<p> The death of a loved one is associated with feelings of grief, which is a multifaceted emotional response for individuals&rsquo; who are attempting to cope with a loss. The grieving process can have an unpredictable trajectory for each person, even though it may encompass many common and familiar features. Grief after a loss incorporates an expansive range of emotional and physical responses, which frequently consists of feelings of sadness, depression, and loneliness. Few studies have reviewed effective interventions for combating the emotional and physical symptoms of grief after the loss of a loved one. Walking is an affordable bereavement care intervention that may prove beneficial in improving grief responses and the related physical and psychological symptoms. A physical activity, such as walking, is a type of activity that is easily performed that may ultimately reduce the effects of stress, decrease depression, and improve mood in persons who have experienced the death of a loved one. The conceptual framework that guided this study was the Roy Adaptation Model. </p><p> The purpose of this study was to decrease the severity of grief related symptoms associated after the death of a loved one using an acute three-week walking regimen and comparing baseline responses to walking completion responses on the Texas Revised Inventory of Grief (TRIG). A convenience sample of 62 persons in southeastern Georgia who had experienced the loss of a loved one participated in the three-week walking regimen. The results showed no statistical improvement in grief scores after a three-week walking program.</p>

<p> Compassion fatigue is of significant concern in critical care settings. Nurses experiencing compassion fatigue suffer physical, emotional, and behavioral symptoms that impact them professionally and personally. When nurses suffer from compassion fatigue, patient care is negatively impacted as nurses lose their sense of caring, compassion and ability to relate to patients or meet their needs resulting in reduced patient outcomes and satisfaction scores. Compassion fatigue prevention programs must be implemented to educate nurses and nurse leaders regarding risk factors, symptoms, and interventions to prevent and treat compassion fatigue. </p><p> Development of a compassion fatigue training (CFT) module occurred to address these concerns at a local healthcare organization. Great care was taken to develop an effective training module. Partnerships were formed. The education department director, staff, and unit managers were valuable resources, assisting with the development and implementation of the CFT module. The plan consisted of: </p><p> &bull; Administration of a Professional Quality of Life (ProQOL) Scale to critical care and highrisk area nurses &bull; Data analysis to determine specific education needs and address deficits &bull; Creation of a CFT Module based on the ProQOL Scale results &bull; Assignment of CFT and deployment of the module in the HealthStream system &bull; Nurse completion of CFT &bull; Post training evaluation of learning &bull; Analysis of evaluation data and summary of learning </p><p> After completion of the CFT module, nurses concluded with a post quiz. Passing scores of 80% were required for successful accomplishment of CFT. All participants achieved the required score and demonstrated meaningful understanding of compassion fatigue, risk factors and interventions through successful completion of a post training quiz. A learning evaluation was available to the nurses to appraise effectiveness of the training and achievement of module objectives. Nurses reported knowledge acquisition regarding compassion fatigue, symptom recognition, coping, and resources. Nurses were able to enumerate coping mechanisms and resources for assistance. They responded that CFT provided valuable information and reported they would use the knowledge and skills gained to secure work-life balance. CFT promoted improvements in career satisfaction, burnout, and secondary traumatic stress levels. CFT must become part of an ongoing measure to ensure staff are receiving instruction necessary to manage the effects of compassion fatigue.</p><p>

<p> <b>Objective:</b> To complete an integrative review of the studies on pediatric chronic illness utilizing the Children&rsquo;s Hope Scale to determine the association between hope and the chronically ill child. </p><p> <b>Method:</b> A comprehensive review of PubMed, PsycINFO, Academic Search Complete, CINAHL, The Cochrane Library, ProQuest, and Dissertations Theses was completed. Titles were reviewed, selected abstracts were then assessed, and full papers were obtained. </p><p> <b>Results:</b> Ten studies were found which met the specified inclusion criteria: participants less than or equal to19 years of age, an illness of more than three months in duration, and hope measured by the Children&rsquo;s Hope Scale. The studies found some support for the positive effect of hope for children with chronic illness, but more research needs to be done with larger samples. </p><p> <b>Conclusion:</b> This integrative review supports the positive impact of hope on the chronically ill child and the need for additional research on the role of hope in the chronically ill child.</p>

