Recruitment strategies and challenges: Lessons learned from a coal ash and children's health study

The purpose of this paper is to describe the approaches and recruitment strategies of a study focused on the impact of coal fly ash on neurobehavioral performance among children living in proximity to coal‐burning power plants. Challenges encountered with each recruitment approach are highlighted as well as solutions used to overcome those challenges and ultimately enroll children and one of their parents or guardians. To ensure participants were distributed throughout the study area, geographical information systems were used to guide recruitment and achieve the target sample size (N = 300). Several approaches were employed to recruit the number of needed participants, including “shoe leather” or door‐to‐door recruitment, placement of flyers and brochures in public spaces, mailings to targeted addresses, media announcements, and local government outreach. Since September 2015, 265 participants have been enrolled in the study using a combination of the described recruitment approaches. Even with a well‐designed plan, it is important to re‐examine strategies at every step to maximize recruitment efforts. Researcher flexibility in adapting to new strategies is vital in facilitating recruitment efforts, and the recruitment of participants in the study remains a dynamic and evolving process.     

Introducing solution‐focussed brief therapy to mental health nurses across a local health district in Australia

Solution‐focussed brief therapy (SFBT) can be applied to effectively address a broad range of mental health‐, alcohol‐, and substance‐related challenges. The compatibility that SFBT has with mental health nursing practice has been widely recognized. The aim of the present mixed‐methods study was to introduce and evaluate the utility of SFBT principles, strategies, and techniques to the clinical work of mental health nurses from a local health district in Sydney, Australia. Following a 4‐hour introductory SFBT workshop, participants were invited to complete a one‐page evaluation and undertake a follow‐up individual telephone interview with a research assistant. Participants (n = 65) were positive about the workshop content and recognized the potential benefits of SFBT in clinical practice. Interviewed participants (n = 14) were enthusiastic about SFBT. However, they also identified that using SFBT was challenging, particularly as the approach was considered different to current practices in mental health services. A lack of confidence with incorporating SFBT in their clinical work was also acknowledged, and participants expressed interest in additional training, including more time to practise SFBT strategies and techniques. Widespread training for mental health nurses in SFBT is indicated, including opportunities for supervision and to observe SFBT being employed by experienced clinicians.     

Solving the obesity epidemic: voices from the community

Science and Community: Ending Obesity Improving Health (S&C) aimed to reduce obesity in Houston by developing community partnerships to identify research priorities and develop a sustainable obesity reduction program. Partnership members were recruited from S&C events and invited to participate in in‐depth interviews to gain insight into obesity prevalence, causes, and solutions. Members (n = 22) completed a 60–90‐min in‐depth interview. The interview guide consisted of 30 questions about pressing health problems in the community, potential solutions to health problems and obesity and how the environment has impacted obesity and health behaviors in the community. Interviewees (n = 12 women and 10 men) were mostly Hispanic/Latino (n = 9) and African American (n = 7). Common problems identified were childhood obesity, balancing a healthy diet and physical inactivity. Interviewees identified obesity as a major problem in their communities and cited access to quality food and physical activity resources as both a problem and a solution. Additional emergent themes focused on solutions, including increasing awareness and education, coordinated efforts among organizations and using an ecologic approach to combat obesity. Community insight gleaned from this study may be used to enhance relevance and sustainability of programs developed to reduce obesity and suggests possible avenues for participatory research and intervention.     

Lessons Learned From the Implementation of an Integrated Prenatal Opioid Use Disorder Program

