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Vicarious trauma, secondary trauma, and workplace violence are the common forms of psychological trauma associated with nurses. Additional areas of nurses' trauma have not been adequately described, defined, or conceptually organized in the literature. In this article, a new middle-range theory of nurses' psychological trauma is presented with a novel discourse of nurse-specific traumas, theoretical statements, and outcomes of psychological traumas that are unique to nurses and the professional worlds in which they live. A middle-range theory is forwarded so that future scholars may test this theory and derive implications for practice, education, policy, and research., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: To describe the experiences of frontline nurses who are working in critical care areas during the COVID-19 pandemic with a focus on trauma and the use of substances as a coping mechanism., Design: A qualitative study based on content analysis., Methods: Data were collected from mid-June 2020 to early September 2020 via an online survey. Nurses were recruited through the research webpage of the American Association of Critical Care Nurses as well as an alumni list from a large, public Midwest university. Responses to two open-ended items were analysed: (1) personal or professional trauma the nurse had experienced; and (2) substance or alcohol use, or other mental health issues the nurse had experienced or witnessed in other nurses., Results: For the item related to psychological trauma five themes were identified from 70 nurses' comments: (1) Psychological distress in multiple forms; (2) Tsunami of death; (3) Torn between two masters; (4) Betrayal; and (5) Resiliency/posttraumatic growth through self and others. Sixty-five nurses responded to the second item related to substance use and other mental health issues. Data supported three themes: (1) Mental health crisis NOW!!: 'more stressed than ever and stretched thinner than ever'; (2) Nurses are turning to a variety of substances to cope; and (3) Weakened supports for coping and increased maladaptive coping due to ongoing pandemic., Conclusions: This study brings novel findings to understand the experiences of nurses who care for patients with COVID-19, including trauma experienced during disasters, the use of substances to cope and the weakening of existing support systems. Findings also reveal nurses in crisis who are in need of mental health services., Impact: Support for nurses' well-being and mental health should include current and ongoing services offered by the organization and include screening for substance use issues., (© 2021 John Wiley & Sons Ltd.)

Background: This project explores the impact of an educational in-service on nurses' knowledge and attitudes toward pain on a postoperative cardiovascular unit., Method: A convenience sample of nurses employed on the postoperative cardiovascular intensive care unit (n = 82) were asked to participate in this project, with 74 nurses attending the in-service training. Surveys that were 70% complete were used for analysis (preeducation, n = 22; posteducation, n = 24)., Results: The results from this project demonstrated that the use of a brief educational in-service is effective and efficient in increasing nurses' knowledge and attitudes related to pain management in this group of nurses. Posteducation survey scores were significantly higher than preeducation survey scores (p < .001)., Conclusion: These findings suggest that a brief educational in-service on pain management can improve nurses' knowledge and attitudes on pain management in this postoperative cardiovascular unit. [J Contin Educ Nurs. 2020;51(8):377-383.]., (Copyright 2020, SLACK Incorporated.)

BACKGROUND: Estimates of substance use (SU) in nurses is on par with that of the general population: between 6% and 8%. However, collecting sensitive information such as SU is difficult based on social desirability and fears of disclosure. AIMS: Part of a larger study surrounding nurses' self-reports of SU ( n = 1,478), the purpose was to explore open-ended responses of nurses ( n = 373) who were invited to "Please add any additional comments related to substance or alcohol use that you have experienced or witnessed in registered nurses." METHOD: This qualitative study employed a content analysis of 373 nurses' open-ended responses collected via an online survey. RESULTS: The majority of nurses ( n = 250) forwarded comments that described SU in other nurses, while 24 comments reflected the nurse's past or current SU. Content analysis revealed the following four themes: (1) differing social network proximity to SU; (2) individual process: vulnerability to adaptive/maladaptive coping resulting in positive and negative outcomes; (3) bedside, system, and organizational spaces and effects; and (4) there are no SU issues in nursing. CONCLUSIONS: Although direct reports of SU constitute approximately one quarter of the comments forwarded, nurses reported peers' struggles with SU, including observing nurses working in patient care while impaired and the use of substances to cope with work and personal stressors. Individual factors and system-related failures appear to be contributors to SU in nurses.

