Passport to Freedom: A Trauma-Informed Mindfulness Program for Previously Incarcerated Women.

Poly-victimization is often reported by formerly incarcerated women and leads to physical and mental health problems that interfere with daily functioning, sustained employment, and housing stability. Although reentry programs exist, few focus on the physical and emotional impact of multiple traumas. Passport to Freedom (P2F), a woman-centered, trauma-informed reentry program, was developed to support formerly incarcerated women. The pilot intervention, performed in 2017, focused on the connections between trauma and health, coping with symptoms, and managing one's own health. To examine the effectiveness and feasibility of the intervention, we performed the current mixed methods study with two phases: (1) focus groups, and (2) sessions combining mindfulness and health promotion activities with follow-up evaluations. Participants (N = 24) showed decreased symptoms of depression and concerns of everyday stressors after the intervention. Of participants, 84% (n = 16) reported practicing mindfulness and 63% (n = 8) stated that mindfulness exercises helped with daily stress management. The P2F program offers a promising approach to support formerly incarcerated women with health self-management. [Journal of Psychosocial Nursing and Mental Health Services, 62(6), 18-26.].

Addressing health disparities of individuals experiencing homelessness in the U.S. with community institutional partnerships: An integrative review.

AIMS: To examine existing community-institutional partnerships providing health care services to people experiencing homelessness by addressing social determinants of health (SDOH) at multiple socioecological levels. DESIGN: Integrative review. DATA SOURCES: PubMed (Public/Publisher MEDLINE), CINAHL (The Cumulative Index of Nursing and Allied Health Literature database), and EMBASE (Excerpta Medica database) were searched to identify articles on health care services, partnerships, and transitional housing. REVIEW METHODS: Database search used the following keywords: Public-private sector partnerships, community-institutional relation, community-academic, academic community, community university, university community, housing, emergency shelter, homeless persons, shelter, and transitional housing. Articles published until November 2021 were eligible for inclusion. The Johns Hopkins Nursing Evidence-Based Practice Quality Guide was used to appraise the quality of articles included in the review by two researchers. RESULTS: Seventeen total articles were included in the review. The types of partnerships discussed in the articles included academic-community partnerships (n = 12) and hospital-community partnerships (n = 5). Health services were also provided by different kinds of health care providers, including nursing and medical students, nurses, physicians, social workers, psychiatrists, nutritionists, and pharmacists. Health care services spanning from preventative care services to acute and specialized care services and health education were also made possible through community-institutional partnerships. CONCLUSION: There is a need for more studies on partnerships that aim to improve the health of homeless populations by addressing social determinants of health at multiple socioecological levels of individuals who experience homelessness. Existing studies do not utilize elaborate evaluation methods to determine partnership efficacy. IMPACT: Findings from this review highlight gaps in the current understanding of partnerships that seek to increase access to care services for people who experience homelessness. NO PATIENT OR PUBLIC CONTRIBUTION: The results of the systematic review were solely from the articles reviewed and do not include information from patients, service users, caregivers, or members of the public.

Addressing systemic racism and intergenerational transmission of anxiety using Bowenian family therapy with African American populations: A Discursive paper.

AIM: To examine the intergenerational impact of systemic racism on mental health, depicting the evolution and patterns of anxiety symptoms and the application of the Bowenian family therapy to understand the interrelatedness and long-standing impact of intergenerational trauma in African American families. This article highlights interventions that increase awareness of and promotes physical and mental health for African American populations. DESIGN: Discursive Paper. METHOD: Searching literature published between 2012 and 2022 in PubMed, SCOPUS, EBSCO Host and Google Scholar, we explored factors associated with systemic racism and generational anxiety. DISCUSSION: Evidence-based literature supports the application of the Bowenian family therapy theoretical framework to understand the intergenerational impact of systemic racism and to address the transmission of anxiety symptoms in African American  populations. CONCLUSION: Culturally appropriate interventions are needed to decrease anxiety symptoms in an attempt to heal intergenerational trauma and to improve family dynamics in African American populations. IMPACT TO NURSING PRACTICE: Nurses play an integral role in providing holistic quality patient-centred care for African American populations who have experienced racial trauma. It is critical for nurses to implement culturally responsive and racially informed care with patients that focuses on self-awareness, health promotion, prevention and healing in efforts to address racial trauma. Application of Bowenian family therapy can aid in the reduction of both intergenerational transmission of racial trauma and generational anxiety. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or drafting of this discursive paper. The authors reviewed the literature to develop a discussion.

