Advocates' Experiences With Media and the Impact of Media on Human Trafficking Advocacy

The present qualitative study explores advocates' opinions of misinformation about human trafficking in the media and describes advocates' strategies to counter the misinformation presented by the media. Thus, 15 advocates who work against human trafficking in Chicago-based nonprofit organizations participated in semistructured interviews about their opinions and strategies. Data were analyzed using thematic content analysis. The present study identifies specific misperceptions of human trafficking in the media, highlights advocates' opinions of this misinformation, and discusses advocates' strategies to counteract inaccurate media, adding support to the role of media advocacy. Advocates note how media images shape and perpetuate stereotypes of trafficking through glamorizing sex work and sensationalizing stories that are most often international depictions of trafficking. Advocates report media generally shares only a piece of the story, simplifying the stories of survivors and the issue of human trafficking. Advocates critique media perpetuating these misperceptions for how they may contribute to policies and programs which fail to address structural factors that create vulnerabilities to be trafficked and the multisystem needs of survivors. However, advocates also note misperceptions can be counteracted by producing sensitive, informed media through social platforms. Advocates share their strategies counteracting misinformation through engaging in informative conversations, utilizing social media to educate, and promoting media messages of survivor agency. Research, clinical, and policy implications are also discussed. The present study emphasizes the importance of decision makers and service providers being critical consumers of media and to assess how media portrayals may (or may not) inform their understanding and response to the issue.

Patients' experiences of psychiatric care in emergency departments: A secondary analysis

The number of psychiatric emergencies presenting to EDs in the United States continues to rise. Evidence suggests that psychiatric ED care encounters can have less than optimal outcomes, and result in stress for providers. The primary aim of this study is to describe the perceptions of ED visits by persons experiencing emotional distress, identifying themes among these that may guide nursing interventions that minimize stress and optimize outcomes in the treatment of psychiatric emergency. This secondary analysis used a qualitative, phenomenological method to analyze a de-identified data set originally collected in a study of experiences of psychiatric emergency in a community based crisis management setting. Findings consist of three major themes: "Emergency rooms are cold and clinical", "They talk to you like you're a crazy person", and "You get put away against your will". An overarching theme through all three is the influence of RN communication, both positive and negative, on patient perceptions of their ED encounters. While nurse-patient communication is basic to all areas of practice, it may be a low priority in the urgent and chaotic context of the ED. However, our findings suggest that increased attention to timely, empathic and validating communication and openness to the patient's reality may decrease severity of symptoms, optimize outcomes, and decrease provider stress.

Health survey of U.S. long-haul truck drivers: work environment, physical health, and healthcare access

OBJECTIVE

While trucking in industrialized nations is linked with driver health afflictions, the role of trucking in U.S. truckers' health remains largely unknown. This paper sheds light on links between the trucking work environment and drivers' physical health.

METHODS

Using a cross-sectional design, 316 truckers were enrolled in the Healthy Trucker Survey. Questions included work history, physical and mental health, and healthcare access. PASW 18 was used to examine patterns among factors.

PARTICIPANTS

316 truckers participated.

RESULTS

Respondents were mainly full-time, long-haul drivers with over 5 years of experience, and who spent over 17 days on the road per month. While almost 75% described their health as good, 83.4% were overweight/obese, 57.9% had sleeping disturbances, 56.3% fatigue, 42.3% musculoskeletal disorders, and about 40% cardiovascular disease concerns. About 33% had no health insurance, 70% had no regular healthcare visits, 24.4% could not afford insurance, and 42.1% took over-the-counter drugs when sick, while 20.1% waited to reach home for medical care. Exercise facilities were unavailable in over 70% of trucking worksites and 70% of drivers did not exercise regularly.

CONCLUSIONS

The trucking occupation places drivers at high risk for poor health outcomes. Prospective studies are needed to delve into how continued exposure to trucking influences the progression of disease burden.

Culturally competent practice in a pre-licensure baccalaureate nursing program in the United States: a mixed-methods study

AIM

This study examined how one pre-licensure baccalaureate nursing program at a public university in the southeastern United States integrated concepts and issues of culture and culturally competent practice into its curriculum.

BACKGROUND

Teaching and learning about culturally competent practice in pre-licensure nursing programs are essential to ensure a culturally competent health care workforce.