Background: Disclosure of family caregiving to work supervisors is needed for nurses to access work support for family caregiving. Little is known about characteristics of nurses who decide to/not to disclose family caregiving to supervisors. Objective: The objective was to examine characteristics of nurses based on whether they disclosed caregiving responsibilities to their nursing supervisors and describe reasons for non-disclosure. Methods: This was a secondary analysis of a cross-sectional survey. Registered nurses who had a work supervisor and cared for an older adult family member completed a survey including demographics, work and caregiving characteristics, and disclosure. Descriptive statistics and binary logistic regression were conducted. Results: The sample included 162 nurses. Participants were on average 50 years old, 90.1% female, 65.4% married, and 80.9% were caring for a parent or parent-in-law. The disclosure was more likely among nurses who provided higher intensity care (hours of care), cared for a parent or in-law, or had a quality caregiver-care recipient relationship. Reasons for non-disclosure included wanting to separate personal and work life, discomfort, and fear of consequences. Conclusions: Nurses struggle with similar disclosure challenges as other family caregivers. Care intensity, caregiver-care recipient relationships, and care stress were associated with disclosure behaviors. [ABSTRACT FROM AUTHOR]

Background: Certified registered nurse anesthetists (CRNAs) are exposed daily to highly addictive substances and stressful work environments, placing them at risk for substance use disorders (SUDs). Previous research, which is scarce, indicated that drugs of choice were opioids and propofol. Therefore, the purpose of this study was to investigate predictors of SUD risk using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test. Method: From June to July 2020, an online survey was sent via the American Association of Nurse Anesthesiology Research Survey Service to 3,000 CRNAs with a response of approximately 225 members. Results: CRNAs were found to be at a moderate risk for SUDs in the following categories: 10.27% for tobacco, 23.56% for alcohol, and 6.28% for cannabis. Regression analysis by substance category includes robust, differing models in this homogeneous sample. Predictors for all three models include a collection of demographic variables, religiosity, anxiety, difficulties due to anxiety, depression, substance use history, contact with the American Association of Nurse Anesthesiology Peer Assistance Program, and organizational support. Conclusion: Over 10% of CRNAs are at risk for developing tobacco use disorder, and almost one quarter of those surveyed are at a moderate risk for developing alcohol use disorder. These data are of concern and may indicate a shift of preferred substances used by CRNAs from controlled substances to alcohol. [ABSTRACT FROM AUTHOR]

Introduction: During the COVID-19 pandemic, nurses have faced various nurse-specific traumas in their workplaces, but there is limited understanding of the resulting outcomes and factors that contribute to them. Objective: To address this gap, the study employed the middle-range theory of nurses' psychological trauma (NPT) to examine these relationships among frontline nurses working in critical care areas. Methods: In a quantitative cross-sectional study, the study compared nurses identified as probable cases of posttraumatic stress disorder (PTSD) with those identified as not probable cases. The study investigated the nurse-specific traumas they experienced, their individual personality traits, and the buffers they possessed. The study also sought to identify specific types of nurse-specific traumas that could be associated with negative outcomes, such as alcohol and drug use. Results: It was found that PTSD-probable nurses reported higher levels of trauma from disasters and system/medically induced trauma compared to not-probable nurses. They also experienced more nonwork-related humankind traumas and displayed lower resilience. Furthermore, PTSD-probable nurses identified with trait urgency and trait avoidance motivation. Additionally, trauma from disasters was associated with alcohol use. Conclusion: The study highlights the elevated levels of trauma, lower resilience, and specific psychological traits associated with PTSD-probable nurses, emphasizing the need for targeted interventions and support to mitigate the negative outcomes experienced by frontline nurses. [ABSTRACT FROM AUTHOR]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1744-6155.2009.00219.x Byline: Karen J. Foli (1), Hala Elsisy (2) Keywords: Attention deficit hyperactivity disorders; auditory decoding; auditory perception; central auditory processing disorders; pediatric nursing Abstract: PURPOSE. This discussion presents central auditory processing disorders to pediatric nurses who can influence decisions, educate parents and children, and advocate for children and families in the healthcare and educational settings. CONCLUSIONS. Nurses' understanding of central auditory processing disorders and their signs and symptoms may help prevent misdiagnosis or underdiagnosis in the pediatric population. PRACTICE IMPLICATIONS. The common indicators of central auditory processing disorders often mimic other childhood disorders such as attention deficit hyperactivity disorder. Testing for central auditory processing disorders is optimized when children are on the appropriate medication at the time of testing. Author Affiliation: (1)School of Nursing (2)Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA Article History: First received January 26, 2009; Final revision received July 31, 2009; Accepted for publication August 19, 2009. Article note: kfoli@purdue.edu or elsisy@purdue.edu, with a copy to the Editor: roxie.foster@UCDenver.edu

