The Experiences of Nurses as Double-Duty Caregivers for a Family Member at the End of Life: Interpretive Description.

Increasing numbers of individuals with complex, advanced illnesses are living longer and being cared for in the home by family members. As a result, family caregivers often experience physical, emotional, psychological, and social distress. A unique subset of this population are nurses who find themselves providing care in both their family lives and work lives, a phenomenon known as "double-duty caregiving." This study explored the experiences of nurses providing end-of-life care for family members while continuing to work as a nurse and the consequences of this experience. A qualitative design, using semistructured, in-depth interviews, was used to capture the double-duty caregivers' experiences. Four overarching themes were identified: It Takes a Village, Driving the Bus, Juggling Many Hats, and Moving Through and Looking Back. These themes captured the components of a support system that are essential for the double-duty caregiver to perform this work, the multifaceted expectations placed upon the double-duty caregiver, the double-duty caregiver's relentless need to balance multiple roles, and the immediate and long-term impact of double-duty caregiving. As nurses, we must acknowledge the need for self-care during this experience, and as a profession, we must provide support for the double-duty caregiver to preserve their personal and professional well-being.

Identifying patient-level factors associated with interest in psychosocial services during cancer: A brief report.

OBJECTIVES: Uptake of psychosocial services during cancer treatment remains relatively low. To use these services efficiently, novel approaches - based on evidence-based theory - are needed to understand cancer patients' readiness to seek psychosocial services. Guided by the transtheoretical model (TTM), we investigated individuals' readiness to use psychosocial services by assessing decisional conflict (pros/cons) and self-efficacy, which are established as the most important constructs of predicting a specific behavior. METHODS: In these secondary analyses, we examined demographic and treatment-related factors in a national sample of adult cancer patients and survivors in the United States as predictors of decisional balance (pros/cons) and self-efficacy (i.e., two core TTM constructs) of engaging in psychosocial services. Participants were recruited through an online survey. In addition to examining demographic factors (age, sex, race, and marital status) as independent variables using t tests and correlations, treatment-related variables, such as having multiple cancers, type of cancer, type of treatment, and treatment setting were included. RESULTS: Four hundred and sixty-six participants completed the survey. The sample was primarily Caucasian (79%) and female (54.7%); average age was 47.9 (SD = 14.8). While no significant relationships emerged for self-efficacy, younger age and non-Caucasian race were significantly related to greater cons of seeking psychosocial care. Finally, those with multiple cancers versus reporting only one malignancy endorsed more cons of seeking psychosocial care. CONCLUSIONS: These data highlight the importance of measuring the cons of seeking psychosocial care during cancer treatment, with younger age, non-Caucasian, and those reporting experience with multiple cancers endorsing greater cons. This may impact eventual uptake of available services. Future research should identify individuals at risk for declining services based on perceived cons of seeking psychosocial care during cancer.

Development and Implementation of a Psychological Service for Patients With Cancer.

Cancer patients frequently experience considerable distress during diagnosis and treatment. The aims of this study were to describe the development and utilization of a psychological service for cancer patients at a community hospital-and to provide preliminary results on clinical outcomes in a "real-world" clinical setting. This program was developed collaboratively by individuals from a university-based clinical psychology doctoral program and a community hospital. The psychological service was comprised of a licensed, PhD-level clinical psychologist and seven clinical psychology doctoral students. Patients were typically referred by their oncologists or nurses. Distress, depression, and anxiety were evaluated for a small subsample of participants. From the time the program was initiated, 238 patients between ages 18 and 95 (M = 66.4) were evaluated over a 3-year period. Most patients (77.8%) were offered psychosocial care. Although 49.8% declined treatment, 23.6% attended one session and 26.6% attended two or more. Average number of individual sessions was 2.77 (SD=8.31, range=0-96) and 0.06 (SD=0.43, range=0-4) for groups sessions. Patients referred through the Survivorship Training and Rehabilitation (STAR) Program® (i.e., a program providing multidisciplinary services) were more likely to engage in psychosocial care than those who found out about behavioral health in other ways. Patients experienced declines in depression (Wilks' Λ=.580, F(2, 14)=5.08, p=.022), but not anxiety (Wilks' Λ=.613, F(2, 12)=3.79, p=.053) across sessions. An in-depth case description is provided. Distress tracking may be improved if nurses, oncologists, and behavioral health providers administer measures. Partnerships between clinical psychology doctoral programs and hospitals may be mutually beneficial - and may advance the dissemination and implementation of evidence-based psychosocial interventions. Hospitals offering cancer treatment may benefit from generating referrals for comprehensive cancer care. These efforts can serve as a model for other hospitals seeking to integrate behavioral health into routine cancer treatment.