METHOD

A mixed-methods case study approach was used. Data were collected from student surveys (n = 111), student focus groups (three groups, n = 9), faculty interviews (n = 14), and school of nursing documents, including the mission statement, faculty and student handbooks, and course syllabi. Data were analyzed using descriptive statistics and content analysis.

RESULTS

Findings provide evidence of cultural competence, barriers to deeper engagement with cultural issues, and suggestions for improvement.

CONCLUSION

These findings suggest teaching/learning strategies and curricular design issues that may lead to greater student and faculty member cultural understandings.

A recovery-oriented alternative to hospital emergency departments for persons in emotional distress: "the living room"

Persons with severe mental illness experience episodic crises, resulting in frequent visits to hospital emergency departments (EDs). EDs, however, are not the most effective treatment environments for these individuals who might better be served elsewhere in an environment based on recovery-oriented framework. The purpose of this study is to describe the lived experience of guests (persons in emotional distress) and staff (counselors, psychiatric nurses, and peer counselors) of a community, recovery-oriented, alternative crisis intervention environment-The Living Room (TLR). The total sample is comprised of 18 participants. An existential phenomenological approach was used for this qualitative, descriptive, study. Through non-directive in-depth interviews, participants were asked to describe what stands out to them about The Living Room. Interviews were audio-recorded, transcribed verbatim, and systematically analyzed using descriptive phenomenological methods of analysis by an interdisciplinary and community-based participatory research team. Participants' experiences in hospital EDs and inpatient psychiatric units contextualized the phenomenological experience of TLR environment. The final thematic structure of the experience of TLR included the following predominant themes: A Safe Harbor, At Home with Uncomfortable Feelings, and It's a Helping, No Judging Zone. Findings from this qualitative study of a recovery-based alternative to hospital EDs for persons in emotional distress are supported by anecdotal and empirical evidence that suggests that non-clinical care settings are perceived as helpful and positive.

Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings.

We need to talk about psychological pain

The author responds to Dr. Shattell's suggestion (Issues in Mental Health Nursing, 30(5), 2009) that it may be time to add psychic pain to the Joint Commission on Accreditation of Healthcare Organizations' pain management standard. Before we do so, some level of agreement is necessary on issues concerning terminology, measurement, and intervention. The author offers a definition of psychological pain as common ground for future research and development in clinical care.

Assertive community treatment and the physical health needs of persons with severe mental illness: issues around integration of mental health and physical health

BACKGROUND

Assertive community treatment (ACT) is characterized as a service delivery platform and represents an ideal setting in which mental health and physical health care can be integrated.

OBJECTIVE

Little is known about the extent to which ACT integrates physical health care with mental health care or the challenges ACT teams experience. To address this gap, focus groups were conducted with five ACT teams in a Midwestern US state to explore how ACT teams address the physical health care needs of persons with severe mental illness.

DESIGN

A qualitative study design was used.

RESULTS

Three major themes emerged: ACT teams recognize serious and chronic physical health problems, ACT teams take on a variety of roles to address physical health problems, and there are challenges to integrating primary and mental health care within an ACT setting.

CONCLUSIONS

ACT needs to be adapted to incorporate promising practices designed to better integrate physical health care and mental health care.

Authors' and editors' perspectives on peer review quality in three scholarly nursing journals

PURPOSE

This study examined the quality of peer review in three scholarly nursing journals from the perspectives of authors and editors. Specifically, the study examined the extent to which manuscript reviews provided constructive guidance for authors to further develop their work for publication, and for editors to make informed and sound decisions on the disposition of manuscripts.

METHODS

Corresponding authors who had submitted manuscripts to the study journals in 2005-2007 were invited via email to complete an online survey about the quality of the peer review process; 320 authors responded. In addition, one third of the reviews of manuscripts submitted in 2005-2007 (a total of 528) were selected for rating by journal editors on level of detail, bias, and constructive tone; usefulness to authors in revising/developing the manuscript; and usefulness to the editor in making a decision.

RESULTS

A majority (73.8%) of authors agreed that peer reviews provided constructive guidance, and 75.6% agreed that reviews provided adequate rationale for editors' decisions. New authors generally reported less satisfaction with reviews than more experienced authors. Ratings of reviews by the editors revealed some problem areas, including inconsistency, insufficient feedback to the author, reviewer bias, and disrespectful tone.

