Patterns of Distress in African American Mothers of Preterm Infants

Objective: To examine inter-relationships among stress due to infant appearance and behavior in the NICU, parental role alteration stress in the NICU, depressive symptoms, state anxiety, posttraumatic stress symptoms, and daily hassles exhibited by African American mothers of preterm infants and to determine whether there were sub-groups of mothers based on patterns of psychological distress. Method: 177 African American mothers completed questionnaires on their psychological distress at enrollment during infant hospitalization and 2, 6, 12, 18, and 24 months after term. Results: Psychological distress measures were inter-correlated. There were four latent classes of mothers: the low distress class with low scores on all measures; the high NICU-related stress class with high infant appearance and parental role stress and moderate scores on other measures; the high depressive symptoms class with high depressive symptoms and state anxiety and moderately elevated scores on NICU-related stress and post-traumatic stress symptoms; the extreme distress class with the highest means on all measures. Infants in the high stress class were sicker than infants in the other classes. The extreme distress class mothers averaged the lowest educational level. The classes differed on distress measures, worry about the child, and parenting stress through 24 months with the extreme distress class having the highest values. Conclusion: Although different types of maternal psychological distress were substantially related, there were distinct sub-groups of mothers that were identifiable in the NICU. Moreover, these sub-groups continued to differ on trajectories of distress and on their perceptions of the infants and parenting through 24 months after term. Originally published Journal of Developmental and Behavioral Pediatrics, Vol. 30, No. 3, June 200

A marketing-communications plan for an innovative teleservice for a nonprofit religious organization

Telemarketing -- Marketing - Communications strategy

Using appreciative inquiry to implement person-centred dementia care in hospital wards

The quality of care of persons with dementia in hospitals is not optimal and can be challenging. Moreover, staff may find difficulty in translating what they have learned during training into practice. This paper report the development and evaluation of a set of workshops using an Appreciative Inquiry (AI) approach to implement person-centred dementia care in two hospital wards. Staff worked collaboratively to develop a ward vision and to implement a number of action plans. Using AI approach, staff attitudes towards persons with dementia improved, inter-professional collaboration was enhanced and small changes in staff practices were noted. Dementia care in hospitals can be enhanced by empowering staff to take small but concrete actions after they engage in AI workshops, during which they are listened to and appreciated for what they can contribute

Guidelines for research recruitment of underserved populations (EERC)

Despite concerted efforts to establish health equity, significant disparities persist. One roadblock to eliminating health disparities is the inadequate recruitment of underserved populations, which prevents researchers from creating culturally-tailored interventions. To further develop the science of recruitment, we argue that a systematic approach should be applied to research participant recruitment. Given the lack of practical and comprehensive recruitment conceptual frameworks or guidelines in the literature, the authors propose newly synthesized guidelines for research recruitment of underserved populations: EERC (evaluate, engage, reflect, and carefully match)

Serving highly vulnerable families in home-visitation programs

Home-visitation programs for families with young children are growing in popularity in the US. These programs typically seek to prevent child abuse and neglect and/or promote optimal development for infants, toddlers, and/or preschool-age children. This paper focuses on improving the capacity of home-visitation programs to meet the complex needs of highly vulnerable families with young children. Poverty, maternal depression and substance abuse, and domestic violence are noted as factors that place young children at risk for poor outcomes. The challenges of providing home-visitation services to families in which these risk factors are present are discussed. Family engagement, matching services to families’ needs, and staff capabilities are highlighted as areas in which improvements can be made to enhance home-visitation programs’ capacity to serve highly vulnerable families. Recommendations are given for improving the effectiveness of home-visitation programs in serving these families, as well for addressing policy and research issues related to the further development and evaluation of these programs.First author draf

Patient engagement in action: Timing and intensity of strategies used to engage low income depressed mothers of infants and toddlers