ObjectiveTo evaluate key lessons learned from efforts at increasing engagement in integrated prenatal and opioid use disorder services.DesignAn interdisciplinary team consisting of a board-certified obstetrician and registered nurse led the implementation of this multipronged approach driven by several plan–do–study–act cycles to develop an integrated prenatal and opioid use disorder program.Setting/Local ProblemAn urban community health center in Chicago, Illinois, where mental health issues, including substance use, are the leading cause of death for pregnant people.ParticipantsConnections were made with local harm reduction agencies, substance use treatment facilities, and community outreach programs to develop partnerships with organizations providing existing addiction and maternal–child services in the community.Intervention/MeasuresPartnership building was achieved through organization needs assessments, dissemination of information about integrated services, and sustained communication. Referral workflow guides and patient education cards were created and distributed to community partners. Incoming referrals were tracked at the clinic site. Use of the referral materials was evaluated via online surveys distributed to community partners.ResultsIn the 18 weeks of enhanced integration, three patients engaged in services and were initiated on medication for opioid use disorder, two of whom had been referred from agencies targeted in the outreach efforts. Surveys showed that community partners believe the referral guides were easy to use and that the harm reduction information on the patient cards was useful.ConclusionAn urban community health center was equipped to provide comprehensive, integrated services to pregnant people with opioid use disorder, but barriers such as community unawareness and stigma impeded engagement. Sustained collaboration with community partners serving pregnant people with opioid use disorder supports program development and linkage to care. Integrated prenatal and opioid use disorder care is feasible, is destigmatizing in nature, and can lead to improved maternal and fetal outcomes.     

The Process of Structuring Community Health Needs by Public Health Nurses Through Daily Practice: A Modified Grounded Theory Study

PurposeIt is extremely difficult to apply the model learned in basic education for public health nurses (PHNs) to conduct community health assessments. The purpose of this study was to clarify the process by which community health needs can be structured through PHNs’ daily practice.MethodsSemistructured interviews were conducted in 29 PHNs, and continuous comparative analysis using a qualitative study was performed with a modified grounded theory approach.ResultsThe participants “used their five senses to understand the relationship between the health and life of people” and “considered those who do not attend” by “learning from stakeholders.” To verify such subjective feelings sourced from vague phenomena within the communities, subjective phenomena were converted into qualitative data.ConclusionThe application of the findings to organizational continuous education systems may not only help appropriately improve community health assessment methods but can also help improve the evaluation of daily practice and contribute to professional human-resource development.     

Undergraduate nursing students’ stigma and recovery attitudes during mental health clinical placement: A pre/post‐test survey study

Undergraduate nursing students have been reported to hold negative and stigmatizing attitudes towards mental health consumers and to be under‐prepared for mental health clinical placement. This study aimed to investigate undergraduate nurses’ stigma and recovery attitudes to mental illness, and describe their understandings of personal recovery on entry and exit to traditional mental health clinical placement. A pre/post‐test survey was administered to N = 249 nursing students in Australia. Demographic data, attitudes towards mental health nursing and clinical placement, the Opening Minds Scale for Healthcare Providers (OMS‐HC), Recovery Attitudes Questionnaire (RAQ‐7), and an open‐ended question on understandings of personal recovery from mental illness were collected on entry (T1) and exit (T2) to placement. At T1, students reported moderate stigma and positive attitudes towards recovery (OMS‐HC mean = 34.6; RAQ‐7 mean = 4.0). At T2, there was a reduction in stigma (social distance P = 0.02, d = 0.26) and improvement in recovery attitudes (P < 0.01, d = 0.40). Attitudes towards mental health nursing and placement also improved (P < 0.01). Having a family member with mental illness predicted improvements in stigma and recovery attitudes. On entry to placement, most students described accurate understandings of personal recovery, which were maintained during placement. The findings indicate that mental health clinical placements are effective in improving students’ mental health stigma and recovery attitudes and provide a prime opportunity to attract students into the field. Co‐produced or consumer‐led education provided by peer workers during clinical placements may improve students’ stigmatizing attitudes and stimulate their interest to work in the field.     

Experiences of intensive home treatment for a mental health crisis during the perinatal period: A UK qualitative study

Some women with severe perinatal mental health difficulties in England are cared for by acute home treatment services, known as Crisis Resolution Teams (CRTs), which provide short‐term home‐based treatment for adults experiencing a mental health crisis. Intensive home treatment has been trialed in a number of countries, but it is not known how well suited it is to the needs of perinatal women. This qualitative study aimed to explore how women and practitioners experience the provision of intensive home treatment for perinatal mental health problems. Semi‐structured interviews were conducted with women who had received intensive home treatment in the perinatal period (n = 15), and focus groups were held with practitioners working in CRTs or in specialist perinatal mental health services (3 groups, n = 25). Data were analysed thematically. Women commonly found intensive home treatment problematic, experiencing it as intrusive and heavily risk‐focused, with poor staff continuity and little tailoring to the perinatal context. However, women valued emotional support when provided, particularly when it had a perinatal focus, sometimes based on practitioners sharing their own experiences. Some women also appreciated avoiding hospital admission, but choice was often limited. Practitioners reported a lack of perinatal training among CRT staff and described difficulties tailoring treatment to perinatal women’s needs. Currently, intensive home treatment, as offered by CRTs, may not be well suited to women with perinatal mental health difficulties. Findings suggest a need to develop community crisis responses that are better tailored to the needs of this population.     

