•Rates of suicide, substance use disorder, and mental health issues have increased in nursing.•The Surgeon General, National Academy of Medicine, and American Nurses Association among others have ...stressed the importance of nurse and health care worker well-being, and the importance of the mental health of health care workers.•Expert Panels of the American Academy of Nursing recommend actions to address risks to mental health and the factors contributing to nurse suicide to inform policy, education, research and clinical practice.
Rates of nurse mental health and substance use disorders are high. Heightened by the COVID-19 pandemic, nurses are challenged to care for patients in ways that often jeopardize their own health and increase risks for their families. These trends exacerbate the epidemic of suicide in nursing underscored by several professional organization clarion calls to nurses’ risk. Principles of health equity and trauma-informed care dictate urgent action. The purpose of this paper is to establish consensus among clinical and policy leaders from Expert Panels of the American Academy of Nursing about actions to address risks to mental health and factors contributing to nurse suicide. Recommendations for mitigating barriers drew from the CDC's 2022 Suicide Prevention Resource for Action strategies to guide the nursing community to inform policy, education, research, and clinical practice with the goals of greater health promotion, risk reduction, and sustainment of nurses’ health and well-being are provided.
Surviving critical illness is associated with persistent and severe physical, cognitive, and psychological morbidities. The Society of Critical Care Medicine has developed pain, agitation, and ...delirium guidelines and promoted mobility to improve care of critically ill patients. A task force has developed tools to facilitate and rapidly implement the translation of guideline care recommendations into practice. The Society of Critical Care Medicine has also assembled a task force to assess the long-term consequences of critical illness. This article will explore relationships between the pain, agitation, and delirium guidelines, mobility recommendations, and post-intensive care syndrome initiative. Implementation of the pain, agitation, and delirium guidelines taking into account current data regarding post-intensive care syndrome outcomes and potential interventions are an important first step toward improving outcomes for patients and their families. Research is needed to reduce the impact of long-term negative consequences of critical illness and to fully understand the best within- and post-ICU interventions, along with the optimal timing and dose of such interventions to produce the best long-term outcomes.
This article provides nursing educators practical tips and evidence-based strategies for effective construction of multiple-choice questions (MCQs). Well-designed MCQs that align with the intended ...learning objectives are critical for implementing sound assessment practices.
This article offers a step-by-step approach to test construction, starting with the assessment blueprint and followed by important considerations when writing the specific components of the MCQ.
Appropriate inclusion of clinical context in the MCQ and a description of common flaws to avoid, with suggested remedies, are also addressed.
Ultimately, the goal of this article is to equip nurse educators with the foundational tools to create high-quality MCQs that effectively assess knowledge acquisition by learners.
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To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002.
The American College of ...Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients. The task force, divided into four subcommittees, collaborated over six years in person, via teleconferences, and via electronic communication. Subcommittees were responsible for developing relevant clinical questions, using the Grading of Recommendations Assessment, Development and Evaluation method (www.gradeworkinggroup.org) to review, evaluate, and summarize the literature, and to develop clinical statements (descriptive) and recommendations (actionable). With the help of a professional librarian and Refworks database software, they developed a Web-based electronic database of over 19,000 references extracted from eight clinical search engines, related to pain and analgesia, agitation and sedation, delirium, and related clinical outcomes in adult ICU patients. The group also used psychometric analyses to evaluate and compare pain, agitation/sedation, and delirium assessment tools. All task force members were allowed to review the literature supporting each statement and recommendation and provided feedback to the subcommittees. Group consensus was achieved for all statements and recommendations using the nominal group technique and the modified Delphi method, with anonymous voting by all task force members using E-Survey (www.esurvey.com). All voting was completed in December 2010. Relevant studies published after this date and prior to publication of these guidelines were referenced in the text. The quality of evidence for each statement and recommendation was ranked as high (A), moderate (B), or low/very low (C). The strength of recommendations was ranked as strong (1) or weak (2) and either in favor of (+) or against (-) an intervention. A strong recommendation (either for or against) indicated that the intervention's desirable effects either clearly outweighed its undesirable effects (risks, burdens, and costs) or it did not. For all strong recommendations, the phrase "We recommend..." is used throughout. A weak recommendation, either for or against an intervention, indicated that the tradeoff between desirable and undesirable effects was less clear. For all weak recommendations, the phrase "We suggest..." is used throughout. In the absence of sufficient evidence, or when group consensus could not be achieved, no recommendation (0) was made. Consensus based on expert opinion was not used as a substitute for a lack of evidence. A consistent method for addressing potential conflicts of interest was followed if task force members were coauthors of related research. The development of this guideline was independent of any industry funding.
These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.
Introduction
Although previous studies have consistently demonstrated that physicians are more likely than non‐physicians to experience work‐related stressors prior to suicide, the specific nature of ...these stressors remains unknown. The current study aimed to better characterize job‐related problems prior to physician suicide.
Methods
The study utilized a mixed methods approach combining thematic analysis and natural language processing to develop themes representing death investigation narratives of 200 physician suicides with implicated job problems in the National Violent Death Reporting System database between 2003 and 2018.
Results
Through thematic analysis, six overarching themes were identified: incapacity to work due to deterioration of physical health, substance use jeopardizing employment, interaction between mental health and work‐related issues, relationship conflict affecting work, legal problems leading to work‐related stress, and increased financial stress. Natural language processing analysis confirmed five of these themes and elucidated important subthemes.
Conclusions
This is the first known study that integrated thematic analysis and natural language processing to characterize work‐related stressors preceding physician suicide. The findings highlight the importance of bolstering systemic support for physicians experiencing job problems associated with their physical and mental health, substance use, relationships, legal matters, and finances in suicide prevention efforts.
Background
Previously it was noted that firearm use by nurses in suicide was changing. The Center for Disease Control and Prevention suicide dataset contains investigation narratives that no ...researcher has analyzed and may provide context to inform suicide prevention.
Objective
Explore firearm deaths in nurse suicide. Second, test topic modeling techniques to analyze investigation narratives.
Methods/Statistical Analysis
Mixed‐method retrospective analysis of 739 nurse versus 94,838 nonnurse suicides. Odds ratios (OR) were calculated to determine relative incidence. After tokenization and stop word removal, Latent Dirichlet Analysis and Latent Semantic Indexing topic modeling techniques were applied. Topics were evaluated for clinical significance and content analysis performed.
Results
Aim 1: Female nurses used firearms significantly less often than other females between 2003 and 2013 (OR: 0.71; p < .001; 95% confidence interval CI: 4.23%–9.83%). A rise in nurse firearm use occurred between 2014 and 2017; with rates now similar to nonnurse females (OR: 0.98; p = .7574; 95% CI: −2.68 to 3.49). Clinically relevant topics identified by topic modeling: preventable deaths, chronic pain, and job loss before suicide.
Conclusions
From this research we know that work‐related issues in nurse suicides by firearms center around chronic pain, substance use, and job loss. The codes tied to suicidal ideation, previous attempt and/or depression, represented preventable deaths because it is known that if a weapon is removed from the home in these situations a suicide can be aborted. The change in firearm use warrants nurse education regarding firearm safety and suicide prevention. Topic modeling holds promise in focusing analyses of suicide investigations.
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