Assisted Living Residents' Sense of Belonging and Psychosocial Outcomes.

Little is known about the psychosocial adjustment of older adults in the assisted living environment. A sense of belonging has been linked to psychological health and a lack of belonging could lead to loneliness. We conducted a cross-sectional descriptive study to examine relationships between social engagement, sense of belonging, and psychological outcomes. Seventy female and 30 male assisted living residents participated. The mean age was 83.9 (range 65-99) years. Structural equation modeling (SEM) revealed that older age, higher physical function, and greater sense of belonging were associated with fewer negative psychosocial outcomes (depression and loneliness) and that sense of belonging functioned as a mediator between social engagement and psychosocial outcomes. Additional work is needed to fully understand how sense of belonging and other factors influence psychosocial outcomes.

Development and testing of a self-regulation model for recurrent depression.

Self-regulation is a strategy for self-management of depression. Study aims were to (1) describe development of an intervention based on metacognition and self-regulation, (2) test intervention feasibility and utility, and (3) determine its effectiveness in reducing depressive symptoms. The Self-Regulated Illness Management of Depression intervention was developed and taught to 22 participants with recurrent depression. There was no attrition 6 months post intervention. At 6 months, there was a significant decrease in depressive symptoms (M = 10.21, standard deviation = 8.0), t(18) = 5.60, p < .001, and 73 percent of participants used Self-Regulated Illness Management of Depression frequently. Results indicated that Self-Regulated Illness Management of Depression was feasible and useful.

Testing the relationship between a self-management intervention for recurrent depression and health outcomes.

BACKGROUND: Depression is a leading cause of disability globally. It is a recurrent chronic illness that affects over three million people worldwide. Self-management has been found to positively impact depression outcomes but few techniques or interventions are theory-based and can be used either with or without the support of mental health care providers. OBJECTIVES: This study aimed to test the relationship between a self-management intervention called the Self-Regulated Illness Management of Depression (SRIM-D) intervention and specific health outcomes (depression, self-efficacy, social support and quality of life). SRIM-D was developed using metacognition and self-regulation theories. SAMPLE AND SETTING: Twenty-three individuals with major depressive disorder (MDD) participated in the study. Individuals over 21 years of age without a diagnosis of bipolar disorder, current substance abuse problem or suicidal ideations who suffered from MDD (BDI-II < 19) were considered for the study. METHODS: The intervention was delivered over three consecutive weeks of 1 ½â€¯hour sessions by two PhD prepared nurses with psychiatric experience. Participants were given a workbook manual with corresponding power point presentations conferring information about depression, and were led through a series of workbook activities designed to teach the self-regulation process as applied to their recurrent depression. Health outcomes were assessed via self-report survey prior to and six-month post-intervention. RESULTS: Six months post-intervention depressive symptoms decreased significantly (M = 6.62, SD = 14.76, t(15) = 5.60, p < .0001). Self-efficacy (M = 161.67, SD = 25.27); t(20) = -2.89, p < .01) and quality of life (13.25, SD = 3.61; t(19) = 2.62, p > .01) both improved significantly. Social support had a negligible, insignificant decrease from pre-intervention (M = 53.05, SD = 19.81) to six months post-intervention (M = 42.14, SD = 19.53). CONCLUSIONS: Overall, the SRIM-D intervention improved health outcomes in this study. The intervention demonstrated applicability to people with recurrent, chronic depression who might or might not have access to care.

Assessing Cognitive Representations of Antidepressants: Development and Validation of the Attitudes Toward Medication-Depression Inventory.

Antidepressant drugs represent the mainstay of treatment for depression; however, nonadherence is a major problem. Attitudes are predictors of long-term adherence and drive medication use. The Attitudes Toward Medication-Depression (ATM-D) Inventory was developed and tested with 131 patients in primary care settings who reported a diagnosis of depression. Content validity was assessed by experts with a 94.4% agreement on item relevancy. Exploratory factor analysis showed three factors (course of medication treatment, identity, and control) that accounted for 57% of the total variance in the final 17-item scale. The instrument demonstrated good internal consistency reliability (α = .76-.84) and test-retest reliability (α = .74-.83). Results support the construct validity and reliability of the instrument and revealed unique insights into patients' cognitive representations of their antidepressants. This study supported that patients have cognitive representations related to depression and antidepressants that go beyond simple concerns about the effects of the medication.

Identifying the Structure and Effect of Drinking-Related Self-Schemas.