Measures of psychosocial care utilization in a national sample of cancer patients.

OBJECTIVE: Cancer is one of the most physically and emotionally debilitating diseases. Despite evidence that psychosocial care can improve psychological and physiological functioning, as few as 4.4% of patients are willing to engage in psychosocial treatment. Few studies explored drivers of psychosocial care underutilization. Therefore, treatment engagement strategies are needed, by identifying patients' barriers to psychosocial treatment. This study evaluated readiness to utilize psychosocial care by developing transtheoretical model (TTM) measures of stage of change, decisional balance, and self-efficacy. METHOD: Online survey data was collected from a national sample of 475 adults (Mage = 47.89, SD = 14.77) with cancer diagnoses. A sequential process of measure development was used. Semistructured expert and research participant interviews were conducted for initial item development, followed by exploratory, confirmatory, and external validation analyses. RESULTS: Principal components analyses (PCA) indicated two, 4-item factors (pros α = .874; cons α = .716) for decisional balance. Confirmatory factor analyses (CFA) supported a 2-factor correlated model, χ²(19) = 68.56, CFI = .962, RMSEA = .078. For self-efficacy, PCA indicated two, 3-item components (physical α = .892; social/emotional α = .708). CFA supported this structure χ²(8) = 23.72, CFI = .989, RMSEA = .067. Physical component items included fatigue, pain, and discomfort. Multivariate analyses indicated significant cross-stage differences for pros, cons, and self-efficacy. CONCLUSIONS: Findings support the validity of the developed stage of change, 8-item decisional balance, and 6-item self-efficacy measures for psychosocial care. Clinicians could use these tools to address perceived cons of psychosocial care, including shame and self-efficacy (e.g., using psychosocial care despite pain). These scales may help treatment teams better address barriers to psychosocial care utilization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Where Does Your State Stand on Shackling of Pregnant Incarcerated Women?

Pregnant incarcerated women have been identified as a particularly high-risk group and among the most vulnerable women in the United States. The use of shackling or restraints poses health risks to pregnant women and their fetuses. Currently, only 22 states have legislation prohibiting or limiting the shackling of pregnant women. Here we provide an overview of the potential negative health outcomes that can result from shackling pregnant women, especially during labor and birth, and suggest strategies for nurses who wish to promote optimal health care for incarcerated women and to advocate for anti-shackling legislation in their states.

The "Voice" and Perspectives of Adolescents Participating in a Short-Term Psychotherapy Group.

Group psychotherapy is an ideal choice for adolescents who engage in mental health treatment. It is considered a "natural" fit, as adolescents are focused on their peer group. This research study presents the effectiveness of an adolescent psychotherapy group with an interpersonal approach, using their "voices" and perspectives. A qualitative descriptive design was selected. Semi-structured, open-ended interviews were conducted with eight adolescents who attended a process-oriented psychotherapy group for a period of three months. The data were analyzed using manifest content analysis. All eight participants described their experiences and the meaning of their experiences. A number of therapeutic factors emerged from the data consistent with Yalom's theoretical framework. The participants also described a number of benefits and identified several recommendations for group therapists.

The Impact of a Mindfulness Based Program on Perceived Stress, Anxiety, Depression and Sleep of Incarcerated Women.

Incarcerated women enter the prison setting with remarkable histories of trauma, mental health and substance abuse issues. Given the stress of incarceration and separation from their children, families, and significant others, it is not surprising that many women experience increased anxiety, depression, and problems with sleep. Due to these negative outcomes, it is imperative to find efficient non-pharmacological interventions. This pilot study examined the impact of a 12-week mindfulness based program on the stress, anxiety, depression and sleep of women with a total of 33 completing the study. In one group, women's perceived stress, anxiety and depression were all significantly lower following the intervention compared to prior to the intervention. Challenges with implementing the pilot study are addressed. Despite challenges and limitations, the low-cost non-pharmacological intervention has potential for a reducing the symptoms of anxiety and depression.

Nurse researchers in corrections: a qualitative study.

The United States has more people, per capita, in prisons and jails than any other country in the world. Because the prison population is largely composed of people who have been economically and socially disadvantaged, a very high percentage enter correctional facilities in poor health. Because of the large concentrated numbers of women, men, and youth in prisons and jails, an exceptional opportunity exists for nurses and other researchers to conduct creative and innovative research to improve the health care of this hard-to-reach population. The purpose of this study was to explore the experiences of nurse researchers who have been successful in conducting studies in different correctional settings. A qualitative descriptive design was used, and telephone interviews with 16 participants were completed. The participants described how they established credibility, the challenges they faced, and the unexpected personal and professional rewards they received. Recommendations for potential researchers will hopefully lead to an increase in research with this invisible population.