CONCLUSIONS

Given the inexperience of many nurse authors, it is incumbent upon editors and reviewers to provide guidance and support. Manuscript reviews could be improved by increasing the consistency of numeric ratings, narrative comments, and recommendations regarding disposition of the manuscripts. Nevertheless, the results of this study reaffirm the worth of the peer review approach.

CLINICAL RELEVANCE

Publication of research and other forms of scholarly work is critical to the development of nursing knowledge that can be used in clinical practice. Authors with a variety of backgrounds, knowledge, and skills have important work to share that can serve healthcare providers and their clients. Thus, ensuring the quality of the peer review process is essential.

Worksite-induced morbidities among truck drivers in the United States

A critical review was conducted of social, psychological, and health science literature on the array of health risks and morbidities of truckers. Multilevel worksite-induced strains (e.g., long work hours and fatigue, shift work and sleep deprivation, postural fatigue and exposure to noise and vibration, sedentary lifestyle and unhealthy diet, exposure to diesel exhaust fumes, and other occupational stressors) were categorized into six primary morbidities for truckers: (1) psychological and psychiatric disorders; (2) detriments resulting from disrupted biological cycles; (3) musculoskeletal disorders; (4) cancer and respiratory morbidities; (5) cardiovascular disease; and (6) risk-laden substance use and sexual practices. Elevated morbidity risks suggest the need for the design and implementation of systematic epidemiological research and environmental interventions in the transport sector.

Mental health patients' experiences of being misunderstood

BACKGROUND

Mental health patients describe "being understood" as an experience that evokes feelings of importance, worthiness, and empowerment. However, the experience of "being misunderstood" is more prevalent in patients' relationships with health care providers. Negative consequences such as vulnerability, dehumanization, and frustration reveal that being misunderstood has the potential to damage or destroy therapeutic relationships.

OBJECTIVE

The purpose of this secondary analysis was to examine mental health patients' experiences of being misunderstood.

STUDY DESIGN

Data consisted of transcripts from 20 interviews with community-dwelling adults with mental illness, which were analyzed using an existential phenomenological approach.

RESULTS

Four figural themes expressed the experiences of being misunderstood: protection from vulnerability, an object to be fixed, treated like a child, and relentless frustration.

CONCLUSIONS

Nurses and other caregivers can use the findings of this study to promote understanding, strengthen therapeutic relationships, and improve the quality of mental health care.

Risk and protection for HIV/AIDS in African-American, Hispanic, and White adolescents

African-Americans and Hispanics are disproportionately affected by HIV/AIDS in the United States. HIV infection is often acquired during adolescence, a time when risky sexual behaviors are at their peak. This study explored relationships among selected risk factors, protective factors, and risky sexual behaviors among African-American, Hispanic, and White adolescents, from a sample of adolescents from the National Longitudinal Study of Adolescent Health. African-Americans and Hispanics were more likely to have sexual intercourse without the use of birth control than were Whites. African-Americans were more likely to have sexual behavior with multiple sexual partners than either Hispanics or Whites were, and African-Americans had higher self-esteem than did Hispanics and Whites. In order to develop culturally sensitive, effective interventions to prevent HIV/AIDS in adolescents, racial differences in risk and protective factors must be examined.

Factors contributing to depression in latinas of mexican origin residing in the United States: implications for nurses

BACKGROUND

Latinas experience more depression and are less likely to receive mental health support than White women or African American women.

OBJECTIVE

This article synthesizes the research on depression in adult Latinas of Mexican origin residing in the United States.

STUDY DESIGN

MEDLINE (PubMed), The Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PsycINFO databases for the years 2000 through 2008 were searched using the keywords Latina, Latino, Hispanic, Mexican American, Mexican immigrant, women, and depression.

RESULTS

The process of acculturation and associated stressors may have a negative effect on the mental health of women of Mexican origin residing in the United States. Separation from family, harmful interpersonal relationships, unmet economic needs, conflict, and isolation may contribute to depression in this population.

CONCLUSIONS

More research is needed on the influence of family and economic strain as well as the effectiveness of assessments and interventions for depression in Mexican and Mexican American women, especially for those living in emerging Latina/o immigrant communities. J Am Psychiatr Nurses Assoc, 2008; 14(3), 193-204. DOI: 10.1177/1078390308319034.

