Let's Get to the Root of Ashwagandha: What Health Care Professionals Need to Know.

The prevalence of stress- and anxiety-related disorders is increasing along with widespread demand for anxiolytics. Due to drug supply shortages and access restrictions, nonprescription remedies have gained popularity. In addition, the marketing of herbals and botanicals as low-cost and all-natural products with fewer access restrictions has increased their use. The current article explores the evidence to provide an overview of the current understanding of Ashwagandha (Withania somnifera), an anxiolytic and apoptogenic herb with therapeutic and health-promoting potentials to help the body reduce stress and maintain a homeostatic state. Due to poor quality controls and diversity of Ashwagandha products, clinical trials on Ashwagandha's effectiveness in anxiety-related conditions reveal conflicting results, although many show favorable findings. Furthermore, health care professionals, such as nurses, advanced practice nurses, physicians, physician assistants, and pharmacists, need to be aware of variability in Ashwagandha products, quality controls, reported evidence regarding use, safety profile, and clinical implications in stress reduction. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 33-40.].

The Price of Gambling: Examining Gambling Disorders.

Gambling disorders are a serious public health problem. This manuscript will provide a comprehensive overview on this topic. Gambling disorder involves repeated patterns of gambling behaviors, that result in significant distress or impairment in a person's interpersonal relationships, employment, educational/career opportunities, and finances over a period of 12 months. Gambling is defined as an activity that involves risking something of value with the hopes of acquiring something of greater value. Comparable to substance use disorders, individuals with a gambling disorder may be unsuccessful in exercising control over their problematic behavior, engage in the behavior despite negative consequences, and have preoccupations/cravings to gamble. Gambling disorder has higher comorbidity rates of mental disorders including depression, anxiety, substance use, and personality disorders. Gamblers rarely seek treatment. Treatments must be tailored to the individual which may include psychological interventions, cognitive behavioral therapy, gamblers anonymous, and psychopharmacological agents such as selective serotonin reuptake inhibitors, mood stabilizers, and opioid antagonists to treat clinical symptoms.

Electroconvulsive Therapy for Treatment-Resistant Depression: Dispelling the Stigma.

The current article is a comprehensive overview of electroconvulsive therapy (ECT) for treatment-resistant depression (TRD), especially with suicidality and psychosis. Common misconceptions and stigma associated with ECT are discussed. Major depressive disorder, one of the most prevalent lifetime mental disorders, is often associated with significant impairments that impacts one's ability to function. Antidepressants may be efficacious in treating depression; however, approximately one third of individuals do not respond to psychotropic medications. Therefore, other treatment options, such as ECT, must be considered for those who do not respond to medications, have psychosis, or are suicidal. [Journal of Psychosocial Nursing and Mental Health Services, 61(6), 11-17.].

Holistic Psychosocial Approaches in the Care of Hispanic Victims of Trauma: An Overview.

The collapse of the Champlain Towers South (CTS), a condominium in Miami, Florida, left a diverse group of survivors and healthcare clinicians tasked with finding ways of coping with the disaster. Within seconds, the CTS collapse became a global tragedy due to the coastal neighborhood's rich international mix of residents. Although this tragedy impacted communities across globe, a large population of Hispanic victims lived in CTS that were deeply affected. Culturally adaptive interventions and holistic healthcare for Hispanic individuals are highly relevant because Hispanic Americans represent one of the fastest growing demographic groups in the United States. To reach, engage, and address the needs of Hispanic victims, this article provides an overview of psychosocial factors that influence Hispanic victims with trauma and discusses holistic psychotherapeutic approaches in nursing care that can be applied to improve victims' well-being. Culture is an important consideration in health; therefore, this article highlights and operationalizes culturally tailored holistic nursing care that draws from the physical, mental, emotional, and spiritual dimensions of health and well-being that can be used in clinical settings with Hispanic clients who have experienced trauma.

Promoting a culture of reciprocity to build social capital in advanced practice nursing students.