The purpose of this study was to illuminate the process of patient engagement and to determine how components of patient engagement were operationalized in the nurse-patient interpersonal relationship with low income, depressed mothers, a traditionally underserved population. Using a descriptive quantitative design, we examined how components of patient engagement were executed across three phases of the nurse-patient interpersonal relationship. We assessed for differences in engagement strategies used in different phases of the interpersonal relationship and with mothers with varying levels of engagement. Through this study, we observed that patient engagement has several dynamic components varying in intensity and frequency, depending on the phase of the nurse-patient relationship. Mothers varied in their degree of engagement. Lack of engagement by mothers limited the nurses’ use of engagement skills and strategies, thus underscoring the importance of effort and time spent in the orientation phase. Findings from this study can inform and advance the science of patient engagement by expanding the knowledge base and understanding as to the rhythm and flow of patient engagement in practice. Patient engagement requires persistence and variation of engagement strategies to establish an ongoing interpersonal relationship with patients. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Non-Pharmacological Interventions for Pain Management of Cognitively Impaired Nursing Home Residents: A Systematic Review

Background: Greater than 50% of nursing home (NH) residents are cognitively impaired, of which 45-80% experience pain on a daily basis. • Current evidence indicates suboptimal pain management of cognitively impaired older adults. • As residents with moderate to severe cognitive impairment are often unable to self-report pain, this subpopulation is at high risk for suffering. • This problem paired with age-related physiological changes that place older adults at risk for adverse reactions to pain medication suggests a need for non-pharmacological interventions. Purpose: In this systematic review, studies of non pharmacological interventions to reduce pain in cognitively impaired NH residents were reviewed. Study findings were assessed 1) to determine what interventions to reduce pain have been studied in cognitively impaired NH residents 2) to evaluate the effectiveness of these interventions, and 3) to assess the potential for these interventions to be implemented in NHs. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided this systematic review. • Included studies were published in English after January 1, 2001, as JCAHO first established standards for pain assessment and treatment in 2001. • End of life interventions, single case studies, and dissertations were excluded. • PubMed, CINAHL, and Embase databases were searched on September 19, 2016. • A standardized data abstraction tool was utilized. • The quality of each study was evaluated regarding sample size, attrition, randomization, control, and blinding. • Data synthesis was conducted by using standardized vote counting within themes. Results: Across the 9 studies, there were 7 different measures of cognitive impairment and 8 different measures of pain. Studies reported 3 different categories of interventions: specialized dementia care units, training and tools to support pain assessment, and non-pharmacological therapies. Both studies of specialized dementia care units reported that residents on these units receive less pain medication than residents on open units. 2 of 4 interventions involving training and tools to support assessment were associated with deceased pain. The nonpharmacological therapies of reflexology, Passive Movement Therapy (PMT), and Namaste were all associated with a decrease in pain, but long-term maintenance of efficacy is unknown. The Namaste study was the only study to require nursing staff reorganization. In addition to the training required to implement pain assessment systems, interventionists of the 3 non-pharmacological therapies required training. No study noted the cost of implementation

Green care as psychosocial intervention for depressive symptoms: What might be the active ingredients?

