Joan A. Kearney

Refocusing Research Priorities in Schools of Nursing

It is critical for schools of nursing to periodically reassess their scholarly programs to ensure that their conceptual framework and approaches address current challenges and enhance productivity. This article describes the process undertaken at Columbia University School of Nursing to evaluate scholarly enterprise so that it remains relevant and responsive to changing trends and to revise our research conceptual model to be reflective of the foci of our clinicians and researchers. As part of a larger strategic initiative, a two-phase Research Excellence Planning and Implementation Workgroup was convened, consisting of a broad representation of faculty and administrative staff, with an overall goal of expanding scholarly capacity. During Phase I, members developed measurable outcomes and tactics and revised the schools conceptual research model. In Phase II, the workgroup implemented and monitored tactics and presented final recommendations to the dean. To measure progress, faculty members completed a survey to establish baseline scholarship and collaboration with results indicating room for growth in interdisciplinary and inter-institutional collaboration. Ongoing assessment of outcomes includes Web-based tracking of scholarly activities and follow-up surveys to monitor expansion of faculty collaboration. We recommend this process to other schools committed to sustainable, increasingly relevant scholarship.

Mental Health Disorders in Elderly People Receiving Home Care: Prevalence and Correlates in the National U.S. Population

BackgroundCurrent evidence on mental health disorders (MHDs) in the U.S. elderly home care population is highly varied and limited to the local level. AimThe objective of this study was to examine the prevalence and characteristics of U.S. elders with MHDs on the national level. MethodsThis is a primary analysis of secondary use data from a 5% random sample of the 2010 National Outcome and Assessment Information Set (OASIS) data spanning a 60-day home care session. MHDs included depression, anxiety, substance abuse, psychotic disorders, aggression, and socially inappropriate behaviors and were identified by diagnosis, symptoms, or mental health service order in the plan of care. Logistic regression was used to identify correlates of MHD. ResultsThe final analysis was conducted on records from 28,475 elderly patients with an average age of 79 (range 65–110). Patients were primarily female, White, Medicare beneficiaries, referred from short-stay acute hospitals, and living with others at home. Prevalence of MHDs was approximately 40%; depression (28.0%) and anxiety (18.9%) were common. Factors associated with MHDs were younger age, female, smokers, frail, living alone, referred from psychiatric hospitals, cognitively or sensory impaired, poorer health status, recent history of falls or multiple hospitalizations, and insufficient social support. Only about one third of patients identified with MHD received mental health services during the 60-day home care episode, including psychiatric nursing services and depression interventions. DiscussionMHDs are a national health concern in the older U.S. home care population and are common but largely undermanaged. Future research in the home care sector should be aimed at developing targeted MHD screening and interventional protocols and training the current workforce, as well as expanding the future workforce to improve psychiatric care for the homebound elderly.

Women and Children Exposed to Domestic Violence: Themes in Maternal Interviews about Their Children’s Psychiatric Diagnoses

Twelve mothers who had experienced domestic violence and whose children had received psychiatric diagnoses before school age were interviewed. An attachment based tool, the Reaction to Diagnosis Interview, was employed as it accesses maternal representational content. Using psychodynamic and attachment based models as a theoretical framework, content analysis was performed and four thematic categories emerged from the data: intense negative emotionality and suffering; diminished cognitive coping and dysregulation; preoccupation with trauma related material; and constricted causal attributions. Thematic categories as well as inter-relationships among themes are described and discussed in terms of current literature.

A Multi-Modal Pilot Intervention with Violence-Exposed Mothers in a Child Psychiatric Trauma-Focused Treatment Program

This multi-method pilot study implemented a relationally-based intervention with mothers of school-aged children receiving treatment for exposure to domestic violence. Grounded in psychodynamic and attachment theories, the short-term intervention consisted of targeted individual and group sessions. Quantitative as well as qualitative data were examined for trends and exemplars of important process outcomes. Improvements were evidenced in a number of key areas including psychiatric symptoms, isolation, defensive avoidance, coping skills, attributional style, and reflective functioning. Results converged to portray improved functioning in critical areas of dysfunction often displayed by these mothers.

Understanding parental behavior in pediatric palliative care: Attachment theory as a paradigm

OBJECTIVE The objective of this conceptual paper was to present important constructs in attachment theory as they apply to parent and caregiver behavior in pediatric palliative care. Clarification of these constructs is provided with specific reference to their clinical application as well as their reflection in current empirical literature. Social attachment theory is proposed as a developmentally contextual model for the study of parenting in pediatric palliative and end-of-life care. METHOD A comprehensive search was conducted of pertinent literatures. These included classic as well as recent theory and research in attachment theory in addition to the empirical literatures on parent and family experience in pediatric palliative care, serious illness, and beyond to parental bereavement. Other relevant literature was examined with respect to the phenomena of concern. RESULTS The empirical literature in pediatric palliative care supports the use of central concepts in attachment theory as foundational for further inquiry. This is evidenced in the emphasis on the importance of parental protection of the child, as well as executive activities such as decision making and other prominent parental operations, parental psychological resolution of the childs diagnosis and illness as well as coping and meaning making, and the core significance of parental relationships with providers who provide secure-base and safe-haven functions. SIGNIFICANCE OF RESULTS The promise for developing integrated, conceptually based interventions from construction through implementation is of urgent importance to children and families receiving pediatric palliative care services. Focusing on key parental behaviors and processes within the context of a well-studied and contextually appropriate model will inform this task efficiently. The attachment paradigm meets these criteria and has promise in allowing us to move forward in developing well-defined, inclusive, and conceptually grounded protocols for child and family psychosocial research, practice, and education in this specialty.

