Purpose To examine the effects of Animal Assisted Therapies with Farm Animals (AATF) with domesticated ducks on depression and anxiety. Aim The proposed study will use single-group time series design and collect survey data to explore the changes in anxiety and depression in patients exposed to AATF. The study will be guided by the Self-Efficacy Theory. The study will involve 30 patients with TBI living in The Crumley House Rehabilitation Center in Limestone, TN. Hypothesis. Engaging in AATF with domesticated ducks will be associated with decrease in anxiety and depression. Approach - Theoretical Framework. Bandura’s Self-Efficacy Theory will be used to guide this study examining AATF effects on anxiety and depression in patients with TBI. Salutogenesis, Social Support, and Self-Efficacy theories were compared in order to select the best theoretical framework for this study. Methods Time series Quasi-experimental design. The study will examine the effects of AATF on anxiety and depression among patients with traumatic brain injury (TBI). Because of the unique characteristics of the patient population (all patients have history of TBI) in this facility no other rehabilitation center can be utilized for comparison. Time series design will ensure that all of the participants will be exposed to the therapeutic intervention, it will not be affected by the conventional treatments the participants are receiving. Projected Results and Anticipated Limitations It is expected that AATF will be effective in reduction of Anxiety and Depression symptoms in the patient with TBI Limitations • Possibility of dropouts may compromise sample size and lead to lower statistical power. • AATF based intervention is impossible to conduct in blinded environment. That in turn may contribute to participant’s expectation of positive outcomes of the interventions in this study. This may be considered an example of subject bias. • AATF treatment cannot be completely standardized. Because the treatment is based on interaction with live animals, animal behavior may be different during each visit to the duck pen. Because of that there is a possibility that the study cannot be exactly replicated. • The participants may have different duration or complexity of treatments for anxiety and depression. This may present a confounding factor that we are not able to control in this study. Conclusion This is a pilot study to examine the effects of AATF with domesticated ducks. This study may serve as a basis in developing more research on this topic with expanding the methodology and sampling in the future.

Evidence Based Health Promotion Scientific Abstract Introduction & Background: Mental Health resources are scarce in rural areas. In 2020, suicide was the third leading cause of death for African Americans ages 15 to 24; this is only one example of the mental health disparities experienced by minority groups. Purpose Statement and Research Question: We saught to answer: “Are there greater mental health disparities among sexual and ethnic minorities, such as LGBTQ+ groups or Middle Eastern women, compared to their heterosexual, majority counterparts; if so, is there anything we can do about the issue as nurses?” Literature Review: To match the guidelines for our assignment, which were to have an article younger than five years with an author who has nursing credentials. We used terms such as “mental health issues” and “minority groups” to drive our search, and from there we chose articles that best fit our own individual interests. Findings: From our research, we found that these groups tend to have a much poorer mental health status compared to their majority counterparts. In healthcare settings, sexual minorities tend to be generalized and treated without understanding of their differences; the same can be said for ethnic minorities, who are often treated by uneducated or biased healthcare workers. Conclusions and Nursing Interventions: There is a severe lack of specialized mental health teaching being given to healthcare workers. In implementing comprehensive care teaching programs, we could greatly improve the therapeutic mental health services being provided to these minority groups.

Aim: To determine if a significant relationship exists between a) nurse-driven interventions to foster collaborative psychiatric and oncology care and b) higher rates of cancer treatment adherence and lower healthcare utilization rates in patients with serious mental illness (SMI) and cancer. Background: It is not uncommon for patients with SMI to suffer from treatment noncompliance and present in the acute care setting, such as the emergency department. Patients with cancer and SMI pose a unique challenge to nurses and providers due to the psychological effect of a cancer diagnosis as well as side effects experienced from psychotropic medications and oncology treatments alike. As a result, these patients are less likely to maintain cancer treatment regimens and present with advances stages of cancer in the acute care setting. Methods: An extensive electronic literature search in the CINAHL Plus and APA PsycINFO databases was completed and included the keywords: cancer, neoplasms, carcinoma, serious mental illness, chronic mental illness, mental disorders, mental disorders, chronic, psychiatric illness, psychiatric disability, cognitive behavioral therap*, intervention*, mindful*, and mental health. Inclusion criteria included: published in the years 2012-2022. The available literature was carefully examined for interventions performed with SMI and cancer for ultimate results to be finalized as a written report. Significance: The results of this research can optimize healthcare and prognosis for the population of mental health patients with cancer and also reduce costs to the healthcare system. Conclusion: The 10 studies reviewed indicated that collaborative psychiatric-oncology care with specific Registered Nurse (RN)-led interventions, such as medication management programs and behavioral counseling, was associated with increased rates of cancer treatment adherence and lower rates of healthcare utilization. Conclusions were based on data collected in cohort studies, randomized control trials, pre- and post-intervention assessments, and clinic data from quality improvement projects. More research is needed to explore the implementation of collaborative care practices.