Self-schemas have received increased attention as favorable targets for therapeutic intervention because of their central role in self-perception and behavior. The purpose of this integrative review was to identify, evaluate, and synthesize existing research pertaining to drinking-related self-schemas. Russell's integrative review strategy guided the search. Sixteen published works were identified, meeting criteria for evaluation ( n = 12 data-based publications and n = 4 models). The retrieved data-based publications rated fair-good using Polit and Beck's criteria; the overall body of literature rated "B" using Grimes and Schulz criteria. Retrieved models rated 4 to 7 using Fitzpatrick and Whall's criteria. The existing literature strongly supports the availability of a drinking-related self-schema among moderate-to-heavy drinking samples, and suggests a positive relationship between elaboration and drinking behavior. The relationship between valenced content of the schema and drinking behavior remains unexplored. Identifying variation in the structural properties of drinking-related self-schemas could lay the foundation for future interventions.

Experiencing transformation: the case of Jordanian nurse immigrating to the UK.

AIMS AND OBJECTIVES: This study explored how Jordanian nurses experienced the transition from home to host country to illuminate the elements of transformation. BACKGROUND: Much research has been conducted on topics such as the current international nursing shortage and the recruitment of nurses from various countries. International nurses have unique needs with regard to adapting to new host cultures and workplaces; furthermore, the literature has revealed little evidence of nurses' professional and personal experiences related to migration. DESIGN: A qualitative study was conducted, collecting data via individual interviews. METHODS: Twenty-five face-to-face and telephone interviews with Jordanian migrant nurses. RESULT: This study showed that living and working in a host country changes the personal, social and professional attributes of migrant nurses. When nurses migrate, they encounter opportunities and significant challenges in their professional and personal lives. Although Jordanian nurses contributed their knowledge and skills to the UK healthcare system, they encountered enormous professional adaptation demands. Work setting discrepancies between source and host country are likely a major element behind the required nursing profession alteration. nurses' lives are transformed in terms of their personal and social networks in the host country. CONCLUSIONS: Social transformation is an integral and inseparable part of engagement with professional organisation(s) in the host community. Professional integration likely has far-reaching effects and consequences involving not only the individual but also their home and host country families and their professional networks. RELEVANCE TO CLINICAL PRACTICE: To provide high-quality nursing care, we must learn about the transformation experience, expand our sense of who we are and gain a degree of control over how we perform our nursing roles when we move away from our home.

Measuring Confidence in Nursing Graduates Within the Framework of the AACN Essentials.

: The American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education provide a framework for assessment of nursing programs. The purpose of this pilot study was to determine if there was a difference in self-perceived confidence in meeting the AACN essentials between senior students who completed a traditional clinical course and those in a preceptorship course. A descriptive, comparative design was used. The results indicate that students who completed both course models had similarly high levels of perceived confidence in meeting the majority of the AACN essentials.

Considering a relational model for depression in Navy recruits.

OBJECTIVE: Key variables that have influenced depression in previous research were examined in this study including adult attachment, perceived social support, sense of belonging, conflict in relationships, and loneliness for their relationships in a relational model for depression with U.S. Navy recruits in basic training. METHODS: This theory-testing analysis study was part of a larger cross-sectional cohort study that examined the factors associated with depression in Navy recruits. The sample for this study included 443 recruits. Structural equation modeling was used to test the fit of the theoretical model. RESULTS: The proposed model explained 49% of the variance in depressive symptoms with loneliness and sense of belonging as the strongest indicators of depression. CONCLUSIONS: The Navy should consider interventions that increase sense of belonging in high risk for depression recruits to decrease loneliness and depression and circumvent recruits not completing basic training. The assumption that recruits are in close quarters and contact with other people and therefore are not lonely and receive adequate social support is not supported. This article contributes to advancing the science of mental health in relation to depression by considering predictors that are amenable to intervention.

The development and testing of the nurses' cardiac triage instrument.

Rapid recognition and treatment of myocardial infarction (MI) reduces morbidity and mortality. Although emergency department (ED) nurses are often the first provider to evaluate individuals and are in a prime position to initiate MI guideline recommendations, no valid and reliable instrument was found to quantify their decision-making processes. The purpose of this study was to develop and test the psychometric properties of a new theoretically driven, empirically based instrument for measuring nurses' cardiac triage decisions. Using a descriptive research design, data were collected using a mailed survey. There were 158 ED nurses who completed a mailed questionnaire. Factor analysis revealed three factors (patient presentation, unbiased nurse reasoning process, and nurse action) with good internal consistency (Cronbach's alpha = .903, .809, .718) and sample adequacy (KMO = .758) of the 30-item instrument. The newly developed instrument has the potential to improve patient outcomes surrounding early MI identification and treatment.

Addressing psychosocial care using an interactive Web site for combat-wounded patients.

