Journal of the American Psychiatric Nurses Association最新文献

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.

Introduction: Persons with dementia (PwD) can experience behavioral and psychiatric symptoms (BPS), impacting their quality of life and sense of well-being. Symptoms can occur due to environmental changes, frustration with being asked to do things they can no longer do, underlying medical conditions, and medication interactions. Fatigue, fear, and misperceptions can lead to BPS, such as apathy, depression, irritability, agitation, and repetitive questions. Medication as treatment of BPS for PwD can lead to side effects and the potential for worsening the symptoms for older adults. Medication should only be considered when non-drug approaches fail.

Aims: This project aimed to introduce virtual reality (VR) to home-based primary care veterans with dementia to determine the effect of VR on psychological well-being in PwD.

Methods: Three consecutive days of VR sessions were completed to evaluate psychological well-being before and after VR intervention.

Results: VR was associated with a significant reduction in frustration or agitation when asked to finish a task. After the intervention, veterans had fewer disapproving or angry verbalizations during contact with others and completed more than 5 min of a single activity. They showed fewer facial expressions of fright and demonstrated less frowning or crying. Compared to pre-intervention, veterans demonstrated less pulling away from others, less listlessness, less resistance to being involved in an activity, and asked repeated questions less frequently after the VR intervention.

Conclusions: VR can be a non-pharmacological management technique for decreasing BPS in PwD to increase their psychological well-being.

Objective: Mental health intake may be a time of vulnerability for transgender and gender-expansive (T/G-E) people. Here, we describe processes that create a supportive environment where T/G-E people can feel welcome and safe.

Methods: After reviewing the literature describing the many negative experiences of T/G-E people when encountering health care, we developed a nursing theory-driven, humanistic approach for initiating the therapeutic relationship at intake. Specifically, our approach weaves together Human Caring Theory, trauma-informed care, and therapeutic use of the self during the first encounter with mental health services. Focusing on gathering information needed for the next steps, this process included an examination of every aspect of the intake process to eliminate bias.

Results: When properly and holistically employed, these processes may facilitate the initiation of a trauma-informed, therapeutic relationship and rapport that welcomes all, but especially T/G-E people.

Conclusions: Human Caring Theory provides necessary guidance that humanizes mental health intake procedures aligns with holistic outcomes and may be especially helpful when providing mental health services to people who identify as T/G-E.

BackgroundThere is a need to strengthen the existing qualitative literature to begin exploring the self-management experiences of individuals with bipolar disorder.AimThis meta-synthesis aimed to identify the common components of self-management in individuals with bipolar disorder and provide a synthesis of the qualitative literature on self-management strategies and patients' experiences with bipolar disorder.MethodThe SPIDER framework tool guided the development of an appropriate search strategy. Studies published between 2011 and 2023 in widely used health databases, including PubMed, Cochrane, and Science Direct, were searched. Included studies underwent quality assessment, and data were synthesized and analyzed using the thematic synthesis method.ResultsThe synthesis identified four analytical themes, encompassing 14 subthemes. These themes include (a) understanding bipolar disorder, (b) coping strategies, (c) changing lifestyle behaviors, and (d) social support. Most of the included studies encompassed self-management strategies and experiences developed to cope with the symptoms of the illness.ConclusionsIndividuals diagnosed with bipolar disorder identified effective self-management strategies, including exercising, regular and sufficient sleep routines, and maintaining social connections. They stressed the importance of being competent, self-aware, and resourceful. Additionally, understanding how they perceived bipolar disorder was crucial for making sense of past mood experiences.

Background: Peer recovery coaches (PRCs) have experienced addiction and are trained to help others in recovery. Indigenous American (IA) adult PRCs may fill gaps of culturally specific support in addiction.

Aims: The aims were to: (1) evaluate the feasibility of implementing a PRC intervention compared to an attention control group recovering from a substance use disorder, (2) compare PRC and attention control groups on relapses and secondary outcomes, and (3) measure PRC strategies.

Methods: In this feasibility trial, we recruited a total of 120 adult IAs with substance use disorders. Ninety participants were randomized to the PRC group which received support from a PRC and 30 to the attention control group which received support from a research nurse. Both groups received weekly support for 12 weeks. Participants completed surveys weekly during the 12-week intervention and then monthly for 3 months.