The improvement in cancer remission rates in children and adolescents due to advances in cancer treatment and therapy has led to the development of guidelines that address long-term follow up for survivors of childhood cancers. Adolescents often experience negative emotions related to the fear of uncertainty about long-term survival after cancer remission, yet often report feelings of hope and optimism for the future more than adult cancer survivors. The purpose of this study was to understand the role of self-efficacy and coping in adolescents after remission of cancer. A secondary purpose was to analyze which coping strategies supported long-term survival goals after cancer remission in adolescent populations. A systematic literature review was conducted from the following online databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature On-line (MEDLINE), Education Resources Information Center (ERIC), and PsycInfo. Selected articles included those published between 2000-2016 that were written in English and were peer-reviewed. The results of the study revealed that most adolescents with cancer remission do not experience long term psychosocial issues related to their cancer diagnosis and treatment. However, a large percentage of adolescent cancer survivors report intermittent depression, suicidal ideation and a lower quality of life due to survival after remission. The literature indicates that multiple, integrative forms of behavioral therapy: cognitive, psychosocial, and family based treatment models, help to enhance long term quality of life in adolescent cancer survivors. Strategies that use positive coping methods and improve self-efficacy related to long term survival after remission have demonstrated improvement in psychosocial behaviors in adolescents and promote a better outlook on planning for the future. Future research that analyzes the most effective coping skills to practice after cancer remission and that optimize self-efficacy related to long term survival can positively influence quality of life for adolescent cancer survivors.

The purpose of this literature review was to identify differentiating risk factors in women for postpartum depression and postpartum psychosis. By understanding differentiating risk factors health care professionals, and nurses in particular, can be alert to women who are at higher risk for postpartum depression or postpartum psychosis. This information allows for early nursing intervention and the development of appropriate treatment plans. Fifteen peer-reviewed, English language research articles published between 2000 and 2015 were analyzed for the purpose of this literature review. Study results were inconclusive for the intention of this review, but do provide valuable information on independent risk factors for both disorders. A history of depression and significant life stressors are strong predictors for postpartum depression. Whereas a history of bipolar disorder is strongly associated with the development of postpartum psychosis. Further research is needed to examine the role of genetics in both postpartum depression and postpartum psychosis and to further evaluate risk factors for postpartum psychosis, specifically in women with no history of bipolar disorder. Moreover, additional research needs to be conducted within the United States due to a lack of generalizability of studies conducted in other nations.

Gay and bisexual men infected with human immunodeficiency virus (HIV) comprise a sizable, medically vulnerable population. Depression is the most commonly experienced mental health disorder affecting this group of people, lending itself to a host of risks associated with depression. As screening of depression in this population can be challenging, it is vital that clinicians have the best available tools and guidelines to detect depressive symptomology. This focused, comprehensive review of the literature examined current data describing the clinical instruments used to detect depressive symptoms in HIV-infected gay and bisexual men. The aim of this analysis was to seek out which instruments were the most widely and successfully employed for this population. An initial search using EBSCOhost and associated databases CINAHL, MEDLINE, PsycINFO, and Health and Psychosocial Instruments alongside inclusion and exclusion criteria found 1,899 articles. Results were narrowed using additional inclusion and exclusion criteria and relevancy, yielding a total of 13 articles for review. The findings of this review suggest screening of depressive symptoms in HIV-infected gay and bisexual men was most successful using the CES-D, the BSI-18, and the BDI. Health care providers should have an understanding of the importance in assessing this population for depression and have access to the best possible tools to do so.

The topic of substance-abuse has received increasing attention in recent years, as the number of individuals experiencing drug abuse and addiction is on the rise. With substance-use on the rise, the number of patients admitted to the hospital with this disorder is increasing also. It is important hospital staff are aware and educated on how to provide adequate care to these patients without judgement regarding their choices or their lifestyle. This study was done to determine how prepared nursing students are to care for patients with drug abuse or addiction. Specifically, the project explores student nurses' attitudes and commitment toward substance- abusing patients. The 20 item Drug and Drug Problem Perceptions Questionnaire (DDPPQ) was used to measure attitudes and therapeutic commitment in working with drug-abusing patients, and was distributed electronically to approximately 400 nursing students. One hundred thirty-one students participated. Scores ranged from 22-102, with the smaller value representing greater overall commitment and preparedness when working with substance-abusing patients. The mean score reported overall was 58. This score indicates improvement is needed to increase students' therapeutic commitment and ability to provide quality care for patients experiencing substance- abuse. More research needs to be done and programs put into place to reach this goal.