Purpose: Information about nontraditional (kinship, foster, and adoptive) families is typically scattered or overlooked both in nursing education and nursing practice settings. Using a nursing‐centric, population‐focused lens, the current state of nontraditional families in the United States is briefly described. An overview of the challenges and psychological dynamics involved when a nonbiological parent assumes the role of caregiver is provided. Conclusion: Based on the 2010 Census findings and other indicators, we now understand that nontraditional families and their children make up a considerable portion of the population. Nurses, regardless of level of practice, have the potential to positively impact health outcomes of nontraditional parents and their children. Knowledge of the formation and needs of nontraditional families can inform, and improve, culturally safe, trauma‐informed nursing care. Practice implications: This discussion is a first step in appreciating the formation of nontraditional families and the importance of trauma‐informed, unbiased, nonstereotypic discourse in nursing care. By describing the heterogeneity of how families are built through kinship care, foster placements, and adoptive homes, nurses' assessments and interventions will be informed and through a lens of the high potential for past traumas. With this foundational knowledge, nurses interfacing with nontraditional families are better prepared to provide much needed support and relevant care for this unique population. [ABSTRACT FROM AUTHOR]

Substance use disorders (SUDs) in nursing have individual well-being, patient safety, and licensure/regulatory implications. Literature is scarce related to predicting SUDs in registered nurses; this study included specific items surrounding nurses' psychological trauma. An online survey, consisting of validated scales and investigator-generated items was distributed to 4,000 registered nurses in Indiana with a yield of 1,478 surveys. The World Health Organization: Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used as the dependent variable to assess risk of SUDs. Three multivariate regression models with predictive variables for risk of tobacco (R 2 = 0.08), alcohol (R 2 = 0.09), and other substances (R 2 = 0.10) use were found. Of concern, nurses are at moderate risk for tobacco use at 11.6%; alcohol use at 11.6% and for other substances at 10.4%. Each regression model contained distinct predictor variables; however, variables occurring in all three models were: depression, anxiety, and items surrounding psychological trauma (adverse childhood experiences, life events, lateral workplace violence). [ABSTRACT FROM AUTHOR]

This concept analysis aims to define affordability within the context of healthcare decision making. Affordability is a complex concept that influences an individual's healthcare decision making. In the year's post‐Affordable Care Act, the United States has seen an increase in insured individuals, but also an increase in underinsured healthcare consumers. Evidence for the concept attributes was found by searching the Cumulative Index of Nursing and Allied Health Literature, EconLit, Family & Society Studies Worldwide, Humanities Full Text, and PsychINFO databases. Literature was synthesized using the Walker and Avant approach. A new definition was derived with four defining attributes, as well as antecedents and consequences. Three cases are forwarded: the model, borderline, and contrary. In healthcare decision making, affordability is a subjective measure that individuals use in determining the ability to engage in a healthcare service or a durable good transaction. Affordability varies based on circumstances. The context of healthcare decision making of individuals stands in contrast to the decision‐making in health systems and to decisions unrelated to one's health. Affordability is a determinant of an individual's ability to engage in a transaction. As such, nurses and policymakers should attempt to understand affordability from the patient's perspective. [ABSTRACT FROM AUTHOR]

