Daryl Sharp

A New Tool to Assess Treatment Fidelity and Evaluation of Treatment Fidelity across 10 Years of Health Behavior Research.

A. Bellg, B. Borrelli, et al. (2004) previously developed a framework that consisted of strategies to enhance treatment fidelity of health behavior interventions. The present study used this framework to (a) develop a measure of treatment fidelity and (b) use the measure to evaluate treatment fidelity in articles published in 5 journals over 10 years. Three hundred forty-two articles met inclusion criteria; 22% reported strategies to maintain provider skills, 27% reported checking adherence to protocol, 35% reported using a treatment manual, 54% reported using none of these strategies, and 12% reported using all 3 strategies. The mean proportion adherence to treatment fidelity strategies was .55; 15.5% of articles achieved greater than or equal to .80. This tool may be useful for researchers, grant reviewers, and editors planning and evaluating trials.

A Self-Determination Multiple Risk Intervention Trial to Improve Smokers' Health

AbstractBACKGROUND: Little is known about how interventions motivate individuals to change multiple health risk behaviors. Self-determination theory (SDT) proposes that patient autonomy is an essential factor for motivating change. OBJECTIVE: An SDT-based intervention to enhance autonomous motivation for tobacco abstinence and improving cholesterol was tested. DESIGN: The Smokers’ Health Study is a randomized multiple risk behavior change intervention trial. SETTING: Smokers were recruited to a tobacco treatment center. PATIENTS: A total of 1,006 adult smokers were recruited between 1999 and 2002 from physician offices and by newspaper advertisements. INTERVENTIONS: A 6-month clinical intervention (4 contacts) to facilitate internalization of autonomy and perceived competence for tobacco abstinence and reduced percent calories from fat was compared with community care. Clinicians elicited patient perspectives and life strivings, provided absolute coronary artery disease risk estimates, enumerated effective treatment options, supported patient initiatives, minimized clinician control, assessed motivation for change, and developed a plan for change. MAIN OUTCOME MEASURES: Twelve-month prolonged tobacco abstinence, and change in percent calories from fat and low-density lipoprotein-cholesterol (LDL-C) from baseline to 18 months. RESULTS: Intention to treat analyses revealed that the intervention significantly increased 12-month prolonged tobacco abstinence (6.2% vs 2.4%; odds ratio [OR]=2.7,P=.01, number needed to treat [NNT]=26), and reduced LDL-C (−8.9 vs −4.1 mg/dL;P=.05). There was no effect on percent calories from fat. CONCLUSIONS: An intervention focused on supporting smokers’ autonomy was effective in increasing prolonged tobacco abstinence and lowering LDL-C. Clinical interventions for behavior change may be improved by increasing patient autonomy and perceived competence.

Validation of the important other climate questionnaire: Assessing autonomy support for health related change.

Self-determination theory suggests that autonomy support from others is important in motivating change of various health behaviors. The present research provides initial validation for the Important Other Climate Questionnaire for smoking (IOCQ–S)and for diet (IOCQ–D)in the context of a large (N 1,006)intensive tobacco treatment and dietary intervention trial. These scales are intended to measure the degree of autonomy support patients experience from important others (non-health care professionals)with respect to tobacco abstinence and eating a healthy diet. Results indicate the measures are reliable ( .87 smoking and .95 diet)and valid. Important other support was associated with change in perceived autonomy and perceived competence for target behaviors. Further, the IOCQ–S was associated with 7-day point prevalence cessation and 6-month prolonged abstinence from tobacco. The IOCQ–D was associated with a change in the percentage of calories from fat, saturated fat, and monounsaturated fat. Initial reliability and validity are supported for the IOCQ.

Evidence-Based Multidisciplinary Strategies for Working With Children Who Set Fires

In 1999, the National Association of State Fire Marshals received a grant from the Office of Juvenile Justice and Delinquency Prevention, which culminated in the development of nationwide workshops designed to help communities intervene with children who play with and/or set fires. The purpose of this article is to describe the content of these multidisciplinary workshops including a comprehensive overview of fireplay and firesetting among youth in the United States. Strategies for assessing and intervening with these children and their families within a community-based framework are discussed, and implications for nursing practice and research are highlighted.

A randomized controlled trial of mentoring interventions for underrepresented minorities

Purpose To conduct a randomized controlled trial to evaluate the effects of different mentoring interventions on the basic psychological need satisfaction of underrepresented minorities and women in academia. Method Participants were 150 mentor/protégé dyads from three academic medical centers and eight other colleges and universities in western and central New York, randomized from 2010 to 2013 into mentor training (using principles of self-determination theory); peer mentoring for protégés; mentor training and peer mentoring for protégés combined; or control/usual practice. Protégé participants were graduate students, fellows, and junior faculty who were from underrepresented groups based on race, ethnicity, gender, or disability. The primary analysis was a comparison of intervention effects on changes in protégés’ satisfaction of their basic psychological needs (competence, autonomy, and relatedness) with their mentor. They completed a well-validated, online questionnaire every two months for one year. Results There was no significant effect at the end of one year of either mentor training or peer mentoring on protégés’ psychological basic need satisfaction with mentor specifically or at work in general. Exploratory analyses showed a significant effect of the mentor-based intervention on the protégés’ overall psychological need satisfaction with their mentor at two months, the time point closest to completing mentor training. Conclusions This randomized controlled trial showed a potential short-term effect of mentor training on changing basic psychological need satisfaction of underrepresented scholars with their mentors. Despite the lack of sustained effect of either mentor training or peer mentoring, these short-term changes suggest feasibility and potential for future study.