The purpose of this integrative review was to examine the effects of music therapy, a complementary intervention, on individuals with dementia. Peer-reviewed journals were retrieved from MEDLINE, CINAHL, CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Music Index to evaluate their relevance to music therapy use in people diagnosed with dementia. English and Spanish-language research articles published from 2000-2017 were included for the review (n=15). The literature indicates the use of music therapy as an adjuvant therapy for the treatment of dementia in older adults may be beneficial in decreasing symptoms of aggression, anxiety, agitation and depression. Music therapy is used in varying settings, but more specifically in long term care facilities. This complementary therapy enhances the quality of life in persons with dementia and facilitates empathetic relationships between residents and the staff.The literature indicates that music therapy, involving singing, listening to music, music and movement, when performed by a certified music therapist can have beneficial effects for people with dementia, especially when pharmacological treatments alone do manage symptoms associated with this disorder. Implications for nursing practice, education, policy and research are discussed along with study limitations.

Trauma informed care nursing education is crucial. Trauma informed care is a method of providing health care which understands the likelihood of past and present traumatic events in patients and families. The experience of past or present trauma often led to chronic diseases, substance abuse disorder, fragmented health care, fears surrounding health care, chronic stress, and other negative health consequences. The purpose of this project is to increase licensed nurses’ awareness and ability to practice trauma informed care in clinical practice, as well as promote policy initiation within the health care facilities. Method planning integrated the Knowledge to Action Cycle. A two hour, Delphi reviewed, evidenced based educational session was developed for licensed nurses in two health care facilities. After the educational session is completed, an anonymous survey will be distributed to determine the licensed nurses’ awareness of trauma informed care. A second anonymous survey will be sent four weeks later to assess changes in clinical practice based on trauma informed care education. One educational session for eleven licensed nurses working in a psychiatric facility has been completed. Two preliminary themes emerged from the first survey. The first theme was more intentional focus on integrating trauma informed care principles into practice. The second theme was an increased need for self-care. Two more educational sessions are planned for licensed nurses in an acute care hospital. Keywords: trauma informed care, nursing, education, KTA Cycle, health care, policy

Heart failure (HF) is a major public health problem throughout the world. It accounts for one death certificate among nine in the United States. Heart failure and sudden death combined are responsible for the largest number of deaths in America. The total costs of HF in the United States are estimated to be $37 billion each year. Despite substantial medical and surgical advances related to treatment of HF, it remains a very costly condition with high mortality and morbidity rates. Although biological factors contribute to high morbidity and mortality in HF, there are many unexplored psychosocial factors that also likely contribute to these rates. Thus, the purpose of this dissertation was to examine the association between some of the psychosocial factors (i.e. depression, anxiety, comorbid depression and anxiety, stress, cognitive appraisal, and coping) and health outcomes as defined by rehospitalisation and mortality among HF patients. The first paper is a report of longitudinal study of 1,260 patients with HF. The purpose of the study was to determine whether co-morbid symptoms of depression and anxiety are associated with all-cause mortality or rehospitalization for cardiac causes in patients with HF. Anxiety and depression were treated first as continuous level variables, then as categorical variables using standard published cut points. Patients were then divided into four groups based on the presence of symptoms of anxiety and depression. When depression and anxiety were treated as continuous level variables, both comorbid depression and anxiety, and depression alone were significant predictors of all-cause mortality. However, when depression and anxiety were treated as categorical variables, comorbid depression and anxiety was a predictor of all-cause mortality, while anxiety and depressive symptoms considered alone were not independent predictors of the same outcome. None of those variables were significant predictors of cardiac rehospitalization outcome, regardless of whether entered as continuous or categorical level variables. The second paper is a report of a study that was conducted to (1) examine the association of stress with 6-month cardiac event-free survival; (2) examine the relationship of stress with salivary cortisol; and (3) examine the association of salivary cortisol level with 6-month cardiac event-free survival. The study sample was 81 HF patients. A prospective design was used in which patients were followed for 6 months to determine occurrence of 6-month cardiac event-free survival, defined as time to the combined endpoint of cardiac rehospitalization or all-cause death. Stress was not a significant predictor of event-free survival in HF, salivary cortisol was a significant predictor of event-free survival in the unadjusted model, but not in the adjusted model, and stress was not a significant predictor of salivary cortisol level. The final paper is a report of prospective design study that aimed to describe self-reported stress level, cognitive appraisal and coping among patients with HF, and to examine the association of cognitive appraisal and coping strategies with event-free survival based on a proposed model of HF patients’ response to stressors that been suggested according to literature to date. The study sample consisted of 88 HF patients who been followed for 6 months to determine occurrence of the combined endpoint of rehospitalization for cardiac causes or all-cause death. The study showed that stress level was associated with harm and loss cognitive appraisal. Harm/loss and threat cognitive appraisals were associated with avoidant emotional coping. Furthermore, harm/loss cognitive appraisal was a significant predictor of avoidant emotional coping and event free survival. Finally avoidant emotional coping was a significant predictor of event free survival among HF patients in the unadjusted model, but not in the adjusted model. The findings from this dissertation provided further evidence of the importance of psychosocial factors to health outcomes in HF patients. It also filled important gaps in the body of knowledge related to health outcomes among those with HF by demonstrating the need for cognitive and behavioral therapy among HF patients who negatively appraise their health condition.