Spirituality, Religiosity, Depression, Anxiety, and Drug-Use Consequences During Methadone Maintenance Therapy

Substance addiction is damaging to the health of persons, families, and society. Often the person with addiction has decreased spirituality and religiosity and suffers from anxiety, depression, or both, increasing the risk for continued substance use and its concomitant negative consequences. The study purpose was to describe spirituality and religiosity, among persons enrolled in methadone maintenance therapy and to examine associations between spirituality, religiosity, anxiety, depression, and drug-use consequences. Using a descriptive and cross-sectional correlational design, 108 participants completed questionnaires assessing the study variables. Spiritual well-being was similar to other addiction samples and lower than healthy person samples. Most participants described themselves as spiritual or religious though religious participation was lower than in their past. The analysis indicated that spirituality, religiosity, depression, anxiety, and negative drug-use consequences are interrelated in the person with addiction. Higher anxiety was predictive of negative drug-use consequences

The Association of Spirituality, Religiosity, Depression, Anxiety, and Drug Use Among Persons Undergoing Methadone Maintenance Therapy

The Substance Abuse and Mental Health Services Administration estimated 22.2 million (9.1 %) of Americans ages 12 and older abused or were dependent on an illicit substance or alcohol in 2005. Substance abuse often leads to addiction, and is damaging to the health of persons, families, and society. Using Neuman\u27s System Model as the conceptual framework, it was proposed that addiction weakens person\u27s defenses with resultant loss of health. The person with addiction often also suffers from anxiety, depression, or both, increasing the risk for continued substance abuse and its concomitant negative consequences, such as loss of employment, poor finances, damaged relationships, and diminished spirituality. Spirituality is a factor in addiction that is poorly understood and warrants further exploration. The purpose of this study was to increase understanding of spirituality religiosity, depression, and anxiety among persons addicted to opioids. A descriptive and cross-sectional correlational design was used to determine the association of spiritual well-being (SWB), religiosity, depression, anxiety, continued drug use, and drug use consequences during methadone maintenance therapy. Participants (n=108) completed questionnaires regarding SWB, religious background and behavior, anxiety, depression, and drug use consequences. Spiritual histories were obtained from participants\u27 medical records. The majority of participants were white with a mean age of 34.8, had been in methadone therapy for an average of 3.1 years and 50% were male. Correlations were examined among the study variables and a regression model examined associations with negative consequences of drug use. The SWB scale mean (86.7) was not significantly different than the mean found in similar groups (85.7, t(107)=0.624, p=0.534). Spiritual well-being had a significant inverse correlation to both the depression (r=-0.47, p\u3c0.01) and anxiety (r=-0.46, p\u3c0.01) measures. Although spiritual well-being did not correlate with the negative consequences of drug use, existential well-being had a significant inverse correlation (r=-.022, p\u3c0.05). Spirituality, religiosity, anxiety and depression accounted for 20.3% of the variance in negative drug use consequences (R2=0.203, F(4,103)=6.57, p\u3c.001). Results demonstrate that spirituality, religiosity, depression, anxiety, and negative drug use consequences are interrelated in the person with addiction. Further understanding of spirituality in addiction is needed in order to provide spiritual care

Perceived Cognitive Changes with Chemotherapy for Breast Cancer: A Pilot Study

Purpose The purpose of this study was to determine perceived cognitive functioning, fatigue, depression and general well-being among women before and after the initiation of chemotherapy for breast cancer compared to a sample of healthy women. Method This descriptive, repeated measures study compared women receiving chemotherapy and healthy women. Women completed measures of quality of life, fatigue, cognitive changes and depression. Results Before chemotherapy, women with cancer reported more fatigue and depression than healthy women. After chemotherapy, women with cancer reported decreased cognitive functioning accompanied by more fatigue and depressive symptoms than healthy women. Conclusion This study is one of the first to use multiple symptom measures before and after starting chemotherapy. Understanding cognitive changes and related symptoms that occur before and during chemotherapy for breast cancer is the first step toward helping women cope with changes that occur with breast cancer treatment

