Effect of Preferred Music on Agitation After Traumatic Brain Injury.

Agitation is a common behavioral problem after traumatic brain injury (TBI), which threatens the safety of patients and caregivers and disrupts the rehabilitation process. This study aimed to evaluate the effects of a preferred music intervention on the reduction of agitation in TBI patients and to compare the effects of preferred music with those of classical "relaxation" music. A single group, within-subjects, randomized crossover trial design was formed, consisting of 14 agitated patients with cognitive impairment after severe TBI. Patients listened to preferred music and classical "relaxation" music, with a wash-out period in between. Patients listening to the preferred music reported a significantly greater reduction in agitation compared with the effect seen during the classical "relaxation" music intervention (p = .046). These findings provide preliminary evidence that the preferred music intervention may be effective as an environmental therapeutic approach for reducing agitation after TBI.

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.

Suicidal thought in the adolescent: exploring the relationship between known risk factors and the presence of suicidal thought.

PROBLEM: The purpose of this retrospective study was to explore the relationship between recognized risk factors for suicidal thought and the presence or absence of self-reported suicidal thought. METHODS: This study was conducted through the secondary analysis of data obtained from a larger, prospective, cluster-randomized intervention study. A subset of 817 recruits between the ages of 17 and 19 was included in this study. FINDINGS: A personal history of mental health/emotional problems and a decreased sense of belonging made unique contributions to predicting the presence of suicidal thought. CONCLUSIONS: The development of interventions to increase sense of belonging may be a key to reducing suicidal thought during stressful events.

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.

Development and psychometric testing of a tool to measure missed nursing care.

BACKGROUND: In a qualitative study, medical-surgical and intensive care staff nurses reported that they did not complete a significant amount of nursing care on regular basis. Thus, it was determined that a quantitative tool was needed to measure the amount and type of missed nursing care and the reasons for missing care. OBJECTIVE: The authors report the results of a psychometric evaluation of this tool (The Missed Nursing Care Survey [MISSCARE Survey]) to measure missed nursing care (part A) and the reasons for missed nursing care (part B). STUDY METHODS: Two studies were conducted--study 1 (n = 459) and study 2 (n = 639). A sample of staff nurses was drawn from 35 medical-surgical, rehabilitation, and intensive care patient units in 4 acute care hospitals. RESULTS: Acceptability was high, with 85% of the respondents answering all items on the survey. Factor analysis with Varimax rotation resulted in a 3-factor solution for part 2 (communication, labor resources, and material resources). Cronbach alpha values ranged from 0.64 to 0.86. Confirmatory factor analysis demonstrated a good fit of the data. Using a contrasting group approach, a comparison of nurse's perceptions of missed care on intensive care units versus rehabilitation units resulted, as hypothesized, in a significantly lower amount of missed care on intensive care units. Pearson correlation coefficient on a test-retest of the same subjects yielded a value of 0.87 on part A and 0.86 on part B. CONCLUSION: Although further validation of the MISSCARE Survey is needed, current evidence demonstrates that the tool meets stringent psychometric standards.

Missed nursing care: errors of omission.

This study examines what and why nursing care is missed. A sample of 459 nurses in 3 hospitals completed the Missed Nursing Care (MISSCARE) Survey. Assessment was reported to be missed by 44% of respondents while interventions, basic care, and planning were reported to be missed by > 70% of the survey respondents. Reasons for missed care were labor resources (85%), material resources (56%), and communication (38%). A comparison of the hospitals showed consistency across all 3 hospitals. Associate degree nurses reported more missed care than baccalaureate-prepared and diploma-educated nurses. The results of this study lead to the conclusion that a large proportion of all hospitalized patients are being placed in jeopardy because of missed nursing care or errors of omission. Furthermore, changes in Center for Medicare and Medicaid Services (CMS) regulations which will eliminate payment for acute care services when any one of a common set of complications occurs, such as pressure ulcers and patient falls, point to serious cost implications for hospitals.

Psychiatric nurses' anxiety and cognition in managing psychiatric patients' aggression.

This study explored the anxiety, attitudes, and cognition of the need for aggression management among Taiwanese psychiatric nurses caring for psychiatric patients. Data were collected with self-report questionnaires from 180 psychiatric nurses in the acute wards of three large psychiatric centers in Taiwan. Results showed increased threat of cognitive appraisal of aggression, increased trait anxiety, and decreased positive attitudes toward aggression predicted higher levels of state anxiety. There were significantly higher levels of state anxiety among psychiatric nurses when patients exhibited verbal and physical aggression rather than just physical aggression. An important outcome of this study is the added understanding of cognitive appraisal, trait anxiety, and attitudes, that influence the anxiety of psychiatric nurses.

Chronic stress, salivary cortisol response, interpersonal relatedness, and depression among community-dwelling survivors of traumatic brain injury.