Promoting community institutional partnerships to improve the health of intimate partner violence survivors experiencing homelessness.

BACKGROUND: Disparities faced by individuals experiencing homelessness pose significant threats to the health and wellbeing of communities. Survivors of intimate partner violence are at heightened risk, with over 80% experiencing homelessness at some point in time. The intersection of homelessness and survivorship creates numerous barriers to care including safety concerns, stable housing, employment and childcare needs. The establishment of community institutional partnerships offers an opportunity to provide healthcare in transitional housing settings. AIMS: The aim of this paper is to discuss the need for community institutional partnerships in addressing the health needs of intimate partner violence survivors and provide a working example of an existing partnership. METHODS: A critical literature review of the literature was conducted. Multiple databases were searched to identify articles relating to health services, community institutional partnerships, intimate partner violence and sheltered housing. Articles were reviewed using The Johns Hopkins Nursing Evidence-Based Practice Quality Guide. FINDINGS: Three types of partnerships that can be leveraged to address the needs of individuals experiencing homelessness were identified: academic-community, hospital-community, and large-scale partnerships. Only one article was identified that focused on the health needs of survivors experiencing homelessness, pointing to the need for implementation of more community institutional partnerships to address the unique needs of homeless intimate partner violence survivors. We highlighted a current successful community institutional partnership that addresses the health needs of survivors living in an emergency shelter. IMPLICATIONS: Addressing the complex needs of this population is imperative to dismantle health inequities and structural barriers to healthcare. Holistic, nurse-led approaches to care are essential to address the health of intimate partner violence survivors experiencing homelessness. The example of a successful community institutional partnership provides a framework for delivering a wide range of healthcare services. Future nursing research is needed to evaluate programmes and provide foundational support for increased funding.

Factors influencing intrapartum health outcomes among Black birthing persons: A discursive paper.

AIM: To examine factors that influence intrapartum health outcomes among Black childbearing persons, including cisgender women, transmasculine and gender-diverse birthing persons. BACKGROUND: Black childbearing persons are three to four times (243%) more likely to die while giving birth than any other racial/ethnic group. Black birthing persons are not just dying from complications but also from inequitable care from healthcare providers compared to their white counterparts. DESIGN: Discursive paper. METHOD: Searching national literature published between 2010 and 2021 in PubMed, CINAHL, Embase and SCOPUS, we explored factors associated with poor intrapartum health outcomes among Black childbearing persons. DISCUSSION: Several studies have ruled out social determinants of health as sufficient causative factors for poor intrapartum health outcomes among Black birthing persons. Recent research has shown that discrimination by race heavily influences whether a birthing person dies while childbearing. CONCLUSIONS: There is a historical context for obstetric medicine that includes harmful stereotypes, implicit bias and racism, all having a negative impact on intrapartum health outcomes. The existing health disparity among this population is endemic and requires close attention. IMPACT ON NURSING PRACTICE: Nurses and other healthcare professionals must understand their role in establishing unbiased care that promotes respect for diversity, equity and inclusion. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or drafting of this discursive paper.

Honoring the past and charting the future: The International Society of Psychiatric Mental Health Nurses' commitment to advance diversity and equity in mental health care.

For more than two decades, the International Society of Psychiatric Nurses has dedicated its efforts to improving mental health care services worldwide, focusing on leveraging the psychiatric nursing workforce and advocating to eradicate systemic health disparities. Part of this labor included creating a culturally centered initiative, the Position Statement on Diversity, Cultural Competence and Access to Mental Health Care to fortify the cultural awareness of ISPN members to improve health-care quality delivered to diverse individuals, families, and communities across the life span and to improve these populations' access to mental health care.

Patient With Very High Opioid Tolerance Enrolled in Opioid Agonist Treatment: A Case Report.

