Nursing professional development practitioners and leadership staff implemented a second Transitional Mentor Education Program. The pilot program was classroom based; however, with pandemic restrictions, a shift to deliver a hybrid mentoring program was needed. Learning needs, clinician well-being, and professional development were addressed. Regardless of the method of educational delivery, the nurses in Phase 2 achieved the same outcomes as the pilot program, including increased clinical confidence, communication, integration of stress reduction strategies, and reflective practice.

Background: Intense emotional demands of oncology nursing create a stressful work environment and increase the likelihood of leaving. The study aims to explore, describe, and understand how pediatric hematology/oncology nurses caring for chronically ill or dying patients use their spirituality to cope with job stress, maintain spiritual well-being (SWB), and continue to work in this specialty. Methods: A concurrent mixed-method research design consisted of a web-based survey and interview. Data collection included demographics, intent to leave questions, and four valid and reliable research instruments measuring spirituality, stress, coping, and SWB. A responsive interview guide directed interviews. Results: Quantitative analysis ( n = 130) revealed moderate to high levels of spirituality, moderate stress, coping, and SWB. Stress and SWB were weakly, inversely correlated ( r = −.221, p = .011) indicating lower stress was associated with greater SWB. Coping and SWB were weakly, positively correlated ( r = .248, p = .005) indicating greater coping was associated with greater SWB. An intent to leave in the next year was reported by 5.4%. Emerging themes from qualitative data ( n = 22) included faith-informed or existential spirituality, work environment, and emotional/psychological stressors such as feeling overwhelmed or witnessing suffering and coping through self-care and spirituality. Dimensions of SWB included spiritually based coping and life’s meaning and purpose. Intent to leave was related to the work environment or travel distance. Discussion: A nurse’s spirituality offers a mechanism for coping with accumulated losses and grief encountered in clinical practice and in turn supports SWB.

Purpose: Intense emotional demands of oncology nursing creates a stressful work environment and increases the likelihood of leaving nursing. The purpose of this study was to explore and describe how pediatric hematology/oncology nurses use their spirituality to cope with job stress, maintain spiritual well-being (SWB) and continue to work in this subspecialty. Method: A concurrent mixed method research design was employed consisting of a web-based survey and an interview. Data collection included demographics, four valid and reliable research instruments that measured spirituality, stress, coping and SWB, and intent to leave questions. Qualitative interviews were directed by a responsive interview guide. Results: Quantitative analysis (n = 130) revealed moderate to high levels of spirituality, moderate stress, coping and SWB. Only 5.4% of participants reported an intent to leave in the next year. Correlations indicated a weak positive relationship between coping and SWB (r = .248, p = .005) and weak negative relationship between stress and SWB (r = -.221, p = .011). A hierarchical regression analysis revealed that 25.3% of the variance in SWB was explained by the model (personal, situational, stress and coping factors). Religion was the only variable that had a strong statistically significant relationship throughout the model steps 1-4 and coping was second highest in model 4. Emerging themes from the qualitative data (n = 22) included faith-informed or existential spirituality; work environment and emotional/psychological stressors; and coping through self-care and spirituality. Dimensions of SWB included spiritually based coping and meaning and purpose in life. Intent to leave themes were not related to patient care but rather to work environment or travel distance. Conclusion: A nurse’s spirituality offers a mechanism for coping with accumulated losses and grief encountered in clinical practice, and in turn supports spiritual well-being.

Nursing professional development practitioners and nursing leadership identified a need for a transitional mentoring program to assist staff nurses’ transition beyond orientation. Mentoring was identified as an effective strategy to promote professional development. The benefits of this year-long transitional mentoring program include an increase in clinical confidence, integration of stress reduction strategies, and reflective practice into daily practice. The transitional mentoring program is a beneficial strategy for enhancing professional development of both mentors and mentees.