PURPOSE: The aims were to examine military nurses and combat-wounded patients' evaluation of a cognitive behavioral intervention Web site called Stress Gym. DESIGN AND METHODS: The use of the intervention was a proof-of-concept design with 129 military nurses and combat-wounded patients in military medical treatment facilities (MTFs). The nurses and patients logged on to Stress Gym, reviewed the nine modules available, and completed a short evaluation of the Web site. FINDINGS: The evaluation of the military nurses and patients was high. There were no significant differences in the evaluation based on military services, sex, deployment, and education levels. PRACTICE IMPLICATIONS: The strength of Stress Gym is that it enables all military members to learn about and get help with problems such as stress, anxiety, anger, and depressive symptoms anonymously and in private. CLINICAL RELEVANCE: Stress Gym is a versatile tool that can help nurses address the psychosocial needs of their patients by encouraging its use and including it in treatment protocols.

The need for reform of human subjects protections in military health research.

A number of factors currently hinder the ability of researchers to conduct military-funded research studies successfully in a timely fashion, including low-risk, psychosocial and behavioral, multisite studies. Our experiences and a review of the literature highlight examples of delays and wide variations in military and civilian Institutional Review Board (IRB) approvals. This article describes the specific experiences from a program of research over a 15-year period, required documents unrelated to protection of human subjects, onsite study principal investigators, examples from other research, and participant recruitment. Concern is raised about significant resources committed to nonstudy interventions, some described as "training," which fall outside of IRB review and its human subject protections. A broad initiative for evidenced-based research, particularly psychosocial and behavioral research, could become marginalized with limited resources redirected to technology-focused quick fixes and data collection during training. Possible solutions and initiatives are proposed that emphasize the need to reform IRB oversight and associated paperwork that is required to undertake military research.

Military nurses and combat-wounded patients: a qualitative analysis of psychosocial care.

PURPOSE: The aims were to explore the lived experience of combat-wounded patients and the military nurses who care for them. DESIGN AND METHODS: The study was a qualitative phenomenological design, and focus groups were conducted with 20 nurses and 8 combat-wounded patients. FINDINGS: Themes common to nurses and patients were coping, shared experiences, finding meaning, psychosocial nursing care, families, and bureaucratic structure. Thematic differences were the patients' perspectives "changed self" while nurses described "professional boundaries." PRACTICE IMPLICATIONS: The importance of finding meaning presents ideas that could help nurses and patients cope better with stressful situations regardless of the setting.

Stress Gym: Feasibility of deploying a web-enhanced behavioral self-management program for stress in a military setting.

Stress and depression can adversely impact the performance of military personnel. Cognitive-behavioral (CBT) interventions for managing stress are efficacious in traditional face-to-face formats, but the Internet supports a broader reach of these programs. This study reports on the feasibility of using an Internet-based self-help stress-management intervention in military personnel. There were 142 officers/enlisted sailors at a Naval Medical Center who completed the program. Evaluation of the program titled "Stress Gym" was positive for the user interface, content, feasibility, and satisfaction. Positive evaluation was not influenced by rank/status, sex, or previous deployment. Stress ratings also decreased significantly while using the program. These data support Stress Gym as being an online CBT-based self-help intervention that is feasible to deploy, accepted by the intended end users, and demonstrates the intended goal of reducing stress.

Development and testing of the Diabetes Self-management Instrument: a confirmatory analysis.

The purpose of this study was to develop and psychometrically test a new instrument for measuring self-management of adults with type 2 diabetes. Data were collected from 634 diabetic adults recruited from three teaching hospitals in Taiwan. Construct validity was determined by confirmatory factor analysis (CFA). Tests of internal consistency and test-retest were used to assess the reliability of the diabetes self-management instrument (DSMI). Initial results of CFA did not fully support the proposed five-factor model. After the model was modified, the fit indices indicated that this model fits the data best. This model was further cross validated in a second sample. Cronbach's alpha coefficient of the DSMI total scale was .94. The test-retest correlations for the DSMI total scale were acceptable (r = .73, p < .01).

Diabetes self-management experience: a focus group study of Taiwanese patients with type 2 diabetes.

AIMS AND OBJECTIVES: The purpose of this study was to understand and document the perspectives of Taiwanese patients with type 2 diabetes regarding the processes and strategies used to self-manage their chronic condition. BACKGROUND: The importance of patients learning self-management through self-regulation has been recognized in the literature, but little of this research has focused on skills to manage symptoms. Besides, studies about how patients self-manage their diabetes in term of patients' perspectives have been scant. Sociocultural context is also an influencing factor in disease management. METHODS: Focus groups were used to collect data from 41 adult participants with type 2 diabetes at three teaching hospitals located in southern Taiwan. The five focus groups ranged in size from six to ten people. The focus groups were recorded, transcribed and analysed. RESULTS: Three themes and ten subthemes were revealed. The first theme 'the impact of the illness' includes three subthemes: facing the predicament of stigmatization, concern about inheritance of diabetes and seeking alternative therapy for hope. The second theme 'self-regulation process' includes four subthemes: struggling for diet control, adjusting to psychological barriers, identifying body response and developing strategies for dealing with diabetes. The third theme 'transformation process' includes three subthemes: resuming conventional illness, support from families and fellow patients and learning to live with the disease. CONCLUSIONS: Findings obtained from the themes of the study illustrated that self-management of patients with diabetes is highly related to their own sociocultural environment and experiences. Understanding the cultural features and the meaning of illness can help in the development of interventions tailored to the needs of this cultural group. RELEVANCE TO CLINICAL PRACTICE: The findings have important implications for healthcare providers to consider individuals' sociocultural backgrounds in which they make choices about their treatment and manage their illness. This recognition will enhance patients with diabetes to transform being active in self-management through the skills of self-regulation.