ABSTRACT: A virtual activity integrating the evidence-based Reciprocity Ring model was designed to enhance confidence and skills for building social capital for advanced practice registered nursing (APRN) students. The central objective of the activity was to reduce the stigma of asking for help by providing a framework for the balanced exchange of favors, thus supporting new connections and feelings of trust among APRN students. Students from two APRN practice tracks ( N = 44) participated in a virtual Reciprocity Ring activity where they could post and respond to requests for help. On average, students posted 2.5 requests and received three offers for assistance; 220 connections were made overall with the major theme requests related to stress management. A retrospective survey was administered at the conclusion of the activity. Questions inquired about student confidence before, and then after, the activity for identifying resources, providing help to others, finding personal support when needed, accessing resources related to academic success, and finding solutions to problems. Student mean confidence scores were significantly higher after the activity compared with mean confidence scores before the activity ( p = .01). Additionally, the effect size was large (Cohen d = 0.89). Therefore, we suggest that integrating Reciprocity Ring exercises into nursing curricula and practice can be a useful tool for promoting skills related to productive help-seeking that will support APRN students' academic and professional success.

The Impaired Nurse.

ABSTRACT: Substance use disorders (SUDs) do not discriminate. Anyone can be affected regardless of age, sex, ethnicity, socioeconomic status, or profession. Nurses with SUDs present serious risks to both their patients and the nursing profession. Frontline nurses' responsibility to provide patients with safe, high-quality care may be too great a challenge for those with SUDs, resulting in adverse consequences. Early recognition and treatment of nurses with SUDs promotes patient safety and retention in the profession. For this reason, all nurses and other health care professionals should be able to recognize behaviors associated with SUDs and should be familiar with the available treatment modalities.

Promoting Nurse-Led Mobility Protocols for Hospitalized Older Adults: A Systematic Review.

Hospitalized older adults (aged ≥65 years) are at risk for functional decline and negative outcomes associated with immobility, such as pressure injuries and falls. There is a paucity of research that examines impacts of mobility interventions in older adults in medical surgical units. The current systematic review examines the impact of mobility-related interventions in this population. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review. Eligibility determination and data extraction, synthesis, and evaluation were independently performed by the authors. Findings revealed that older adult patients who participated in mobility protocols or early mobility programs were mobilized significantly more and were more mobile after discharge. Several studies also showed reduced hospital length of stay (LOS). The literature supports mobility programs as interventions that can have significant impacts on mobilization for medical surgical patients and reduce hospital LOS. [Journal of Gerontological Nursing, 48(7), 24-30.].

Calm Down With Kava: What Clinicians Need to Know.

Kava is a neuroactive medicinal herb that can induce pharmacological effects when ingested. As an herbal remedy, kava exhibits sedative, anesthetic, euphoriant, and entheogenic effects. Kava is used as a relaxant, pain reliever, and remedy for anxiety and insomnia. In the United States, kava is marketed as a safe dietary supplement. Kava's popularity is on the rise due to heightened awareness and interest in natural plant-based health alternatives. Although meta-analyses and systematic reviews of kava use in treating anxiety are favorable, results remain inconsistent. Due to poor quality control, diversity of kava products, and lack of standardization, health care professionals, such as nurses, advanced practice nurses, physicians, physician assistants, and pharmacists, need to be familiar with the pharmacology, possible polydrug interactions, and management of kava use as a remedy for anxiety-related conditions. The purpose of the current article is to provide an overview of kava and its use as a remedy for psychological issues, such as anxiety and nervousness. [Journal of Psychosocial Nursing and Mental Health Services, 60(12), 17-24.].

Moral Injury and Telemental Health Services: An Overview on Clinician Impact.