Teaching students to teach patients: A theory-guided approach

Nurses in every setting provide patient teaching on a routine basis, often several times a day. Patient teaching skills are essential competencies to be developed during pre-licensure nursing education. While students learn what to teach for specific conditions, they often lack competence in how to teach in ways that individualize and optimize patient learning. The ultimate goal of patient teaching is to arm patients with the knowledge and skills, and the desire and confidence in their ability to reach their targeted health outcomes. We describe the creation of a theoretical framework to guide development of patient teaching skills. The framework, rooted in the contemporary health care values of patient-centered care, is a synthesis of four evidence-based approaches to patient teaching: patient engagement, motivational interviewing, adult learning theory, and teach-back method. Specific patient teaching skills, derived from each of the approaches, are applied within the context of discharge teaching, an important nursing practice linked to patient outcomes. This exemplar emphasizes the use of critical teaching process skills and targeted informational content. An online student learning module based on the theoretical framework and combined with simulation experiences provides the nurse educator with one strategy for use with nursing students. The theoretical framework has applicability for skill development during pre-licensure education and skill refinement for nurses in clinical practice

Promoting Team-Based Exercise Among African American Breast Cancer Survivors

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants (n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors

Survivors Speak: A Qualitative Analysis of Motivational Factors Influencing Breast Cancer Survivors’ Participation in a Sprint Distance Triathlon

Aims and Objectives To examine motivational factors influencing breast cancer survivors to participate in triathlon training, complete a triathlon and maintain an exercise thereafter. Background Routine exercise has been shown to improve quality of life and reduce recurrence for breast cancer survivors. Yet physical and psychological factors present barriers for initiating and maintaining an exercise routine. Research is limited in exploring factors of exercise motivation from the survivor\u27s perspective. Design Qualitative design using focus groups and individual follow-up phone interviews to explore motivation for exercise initiation and maintenance. Methods One to two weeks after completing a triathlon, 11 breast cancer survivors who trained together participated in one of three focus groups to discuss their experience. Five months post triathlon 6 of the 11 participants were successfully contacted and phone interviews were conducted to explore exercise maintenance. Focus groups and interviews were analysed using content and thematic analysis. Results Five themes emerged (1) Champion for Exercise, (2) Part of a Team, (3) Everyone Had a Story, (4) Not Really Exercise and (5) What Do We Do Now? Overall, survivors recognised their need for lifestyle change (e.g. moving from a sedentary lifestyle to a more active one). More importantly, they identified the team approach to exercise initiation was crucial in their success in sustaining a behavioural change. Conclusions Emphasis needed on developing team exercise training programmes for survivors. Nurses can play a critical role in discussing with survivors, the benefits of exercise initiation and maintenance. Relevance to clinical practice Breast cancer survivors are hesitant to initiate routine exercise. Training with women who share a common lived experience increases the likelihood of success. Nurses are in a position to encourage breast cancer survivors to participate in group exercise programmes as a way to improve quality of life

Perceived Readiness for Hospital Discharge in Adult Medical-Surgical Patients

Purpose: The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients\u27 perceptions of their readiness for hospital discharge. Design: A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables. Setting: Midwestern tertiary medical center. Sample: 147 adult medical-surgical patients. Methods: Predictor variables included patient characteristics, hospitalization factors, and nursing practices that were measured prior to hospital discharge using a study enrollment form, the Quality of Discharge Teaching Scale, and the Care Coordination Scale. Discharge readiness was measured using the Readiness for Hospital Discharge Scale administered within 4 hours prior to discharge. Outcomes were measured 3 weeks postdischarge with the Post-Discharge Coping Difficulty Scale and self-reported utilization of health services. Findings: Living alone, discharge teaching (amount of content received and nurses\u27 skill in teaching delivery), and care coordination explained 51% of readiness for discharge score variance. Patient age and discharge readiness explained 16% of variance in postdischarge coping difficulty. Greater readiness for discharge was predictive of fewer readmissions. Conclusions: Quality of the delivery of discharge teaching was the strongest predictor of discharge readiness. Study results provided support for Meleis\u27 transitions theory as a useful model for conceptualizing and investigating the discharge transition. Implications for Practice: The study results have implications for the CNS role in patient and staff education, system building for the postdischarge transition, and measurement of clinical care outcomes

Expectation Modulates Human Brain Responses to Acute Cocaine: A Functional Magnetic Resonance Imaging Study

