Steps to Achieve Universal Suicide Screening in Emergency Departments: A Call to Action

American individuals attempt suicide at alarmingly high rates of approximately 1.1 million times per year. Yet the United States has failed to adopt a systematic approach to suicide prevention, particularly via universal screening. Given the increasing number of individuals with suicidal ideation presenting to emergency departments (EDs), all patients who present to the ED for treatment should be screened, as opposed to only individuals with mental health complaints. In the current article, barriers to suicide screening in the ED are discussed, as well as strategies to move ED providers toward the goal of universal screening. The current article entreats nurses to be leaders in achieving universal screening and provides practical actions to begin the process. Specific recommendations for action include improving training, increasing lethal means assessment, and achieving compliance with The Joint Commission suicide screening guidelines. [Journal of Psychosocial Nursing and Mental Health Services, 56(10), 21-26.].

Public Dialogue in Nursing and Healthcare

Dialogue between two scholars on the importance of engagement with consumers as well as professionals. Social media is emphasized as a critical mode of communication.

Capturing the Interpersonal Process of Psychiatric Nurses: A Model for Engagement

Staff members' engagement with patients is a critical element of inpatient psychiatric care, essential to safety, the hospitalization experience and the development of a culture of care. Currently broad concerns exist around the amount of time inpatient psychiatric nurses expend in patient engagement and the quality of these interactions. In this paper we present a model of engagement that clarifies necessary skills to support the engagement process. The model is based on Peplau's theory of interpersonal relations, patients' ideas on healing elements of psychiatric hospitalization and research on inpatient therapeutic relationships. We are currently using this model for a web-based teaching/learning course to cultivate interpersonal engagement, and to explicate how through operationalizing their inpatient role, nurses support patients in the development of their mental health and well-being.

Preferences for Medical Marijuana over Prescription Medications Among Persons Living with Chronic Conditions: Alternative, Complementary, and Tapering Uses

OBJECTIVES

Despite expanded legalization and utilization of medical cannabis (MC) internationally, there is a lack of patient-centered data on how MC is used by persons living with chronic conditions in tandem with or instead of prescription medications. This study describes approaches to use of MC vis-à-vis prescription medications in the treatment of selected chronic conditions.

DESIGN

Participants completed semistructured telephone interviews with open-ended questions. Content analysis of qualitative data identified themes and subthemes relating to patient approaches to using MC products.

PARTICIPANTS

Thirty persons (mean age = 44.6 years) living with a range of chronic conditions (e.g., rheumatoid arthritis, Crohn's disease, spinal cord injury/disease, and cancer) who had qualified for and used MC in Illinois.

RESULTS

Participants described a range of approaches to using MC, including (1) as alternatives to using prescription or over-the-counter medications; (2) complementary use with prescription medications; and (3) as a means for tapering off prescription medications. Motives reported for reducing or eliminating prescription medications included concerns regarding toxicity, dependence, and tolerance, and perceptions that MC improves management of certain symptoms and has quicker action and longer lasting effects.

CONCLUSIONS

MC appears to serve as both a complementary method for symptom management and treatment of medication side-effects associated with certain chronic conditions, and as an alternative method for treatment of pain, seizures, and inflammation in this population. Additional patient-centered research is needed to identify specific dosing patterns of MC products associated with symptom alleviation and produce longitudinal data assessing chronic disease outcomes with MC use.

Impacts on Global Health from Nursing Research

Infectious disease continues to adversely affect populations in low- and middle-income countries. Investments in solutions often focus on technology, yet health-care workers remain in short supply. Nurses are the largest cadre of health-care workers and are largely responsible for patient care around the world. In fact, it is estimated that nurses care for nine out of every 10 patients seen. Importantly, sound nursing science contributes to solutions that directly impact patient care, especially those that pertain to infectious disease. Here we share several examples of nursing science that are improving care delivery in three global health areas: human immunodeficiency virus testing and prevention strategies in Malawi, family planning in Kenya, and response to Ebola virus disease.