Moral injury develops from enduring complex moral conflicts that occur when one's beliefs and values are violated by committing, perpetrating, failing to prevent, or witnessing acts that transgress one's deep moral compass. In response to the coronavirus disease 2019 pandemic and the extraordinary impact to patients and health care systems around the globe, telemental health has rapidly expanded as a means to optimize resource use and comply with social distancing mandates. Social determinants of health, which include financial inequity, have influences on pandemic situations, such as physical distancing and lockdowns, resulting in disproportionate delays in timely mental health diagnosis and management. The current article discusses an overview of how the demands of the pandemic have forced mental health clinicians working in telemental health to face a wide range of complex ethical and moral dilemmas. [Journal of Psychosocial Nursing and Mental Health Services, 60(11), 49-54.].

Moving toward AI-assisted decision-making: Observation on clinicians' management of multimedia patient information in synchronous and asynchronous telehealth contexts.

BACKGROUND: Artificial intelligence (AI) intends to support clinicians' patient diagnosis decisions by processing and identifying insights from multimedia patient information. OBJECTIVE: We explored clinicians' current decision-making patterns using multimedia patient information (MPI) provided by AI algorithms and identified areas where AI can support clinicians in diagnostic decision-making. DESIGN: We recruited 87 advanced practice nursing (APN) students who had experience making diagnostic decisions using AI algorithms under various care contexts, including telehealth and other healthcare modalities. The participants described their diagnostic decision-making experiences using videos, images, and audio-based MPI. RESULTS: Clinicians processed multimedia patient information differentially such that their focus, selection, and utilization of MPI influence diagnosis and satisfaction levels. CONCLUSIONS AND IMPLICATIONS: To streamline collaboration between AI and clinicians across healthcare contexts, AI should understand clinicians' patterns of MPI processing under various care environments and provide them with interpretable analytic results for them. Furthermore, clinicians must be trained with the interface and contents of AI technology and analytic assistance.

Primary Care Clinician's Knowledge of Trafficking in Persons: A Systematic Review.

INTRODUCTION: Human trafficking is an enormous global threat. Primary care clinicians are part of a safety net of professionals who may be able to identify and assist trafficking in persons (TIPs). The purpose of this systematic review was to explore clinicians' knowledge, attitudes, and behaviors in identifying and assisting TIPS in health care settings. METHODOLOGY: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review. Searches were conducted using PubMed, Medline Plus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases that yielded 130 articles, of which 10 quantitative articles met eligibility criteria. Eligibility determination, data extraction, synthesis, and evaluation were independently conducted by the authors. RESULTS: Findings revealed deficits in clinician's knowledge, attitudes, and behaviors on identifying TIPs in clinical settings. In addition, cultural influences affect TIP's decision-making. DISCUSSION: To support the wide-ranging needs of TIPs, education programs that include clinician trainings on the skills required to identify and assist TIPs across cultures is warranted.

How Clinicians Perceive Artificial Intelligence-Assisted Technologies in Diagnostic Decision Making: Mixed Methods Approach.

BACKGROUND: With the rapid development of artificial intelligence (AI) and related technologies, AI algorithms are being embedded into various health information technologies that assist clinicians in clinical decision making. OBJECTIVE: This study aimed to explore how clinicians perceive AI assistance in diagnostic decision making and suggest the paths forward for AI-human teaming for clinical decision making in health care. METHODS: This study used a mixed methods approach, utilizing hierarchical linear modeling and sentiment analysis through natural language understanding techniques. RESULTS: A total of 114 clinicians participated in online simulation surveys in 2020 and 2021. These clinicians studied family medicine and used AI algorithms to aid in patient diagnosis. Their overall sentiment toward AI-assisted diagnosis was positive and comparable with diagnoses made without the assistance of AI. However, AI-guided decision making was not congruent with the way clinicians typically made decisions in diagnosing illnesses. In a quantitative survey, clinicians reported perceiving current AI assistance as not likely to enhance diagnostic capability and negatively influenced their overall performance (ß=-0.421, P=.02). Instead, clinicians' diagnostic capabilities tended to be associated with well-known parameters, such as education, age, and daily habit of technology use on social media platforms. CONCLUSIONS: This study elucidated clinicians' current perceptions and sentiments toward AI-enabled diagnosis. Although the sentiment was positive, the current form of AI assistance may not be linked with efficient decision making, as AI algorithms are not well aligned with subjective human reasoning in clinical diagnosis. Developers and policy makers in health could gather behavioral data from clinicians in various disciplines to help align AI algorithms with the unique subjective patterns of reasoning that humans employ in clinical diagnosis.

