includes proactive, visible, and easy-to-access supportive psychological services that expand the safety net and help address immediate and future mental health challenges of HCWs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychological Treatment of Factitious Disorder Imposed on Another/Munchausen by Proxy Abuse.

The purpose of this article is to propose management and treatment protocols for family members impacted by MBP abuse. A brief review of psychopathology, co-morbidities, MBP risk level, treatment outcomes, and rationale for treatment is presented, followed by detailed guidance regarding psychological treatment and management. We propose five components of psychotherapy for abusers, best remembered by using the acronym of ACCEPTS: ACknowledgement, Coping, Empathy, Parenting, Taking charge, and Support. Guidance for the treatment of spouses/partners of the abuser, other involved family members/friends, and child victims are also provided.

Education Research: Evaluation of curriculum to teach resilience skills to neurology residents.

OBJECTIVE: To evaluate feasibility and acceptability of a health professional resilience skills training program with neurology residents. METHODS: The curriculum consists of five 1-hour-long modules that included the following skills: reflective narrative practices, emotion regulation, communication with highly distressed individuals, boundary management, and the identification of depression and trauma. Using a web-based survey tool, we administered the Brief Resilience Scale (BRS) and Abbreviated Maslach Burnout Inventory (aMBI) at baseline, in addition to a pre- and post-survey assessing change in beliefs and self-efficacy, as well as satisfaction with the intervention. Means were compared using the Wilcoxon rank-sum and signed rank tests. RESULTS: Twenty-two residents representing each year of training completed the pre-survey; 41% were women. Subscale scores on the aMBI revealed that 50% had moderate or high emotional exhaustion, 41% had moderate depersonalization, and 37% had moderate or low personal accomplishment, though 77.3% reported high career satisfaction. Female residents had lower scores on the BRS (mean 3.26 vs 3.88, p < 0.05), though scores on aMBI subscales did not differ by sex. Scores did not differ by year of training. Sixteen residents completed both the pre- and post-survey. Significant increases were detected in 4 of 9 self-efficacy statements. Seventy-one percent of residents were satisfied or extremely satisfied with the training. CONCLUSIONS: Residents were satisfied with the curriculum and reported improved ability to identify and cope with work-related stress. Further study is needed to evaluate the influence of skills adoption and practice on resilience and burnout.

Feasibility of Online Mental Wellness Self-assessment and Feedback for Pediatric and Neonatal Critical Care Nurses.

PURPOSE: The primary goal of this study was to test the feasibility of an educational online self-assessment of burnout, resilience, trauma, depression, anxiety, and common workplace stressors among nurses working in a pediatric intensive care unit or neonatal intensive care unit setting. The secondary, exploratory objectives were to estimate the prevalence of psychiatric symptoms in this sample and to identify those variables that most strongly predict burnout. DESIGN AND METHODS: Data from optional and anonymous online measures were analyzed for 115 nurses (67.9% aged 25-44; 61.7% Caucasian) working in an urban children's hospital pediatric or neonatal ICU. Multiple linear regressions identified demographic variables and workplace stressors that significantly predicted each of three components of burnout. RESULTS: Most respondents found the educational assessment and feedback to be helpful. Choosing nursing as a second career was associated with better resilience. Having worked in ICU settings longer and being older were both linked to lower levels of anxiety. Predictors of burnout varied across the three burnout subscales. CONCLUSIONS: Implementation of an online self-assessment with immediate educational feedback is feasible in critical care settings. The variability of predictors across the three burnout subscales indicates the need for tailored interventions for those at risk. Future research may include follow-up of nurses to examine changes in scores over time and expansion of the tool for other medical personnel. PRACTICE IMPLICATIONS: An educational online self-assessment can be a helpful tool for pediatric critical care nurses experiencing varying degrees of burnout and distress.

Sibling-Controlled Study of Parental Bonding, Coping, and Urgent Health-Care Use in Families With Children With Nonepileptic Seizures.

Objectives: Pediatric psychogenic nonepileptic seizures (PNES) is a functional somatic symptom condition with significant health-care service burden. While both family and individual factors play an important role in the development and maintenance of PNES, little is known about what predicts urgent health-care use in families with children who have PNES. The aim of the current study was to explore whether child coping and parental bonding styles influence the decision to seek urgent medical care in these families. Methods: Data were analyzed from youth of age 8-18 years, 47 with PNES, and their 25 sibling controls. Parents provided the number of youth emergency room visits and hospitalizations in the preceding year. Youth completed a questionnaire about their coping styles and a measure about their mothers' and fathers' bonding styles. Using a mixed model with family as a random effect, we regressed urgent health-care use on participant type (youth with PNES or sibling), parental bonding style, and youth coping style, controlling for number of child prescription medications. Results: Higher urgent health-care use was associated with having PNES, coping via monitoring, and perceiving one's father to be rejecting and overprotective. Lower urgent health-care use was associated with coping via venting and with perceiving one's mother to be caring and overprotective. Conclusions: This study provides preliminary empirical support for family-based clinical efforts to reduce child urgent health-care use by enhancing effective child coping skills and improving parental response to child impairment and distress in families with youth with PNES.

Psychological Treatment.

Psychological approaches to pain management have been demonstrated to be effective for individuals newly diagnosed with cancer, in remission, and/or with progressive or terminal disease. Modalities that have been demonstrated to be most effective are cognitive behavioral approaches that include relaxation skills and/or hypnotherapy.