BACKGROUND: Fentanyl and fentanyl analogs have invaded the street-sourced opioid market in North America which has resulted in an unprecedented number of unintentional opioid overdoses. Existing guidelines to treat opioid use disorder are based on evidence that was developed when heroin was the primary street-sourced opioid and proposed dosages of opioid agonist treatments are increasingly inadequate to address patients with high opioid tolerances. CASE SUMMARY: The authors examine one case study of a patient with an extremely high opioid tolerance and review how responsive dose adjustments outside of the recognized maximum doses allowed for meaningful functional outcomes. DISCUSSION: This case demonstrates how patient-centered dose responses with a focus on functional outcomes supersede existing opioids agonist treatment dosing ranges, especially in the context of a patient with a higher than typical opioid tolerance.

A mixed-methods systematic review identifying, describing, and examining the effects of school-based care coordination programs in the US on all reported outcomes.

Children learn best when they are healthy. Therefore, access to school-based health and providing family support for social needs play an essential role in shaping a child's ability to succeed academically. The purpose of this mixed-methods review, which considers studies with all methods, is to describe and examine the effect of US school-based care coordination programs on all the outcomes reported. Care coordination is an organized approach to connect families to resources in the community to address social needs. The literature search identified 260 papers published since 2012 through CINAHL, ERIC, EMBASE, MEDLINE, Social Sciences Full Text, and Web of Science, from which 11 were included that described a US school-based care coordination program. An a priori organizing framework: Program Development, Implementation, and Evaluation were used to organize the findings. Whether quantitative or qualitative, all evaluation results were transformed into qualitative texts, then converted into codes then themes. Various health and learning issues such as asthma and vision screening were addressed. More than half of the care coordination programs were nurse-led. Parents and students characterized care coordination activities as convenient, trusting, and perceived to improve parent-teacher engagement. They also enhanced asthma knowledge and management, immunization adherence, follow-up care for vision and hearing, mental health, and school attendance. Nevertheless, challenges included staff shortages, unmet family needs, privacy laws regarding student data, and lack of resources (i.e., medications). This review highlights the need to expand school-based care coordination programs in the US and conduct robust program evaluations to assess their effectiveness.

Telehealth and the Psychiatric Mental Health Nurse Practitioner: Beyond the COVID-19 Pandemic.

OBJECTIVE: Examine the advantages, disadvantages, and challenges of telehealth for the psychiatric mental health nurse practitioner (PMHNP) in practice and student education. Describe areas for future research and policy development regarding telehealth in PMHNP practice and training during and beyond the COVID-19 pandemic. METHODS: Review current evidence, standards of practice, and education for the PMHNP. RESULTS: Recent rapid pandemic-related shifts in utilization of telehealth for clinical practice and student education have highlighted the advantages, disadvantages, and areas in need of additional study. CONCLUSIONS: Postpandemic telehealth care delivery will likely persist or expand. PMHNPs must advocate for high practice and education standards.

Trauma informed interventions: A systematic review.

BACKGROUND: Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. METHODS: We performed database searches- PubMed, Embase, CINAHL, SCOPUS and PsycINFO-to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. RESULTS: More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). CONCLUSIONS: There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.

The relationship between housing instability and intimate partner violence: A retrospective study.

OBJECTIVE: To examine the relationship between housing instability (HI) and intimate partner violence (IPV) over time, controlling for individual, situational, and social structural factors among women and to determine whether race/ethnicity modifies these relationships. DESIGN AND SAMPLE: The study was a retrospective secondary data analysis from the Fragile Families and Child Well-Being Study. The sample included women who reported their housing status at year 5, yielding 4,000 women. MEASURES: Housing instability was our main independent variable. Our dependent variable of IPV was divided into two categories: no IPV or IPV overtime (IPV reported at baseline, year 1 and year 5). RESULTS: Women were more likely to report HI if they were between the ages of 20-24 (36%), Black (53.2%), did not graduate from high school (48.6%), and were employed with an income of less than $10,000 USD (69%). Race/ethnicity was not found to influence the association between HI and IPV overtime. CONCLUSIONS: Women in their early to mid-twenties, with a low level of education and are employed at low-wage jobs have an increased risk for HI and experiencing IPV. Therefore, nurses need to move beyond traditional assessments and screening to elicit information that will help determine increased risk for HI.