Ayahuasca: What Healthcare Providers Need to Know.

ABSTRACT: Ayahuasca is a pan-Amazonian botanical hallucinogenic decoction made from a mixture of the bark of the Banisteriopsis caapi plant, containing a monoamine oxidase inhibitor, and Psychotria viridis (Rubiaceae) or Diplopterys cabrerana shrubs containing a serotonergic 2A receptor agonist, N,N-dimethyltryptamine, a powerful psychoactive substance. Ayahuasca is a traditional psychoactive sacrament that has been used for shamanic ceremonies for centuries. Ayahuasca is acclaimed for spiritual and psychotherapeutic benefits and is gaining popularity in the United States. Potential risks involved with usage of this hallucinogenic drug include psychotic episodes related to N,N-dimethyltryptamine and serotonin syndrome, which can be potentially life threatening. The consequences of ayahuasca use remain uncertain because of poor quality control, unpredictability, and polydrug interactions. Nurses, advanced practice nurses, and other healthcare providers working in outpatient settings, hospitals, and treatment centers need to be familiar with the pharmacology, possible drug interactions, and management for ayahuasca ingestion for optimal decision making. Nurses are well positioned to facilitate understanding and to advise and educate the public about the potential risks associated with ayahuasca ingestion.

Cultural and Practical Implications for Psychiatric Telehealth Services: A Response to COVID-19.

In the midst of the current COVID-19 pandemic, telehealth or the remote delivery of mental health services via videoconferencing technology is experiencing exponential growth in utilization. Telehealth services provide mental healthcare providers the ability to deliver timely assessments, facilitate and leverage scarce resources, and maintain client connections in a time where social distancing is endorsed. The delivery of culturally appropriate psychiatric telehealth services is particularly relevant for diverse ethnic populations along with best practices to promote client-provider engagement and client satisfaction. The aim of this article is to provide an overview of psychiatric telehealth services and its functions and deliver insights into culturally appropriate practice strategies.

Pseudobulbar Affect: An Overview.

Pseudobulbar affect (PBA) is a disorder that develops in the context of a brain injury or underlying neurological dysfunction. It is characterized as an affective disorder of emotional expression. PBA manifests as frequent uncontrollable outbursts of laughing or crying, incongruent with the individual's internal emotional state. It can be challenging for clinicians to differentiate PBA from mood disorders, contributing to its high rate of misdiagnosis. This lack of recognition leads to ineffective and insufficient treatment, impacting patients' quality of life. The current article provides an overview of PBA, including its history, prevalence, pathophysiology, diagnostic criteria, clinical implications, and treatment. [Journal of Psychosocial Nursing and Mental Health Services, 58(9), 19-24.].

Title Correction: The Association Between Willingness of Frontline Care Providers' to Adaptively Use Telehealth Technology and Virtual Service Performance in Provider-to-Provider Communication: Quantitative Study.

[This corrects the article DOI: .].

Kratom: Implications for Health Care Providers.

Kratom is an herbal drug originating from the Mitragyna speciosa, a plant indigenous to Southeast Asia. Kratom has been widely used for its stimulant and opioid-like effects derived from its main psychoactive alkaloid properties mitragynine and 7-hydroxymitragynine. In the United States, kratom is gaining popularity as an herbal and natural dietary supplement, as well as a natural and legal alternative to narcotics. Kratom use is typically accompanied by increasing tolerance and dependence making it highly problematic. Kratom's potentially toxic and lethal properties have become an emerging public health threat. Due to deficiencies of governmental controls and its rising prevalence among individuals who ingest kratom, health care providers need to be familiar with the pharmacology, adverse effects, and problems associated with kratom ingestion when caring for individuals. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 15-20.].

