Journal of the American Psychiatric Nurses Association最新文献

Introduction: Transgender and gender diverse (TGD) youth disproportionately experience suicidality and acute psychiatric visits. However, research on affirming care in this setting is severely limited.

Aims: This mixed-methods study aimed to (1) assess pediatric acute psychiatric professionals' knowledge, attitudes, and comfort working with TGD youth and (2) examine pediatric acute psychiatric professionals' experiences and perceptions of providing affirming care to TGD youth.

Methods: This study used a mixed-methods approach to assess pediatric acute psychiatric health professionals' knowledge, attitudes, and comfort working with TGD youth and examine their experiences and perceptions of providing affirming care. Participants completed an online questionnaire consisting of demographic and professional characteristics, transgender-related attitudes and beliefs, and a series of true/false knowledge questions.

Results: Among participants (N = 31), most (n = 22, 71%) reported prior specific training and/or education on TGD youth, while less than a quarter (n = 7, 23%) reported the amount to be adequate. The mean knowledge score was 94.4% (SD = 7.1; range: 73%-100%). Optional interviews (n = 9) yielded nine inductive themes: five describing experiences of TGD youth care and four describing perceptions of affirming care.

Conclusions: Acute psychiatric settings provide crucial care for youth in crisis. Given starkly high rates of suicidality among TGD youth, there is a pressing need for targeted training to enhance healthcare workers' abilities to intervene effectively. Competency training should emphasize gender identity and expression, use of preferred pronouns, and understanding healthcare needs like hormone therapy and gender-affirming surgeries.

Background: Sexual health is a vital aspect of holistic nursing care, yet its integration into psychiatric practice remains limited, particularly among nursing students. Understanding how students approach sexual health in psychiatric settings is crucial for improving education and care quality.

Aims: This study aimed to investigate the factors influencing nursing students' provision of sexual health care to individuals with psychiatric disorders.

Methods: A descriptive qualitative design was used to explore the experiences of 28 undergraduate nursing students enrolled in a psychiatric nursing course in Sakarya, Turkey. Each student assessed the sexual health of individuals with psychiatric disorders during clinical practice with psychiatric patients. Data were collected through semi-structured interviews and were analyzed thematically.

Results: Four themes emerged: (1) inclusion of sexuality in the clinical process, (2) the empowering role of education, (3) uncertainty in sexual care, and (4) systemic invisibility. Facilitators of comprehensive assessment included recognizing diagnosis-related changes in sexual desire, understanding sexuality's role in psychological well-being, and receiving education that strengthened communication skills and confidence. Barriers included conflicts between personal values and professional roles, discomfort and potential misunderstandings in gender-based interactions, cultural norms surrounding sexuality, lack of counseling resources or standardized care plans, and insufficient privacy in psychiatric settings.

Conclusions: Nursing students face educational, cultural, and systemic barriers that complicate sexual health care in psychiatric settings. Targeted educational programs and institutional support are needed, with content addressing privacy, ethics, boundaries, and cultural sensitivity, supported by practice-based learning to better prepare students for sexual health discussions in clinical practice.

Background: The complexity of health concerns associated with unregulated substance use has led to increased hospital utilization by people who use unregulated substances. Health care providers have described inadequate knowledge to adequately support this patient population during hospitalization.

Aims: The aim of this research was to explore health care providers' perspectives on harm reduction and substance use education in hospital settings.

Methods: A qualitative secondary analysis was conducted using an interpretive lens. The research was conducted across three hospitals in one city in Southwestern Ontario. To guide the research, 31 health care providers, the majority being nurses, participated in either focus groups or individual interviews based on preference. All focus group or interview data were analyzed using an ethnographic method of analysis focusing on the hospital environment and education.

Results: Health care providers described two interconnected states regarding harm reduction and substance use education: the current state and the desired state. Key themes which emerged in the current state and desired state include: (a) insufficient education, (b) lack of resources, (c) inconsistent policy, (d) culture of stigma and suboptimal care, (e) enhanced education, (f) resources, (g) policy change, and (h) culture shift and optimal care.

Conclusion: Findings of this study demonstrate the need for supportive policies, adequate resources, and enhanced harm reduction and substance use in hospital settings. Addressing these gaps is essential to transforming hospital culture and improving care for people who use unregulated substances. These insights can inform future policy, practice, education, and guide new research initiatives.

