Journal of the American Psychiatric Nurses Association最新文献

Introduction: Increased aggression in a regional Comprehensive Psychiatric Emergency Program (CPEP) led to a significant rise in physical assaults, restraints, and use of security personnel. Root cause analysis revealed a need for more extensive training on de-escalation, teamwork and communication.

Aims: This quality improvement project evaluated the impact of an interprofessional, high-fidelity simulation project on interdisciplinary collaboration to manage de-escalation and aggression safely and effectively.

Methods: Interdisciplinary team members (N = 171 nurses, psychiatrists, social workers, crisis specialists, and safety officers) participated in a 2.5-hr educational initiative that included Crisis Prevention Intervention (CPI) and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) interventions, high-fidelity simulation using standardized patients, observation, and debriefing. Quantitative data collection and analysis included the use of the Confidence in Coping with Patient Aggression Instrument (CCPAI), TeamSTEPPS Perception Questionnaire (T-TPQ), pre-post data on restraints, injuries, and an educational survey. A qualitative analysis of debriefing themes was also performed.

Results: Statistically significant improvement was noted in individuals' confidence to manage aggression. In addition, data collected over a 5-month period before and after simulation demonstrated a 35% reduction in restraints and a 52% reduction in injuries. Interestingly, quantitative evidence revealed no changes in perceptions of teamwork. Results from the educational survey highlighted the positive impact of standardized patients and debriefing, and gaining new insights into patient care. Qualitative analysis of debriefing themes revealed educational opportunities to improve communication, role clarity, de-escalation, and insights into patient impact.

Conclusion: The use of high-fidelity simulation with standardized patients has the potential to strengthen interdisciplinary collaboration to safely manage aggression in an acute psychiatric setting.

Background: Violence against women and girls (VAWG) is a serious threat to individual and public health with vast negative impacts, including numerous physical and mental health issues, as well as societal and economic consequences. Numerous women's self-defense interventions have been proposed to reduce the risk of victimization.

Aims: The current integrative review, based on Whittemore and Knafl's framework, was completed to synthesize current evidence on women's self-defense training, the impact of such training on outcomes related to VAWG, and evaluate the strength of evidence for women's self-defense training interventions.

Methods: A systematic literature search, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, was performed including a comprehensive computer-assisted database search, as well as citation searching and website searching for studies that included quantitative outcomes related to VAGW published between 2011 and 2023. Data were extracted and analyzed in accordance with Whittemore and Knafl's (2005) methodology, and the body of evidence was synthesized and best evidence recommendations developed based on the ©The Johns Hopkins Hospital/The Johns Hopkins University Evidence-Based Practice Model.

Results: Ultimately, 19 publications met inclusion criteria and were included in this review. Key findings included strong evidence demonstrating that participants in women's self defense training reported fewer incidents of attempted rape, completed rape, and nonconsensual sexual contact compared to controls, as well as fewer postraumatic stress disorder (PTSD) symptoms, among other positive outcomes.

Conclusions: Further research is needed in more diverse populations at risk for violence and to identify key characteristics of effective interventions, including optimal content and dose.

Background: The shortage of inpatient psychiatric mental health care nurses in Saudi Arabia represents an important health care challenge.

Aim: The aim of this study was to illuminate perspectives of psychiatric mental health nurses employed in psychiatric inpatient settings about their employment experiences.

Method: This study adopted an exploratory qualitative approach using thematic content analysis. Ten professional nurses with psychiatric inpatient caring experience participated in two focus groups composed of Master of Nursing students.

Results: Four main themes emerged: inadequate professional skills and knowledge for psychiatric mental health care practice, negative public attitudes toward psychiatric/mental health nurses, concerns for personal safety, and alternatives and advantages. The findings of this study suggest that nurses' lack of interest in working in psychiatric units is not merely personal but also social and organizational.

Conclusions: The study findings may encourage managers and authorities to develop measures to attract more mental health nurses to work in psychiatric units. Such strategies may include modification of nurses' skills, training, and professional knowledge, collegial supervision, mentoring, and working conditions and environment.

Introduction: One in five adults in the United States suffers from mental illness. Negative social influences in the Hmong community stigmatize those who have mental health challenges and mental health outcomes are impacted by poor mental health literacy. Language barriers, conflicting traditional beliefs, and Western concepts of health contribute to low mental health literacy and willingness to seek professional mental health services among the Hmong.

Aims: The aim of this project was to successfully implement Mental Health First Aid (MHFA) to a group of 30 or more Hmong adult church leaders in a faith-based setting.