To describe nurses' personal and professional psychological trauma. A content analysis of 372 responses surrounding personal and professional trauma was performed. Five themes emerged. A new type of trauma was uncovered, heretofore undescribed in the literature: insufficient resource trauma caused by a lack of resources and staff needed to render quality, safe care. Nurses' reports were vivid, frequently indicating they were still recovering from traumatic experiences. Professional sources of trauma were categorized as inherent in the role of the nurse and those that could be mitigated through organizational policy, adequate resources, and oversight. • Insufficient resource trauma, a new form of nurse-specific trauma, is present when needed resources are lacking. • Psychological trauma affecting nurses may be avoidable or unavoidable. • Outcomes of psychological trauma indicate nurses' mental health and career issues that need to be addressed. [ABSTRACT FROM AUTHOR]

The article reports a study which describes the lived experiences of nurses of providing care to the adoption triad (AT; birth parents, adoptive parents, and the child). The results revealed four themes which reflected thoughts of nurses gained from both personal and professional roles. Nurses often have a personal connection to adoption and therefore they can improve clinical practices for these patients; nursing education should include care rendered to the AT.

PURPOSE: This study describes the practice settings and interventions of nurses who care for members of the adoption triad (AT; birth parents, adoptive parents, child). DESIGN AND METHODS: A 28-item, descriptive, cross-sectional survey was used. FINDINGS: Ninety-seven (97) nurses provided complete (65) or partial (32) responses. Most frequently reported practice settings were labor, delivery or postpartum unit, and pediatrics. Assessed needs varied by AT members. However, interventions for all members of the triad included emotional support and therapeutic communication. PRACTICE IMPLICATIONS: The unique placement of advanced practice nurses in various clinical settings allows for contact with members of the AT in vulnerable and crisis periods. [ABSTRACT FROM AUTHOR]

Aim: To create a comprehensive understanding and definition of guilt in caregivers of individuals with dementia. Through this concept analysis, we hope to empower nurses to more accurately identify guilt in caregivers and tailor interventions to specifically reduce these symptoms of guilt. Background: Individuals with dementia are often cared for by relatives, friends and neighbours. Many caregivers express feelings of guilt, increasing the risk of depression and psychological burden. In turn, this impacts their availability to render care. Design: Concept analysis according to Walker and Avant (Strategies for theory construction in nursing. Boston, MA: Prentice Hall; 2011). Method: A literature search was completed utilising the following databases Cumulative Index to Nursing and Allied Health, PubMed, PsycINFO and Google Scholar for the years 2003–2017. Common definitions and lay usage were also considered. Results: The identified critical attributes of guilt experienced by caregivers to individuals with dementia include the following: (a) The expectation of a moral responsibility to care for the individual with dementia; (b) a negative, subjective appraisal of one's own caregiving performance, including neglecting other roles and responsibilities and self‐neglect; and (c) a sense of transgression or violation of a moral standard as a caregiver to the individual with dementia. These defining attributes were then applied in three cases: model, borderline and contrary. Pertinent antecedents and consequences to the concept of guilt in caregivers to individuals with dementia were identified. Discussion: As a result of the guilt, the caregiver may experience poor mental and physical health, symptoms of anxiety and depression, and a greater sense of caregiver burden. Conclusion: A new, comprehensive conceptual definition of guilt in caregivers to individuals with dementia is described. Implications for practice: A conceptual definition of guilt in caregivers of individuals with dementia allows nurses to assess and identify caregivers at risk for, or currently experiencing, guilt and help direct caregivers to appropriate interventions and supportive services. [ABSTRACT FROM AUTHOR]