<p> When patients present with complaints of anxiety or depression, providers in the primary care setting often prescribe anxiolytics or antidepressants without conducting an early emotional trauma or adverse childhood experiences assessment. Several studies demonstrate the link between early emotional trauma (EET) or adverse childhood experiences (ACEs) and the increased risk of anxiety or depression as adults. This Clinical Scholarly Project (CSP) implemented the use of the Adverse Childhood Experience (ACE) Questionnaire with patients who had a diagnosis of anxiety or depression in the primary care setting to increase patient access to resources and align clinical practice with practice guidelines. Participants included eight primary care providers, 30 patients and 21 chart review patients. The CSP utilized a quasi-experimental design to determine if the use of the ACE Questionnaire by patients with anxiety or depression would result in patients receiving more community resources (to include counseling), strengthen the provider-patient relationship, increase provider comfort in discussing ACEs with their patients and result in patients receiving care that was evidence based. Patient sample participants received significantly more resources (M = 8.27, SD = 2.27) than the chart audit sample (M = 0.90, SD = 0.30). Patient sample members received an average of eight resources (M = 8.27) and utilized an average of five resources (M = 5.07). Use of the ACE Questionnaire resulted in more trust in provider-patient relationship by patients (80.0%) and the majority of the provider sample more comfortable discussing ACEs after the project (85.7%). </p><p>

The nurse-client relationship is the context in which all nursing care is delivered. Despite changing trends in mental health nursing, authenticity has been identified as an enduring aspect of the therapeutic relationship. A behavioral aspect of therapeutic relationships that expresses authenticity on the part of the clinician is self-disclosure. The decision to self-disclose to clients remains a complex and unexplored area of clinical practice. As healthcare and economic trends push for briefer treatment in mental health, nurses are exploring new ways to build the therapeutic alliance more efficiently. Research from other disciplines indicates that therapist self-disclosure may have therapeutic value. This hermeneutic, phenomenologic study explored the experiences and the meaning that psychiatric nurse clinicians make of self-disclosure, and inevitably, nondisclosure in their therapeutic relationships with clients. Participants included 13 European American nurse practitioners or clinical nurse specialists board-certified in mental health nursing with at least 4 years experience. Data were collected from demographic questionnaires, interviews, written correspondence, and researcher notes. Narrative analysis revealed five types of self-disclosure: (a) environmental; (b) intentional-direct; (c) intentional-indirect; (d) unintentional-direct; and (e) unintentional-indirect. The data also yielded antecedents contributing to decisions by participants for both disclosure and non-disclosure with clients. Goals, benefits, positive experiences, risks and negative outcomes were explored for clinician self-disclosure. The participants’ perceptions of the meaning of self-disclosure were described. Results showed the context that participants developed for actual use of self-disclosure was well developed with specific antecedents. Self-disclosures were usually seen as effective when carefully applied based on assessment of the client’s developmental stage, the length of the relationship, client need, and boundary strength. Self-disclosure, to be effective, seems to be associated with a level of context-dependent discernment and relational skill found in the experienced or expert nurse. Finally, changing patterns in the use of self-disclosure by nurse clinicians emerged from the interview data. Implications for practice include participants’ belief that self-disclosure by the clinician is unavoidable and that it can contribute to strengthening or weakening the therapeutic alliance. As such, self-disclosure by clinicians warrants training and discussion. Further research in the area of nurse clinician self-disclosure, especially client perceptions of the experience and its meaning, is indicated.

<p> Postpartum depression (PPD) is linked to diminished maternal, pediatric, and family health outcomes and is designated as the most common childbirth complication. PPD is an international public health concern and found in most populations. Studies suggest that American Indian/Alaska Native (AI/AN) women suffer higher PPD prevalence (14% to 29%) than other United States' women, revealing a racial/ethnic disparity. Health disparities research is a national public health priority and substantiates the need to explore PPD in AI/AN women. Clinicians define PPD as an episode of major depressive disorder with a "peripartum onset" specifier that occurs within the first year after delivery. </p><p> This dissertation work explored and synthesized PPD research about AI/AN women, where there remains considerable mystery surrounding the causes and consequences of PPD. Even with federal regulations in place requiring the inclusion of minorities and women and other underrepresented groups in research, AI/AN women have been mostly excluded, as evidenced by few studies and small sample compositions that include AI/AN women in PPD research. </p><p> Using a comparative analysis approach, validation studies of the EPDS and the PHQ-9 were examined. While possessing excellent concurrent validity, the low predictive accuracy of both tools in non-Western samples suggests cultural bias. No PPD screening instrument has been validated in samples of AI/AN women. Cross-cultural adaptation advances the science of comparative effectiveness research, and is therefore a logical next step. Using a phenomenological methodology with a community-based participatory approach, AI/AN women's "lived" PPD experiences were described. AI/AN women who experienced PPD now or in the past were interviewed using a semi-structured interview guide. De-identified demographic data were collected. Thematic analysis guided by Moustakas' (1994) procedure followed and seven major themes emerged. </p><p> This dissertation has advanced nursing science by providing an understanding of PPD in AI/AN women. Future research for AI/AN women with PPD should focus on: 1) their access to and use of PPD services; 2) the cross-cultural adaptation for PPD screening; 3) the possible relationship between PPD and intimate partner violence; 4) their preferences for PPD treatment; and 5) the possible relationship between PPD and acculturation.</p><p>