Depression is a common mood disorder after traumatic brain injury (TBI). Largely, study of this phenomenon is theoretical and without biological measures. This explanatory study, guided by McEwen's allostasis model of stress, examined relationships among chronic stress, salivary cortisol profiles, post-injury depression, and interpersonal relatedness. Seventy-five participants, who were or had participated in outpatient brain injury rehabilitation therapies and experienced mild-to-moderate levels of brain injury, were recruited for this cross-sectional study. Salivary cortisol levels showed the usual patterns of circadian rhythmicity, and those with milder injuries had higher 8 am cortisol levels. Salivary cortisol values were not related to measures of chronic stress, interpersonal relatedness, or depression with two exceptions. The 8 am and noon mean values were significantly greater for those who reported more pre-injury childhood adversity, while the 8 pm cortisol mean level was associated with the frequency of pre-injury stressful life events. For this outpatient sample, salivary cortisol levels do not appear to be elevated after TBI or to lack circadian rhythmicity as previously reported. There may be some value in using this measure as a correlate with persons treated in specialized TBI clinics who report pre-injury chronic stress, but future studies are needed with TBI persons who were not treated in specialized clinics or were not taking medications known to influence the hypothalamic-pituitary-adrenal axis.

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.

Trier Social Stress Test: a method for use in nursing research.

BACKGROUND: Researchers face the difficulty of inducing psychosocial stress in a laboratory setting using a method that institutional review boards could consider an acceptable research protocol. METHODS: This article describes the Trier Social Stress Test, a research protocol that can be used to induce psychosocial stress and capture the integrated aspects of an individual's biologic and psychological responses. RESULTS: The test involves 15 minutes of psychosocial stress induced by a mock job interview and followed by a mental arithmetic challenge before a panel of three judges. The discomfort associated with performance requirements induces stress in socially acceptable ways that can be measured using physiologic and/or psychological parameters. CONCLUSIONS: This method allows stress to be induced and measured in a controlled, laboratory setting.

Childhood antecedents of adult sense of belonging.

Sense of belonging has been proposed to be a basic human need, and deficits in sense of belonging have been linked to problems in social and psychological functioning. Yet, there is little evidence about what early life experiences contribute to sense of belonging. The purpose of this study was to examine potential childhood antecedents of adult sense of belonging. The sample consisted of 362 community college students ranging in age from 18 to 72 years, with a mean age of 26 years. Measures included the Sense of Belonging Instrument, the Parental Bonding Instrument, and the Childhood Adversity and Adolescent Deviance Instrument. Multiple regression analysis was used to correlate childhood antecedents with adult sense of belonging. The final reduced model included 12 variables, which accounted for 25% of the variance in sense of belonging. Significant positive antecedents with a relationship with sense of belonging were perceived caring by both mother and father while growing up, participation in high school athletic activity, and parental divorce. Significant negative variables with a relationship with sense of belonging included perceived overprotection of father, high school pregnancy, family financial problems while growing up, incest, and homosexuality. Knowledge of these factors should influence interventions with families regarding child-rearing and parenting practices, mediating the effects of crises during childhood such as divorce and teen pregnancy, and the interpersonal growth needs of teenagers.

Emergency nurses' experience with violence: does it affect nursing care of battered women?

OBJECTIVE: To determine what effect nurses' experience of interpersonal violence had on proposed nursing care of battered women ED patients. METHODS: One hundred ninety-five emergency nurses completed surveys on their personal experiences with violence involving patients or intimate partners and on their proposed nursing care of battered women given 2 vignettes. RESULTS: Seventy percent of participants experienced violence perpetrated by a patient; 40% of the nurses reported violence perpetrated by their intimate partners; and 19% had used force on their partners. Prior assault of a nurse by a patient or partner did not affect the proposed nursing care that would be provided by that nurse to battered women ed patients. Female nurses who committed violence against their intimate partners proposed less nursing care than did those who did not commit violence against their intimate partners for the vignette describing a woman who had received minor injuries. CONCLUSIONS: This study documents the vulnerability of nurses to assault by patients and intimate partners. This vulnerability does not affect their proposed nursing care of battered women. An exception is nurses who themselves commit violence against intimate partners. Findings point to the need to increase safety for nurses in the workplace and provide employee assistance to help nurses confront violence at home.

Factors associated with depression in navy recruits.

The age of onset for depression is decreasing and seems to be linked with major life events. This study examined predisposing and concomitant factors related to Navy recruit basic training, and consisted of 443 recruits (200 with depressive symptoms and 243 matched comparison subjects). Two hypotheses were proposed, and both were supported by results of the study. Depressed recruits were more likely to be separated from the Navy and not complete training. They had significantly more predisposing factors than comparison recruits including family history of mental illness, family history of alcohol abuse, and history of psychiatric problems. They also had significantly more concomitant factors such as higher levels of stress, more loneliness, more life-change events, lower sense of belonging, more emotion-oriented coping, and less task-oriented coping. Although the study examined Navy recruits, the findings are applicable to depression in young people. This study adds to understanding the role of life stressors, interpersonal functioning, and development of depressive symptoms.