Mental health service needs of a Latino population: a community-based participatory research project

Community-based participatory research bridges the gap between academic researchers and the real-life issues of communities and offers promise for addressing racial and ethnic disparities in mental health care. The purpose of this community-based participatory research was to identify factors that affect access, use, and perception of mental health services by a Latino population at individual, organizational, and community levels. Individual level factors included health beliefs about mental illness and care, suspicions of providers, financial concerns, and culturally determined gender roles. Organizational factors included problems with access to care related to cost, lack of bilingual providers, and culturally competent care; and community level factors included distance between resources and the need for services to be provided in community sites. Immigration status and acculturation were identified as factors at all levels.

'Take my hand, help me out': mental health service recipients' experience of the therapeutic relationship

The purpose of this study was to describe mental health service recipients' experience of the therapeutic relationship. The research question was 'what is therapeutic about the therapeutic relationship?' This study was a secondary analysis of qualitative interviews conducted with persons with mental illness as part of a study of the experience of being understood. This secondary analysis used data from 20 interviews with community-dwelling adults with mental illness, who were asked to talk about the experience of being understood by a health-care provider. Data were analysed using an existential phenomenological approach. Individuals experienced therapeutic relationships against a backdrop of challenges, including mental illness, domestic violence, substance abuse, and homelessness. They had therapeutic relationships with nurses (psychiatric/mental health nurses and dialysis nurses), physicians (psychiatrists and general practitioners), psychologists, social workers, and counsellors. Experiences of the therapeutic relationship were expressed in three figural themes, titled using participants' own words: 'relate to me', 'know me as a person', and 'get to the solution'. The ways in which these participants described therapeutic relationships challenge some long-held beliefs, such as the use of touch, self-disclosure, and blunt feedback. A therapeutic relationship for persons with mental illness requires in-depth personal knowledge, which is acquired only with time, understanding, and skill. Knowing the whole person, rather than knowing the person only as a service recipient, is key for practising nurses and nurse educators interested in enhancing the therapeutic potential of relationships.

"She took the time to make sure she understood": mental health patients' experiences of being understood

The foundation of psychiatric/mental health nursing is the relationship between nurse and patient. Caring for persons with mental illness within the context of this relationship requires knowledge of the individual. To gain this knowledge, understanding the patient's perceptions and concerns is essential. Research suggests that this understanding does not always occur. The study reported here examined what it means to individuals with mental illness to be understood. In-depth phenomenological interviews revealed three predominant themes: "I was important," "it really made us connect," and "they got on my level." Nurses can use these findings to improve the care of those with mental illness.

Hall's authentic meaning of medicalization: an extended discourse

The purpose of this article is to inform emerging theoretical understanding of medicalization by challenging, updating, and affirming a previously published essay on this topic by Hall. We accomplished this through the creation of a discourse among the 3 authors using the essay, written entirely from a personal perspective, and integrated our own personal experiences as nurses and patients. Hall's essay on the authentic meaning of medicalization provided a critical understanding of medicalization of cancer describing the factors, forces, and consequences, seeking to raise consciousness and provoke reform. The 3 of us added our voices to her narrative seeking to expand the discourse on medicalization and inform theory development. We have shared our individual and collective voices and identified elements that might point the way to theoretical emergence and ending with our own call for nursing to evolve further as a field worthy of human inspiration.

An exploration of the meanings of space and place in acute psychiatric care

Spatial human experiences such as confinement and freedom are important to acute psychiatric care. The physical space that inpatient psychiatric/mental health nurses and acute psychiatric patients share influences human relationships. The purpose of this paper is to explore the meanings of space and place in acute psychiatric settings, to discuss how these meanings affect human relationships, nurses' work environment and patients' perception of care, and to present how the design and use of nursing stations affects therapeutic relationships. We hope to encourage dialogue and research that will help clarify the meaning of space and place in acute care psychiatric units, and make for healthier work environments for nurses and healing care environments for patients.

The Interpretive Research Group as an Alternative to the Interpersonal Process Recording

In the spirit of trying something new, we abandoned the traditional interpersonal process recording for an entirely new way to teach students about communication--an interpretive research group. We propose the interpretive research group as a strategy for teaching communication and analysis that encourages active student-faculty participation, provides for more egalitarian student-teacher relationships, and creates a liberating learning environment.