Advocating for pregnant women in prison: the role of the correctional nurse.

On any given day, approximately 6%-10% of women who are incarcerated in prisons and jails in the United States are pregnant. Although incarcerated pregnant women have been identified as a high-risk group because of compromised physical and emotional health when they enter these settings, their specific healthcare needs are frequently unmet or partially met during their imprisonment. Stressors imposed by prison life and separation from their newborn at birth often exacerbate existing mental health issues including posttraumatic stress disorder, depression, anxiety, and insomnia. Nurses in correctional settings play a strategic role in improving the health care of this population by promoting teamwork, incorporating standards of care, and advocating for changes in policies. Collaboration with the warden, physician or nurse practitioner, correctional officers, and social workers can lead to positive changes in health outcomes. Given the national emphasis on gender responsive treatment in prisons and jails, a window of opportunity exists to be a voice for these women and make significant changes in health care for this largely underserved [corrected] population.

Health care of pregnant women in U.S. state prisons.

BACKGROUND: Although standards for pregnancy-related health care in correctional facilities have been established, there is no mandatory accreditation that requires adherence to these standards. Furthermore, this information has been difficult to access from correctional facilities across the country. METHODS: To examine the health care practices of pregnant women in state prisons, a survey with 62 multiple choice questions and four open-ended questions was developed. Wardens of 50 women's state correctional facilities were contacted to describe the study and request participation. Nineteen facilities completed the survey, for a 38% response rate. RESULTS: The findings of this study provide further evidence of the substandard care that pregnant incarcerated women receive in correctional facilities. In many state prisons, nutritional recommendations for a healthy pregnancy are not met, adequate rest is compromised and lower bunks are not required. Psychosocial support and education are minimal at best. The use of restraints, which can compromise the health and safety of the woman and her baby, continues as a matter of procedure in many facilities even during labor and delivery. CONCLUSIONS: The providers of health care for pregnant women fail to use best practices and established standards in many women's state prisons. A concerted effort is urgently needed to address the unmet health care needs of this marginalized population and support legislation to limit the use of restraints with pregnant incarcerated women in all states.

Who will speak for me? Advocating for pregnant women in prison.

The 1999 publication of a report by Amnesty International on the use of shackles and restraints with pregnant incarcerated women by correctional facilities in the United States was an attempt to highlight this ongoing practice. Despite the initial outrage expressed in many professional arenas, it continues in many states. This commentary provides a snapshot of incarcerated pregnant women and briefly discusses the risks associated with the use of shackles and restraints. Specific strategies describing how to advocate for this invisible and vulnerable population are provided with the hope that more nurses will be the voice for these women in correctional institutions, hospitals and in state government.

Navigating the challenges of prison research with women.

Despite the healthcare needs of an increasing number of incarcerated women in the United States, few researchers access this underserved population. The authors provide practical information to help novice researchers navigate potential institutional challenges including obtaining institutional review board approval, gaining entry, complying with rules and regulations, recruiting and retaining participants, and collecting data.

Suicide assessment by psychiatric nurses: a phenomenographic study.

Although suicide assessment has been researched, nurses haven't been included in studies nor has this been explored from a phenomenographic perspective. Suicide assessment by nurses was investigated using a phenomenographic design. Data were collected through observations, vignettes, and interviews. Phenomenographic analysis discovered four qualitative differences in suicide assessment among nurse participants: reliance on (1) examples of other suicide cases, (2) intuition, (3) others' assessments, and (4) prior experience. The categories were classified into a three dimensional theoretical structure of suicide assessment: (a) Knowledge, (b) Method, and (c) Reference. Variability in participants' assessments established a structure of suicide assessment that furthers understanding of how nurses assess suicide and provides implications for practice.

Development of an educational/support group for pregnant women in prison.

It is estimated that 6-10% of women are pregnant when they enter the prison system. The majority have had little, if any, prenatal care and/or childbirth education. Given economic constraints, the educational and support needs of this population are often not met. In response to these needs, an educational/support group was developed and led by a social worker, a mental health clinical nurse specialist, and a nurse midwife in a women's correctional facility in the Northeast. Women in various stages of pregnancy and early postpartum voluntarily attended. The need for education and psychosocial support was overwhelming. This group fostered a safe space for women to discuss real-life issues in a supportive environment. Meeting the educational and support needs of incarcerated women is paramount.