STARS: strategies to assist navy recruits' success.

The purpose of the Strategies to Assist Navy Recruits' Success (STARS) project, a prospective cluster-randomized intervention trial, was to determine the effects of the BOOT Camp Survival Training for Navy Recruits-A Prescription (BOOT STRAP) mental health intervention on divisions of Navy recruits. A total of 1,199 recruits participated in the study. The intervention was provided weekly during basic training to an entire division. The percentage of recruits separated from the Navy who did not receive the intervention was almost twice as large as compared to the recruits who did receive intervention (10.33% vs. 5.17%; p < 0.05) during surge training. The intervention group recruits developed significantly higher group cohesion, higher scores on problem-solving coping strategies, and higher perceived social support, while reporting lower scores on anger expression coping strategies than the control group recruits. Potential cost savings per year on recruit training were estimated to be $18.6 million. Training facilitators and conducting the group intervention would cost an estimated $1.5 million per year. Building on previous research, the results of this study have the potential to decrease attrition, improve recruit performance levels, and provide a cost-effective method of enhancing recruit retention.

Depressive symptomatology after mild-to-moderate traumatic brain injury: a comparison of three measures.

Measurement of posttraumatic brain injury depression is problematic. Disagreement exists about the best screening measure, and symptoms of brain injury often overlap those of depression. In an outpatient sample of 75 persons, we compared aspects of Criterion A of the Diagnostic and Statistical Manual of Mental Disorders--Fourth Revision, Text Revision (2000), with three depression subscales: the Neurobehavioral Functioning (NFI-D), Profile of Moods State (POMS-D), and Center for Epidemiologic Studies (CES-D). Nearly 40% of this outpatient sample had significant levels of depressive symptoms. All measures were internally consistent, reliable, and highly correlated. For persons with mild-to-moderate traumatic brain injury, the CES-D was the best screening instrument because of its ease in administration, sensitivity in detecting probable major depressive disorders, its established categories of severity, and its comprehensiveness. Further effort in the establishment of depression severity categories using the NFI-D is needed.

The role of sense of belonging and social support on stress and depression in individuals with depression.

This longitudinal study examined the role of sense of belonging, social support, and spousal support on the relationship between perceived stress and symptoms of depression in 90 men and women who had a history of depression (n = 51) and who did not have (n = 39) a history of depression. Data were obtained at 3, 6, and 9 months after initial entry into the study. A series of regression analysis procedures revealed a mediation effect, but not a moderation effect, of sense of belonging and perceived social support on the relationship between perceived stress and depression in only the depressed group. Spousal support had neither a direct effect nor an interaction effect on the perceived stress-depression relationship in the depressed group. For the comparison group, perceived stress did not correlate significantly with the symptoms of depression. Repeated measures analysis of variance showed that increased perceived stress and lower sense of belonging had significant direct effects on the severity of depression and the effects were consistent over the period of 9 months. Social support and spousal support had only indirect effects that fluctuated over time. The results emphasize that interventions geared toward stress reappraisal and promotion of sense of belonging should yield direct and stable effects of decreasing depression.

Psychosocial effects of the BOOT STRAP intervention in Navy recruits.

The purpose of this prospective study was to investigate the effects of the Boot Camp Survival Training for Navy Re cruits--A Prescription (BOOT STRAP) intervention on stress depression, situational events, interpersonal factors, and recruit training performance. Divisions of Navy recruits were randomly selected and 801 recruits participated for the 9 weeks of their training. Recruits "at risk" for depression were randomly assigned to the intervention or nonintervention groups, and the remaining recruits served as the comparison group. The at-risk recruits who received the BOOT STRAP intervention significantly increased their sense of belonging, experienced less loneliness, used more problem-solving coping skills, and decreased insecure attachment by the end of recruit training. Percentages of recruits in the study success fully completing basic training were 84% of the comparison group, 86% of the intervention group, and only 74% of the nonintervention group. Results suggest that the BOOT STRAP intervention improves recruit functioning, strengthens train ing performance, helps reduce attrition, and may have impor tant implications for stress and depression interventions.