Results: The two groups had similar quantities of alcohol consumed, days of alcohol use, and days of drug use except that the PRC group had fewer days of alcohol use in the first 3 weeks of the intervention phase (2.05 vs. 3.5 days, p = .04). "Support and advocacy" was the most common PRC intervention. PRCs were widely accepted by individuals who completed the program, receiving positive feedback from 79% of participants.

Conclusion: This pilot demonstrated that racially concordant PRC services likely have high acceptability among IA populations. Future studies may draw on these findings by having trained IA coaches recruit and work with individuals in-person to assist with retention.

Background: Urban, ethnically/racially diverse, impoverished people are predisposed to experience unaddressed depression and anxiety. The use of lay mental health ambassadors (MHAs) may effectively expand access to mental health care in underserved neighborhoods.

Aims: This study described the role of lay MHAs as they provided mental health prevention in their communities.

Methods: Using community-based participatory research in the context of long-term partnerships between a department of nursing and three urban, racially/ethnically diverse, and impoverished neighborhoods, the researchers trained 22 Black, White, and Hispanic neighborhood residents to serve as lay MHAs. Descriptive data were collected on the MHAs, their "touches" (mental health conversations) with community residents, responses to these "touches," and role satisfaction of the MHAs.

Results: The MHAs conducted 3,782 "touches" with 1,614 persons during the 28 months of data collection. The recipients of the "touches" were primarily female, middle-aged, and Black. The MHAs employed the strategies of listening and teaching self-care/coping strategies most often. Neighborhood residents' major "take aways" from the "touches" were education and resources. The MHAs were highly satisfied with their role. MHA mental health literacy increased, and mental health stigma decreased from before to 4 to 9 months after training.

Conclusions: The community-driven solution of training lay MHAs to do preventive, upstream mental health work in their neighborhoods holds potential to address existing mental health inequities. This study contributes to an emerging evidence base that can empower communities and nurses to collaborate in the development of useful research agendas, meaningful policy, and tailored mental health care.

BackgroundAdolescent suicide crises usually require mental health services (inpatient and/or outpatient) to address their needs. Navigating the health care system, especially around suicide crises, is difficult and parents of adolescents usually manage their treatment access and engagement. Little research has examined how parents take on this care management role, vital to maintaining safety and improving adolescent menta health, and the barriers and facilitators they experience in these processes.AimsTo explore parents' experiences around adolescent suicide crises, with a focus on care management and barriers/facilitators to this role.MethodsInterviews were conducted with 18 parents of adolescents in the United States who had suicide crises in the previous 3 years. Using a family-systems lens and thematic analysis, researchers identified three themes and three subthemes.ResultsRelevant themes and subthemes were Care Manager Role Transition (subtheme: Home Safety); Barriers after Barriers (subthemes: Logistical and System Barriers; Poor Communication); and Facilitating Engagement. Parents had a sudden transition to the role of care manager during the adolescent's suicide crisis. They experienced difficulty in managing safety and navigating health care systems. Parents of adolescents with eating disorders had more difficulty in navigating systems and managing safety.ConclusionsPolicies and clinical practice must recognize the role and value of parents as care managers of adolescent's mental health services, especially around transitions out of acute care settings. Psychiatric nurses are well positioned to assist parents with this role transition so that parents can better support adolescents during and after suicide crises.

Objective: To explore how integrating Narrative Identity (NI) theory and the Suicidal Narrative (SN) framework into nursing practices can enhance suicide risk assessments and therapeutic engagement, promoting resilience, hope, and recovery among patients.

Methods: This study reviews existing literature on NI and SN frameworks, examining their theoretical foundations and applicability in nursing. It analyzes how these frameworks improve understanding of patient suicidality through qualitative assessment of personal narratives and identifies practical steps for implementation in clinical settings.

Results: The integration of NI and SN into nursing practices has shown potential in improving the quality of suicide risk assessments. It enables nurses to gain a deeper, empathetic understanding of the factors influencing each patient's suicidality, fostering enhanced therapeutic engagement. Challenges such as time constraints and the need for specific training in narrative techniques are identified.

Conclusions: Incorporating NI and SN into nursing assessments can significantly enrich the suicide risk assessment process, providing a more nuanced and empathetic approach that focuses on individual patient stories. However, effective implementation requires overcoming several barriers, including enhancing nurse training in narrative methods and adjusting clinical workflows to accommodate more in-depth patient interactions.