Methods: A pretest posttest project design was used. The project implementation process was guided by the Plan-Do-Study-Act (PDSA) model and took place from June 2023 to August 2023. Participants were recruited from three local Detroit Hmong churches. Indicator measures included the Mental Health Literacy Scale (MHLS) and Community Attitudes toward Mental Illness (CAMI) Scale before and immediately after training. One final survey was administered at 6 weeks post MHFA training to measure information retention, stigma, and utilization of MHFA skills.

Results: Results reflect the existing body of literature regarding MHFA and the positive impacts on mental health literacy, confidence level, mental health awareness, and decreasing stigma.

Conclusion: MHFA continues to demonstrate successful implementation across many settings and populations, especially for this project among Hmong adult church leaders. More research is needed to expand on mental health and the Hmong.

Background: While most people experience potentially traumatic events (PTEs), including Adverse Childhood Experiences (ACEs), the stress reactions to PTEs on mental health outcomes are highly heterogeneous. Resilience is influenced by a complex biopsychosocial ecological system, including gene serotonin transporter-linked promoter region or 5-HTTLPR /rs25531 by ACEs interactions.

Aims: This pilot study investigated the gene-by-environment interactions on mental health outcomes in adults enrolled in a health care profession program using a generalized additive model (GAM).

Methods: Seventy health care college students (mean age = 27.4 years, 67.1% women) participated in this cross-sectional study. Saliva samples were collected from students to analyze 5-HTTLPR/rs25531. Participants completed the ACE Questionnaire and the Mental Health Inventory. GAMs with different interaction terms were built adjusting for age, gender, and race. The value of the effective degree of freedom (EDF) quantifies the curvature of the relationship.

Results: Among participants with the long allele of 5-HTTLPR/rs25531, a linear pattern was found between the total ACE score and mental health outcomes (EDF = 1). Conversely, among participants with the short allele, EDF was approximately 2, indicating a curved association suggesting that mental health worsens in individuals exposed to up to four types of ACEs.

Conclusions: The impact of up to four ACEs on mental health was stronger among individuals with the short allele of 5-HTTLPR/rs25531 than those with the long allele. Although this study does not claim to provide a definite approach to analyzing gene-by-environment interactions, we offer a different perspective to explore the relationship.

Background: Severe and persistent mental illnesses (SPMIs) affect a significant portion of the adult population in the United States. Despite their increased medical disease burden, individuals with SPMIs often lack access to appropriate medical care. Home health services offer cost-effective options for caring for this population in the comfort of their homes. However, little is known about the perceptions of home health nurses providing care to persons with SPMIs, and how they are adjusting care to persons with SPMIs.

Aims: This study aimed to explore home health nurses' perspectives on caring for persons with SPMIs.

Methods: Using a grounded theory approach, individual semi-structured interviews were conducted with home health and home hospice nurses. The research questions focused on the nurses' experiences, barriers and facilitators to care, and the impact of the home environment on caring for persons with SPMIs. Data analysis followed coding procedures outlined in grounded theory, resulting in the development of an axial coding model.

Results/conclusions: The findings provide valuable insights into the challenges and opportunities faced by home health nurses when providing care for individuals with SPMIs. The outcomes of this study are intended to contribute to the understanding of current care practices and can guide the allocation of resources to improve care for this vulnerable population, such as incorporating training specific to persons with severe psychiatric illnesses.

BACKGROUND: Institutional betrayal (IB) refers to the wrongdoings, encompassing both action and inaction, committed by institutions against their affiliated individuals. Military members are particularly vulnerable to IB due to strong social identification with the military, values of loyalty and self-sacrifice, dependence on the institution, the military power structure and legal system, and the complexity of morality in an occupation centered around war. AIMS: This review examines the state of IB literature within the military/Veteran population, identifying research gaps and implications for future policy and clinical care. METHODS: Conducting a systematic scoping literature review across seven databases resulted in 16 eligible publications out of 44 found. RESULTS: Findings indicate a high prevalence of IB experiences within the studied population, correlating with increased psychiatric symptoms and clinical features. The existing literature primarily focuses on military sexual trauma, with limited exploration of IB in the context of combat, politics, return from deployment, illness, military exposures, and moral injury. CONCLUSIONS: Future research should expand on IB in other military experiences, evaluate intervention efficacy and policies, and validate a standardized IB measure. These insights highlight the need for provider education, revised assessments, and interventions tailored to address the complex impact of IB on military and Veteran populations.