The Association Between Willingness of Frontline Care Providers' to Adaptively Use Telehealth Technology and Virtual Service Performance in Provider-to-Provider Communication: Quantitative Study.

BACKGROUND: Telehealth technology can create a disruptive communication environment for frontline care providers who mediate virtual communication with specialists in electronic consultations. As providers are dealing with various technology features when communicating with specialists, their flexible attitude and behaviors to use various telehealth-related technology features can change the outcome of virtual care service. OBJECTIVE: The objective of this study is to examine frontline care providers' technology adaptation behaviors in the electronic consultation context. From the perspective of frontline care providers, we reapply and retest a theoretical model, reflecting a mechanism through which technology users' personal characteristics and technology adaptation behavior enhance virtual service performance, which is an important performance enabler in this online meeting context. In provider-to-provider communication, particularly, we explore the association among providers' information technology (IT)-related personal characteristics, adaptive telehealth technology use, and virtual service performance. METHODS: An online survey was administered to collect individual providers' personal traits, IT adaptation, and perception on virtual service performance. Partial least squares-structural equation modeling was used to estimate our predictive model of personal traits-IT adaptation, such as exploitative use (use the telehealth technology in a standard way), and exploratory use (use the telehealth technology as innovative way)-and virtual service performance. RESULTS: We collected 147 responses from graduate nursing students who were training to be nurse practitioners in their master's program, resulting in 121 valid responses from the cross-section online survey. Our theoretical model explained 60.0% of the variance in exploitative use of telehealth technology, 44% of the variance in exploratory use of telehealth technology, and 66% of the variance in virtual service performance. We found that exploitative IT use is an important driver to increase virtual service performance (ß=0.762, P<.001), and personal characteristics such as habit are positively associated with both exploitative (ß=0.293, P=.008) and exploratory use behaviors (ß=0.414, P=.006), while computer self-efficacy is positively associated with exploitative use of telehealth technology (ß=0.311, P=.047). CONCLUSIONS: This study discusses the unique role of frontline care providers in a virtual care service context and highlights the importance of their telehealth adaptation behavior in provider-to-provider communication. We showed that providers perceive that telehealth technologies should function as intended, otherwise it may create frustration or avoidance of the telehealth technology. Moreover, providers' habitual use of various technologies in daily lives also motivates them to adaptively use telehealth technology for improving virtual care service. Understanding providers' technology habit and adaptation can inform health care policy and further provide a better view of the design of telehealth technology for online communication.

Correction to: Role of empathy in the perception of medical errors in patient encounters: a preliminary study.

In the original publication of this article [1], an author name was misspelled.

Role of empathy in the perception of medical errors in patient encounters: a preliminary study.

OBJECTIVE: Healthcare professionals' empathy have been empirically demonstrated to decrease the risk of medical errors. Medical errors affect patient's outcomes and healthcare providers' well-being. Therefore, the purpose of this study was to determine the relationship between patients' perception of healthcare providers' empathy, their intention to adhere to treatment, and their perception of medical errors made. An anonymous survey was emailed to staff at a health center and an urban university in Miami, Florida, USA. RESULTS: A total of 181 participants were enrolled. Participants rating their healthcare provider as high in empathy had 80% lower odds of reporting errors (CI 0.04-0.6). The intention to follow-up with recommendations or return to the provider were not significantly associated with provider's empathy. Patients of high empathy providers were no more treatment adherent that those who rated their provider with low empathy but were less likely to perceive medical error. Providers' empathy significantly affected patients' perception of medical errors. Our results underscore that healthcare curricula need to address the link between empathy and perception of medical errors, including its potential legal implications.