Social Media Awareness and Implications in Nursing Leadership

Many nursing professionals-may be reluctant to engage in or are confused about appropriate use of social media in a clinical, research, or policy context. To address this issue, we developed a study to enhance nurse leaders' facility with social media in the context of a national professional meeting. This study examined a social media campaign at the 2015 American Academy of Nursing conference. The campaign was intended to bridge the gap between active social media users and nonusers attending the conference. Following a targeted social media campaign at the American Academy of Nursing 2015 Transforming Health, Driving Policy Conference, responses to the conference evaluation questions about social media were reviewed and analyzed. Overall, evaluations were positive about the campaign; however, some conference attendees were not aware of its various components. Despite perceived barriers to its use, there is significant curiosity about social media use among nurse leaders. With the engagement of these leaders, there may be opportunities to enhance social media use at professional meetings and to make broader use of this valuable tool throughout the nursing profession.

Exploring the Intersections of Trauma, Structural Adversity, and Psychosis among a Primarily African-American Sample: A Mixed-Methods Analysis

Traumatic life events (TLEs) have been associated with multiple psychiatric diagnoses, including anxiety disorders, major depression, PTSD, and psychosis. To advance our understanding of the complex interactions between forms of adversity as they manifest across the lifespan, psychosis, and symptom content, we undertook a mixed-methods investigation of TLEs and psychosis. Our research explored the association between cumulative exposures, type of TLE, and proximity to the traumatic event and psychosis; the association between TLEs and clinical symptomology including specific types of delusions and/or hallucinations; and how qualitative data further inform understanding of complex relationships and patterns of past trauma and symptoms as they unfold over time. There were a total of 97 participants in the quantitative study sample, 51 participants with present state psychosis and 46 non-clinical. There were a total of 34 qualitative study participants, all of whom were experiencing psychosis. The quantitative analysis showed that when comparing persons with psychosis to the non-clinical group, there were no group differences in the overall total score of TLEs. However, there was a significant difference in cumulative TLEs that "Happened," demonstrating that as the number of TLEs increased, the likelihood of clinical psychosis also increased. We also found a correlation between lifetime cumulative TLEs that "Happened" and PANSS five-factor analysis: positive, excitement, depression, thought disorder, activation, and paranoia scores. The qualitative analysis further built on these finding by providing rich narratives regarding the timing of trauma-related onset, relationships between trauma and both trauma-related and religious-spiritual content, and trauma and hallucinatory modality. Analysis of participant narratives suggests the central role of localized cultural and sociopolitical influences on onset, phenomenology, and coping and contributes to a growing literature calling for strengths-based, client-driven approaches to working with distressing voices and beliefs that centers the exploration of the personal and social meaning of such experiences including links to life narratives. Findings also underscore the clinical importance of trauma assessment and trauma-informed care.

God in the brain: Experiencing psychosis in the postsecular United States

There is a growing literature on what contemporary cultural theorists have broadly termed the "postsecular": the abandonment of clear-cut boundaries between the secular and nonsecular in the industrialized West and an embrace of a complex understanding of what is real that neither accepts nor rejects the supernatural. These new cultural currents may affect not only philosophers and theologians, but also the ways in which individuals with psychosis make sense of their experiences. This paper reports on the key findings of an in-depth qualitative analysis of 19 interviews of individuals diagnosed with psychotic disorders. The majority of participants described ongoing and self-conscious struggles to demarcate their experiences as the products of the real world or a "crazy" mind. With equal frequency, participants weighed and debated competing secular and supernatural explanations, often juxtaposing and blending different explanatory frameworks. We found that this syncretic process affected not only the content of psychotic experiences-what delusions or hallucinations are about-but also the type of arguments or logics used to justify particular interpretations. We discuss the implications of these observations with respect to clinical practice and the broader phenomenology of psychosis, challenging often oversimplified discourse on "insight" and suggesting that polarization(s) between "biomedical" and "psychosocial" explanations may be of less relevance to patients' real-world experiences than is often assumed.

