Difficulty Coping Research Articles

Virtual mind-body treatment for adolescents with neurofibromatosis: Study protocol for a single-blind randomized controlled trial

BackgroundNeurofibromatoses (NF) are a group of genetically distinct disorders of the nervous system unified by the predisposition to nerve sheath tumors. Although adolescents with NF types 1 and 2 (NF1 and NF2) report poor quality of life and high psychosocial burden, there are no evidence-based interventions to address these needs. This paper presents the study design and protocol for the first randomized controlled trial (RCT) of a mind-body intervention for adolescents with NF, Resilient Youth with NF (RY-NF), versus an educational control group, Health Education for NF (HE-NF), both delivered in groups via secure live video. MethodsThis is an ongoing, single-blind efficacy RCT. Recruitment began in November 2019 and will continue until March 2022. We will enroll 200 English-speaking, geographically diverse adolescents (ages 12–17) with NF1 and NF2 who report significant distress or difficulty coping with their NF symptoms. We will use a shared-baseline, linear mixed model to compare the effect of RY-NF versus HE-NF on changes in quality of life (QoL) and psychosocial outcomes from baseline to post-intervention, and 6- and 12-month follow-ups. We will also develop NF-specific minimal clinically important difference (MCID) for QoL variables, and conduct mediation and moderation analyses to understand mechanisms of improvement. DiscussionThis study has important clinical and public health implications for the psychosocial functioning of adolescents with NF. It provides a model for efficient delivery of virtual psychosocial care for adolescents with rare diseases. Plans for dissemination and implementation of the RY-NF should efficacy be ascertained are also discussed.

Handicapés et confinés en résidence universitaire : des étudiants oubliés, à l’épreuve de « la continuité pédagogique »

The health crisis due to the outbreak of Coronavirus since the beginning of 2020 has strongly exposed the effect of decades of public service cuts in France, especially in the fields of education or health. Although the French President has recently declared that the living conditions of people with disabilities were a “national priority”, this issue has not been addressed by public authorities while managing the current crisis. This article analyses and helps to understand the situation of young people with disabilities living in student residences in lockdown for about two months, an issue that has been overlooked. The case study is based on a series of interviews with Joseph, a blind Master's student, and some of his relatives. It looks back on Joseph's experience and academic career, his living conditions in lockdown, his difficulties in coping with distance learning, as well as the resources and support he gets to be able to live and get through.

Patient and care partner views on exercise and structured physical activity for people with Progressive Supranuclear Palsy.

IntroductionProgressive Supranuclear Palsy (PSP) is a debilitating form of atypical Parkinsonism. People living with PSP experience movement disorders affecting walking, balance and eye movements. The role of exercise in optimising movement remains unclear.AimsTo identify beliefs about exercise and structured physical activity through the experience of people with PSP.MethodsUsing a phenomenological theoretical framework, qualitative methods were employed to obtain the views of people living with PSP, and their care partners, by in-depth interviews. Questions derived from a systematic review and expert opinions guided the interviews which were audio-recorded, transcribed and de-identified. Two researchers independently conducted thematic analysis and reached consensus on emerging themes.ResultsThere were 16 participants. Four themes were identified: (i) there are beliefs and preferences about exercise and physical activity that can impact on engagement; (ii) difficulty coping with disease progression impacts activities; (iii) facilitators to exercise include individual preferences, access to facilities and expert advice; and (iv) perceived barriers include beliefs about limited exercise options, falls risk, cost, transport and access to credible information.DiscussionPeople living with PSP want early guidance about the condition and the role of exercise. It is important to quickly enable people to have access to evidence and resources supporting exercise and structured physical activities. Consideration of individual preferences and access to expert advice facilitate engagement. Individual barriers need to be identified and solutions found.ConclusionPeople living with PSP are amenable to exercise, especially early in the disease process. Clear guidelines are warranted to document which exercises, and physical activities are most beneficial.

