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• Veteran disparities. • Leadership influence. • Psychiatric nursing residency. • VA nursing research. Studies in Veteran populations have examined disparities in health service use, care quality, outcomes and increased demands for behavioral health. The purpose is to describe the development of nursing leadership roles that influenced practice improvements and demonstrated outcomes related to health disparities in a Veterans Affairs (VA) population over a 12-year period. The Sundean and colleagues' concept analysis of nurse leadership influence was applied to frame the initiative process and impacts. Antecedents and processes that facilitated leadership development included mentorship, disparities expertise, partnerships, consultation, scholarship, dissemination, advocacy, education, and strong coauthor collaboration. Improvements and outcomes included access to services, improved health indicators, tools, workforce, funding, innovations, and nurse investigator studies, consistent with VA priorities and policy related to disparities and equity. Limitations and barriers were addressed. This initiative models' strategies to increase nurse leadership in health equity and care transformation in health systems and community practices. [ABSTRACT FROM AUTHOR]

Background The Veterans Administration (VA) has been committed to academic affiliate training partnerships for nearly 70 years in efforts to enhance veteran-centric health care. One such effort, the VA Nursing Academy (VANA) program, was developed in 2007 in response to the nationwide nursing shortage and began as a five-year pilot with funding competitively awarded to 15 partnerships between local VA medical centers and schools of nursing. The VANA program evolved into the VA Nursing Academic Partnership (VANAP) program following the initial pilot. Purpose This article describes the development and evolution of the Charleston VANAP, which includes the Ralph H Johnson VA Medical Center (RHJ VAMC) and the Medical University of South Carolina College of Nursing (MUSC CON). Methods The VA Office of Academic Affiliations (OAA) funded a large portion of the initial five years of the Charleston VANAP. Once the national funding source ceased, the RHJ VAMC and the MUSC CON entered into a Memorandum of Understanding (MOU) to offer in-kind contributions to the partnership. Discussion The Charleston VANAP is the only program in the nation to offer three different nurse trainee programs and this article highlights some of the more notable achievements from each program. Conclusion The Charleston VANAP is a comprehensive partnership between the RHJ VAMC and the MUSC CON that truly demonstrates a commitment to assure that the very best care be provided to Veterans, our Nation's heroes. [ABSTRACT FROM AUTHOR]

Background Behavioral health disorders (psychiatric illness and substance abuse disorders) represent a significant burden across the nation's health care system. About one half of the problems that present in primary health care settings are behavioral in nature. There is urgent need to improve the integration of behavioral health care services into primary care. Methods The purpose of this paper is to describe how an asynchronous online graduate nurse practitioner program utilized a constructivist paradigm to creatively combine online problem based learning cases and on campus learning intensives to scaffold student learning. Results Student E -value scores were high and comments reflected improved knowledge, skill and comfort managing behavioral health problems in a primary care setting. Conclusion This innovative model can serve as a template for other educational programs and improve student's ability to identify, manage and treat common behavioral health care problems that present in primary care settings. [ABSTRACT FROM AUTHOR]

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a public health intervention to address overuse and risky use of alcohol and illegal substances. In order to increase SBIRT in clinical practice, training should start with future health care provider students and faculty. The main objective of this program was to improve and enhance the training of health professions students to provide competent screening, brief intervention and referral to treatment for persons who have or are at-risk for substance use disorder. This paper shares the results of an SBIRT training program at an academic health sciences center for undergraduate nursing, graduate nursing, and medical students. 1229 undergraduate and graduate nursing students, medical students, faculty and preceptors at an academic medical center completed SBIRT coursework integrated into their existing curriculum. Coursework utilized an online learning platform as well as in-person skills training experiences. An interprofessional team collaborated to create an online SBIRT curriculum consisting of 5 primary modules (total 3 h) and an SBIRT Booster module (0.5 h). The team also developed pre- and post-module quizzes and satisfaction surveys to measure changes in knowledge, confidence, and satisfaction; as well as simulations, videos, a screening tool, a provider pocket card, and an online resource library to support learning. Faculty and preceptors were trained in the program to model skills and answer student questions. A motivational interviewing specialist provided the in-person skills training sessions. A sustainable interprofessional SBIRT training program demonstrated gains in knowledge, confidence, and skills across all programs. The team used clinical opportunities and simulation with education to promote clinical proficiency. Interprofessional training mirrors real world clinical situations and encourages all providers to implement SBIRT in practice and decrease poor outcomes associated with substance use disorders. [ABSTRACT FROM AUTHOR]

Association of Acute Disseminated Encephalomyelitis (ADEM) with both recent vaccination and viral infections is well described in current literature. However, the coincidence of ADEM and bacterial infections has been rarely documented. In this report, we present a case of ADEM which occurred after bacterial meningoencephalitis and prior vaccination against tetanus, diphtheria, and pertussis (Tdap). A 62-year old woman was hospitalized with an upper respiratory tract infection three weeks after Tdap triple vaccination. A few days after admission, she became somnolent and developed meningism. Cerebrospinal fluid (CSF) analysis revealed pleocytosis and increased protein/lactate levels compatible with bacterial meningoencephalitis. The patient was treated with intravenous antibacterial triple therapy in combination with dexamethasone leading to a significant improvement of clinical symptoms and improvement of CSF parameters. Five days later, the patient's condition worsened again, and she developed aphasia and right-sided hemiparesis. A magnetic resonance imaging (MRI) scan revealed distinct fluid-attenuated inversion recovery sequence (FLAIR)-hyperintense lesions in both hemispheres. Following brain biopsy, the diagnosis of ADEM was made and methylprednisolone pulse therapy was initiated for five days leading to a nearly complete remission of symptoms. ADEM is a neurological syndrome which may be associated with bacterial infection of the central nervous system (CNS). We hypothesize that the preceding Tdap triple vaccination may have contributed to the development of ADEM. [ABSTRACT FROM AUTHOR]