Problematic Interviewee Behaviors in Qualitative Research

The interview is a staple of many qualitative approaches. Although textbooks offer extensive guidance to researchers about conducting interviews, less guidance is available about problematic interviewee behaviors, such as flattery or statements indicative of social desirability response bias. In this study, a secondary analysis of 22 phenomenological interview transcripts, we sought to examine problematic interviewee behaviors. More than 300 pages of typed text were subjected to line-by-line scrutiny, yielding only six potential instances of the phenomenon. Each could be interpreted several ways. What appeared to be flattery could also be perceived as simple gratitude or appreciation. We concluded that problematic behavior was rare in this data set.

Complicating Counterspaces: Intersectionality and the Michigan Womyn's Music Festival

The counterspaces framework articulated by Case and Hunter (2012), follows from community psychology's long-standing interest in the potential for settings to promote well-being and liberatory responses to oppression. This framework proposes that certain settings (i.e., "counterspaces") facilitate a specific set of processes that promote the well-being of marginalized groups. We argue that an intersectional analysis is crucial to understand whether and how counterspaces achieve these goals. We draw from literature on safe spaces and present a case study of the Michigan Womyn's Music Festival (Michfest) to illustrate the value of an intersectional analysis and explore how these processes operate. Based on 20 in-person interviews, 23 responses to an online survey, and ethnographic field notes, we show how Michfest was characterized by a particular intersection of identities at the setting level, and intersectional diversity complicated experiences at the individual level. Moreover, intersectional identities provided opportunities for dialogue and change at the setting level, including the creation of counterspaces within counterspaces. Overall, we demonstrate the need to attend to intersectionality in counterspaces, and more broadly in how we conceptualize settings in community psychology.

Risk behaviours of an interrelated syphilis-infected sexual network of men who have sex with men

AIMS AND OBJECTIVES

We examined the risk behaviours in an interrelated sexual network of 33 syphilis-infected men who have sex with men on the use of condoms, substances and websites to meet sexual partners. Our study used a descriptive exploratory design to investigate co-occurring high-risk behaviours in this interrelated sexual network to inform future health interventions and research directions.

BACKGROUND

Although the risk behaviours for human immunodeficiency virus transmission in men who have sex with men have been studied, few have studied the high-risk population of men who already have syphilis, and even fewer have studied the risk behaviours in sexual networks of syphilis-infected men who have sex with men who were identified using contact tracing.

DESIGN/METHODS

The data were collected from semi-structured, individual interviews at a not-for-profit lesbian, gay, bisexual and transgender health centre in a large city in the Midwestern USA.

RESULTS

Inconsistent condom use was substantial during both insertive (92%) and receptive (88%) anal intercourse. Most participants (97%) reported using one or more substances prior to or during anal intercourse, and Internet websites were the most common place to meet sexual partners (88%).

CONCLUSIONS

High-risk behaviours were significant within this syphilis-infected sexual network of men who have sex with men. The majority of our 33 participants were non-Hispanic Whites (n = 27, 82%), possessed a baccalaureate degree or higher (n = 23, 70%), and actively sought out unprotected anal intercourse [21 participants (64%) used BareBackRT.com, a website to seek out unprotected anal intercourse].

RELEVANCE TO CLINICAL PRACTICE

Nurses should be more informed about the risk factors of a high-risk sexual network of syphilis-infected men who have sex with men. Interrelated sexual networks have high levels of similarity among participants' high-risk behaviours; contact tracing may be used to identify individual participants for relevant risk-reduction interventions.

Trans women and Michfest: An ethnophenomenology of attendees' experiences

The rise of queer and transgender studies has greatly contributed to feminist and lesbian understandings of sex, gender, and sexuality and also has resulted in rifts, tensions, and border wars. One such tension is around the inclusion of trans women in women-only space, such as the Michigan Womyn's Music Festival (Michfest). In this ethnophenomenological study, we interviewed and surveyed 43 cisgender women who attended Michfest in 2013. Participants had a variety of perspectives on trans inclusion and on the dialogue surrounding it, and these paralleled intersections, frictions, and tensions between feminism, queer theory, and transgender studies.