A Systematic Review of Community Health Center Based Interventions for People with Diabetes.

Community health centers (CHCs) focus on serving socioeconomically disadvantaged populations with heightened chronic disease burden, making CHCs an ideal setting for implementing diabetes care programs that target vulnerable populations. We aimed to synthesize evidence concerning the effects of CHC interventions in people with diabetes. To do this, four electronic databases were searched, including PubMed, EMBASE, CINAHL, and Scopus, and hand searches of reference collections were undertaken to identify intervention trials published in English. We screened 892 unique titles and abstracts. Two reviewers then independently evaluated 221 full-text articles. We discovered 29 articles met our eligibility criteria for inclusion. We found 27 unique studies with two companion articles. Seventeen studies were randomized controlled trials and the majority had a higher proportion of female and racial/ethnic minorities in the study sample. CHC interventions often involved either one-on-one or group education sessions supplemented by a phone follow-up that were delivered by health providers, nutritionists, or community health workers. CHC interventions using education sessions combined with follow up via phone generally resulted in significant improvements in hemoglobin A1C, while sole telephone-based education studies showed no significant improvements. CHC interventions had no significant effects on physical activity in all six studies that examined the outcome. Overall, we found that CHC interventions were in general effective in improving glucose control when using face-to-face interactions in low-income, underserved, and racial and ethnic minority patients with diabetes. Evidence was limited, however, in regards to other outcomes which suggests the need for continued evaluations of CHC intervention models.

Community health worker interventions to promote psychosocial outcomes among people living with HIV-A systematic review.

BACKGROUND: Community health worker (CHW) interventions are a successful strategy to promote health among HIV-negative and persons living with HIV (PLWH). Psychosocial factors are critical dimensions of HIV/AIDS care contributing to prognosis of the disease, yet it is unclear how CHW interventions improve psychosocial outcomes in PLWH. The purpose of this study was to critically appraise the types, scope, and nature of CHW interventions designed to address psychosocial outcomes in PLWH. METHODS: We performed database searches-PubMed, EMBASE, CINAHL, and Cochrane-to identify randomized controlled trials published in English before April 2017. Fourteen articles met the eligibility criteria. RESULTS: Half of the studies were conducted in the United States. Social cognitive theory was used more than once in nine theory-guided studies. CHW interventions were largely focused on reducing depression (n = 6) or stigma related to HIV (n = 4), or promoting quality of life (n = 4), social support (n = 4), and self-efficacy (n = 4). Didactic methods and role-playing were used to train CHWs. CHWs played multiple roles in delivering intervention, including a counselor and a supporter (n = 10), educator (n = 5), or a navigator (n = 3). CHW intervention fidelity was assessed in 4 studies. Five studies found positive changes in six psychosocial outcomes including quality of life (2 of 4) and self-efficacy (2 of 4). CHW interventions had no effect on social support in 2 of 4 studies, and stigma in 3 of 4 studies. None of the CHW interventions were successful in reducing depressive symptoms among PLWH. CONCLUSIONS: Evidence partially supported the use of CHWs in promoting psychosocial outcomes in PLWH. Future CHW intervention should be expanded in scope to address key psychosocial determinants of HIV/AIDS outcomes such as health literacy. Further, fidelity measures should be incorporated into intervention delivery.

House to house, shelter to shelter: experiences of black women seeking housing after leaving abusive relationships.

Locating safe and affordable housing is a vital step for women who decide to leave their abuser. Without housing, many women, particularly those who live in poverty, are forced to remain in abusive relationships, accept inadequate or unsafe housing, or become homeless (Menard, 2001; Moses, 2010). Women who choose to leave their abusers are faced with multiple barriers in establishing their independence such as limited financial resources, mental illness, and the lack of affordable housing (Botein & Hetling, 2010), putting them at risk of revictimization. This pilot study explores the narratives of Black mothers currently residing at an emergency intimate partner violence shelter to discover their experiences in seeking housing after leaving abusive relationships with a focus on housing instability and mental health. Utilizing a qualitative descriptive design, four major themes emerged: (a) unstable/insecure housing over time, (b) limited support,