Background: Green care is an umbrella term for psychosocial interventions that integrate biotic and abiotic elements of nature to promote an individual s health and well-being (Haubenhofer, Elings, Hassink, & Hine, 2010). Green care interventions include animal assisted therapy, therapeutic horticulture, care farming, and others (Sempik, Hine, & Wilcox, 2010). A variety of green care interventions are used in countries such as Finland, Norway, Japan, Germany, the United Kingdom, and the United States, indicating its capacity for cultural diversity and sensitivity (Annerstedt & Währborg, 2011; Haubenhofer et al., 2010). Some green care therapies, such as community gardening, can be used as low-cost health promotion and disease prevention interventions in difficult-to-target and vulnerable populations; community gardening has been used as an intervention for displaced refugees and improves physical activity, mental health, and community development (Gerber et al., 2016). Many green care interventions can be adapted to treat depression, which directly affects approximately 350 million and is the leading cause of disability worldwide (World Health Organization, 2015). Depression is under-diagnosed, under-treated, and recurs in at least 50 percent of patients who receive treatment (Schwenk & Terrell, 2014). Many people delay seeking treatment for symptoms, causing their depression to remain undiagnosed and untreated (Thompson, Hunt, & Issakidis, 2004). When individuals do seek help, they may encounter barriers in accessing treatment (Mohr et al., 2010). Finally, treatments are sometimes ineffective and fail to decrease symptoms by at least half (McPherson et al., 2005). Green care interventions are novel and evidence based, offering many benefits in terms of access and cost because of their alternative delivery formats. Green care interventions are rarely clinic-based, making treatment more easily integrated into community settings (Sempik et al., 2010). Many green care interventions, such as animal-assisted therapy and horticulture therapy, vary significantly from traditional psychotherapeutic approaches in terms of their settings and format. Qualitative research shows that patients seeking green care do not feel as stigmatized in this type of therapeutic environment (Iancu, 2013). Additionally, green care interventions can often be offered in a group therapy format, which can be tailored to individual needs while providing social benefits (Sempik et al., 2010). Multiple quantitative studies have found decreased depressive symptoms following green care therapies (Gonzalez, Hartig, Patil, Martinsen, & Kirkevold, 2011; Pedersen, Martinsen, Berget, & Braastad, 2015). Key elements identified by participants in qualitative and mixed methods studies include a positive and supportive atmosphere, social engagement, increased physical activities, and increased feelings of skill and competence (Elings & Hassink, 2008; Kam & Siu, 2010; Kogstad, Agdal, & Hopfenbeck, 2014; Nordh, Grahn, & Währborg, 2009; Pedersen, Ihlebæk, & Kirkevold, 2012). Objectives: Through a systematic review of the literature, the researchers evaluated the evidence that social support, behavioral activation, and self-efficacy mediate improvement of depressive symptoms in a range of psychosocial interventions. The findings have been used to expand the consideration of green care as an evidence based therapy and provide insight into possible active ingredients. Design: The researchers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and sourced English-language articles from PubMed, CINAHL and PsycINFO through July 2016. Database searches identified 159 unique articles. To meet inclusion criteria, all studies had to examine depressive symptoms, one of the three mediators of interest, and a psychosocial intervention for adults. With that in mind, the first and second author reviewed the articles separately, excluding 139 articles based on title and abstract. The remaining twenty abstracts were reviewed and screened again by authors, excluding another eight articles after discussion and agreement. Upon full text review, six articles were excluded for the following reasons: five did not analyze the effect of the mediator of interest on depressive symptoms and one did not measure depressive symptoms after the intervention was completed. Two additional articles that were known to the primary author and fit the requirements for inclusion were added at this stage. After screening and exclusions, eight articles were included in the synthesis. Each article was extracted independently; the data were combined into a matrix and analyzed for thematic content. Results: Two studies addressed the mediator of behavioral activation (Losada, Marquez-Gonzalez, & Romero-Moreno, 2011; Ryba, Lejuez, & Hopko, 2014), two addressed social support (Dour et al., 2014; Roth, Mittelman, Clay, Madan, & Haley, 2005), and four addressed self-efficacy(Backenstrass et al., 2006; Kavanagh & Wilson, 1989; Oman & Bormann, 2015; White, Kendrick, & Yardley, 2009). The studies were completed in a variety of Western countries: four in the United States, one in Australia, one in Spain, one in Germany, and one in England. Studies ranged in sample size from 23 subjects to 1004 subjects. A range of interventions were performed across the studies. Out of the eight studies, four interventions included some amount of Cognitive Behavioral Therapy, one was an unspecified combination of individual, family, and group psychotherapy, one was Mantram Repetition Therapy, one utilized Behavioral Activation therapy, and one was purely based on individual physical activity. The duration of each intervention also varied, ranging from six weeks in one study to one year in another study. Evidence from the studies support behavioral activation, social support, and self-efficacy as mediators of improved depressive symptoms in psychosocial interventions. Conclusions: Green care interventions offer a portal for individuals of different depressive symptoms and severities to be treated alongside each other while being modified to meet the needs of each individual participant. Additionally, it offers the opportunity for interventions that target all three active mediators that could be harnessed by nurses at a variety of training levels as well as community health workers