A review of research by nurses regarding tobacco dependence and mental health.

The prevalence of tobacco use and dependence among those with psychiatric and/or substance use disorders is exceptionally high, contributing to significant morbidity and mortality. The purpose of this review is to discuss the findings conducted by nurses regarding smoking and mental health. A search of the available literature since 1950 resulted in a review of 17 studies authored or coauthored by nurses. Most study designs were descriptive with only one investigator reporting the results of a small clinical trial. In addition to documenting smoking patterns in this population, investigators found that many psychiatric nurses assessed their clients for tobacco use and advised them to stop smoking but few intervened intensively to aid cessation. Psychiatric nurses reported low efficacy for delivering interventions and considerable doubt about their clients’ abilities and motivation to stop smoking. Although some desired additional training in tobacco dependence interventions, nurses reported feeling ethically conflicted about, and were inconsistently supportive of, system level interventions such as tobacco free health care settings. It is likely that these findings, as well as the paucity of tobacco dependence studies, reflect the relatively small number of psychiatric nurses conducting research as well as the inattention, until recently, of mental health leaders, policy makers, and funders to the importance of tobacco dependence research in this clinical population. As tobacco dependence treatment for those with mental illnesses and/or addictive disorders becomes more of a public health priority, opportunities abound for nurse researchers to contribute to the growing evidence in this often neglected area.

Mentoring Interventions for Underrepresented Scholars in Biomedical and Behavioral Sciences: Effects on Quality of Mentoring Interactions and Discussions

Mentor education and peer mentoring can enhance the breadth of mentor–protégé discussions and quality of dyad time for underrepresented minority scholars.

Making a Case for Systematic Integration of Theory-Based Tobacco Education Into Graduate Psychiatric/Mental Health Nursing Curriculum

Tobacco use and dependence is a serious public health issue that disproportionately affects the mentally ill client population. Mental health professionals, including psychiatric/mental health advanced practice nurses (PMHAPNs), are disinclined to integrate tobacco cessation interventions into their practice, due in part, to a general lack of tobacco-related knowledge (C. Essenmacher, C. Karvonen-Gutierrez, J. Lynch-Sauer, & S. A., Duffy, 2008; A. J. Molina, T. Fernandez, D. Fernandez, M. Delgado, S. de Abajo, & V. Martin, 2012; L. Sarna, L. L. Danao, S. Chan, S. Shin, L. Baldago, E. Endo, & M. E. Wewers, 2006); D. Sharp, S. Blaakman, R. Cole, & J. Evinger, 2009). This paper provides an in-depth literature review of tobacco education in nursing curricula and proposes the systematic integration of theory-based tobacco content into psychiatric/mental health graduate nursing programs.

Report From the APNA Tobacco Dependence Council

It is well established that in comparison with the general population, those with psychiatric disorders and/or addictive disorders are disproportionately burdened by the harmful effects of tobacco dependence (Ziedonis et al., 2008). Although momentum is now building to address this chief avoidable cause of morbidity and mortality, psychiatric clinicians have been slower than other health care professionals to intervene with their clients who smoke despite the presence of efficacious interventions (Fiore et al., 2008; Williams & Ziedonis, 2004). In the latter part of 2007, the deputy director of the Smoking Cessation Leadership Center (SCLC; a program office of the Robert Wood Johnson with funding from the American Legacy Foundation) invited the American Psychiatric Nurses Association (APNA) to collaborate with SCLC to address the tobacco dependence epidemic among those with psychiatric and/or addictive disorders. In response, the APNA Board of Directors convened the Tobacco Dependence Task Force, which initiated its work in February 2008 with a Smoking Cessation Performance Partnership Summit in Leesburg, Virginia. The APNA Tobacco Dependence Task Force was charged to devise a nationwide strategic plan designed to strengthen the scope and effectiveness of nurses’ interventions with their clients who use tobacco. Selected from a national pool of applicants who responded to a call to participate, task force members included registered and advanced practice psychiatric nurses from clinical, educational, and research venues throughout the country as well as SCLC staff. Guided by the performance partnership model (Mills, Revell, & Hudmon, 2005), a skillful consultant helped lead the task force to develop a detailed plan aimed at helping nurses support their clients’ efforts to decrease and/or stop using tobacco products. In addition to identifying key stakeholders, the model (which has been used widely to advance public policy initiatives) provides a framework for delineating clear measurable target outcomes. It comprises four basic questions:

A clinical translation of the research article titled, "the impact of opening a smoking room on psychiatric inpatient behavior following implementation of a hospital-wide smoking ban".

The primary purpose of this study was to compare patient behaviors and staff opinion regarding two different psychiatric inpatient unit conditions during a hospital-wide smoking ban. In the first condition, patients from two inpatient units were not allowed to smoke inside or outside on the grounds because of a hospital-wide smoking ban. A year later, a smoking room was opened in one of the units, and patients from both units were allowed to access it. The patient outcomes that were compared across the total smoking ban and smoking room conditions included length of stay, percentage of involuntary admissions, number of discharges against medical advice, days of high observation room usage, disruptive episodes, use of nicotine replacement therapy, and use of PRN medications. The staff opinions that were compared included their view of the smoking room, their perception of safety in their work environment, perceived time spent discussing smoking privileges and managing presenting psychiatric problems, and the extent to which off-unit privileges were granted solely to allow patients to smoke.