Background: Trends in perinatal anxiety (PNA) and perinatal depression (PND) have been increasing among pregnant and parenting adolescents (PPAs). We examined the state of research on perinatal mental health focused on PPAs experiencing PND or PNA, including knowledge and perceptions of PNA and PND, mental health needs, care preferences, and access to perinatal mental health care among PPAs.

Aims: Our goal was to improve our understanding of PND and PNA among PPAs to enable the development of culturally relevant perinatal mental health interventions, reduce maternal morbidity and mortality, and enhance health outcomes for mothers and infants.

Methods: We used the Whittemore and Knafl (2005) five-stage methodology to search five electronic databases and the Mixed Methods Appraisal Tool to rate the methodological quality of the selected articles.

Results: Our search yielded 26 studies with various designs that assessed PNA and PND. Although we found limited research on PNA, quantitative studies reported PND rates ranging from 16% to 40% among PPAs. PPAs and their families often struggle to differentiate between PND and PNA. Research on PPA's preventive practices for PND and PNA is limited, though coping strategies for PND have been identified. PPAs expressed diverse perspectives on their mental health needs, expecting services to address a broad range of psychosocial issues. Factors influencing PPA's access and engagement with perinatal mental health services should be considered in future interventions to improve adherence and uptake. Tailored web-based interventions, combining professional support with online flexibility, are needed to enhance engagement among PPAs.

Conclusion: Perinatal mental health research for PPAs is evolving. The findings emphasize the need for increased support and adaptive care for PND and PNA in this vulnerable group, particularly in resource-limited settings requiring self-management.

Background: Women Veterans are at increased risk for both substance use and suicidality, both of which can contribute to early morbidity and mortality.

Aims: This study aimed to examine the impact of substance use on suicidality among women Veterans compared to their peers, and how this relationship might be moderated by access to care.

Methods: This study utilized data from the 2015 to 2019 National Surveys on Drug Use and Health (NSDUH) administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) (n = 131,344). A series of binary logistic regression analyses was used to examine the relationship between substance use and suicidality, adjusted for demographic factors and stratified by sex and Veteran status.

Results: Women Veterans were at increased odds of suicidality compared to their peers. In women Veterans, only lifetime non-prescribed prescription opioid use (aOR = 1.99 [1.04-3.79], p = .038) and lifetime cocaine use (aOR = 1.74 [1.10 = 2.74], p = .018) increased the odds of past-year suicidal ideation. Past-year cannabis use disorder, but not combined drug use disorders, increased the odds of suicidal ideation in women Veterans (aOR = 3.93 [1.21-13.81], p = .033). Lifetime cannabis use (aOR = 2.02 [1.03-3.96], p = .040), lifetime cocaine use (aOR=2.24, 1.20-4.05, p = .011), and lifetime stimulant use (aOR = 1.87 [1.05-3.33], p = .034) increased the odds of past-year suicide plans among women Veterans.

Conclusions: Women Veterans are at increased risk for suicidality, and substance use may predict suicidality in this population. Psychiatric nurses can be instrumental in ensuring timely access to care for women Veterans, underscoring this study's clinical relevance.

Objective: The diagnostic landscape in psychiatric practice has shifted significantly in recent years, particularly around neurodevelopmental and trauma-related conditions. Where diagnosis once functioned primarily as a medical tool to identify and treat functional impairment, it is increasingly used as a narrative framework to explain suffering, validate identity, and confer legitimacy within both clinical and social contexts. This conceptual article critically examines the cultural inflation of psychiatric diagnoses, especially autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and trauma-related conditions, and explores implications for psychiatric nursing practice.

Methods: We conducted an integrative review of literature on diagnostic inflation in psychiatry from 2010 to 2024, with particular attention to nursing implications. Literature findings are synthesized with composite case examples representing common clinical dilemmas-identity-based self-diagnosis, diagnostic ambiguity, and the pathologization of adaptive behavior-to illustrate key concepts.

Results: Diagnostic inflation impacts psychiatric nursing in areas including assessment validity, therapeutic alliance, resource allocation, ethical decision-making, and professional identity. Digital culture accelerates these challenges by promoting self-diagnosis and identity-based diagnostic frameworks, particularly among young adults seeking explanations for psychological distress and interpersonal difficulties.

Conclusion: Psychiatric nurses are increasingly called upon to discern between pathology and personhood. We propose a practice framework that maintains diagnostic integrity while honoring lived experience and the meaning that diagnostic narratives hold for individuals seeking understanding of their experiences.