Undergraduate student nurses’ experience of mental health simulation pre‐clinical placement: A pre/post‐test survey

Undertaking a mental health clinical placement can be anxiety‐provoking for nursing students at times. There is a need to adequately prepare undergraduate nursing students for clinical placement in a mental health setting in relation to their skills and confidence. This study aimed to evaluate the effect of a mental health simulation workshop on the skills and confidence of nursing students in providing care to consumers living with a mental illness. The study also evaluated the design of the mental health simulation workshop from an educational perspective. A pre/post‐test survey was administered to a cohort of N = 89 Australian pre‐registration nursing students. Exploratory factor analysis identified three factors: Mental health therapeutic engagement, mental health assessment skills, and mental health placement preparedness. Analyses of pre–post differences indicated that all three factors were significantly different between the initial and follow‐up responses, with follow‐up responses being more favourable. The findings of this study demonstrate that there is value in including mental health simulated patient exercise as part of the learning strategies in the curriculum of pre‐registration nurses. This has implications for the quality of care in the clinical environment and level of preparedness of these students’ nurses for mental health clinical placement where they will be providing care to consumers living with a mental illness under direct supervision.     

A Large‐Scale Survey on Trauma,Burnout, and Posttraumatic Growth among Nurses during the COVID‐19 Pandemic

A large‐scale survey study was conducted to assess trauma, burnout, posttraumatic growth, and associated factors for nurses in the COVID‐19 pandemic. The Trauma Screening Questionnaire, Maslach Burnout Inventory, and Posttraumatic Growth Inventory‐Short Form were utilized. Factors associated with trauma, burnout, and posttraumatic growth were analysed using logistic and multiple regressions. In total, 12 596 completed the survey, and 52.3% worked in COVID‐19 designated hospitals. At the survey’s conclusion in April, 13.3% reported trauma (Trauma ≥ 6), there were moderate degrees of emotional exhaustion, and 4,949 (39.3%) experienced posttraumatic growth. Traumatic response and emotional exhaustion were greater among (i) women (odds ratio [OR]: 1.48, 95% CI 1.12–1.97 P = 0.006; emotional exhaustion OR: 1.30, 95% CI 1.09–1.54, P = 0.003), (ii) critical care units (OR: 1.20, 95% CI 1.06–1.35, P = 0.004; emotional exhaustion OR: 1.23, 95% CI 1.12–1.33, P < 0.001) (iii) COVID‐19 designated hospital (OR: 1.24, 95% CI 1.11–1.38; P < 0.001; emotional exhaustion OR: 1.26, 95% CI 1.17–1.36; P < 0.001) and (iv) COVID‐19‐related departments (OR: 1.16, 95% CI 1.04–1.29, P = 0.006, emotional exhaustion only). To date, this is the first large‐scale study to report the rates of trauma and burnout for nurses during the COVID‐19 pandemic. The study indicates that nurses who identified as women, working in ICUs, COVID‐19 designated hospitals, and departments involved with treating COVID‐19 patients had higher scores in mental health outcomes. Future research can focus on the factors the study has identified that could lead to more effective prevention and treatment strategies for adverse health outcomes and better use of resources to promote positive outcomes.     