Background Human expectation of psychoactive drugs significantly alters drug effects and behavioral responses. However, their neurophysiological mechanisms are not clear. This study investigates how cocaine expectation modulates human brain responses to acute cocaine administration. Methods Twenty-six right-handed non–treatment-seeking regular cocaine abusers participated in this study. Changes in blood oxygenation level-dependent (BOLD) signals were measured, and online behavioral ratings during cocaine expectation and acute cocaine administration were recorded. Results Distinct regional characteristics in BOLD responses to expected and unexpected cocaine infusions were observed in the medial orbitofrontal gyrus (Brodmann area [BA] 11), frontal pole (BA 10), and anterior cingulate gyrus regions. Active engagement in the amygdala and the lateral orbitofrontal cortex (OFC; BA 47) by unexpected but not expected cocaine infusion was discovered. Cocaine expectation did not change BOLD responses to acute cocaine administration in a set of subcortical substrates, the nucleus accumbens, ventral putamen, ventral tegmental area, and thalamus. Conclusions These results suggest that cocaine expectation modulates neural-sensitivity adaptation between the expected events and the actual outcomes but did not modulate the pharmacological characteristics of cocaine. In addition, the amygdala–lateral OFC circuitry plays an important role in mediating stimulus-outcome relations and contextual factors of drug abuse

Building a Community-Academic Partnership to Improve Screening for Intimate Partner Violence: Integrating Advocates in Healthcare Clinic Settings

Aims To develop an innovative community-academic partnership to advance, test and promote intimate partner violence screening and referral protocols by comparing the effect of integrating intimate partner violence advocates versus enhancing medical training in medical clinic settings serving women from vulnerable populations. Detecting intimate partner violence in healthcare settings allows for survivors to connect to safety and referral resources prior to violence escalating. Screening for intimate partner violence and connecting patients to referral resources requires creating a safe and trusting relationship between healthcare providers and patients. Developing screening and referral protocols responsive to survivors\u27 needs requires involvement of clinic staff, survivors and community agencies that support survivors. Design Three phases of the project include Discovery, Implementation and Dissemination. Mixed-methodology will help in understanding current practices and effects of interventions. Methods Actions included in each phase: Discovery: 1) nurse-led focus groups of clinic staff, providers and survivors to understand current clinic practices; 2) retrospective chart review of the number of screens performed, positive screens detected and interventions performed. Implementation: 1) randomization of patients to be interviewed by a trained advocate or by healthcare provider with enhanced training; and 2) assess the number of screenings and referrals performed in each arm and 3) evaluate outcomes of intervention. Dissemination through: presentations, manuscripts and policy recommendations at the institutional and regional level. This IRB-approved proposal was funded in July 2021 by an Advancing a Healthier Wisconsin grant. Discussion The partnership has improved channels of communication and understanding between diverse clinical care providers, survivors and community agency staff as they navigate the complex challenges to the development and integration of screening and referral protocols. Impact This project will provide evidence of the most effective intimate partner violence screening and referral methodology that can be utilized in a wide variety of medical settings

Lived Experiences of American Adults who Survive COVID-19: Implications for Physical Activity and Interpersonal Stress

Introduction: The cumulative number of COVID-19 cases has surpassed 579 million globally. Symptoms during and after COVID-19 infection vary from mild cold symptoms to severe multisystem illness. Given the wide range of symptom presentations and complications post COVID-19, the purpose of this study was to describe the lived experience of American adults surviving COVID-19. Method: This study employed an exploratory qualitative description design. Semi-structured interviews were conducted with a sample of 35 individuals, [white (94%), female (71%), mean age = 43.7 years], with proximity to a university in an urban Midwest American city. Interviews occurred between May and August 2021, three or more months after participants tested positive for COVID-19. Results: Forty percent of the 35 participants experienced prolonged COVID-19 symptoms impacting their lifestyle. Four themes characterized the impacts of the post COVID-19 condition on the lives of the participants within the context of a global pandemic: (a) disruptions in health & well-being, (b) persistent uncertainty, (c) disruptions in interpersonal relationships, (d) beneficent outcomes and adaptation. Discussion: This study of COVID-19 has identified important implications for physical activity and interpersonal stress. Prolonged COVID-19 symptoms led to disruptions in the health, well-being, and interpersonal relationships of participants. Healthcare professionals need to attend to symptoms post COVID-19, assess interpersonal functioning, and provide guidance on physical activity. Future studies are recommended to track consequences of COVID-19’s impact on long-term health and well-being