Aims. To examine the impact of multiple psychiatric disorders over the lifetime on risk of mortality in the general population. Methods. Data came from a random community-based sample of 1397 adults in Atlantic Canada, recruited in 1992. Major depression, dysthymia, panic disorder, generalised anxiety disorder and alcohol use disorders were assessed using the Diagnostic Interview Schedule (DIS). Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. Cox proportional hazard models with age at study entry as the time scale were used to investigate the relationship between DIS diagnoses and mortality, adjusted for participant education, smoking and obesity at baseline. Results. Results suggested that mood and anxiety disorders rarely presented in isolation - the majority of participants experienced multiple psychiatric disorders over the lifetime. Elevated risk of death was found among men with both major depression and dysthymia (HR 2.56; 95% CI 1.12-5.89), depression and alcohol use disorders (HR 2.45; 95% CI 1.18-5.10) and among men and women who experienced both panic disorder and alcohol use disorders (HR 3.80; 95% CI 1.19-12.16). Conclusion. The experience of multiple mental disorders over the lifetime is extremely common, and associated with increased risk of mortality, most notably among men. Clinicians should be aware of the importance of considering contemporaneous symptoms of multiple psychiatric conditions.

Nursing professional development practitioners and nursing leadership identified a need for a transitional mentoring program to assist staff nurses’ transition beyond orientation. Mentoring was identified as an effective strategy to promote professional development. The benefits of this year-long transitional mentoring program include an increase in clinical confidence, integration of stress reduction strategies, and reflective practice into daily practice. The transitional mentoring program is a beneficial strategy for enhancing professional development of both mentors and mentees.

Neurological soft signs (NSSs), minor neurological abnormalities, have been implicated as risk factors for poor cognitive performance in small-scale studies. Here we investigate the associations between NSSs and multiple domains of cognitive performance in a large, population-based cohort and evaluate sex differences in these associations. We analyzed data from 35,710 seven-year-old children in the Collaborative Perinatal Project to study the association between the number of NSSs and cognitive test scores using multiple linear regression models adjusting for risk factors for brain injury and aberrant neurodevelopment. NSSs were associated with lower scores on all domains of cognitive performance. Each additional soft sign was associated with lower full-scale IQ (b = -4.83, 95% CI [-5.06, -4.60]), performance IQ (b = -4.28, 95% CI [-4.54, -4.02]), and verbal IQ scores (b = -4.53, 95% CI [-4.76, -4.30]), as well as arithmetic (b = -4.06, 95% CI [-4.26, -3.85]), spelling (b = -3.53, 95% CI [-3.75, -3.30]), and reading (b = -4.00, 95% CI [-4.26, -3.75]) scores on the Wide Range Achievement Test (WRAT). Only one sex difference was observed: The association between NSS and the WRAT spelling test was somewhat stronger in girls (b = -4.01, 95% CI [-4.26, -3.36]) than in boys (b = -3.53, 95% CI [-3.75, -3.30]). There is an association between NSSs and poor cognitive performance that is not attributable to established risk factors for brain injury and aberrant neurodevelopment. Further research is needed to investigate the mechanisms underlying this association and to determine if interventions targeting NSS in children might have beneficial effects on neurocognitive development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

INTRODUCTION:Dehydration is a potentially preventable complication post-tonsillectomy and can result in an Emergency Department visit and/or readmission. Our objectives were to identify risk factors for dehydration readmissions and develop interventions to prevent them.METHODS:We used retrospective chart reviews to determine if increased intravenous (IV) hydration post-tonsillectomy prevented hospital readmissions for dehydration. All children aged 1-18 years who underwent tonsillectomy between July 1, 2007 and September 30, 2015 were included in this quality improvement study. Using the Pediatric Health Information System database, patients who experienced a readmission for dehydration within 72 hours of surgery were identified and validated with internal data. We analyzed the pre-implementation and post-implementation readmission rates after standardization of increased IV fluids (1.5 times maintenance). An interrupted time series analysis was used to estimate the effects of our hydration initiative.RESULTS:Of 11,157 patients who underwent tonsillectomy during the study period, 96 (0.9%) met the criteria for readmissions for dehydration. The pre-implementation readmission rate was 1% compared to 0.2% post-implementation, a reduction of 82%.CONCLUSIONS:The hydration initiative was associated with a significant decrease in hospital readmissions. This safe, low-cost, easy-to-implement approach to preventing dehydration post-tonsillectomy could be explored at other institutions.