Critical Association Between Mental Health Disorders and Medical Status: Depression Intervention Use Indicates a Two-Fold Risk for Subsequent Medical Events in Older American Home Health Care Patients

The current study examined longitudinal associations between mental disorders and all-cause subsequent medical events in a 5% random sample of records in the 2010 national Outcome and Assessment Information Set. Records of older adults (N = 28,475) receiving home health care (HHC) services were examined with respect to mental disorders and medical events, including acute care hospitalization, emergency department admission, and 30-day rehospitalization. Predominant mental disorders were depression and anxiety identified by formal diagnoses, symptom clusters, and/or prescription of related mental health services. Depression intervention use was the strongest risk factor for all three types of medical events. However, 61.6% of patients receiving depression interventions did not screen positive at admission using the Patient Health Questionnaire-2. Moving forward, nurses must closely monitor high-risk older adults throughout the HHC stay using sensitive depression screening tools, as well as receive targeted training in geriatric psychiatry. [Journal of Gerontological Nursing, 42(10), 42-55.].

Mental health disorders in home care elders: An integrative review

Home care is the fastest growing U.S. health care sector, serving a predominance of highly vulnerable elderly patients. Mental health disorders (MHDs) are a major health concern in this population, however, current knowledge regarding their occurrence and associated correlates is inadequate. To address this gap, this integrative review examined existing findings regarding the prevalence and correlates of MHDs in home care elders. A search of six electronic databases and a hand search produced a final group of 36 articles for review. Poor data representativeness and methodological limitations impacted the quality of these studies, as reflected in an extremely wide range of prevalence estimates for these disorders (12% - 62%). A number of recommendations are made with respect to future research in this area. These include conducting multi-site investigations and the use of consistent and clear protocols for identification of MHDs in home care elders, a growing and significantly under-served population.

Planning with parents for seriously ill children: preliminary results on the development of the parental engagement scale.

OBJECTIVE The objective of this study was to develop a clinically relevant tool to assess parental engagement in decision making and planning for seriously ill children during palliative care consultations. Although little is known about the structure and process of planning meetings between parents and providers, less is known about the nature of parental engagement as it relates to decision making ability in pediatric end-of-life care. Using attachment and caregiving as a framework, this study clarified important dimensions of parental engagement. METHOD Using a multi-phase, template-matching technique, both literature and pediatric palliative care consultation data were analyzed, iteratively reviewed, matched, and categorized to create a measure of parental engagement. The attachment paradigm serves as the theoretical framework for the study, which focuses on parental engagement in decision making as a caregiving system function. Attachment and related literatures as well as coping and pediatric palliative care literatures were used in the initial conceptual sampling phase. RESULTS The study yielded two groups of findings. The first set of findings centered on the findings of the literature and consultation template-matching phases of the work. These two phases yielded a conceptual model of parental engagement as a psychobehavioral complex consisting of three dimensions: information-centered dialogue, insightful participation, and achievement of a collaboratively agreed-upon plan. The final phases consisted of creation of a 9 point Parental Engagement Scale, scoring of the consultations, and establishment of initial inter- rater reliability at .80. Psychometric testing continues. SIGNIFICANCE OF RESULTS Parental engagement in decision making is a critical area for study and intervention. If we can support parents in their caregiving executive functions while understanding the psychological and emotional underpinnings of the caregiving system and parental engagement itself, we can move inquiry forward in understanding parental needs for intervention during this most profoundly challenging time.

Urban-Dwelling Community Members’ Views on Biomedical Research Engagement

In this study, we explore community members’ overall understanding and experience with biomedical research engagement. We conducted a qualitative analysis to explore a concept that emerged but was not specifically addressed in a pre-existing dataset obtained using four focus group sessions with 30 urban-dwelling community members. Transcripts were read in an iterative process, and an emergent content analysis was performed. Five main themes were identified: (a) engaging in research to contribute to personal or greater good, (b) hierarchy of trust, (c) the importance of disclosure and transparency, (d) practical barriers to research engagement, and (e) fear of research procedures. Community members view research engagement as a collaborative process whereby community members and researchers are involved in all stages of the investigation. Focusing on research engagement, and not merely participation, may enhance community knowledge of the research process and advance scientific knowledge.

Nurse to nurse referral: The role of the child psychiatric nurse consultant

Nurse to nurse referral is a process by which nurses can use various areas of expert knowledge within their profession. Nurse to nurse referral is examined here with specific reference to the role of the child psychiatric clinical nurse specialist as consultant to the pediatric nurse practitioner. Current research and Chisholms guidelines for the nurse consultant role are reviewed. With a focus maintained on the ambulatory care area, the referral and consultation process in such settings is discussed. Parameters for using nurse to nurse referral between pediatric nurse practitioners and child psychiatric clinical specialists are outlined and recommendations given for implementing the process. The conclusion is reached that this type of referral process includes a number of components that must be examined, if it is to continue to develop and flourish.