A room for design: Through participatory design young adults with schizophrenia become strong collaborators

Smartphone technology is being increasingly viewed as key to engaging young adults with schizophrenia in their own mental health care. In an attempt to use smartphones as an engagement tool, we conducted a participatory design process, where young adults with schizophrenia (n = 4), healthcare providers (n = 7), software designers (n = 3), graphic designer (n = 1), graphic recorder (n = 1), and team leader (n = 1) co‐designed a smartphone application for use in early phase schizophrenia care. This paper reports the co‐design process. Based on a variety of written data‐sources, the paper describes if, and how, participatory design can help construct a physical and relational environment that enables young adults with schizophrenia to become active participants in the design of a more participatory mental health practice. Guided by Etienne Wenger's construct of Community of Practice, three major categories of characteristics and construction of a physical and relational environment supporting and inspiring participation and engagement were identified: (i) a pre‐narrative about a community of practice, (ii) the room for design is a community of practice and (iii) the community of practice as a practice of special qualities. It is concluded that participatory design can support and inspire participation and engagement in the development of mental health care with young adults with schizophrenia, given that the environment in which participatory design unfolds is transparent, flexible, secure and informal.     

Overcoming barriers and improving public health nursing practice

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well-educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision-making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded.     

Impact of nurse‐led behavioural counselling to improve metabolic health and physical activity among adults with mental illness

The life expectancy of adults with mental illness is significantly less than that of the general population, and this is largely due to poor physical health. Behavioural counselling can improve physical health indicators among people with non‐communicable disease. This repeated‐measures, single‐group intervention trial evaluated the effects of a 19‐week behavioural counselling programme on metabolic health indicators and physical activity levels of outpatient adults with mental illness. Sixteen participants completed the intervention that comprised individual face‐to‐face counselling sessions with a registered nurse every 3 weeks, and progress reviews with a medical practitioner every 6 weeks. Assessment included self‐report and objective measurement of physical activity, and measures of blood pressure and anthropometry. Statistically‐significant changes were demonstrated between baseline and post intervention for participants’ waist circumference (P = 0.035) and waist‐to‐height ratio (P = 0.037). Non‐significant improvements were demonstrated in weight and physical activity. The findings indicated that adults with mental illness can engage in a nurse‐led behavioural counselling intervention, with improvements in some metabolic health measures after 19 weeks. It is recommended that behavioural counselling programmes for adults with mental illness be sustained over time and have an ‘open door’ policy to allow for attendance interruptions, such as hospitalization.     

Mental health service users' and practitioners' experiences of engagement in assertive outreach: a qualitative study

Assertive outreach services have been central to community mental health policy within the UK. These multidisciplinary teams were established to engage with service users who have severe and enduring mental health problems and have found traditional community services unable to meet their needs. Mental health nurses have a pivotal role in these multidisciplinary teams, yet the nature of these relationships from the perspective of those who work in and receive care is poorly understood. This study set out to explore the nature and meaning of engagement for practitioners and service users within assertive outreach services. A qualitative approach, informed by philosophical hermeneutics, underpinned the study. Participants were recruited from a single assertive outreach team in the UK. To be eligible for the study, mental health practitioners needed to be employed within the assertive outreach team. All service users residing in the community and receiving care from the team were also eligible for inclusion. In total 14 interviews were conducted with mental health practitioners and 13 with service users. Data analysis was informed by Turner's method. Four themes emerged from the data; contact, dialogue, transformation and shared understanding. Meaningful engagement was found to manifest itself through experiences such as providing and receiving practical assistance, having a genuine two-way conversation and valuing the experiences and personal attributes of the other person. The findings indicate that engagement is an active, dynamic and skilled process, which leads practitioners and service users to transform together to create a new relationship.     

Going the Extra Mile: Beyond Health Teaching to Political Involvement

TOPIC. Addressing community health problems through political involvement. PURPOSE AND SOURCES OF INFORMATION. This article describes how a group of RN–BSN students completing an assigned community‐assessment and health‐teaching project in a small, rural, southern county exceeded course requirements to address a significant community health problem. Specifically, after documenting a high rate of dental caries among local children and consulting with state officials and other experts, these students involved themselves in local politics in an effort to persuade county officials to implement community water fluoridation. CONCLUSIONS. These RN–BSN students successfully demonstrated their ability to move beyond a focus on individuals to embrace the concept of community as client. In the process, they honed their skills in advocacy, communication, and political involvement, and achieved all of their BSN program's objectives.