Background: Depression and anxiety disorders are highly comorbid, and share significant symptom overlap. Whereas depression has been consistently associated with excess mortality, the association between anxiety and mortality is less clear. Our aim was to identify constellations of anxious and depressive symptoms and examine their associations with mortality. Method: This study considers respondents from the 1970 (n=1203) and 1992 (n=1402) cohorts of the Stirling County study. Symptoms of depression and anxiety were assessed using structured at-home interviews. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. Results: Exploratory factor analysis yielded three correlated factors in each cohort. Items loading on each factor varied slightly between cohorts, but roughly corresponded to (1) depressive symptoms, (2) anxious symptoms, and (3) somatic symptoms. The depressive factor was associated with increased risk of mortality in both the 1970 (HR: 1.35, 95% CI: 1.12, 1.62) and 1992 (HR: 1.25, 95% CI: 1.05, 1.48) cohorts. Anxious symptoms were associated with a reduced risk of mortality in the 1992 sample (HR: 0.72; 95% CI: 0.53, 0.90). Somatic symptoms were associated with a reduced risk of mortality in the 1970 sample (HR: 0.83, 95% CI: 0.69, 0.99), but an elevated risk of mortality in the 1992 sample (HR: 1.29; 95% CI: 1.11, 1.51). Conclusions: This study provides evidence that symptoms of depression and anxiety may have differential associations with early mortality. Somatic symptoms such as upset stomach and loss of appetite may be protective against mortality, perhaps through increased use of health care services. Conversely, symptoms such as weakness and cold sweats may be indicative of failing health.

BACKGROUND: Many studies have shown that depression increases mortality risk. We aimed to investigate the duration of time over which depression is associated with increased risk of mortality, secular trends in the association between depression and mortality, and sex differences in the association between depression and mortality.METHODS: We conducted a cohort study of 3410 adults enrolled in 3 representative samples of a county in Atlantic Canada in 1952 (n = 1003), 1970 (n = 1203) or 1992 (n = 1402) (the Stirling County Study). Depression was measured using a diagnostic algorithm based on the presence of depressed mood and associated symptoms, duration of more than 1 month, and substantial impairment. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database.RESULTS: Depression was associated with a heightened risk of mortality among men during the 3 time periods of the study, with hazard ratios (HRs) of 2.90 (95% confidence interval [CI] 1.69-4.98) between 1952 and 1967, 1.97 (CI 1.34-2.89) between 1968 and 1990, and 1.52 (CI 1.09-2.13) between 1991 and 2011. Elevated risk of mortality was noted among women only between 1990 and 2011 (HR = 1.51; CI = 1.11-2.05).INTERPRETATION: The association between depression and mortality persists over long periods of time and has emerged among women in recent decades, despite contemporaneous improvements in the treatment of depression and reduction of stigma associated with depression. Further research is needed to better understand the mechanisms involved.

Psychiatric epidemiology: dimensions and categories Jane M Murphy,* Stephen Gilman, and Ian Colman Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Department of Psychiatry, Dalhousie Faculty of Medicine, Halifax, Nova Scotia, Canada and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.To the Editor: We appreciate the interest of Drs Wakefield and Schmitz in our study of the bereavement exclusion in major depressive disorder (MDD). In fact it was Wakefield and colleagues†prior work on this issue2 that motivated our study.The crux of their letter is that our ability to identify cases of complicated bereavement was compromised by methodological decisions and by the structure of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) interview, both of which distort our findings and invalidate our conclusions

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.To the Editor: Gilman et al1 support eliminating the DSM "bereavement exclusion" on the basis of results from their National Epidemiologic Survey on Alcohol and Related Condition (NESARC) epidemiologic analysis. However, the results of their analysis actually suggest the validity of the bereavement exclusion, consistent with other recently emerging evidence.The bereavement exclusion classifies "uncomplicated" bereavement-related depressive episodes as normal distress and excludes them from major depressive disorder (MDD).