Effectiveness of psychotherapeutic interventions on psychological distress in women who have experienced perinatal loss: a systematic review protocol

BackgroundPerinatal loss is a traumatic and complex experience that contributes to negative maternal psychological states and adverse outcomes impacting fetal development, maternal-fetal/infant bonding, marital/partner relationships, and child cognitive, emotional, and behavioral development. These outcomes present preventable disease burden and financial liability to individuals, families, and the healthcare system. Psychological interventions have the potential to improve outcomes for women and their families after perinatal loss. A few studies have explored the effectiveness of individual psychotherapeutic interventions in reducing maternal psychological distress after perinatal loss; however, a systematic review to compare these interventions has not been conducted. The primary objective of this systematic review is to determine the effectiveness of psychotherapeutic intervention on psychological distress and perception, coping, and adjustment in women who have experienced perinatal loss. The secondary objective of this review is to examine the content and delivery methods of effective psychotherapeutic interventions.MethodsWe endeavor to search electronic databases (PsycINFO, MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, CINAHL, Social Work s, Family and Society Studies Worldwide, Family Studies s, Academic Search Premier), gray literature databases (Proquest Dissertation and Theses Global, Web of Science Conference Proceedings Citation Index, OAIster, Open-Grey, Canadian Electronic Library, Canadian Research Index), and relevant organizational websites and conduct forward and backward citation searches of included studies. Inclusion criteria will consider studies that (1) are randomized controlled trials (RCTs), quasi-experimental (e.g., before-after design), and observational (prospective cohort); (2) include women affected by perinatal loss accessing psychotherapeutic intervention or support; and (3) evaluate a mental health or related outcome. Two authors will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using an appropriate tool. The primary outcome(s) will be measurements on the severity of depressive, anxiety, grief, and post-traumatic stress symptoms. Secondary outcomes will include measurements on difficulties in perception, coping, social, or dyadic adjustment. Conducting a narrative synthesis will identify relationships within study findings, and if appropriate, a random effects meta-analysis will be performed.DiscussionThis systematic review will summarize the effectiveness of psychological interventions, including their content and delivery method, in reducing psychological distress and improving outcomes for women affected by perinatal loss. The evidence generated from this review can inform researchers and policymakers in expanding on related research and developing customized interventions or programs.Systematic review registrationPROSPERO CRD42019126456.

The effect of living a 'yogic lifestyle'on stress response and self-image in healthcare professionals: a pilot study.

Background:Healthcare staff in modern metropolitan settings face higher rates of burnout characterized by emotional stress and difficulty coping with not only building work pressure but also balancing personal life stress. The aim of this pilot study was to see the impact of a yogic lifestyle, incorporating diet, exercise and mindfulness activities based on tantra yoga.Materials & methods:Fifteen participants were recruited and completed three or more of the interventions.Results:The 4-week pilot study showed increased self-compassion and decreased stress among the participants.

Mishel's Model of Uncertainty Describing Categories and Subcategories in Fibromyalgia Patients, a Scoping Review.

The aim of this review was to demonstrate the presence of categories and subcategories of Mishel’s model in the experiences of patients with fibromyalgia by reviewing qualitative studies. Uncertainty is defined as the inability to determine the meaning of disease-related events. A scoping review of qualitative studies was carried out. Twenty articles were included, with sample sizes ranging from 3 to 58 patients. Articles from different countries and continents were included. Three categories of the model and eight subcategories could be shown to be present in the experiences of fibromyalgia patients through the scoping review. The first category, concerning antecedents of uncertainty in patients with fibromyalgia, is constituted by the difficulty in coping with symptoms, uncertainty about the diagnosis and uncertainty about the complexity of the treatment. The second concerns the cognitive process of anxiety, stress, emotional disorder and social stigma. The third category refers to coping with the disease, through the management of social and family support and the relationship with health care professionals.

Pathwise stability of multiclass queueing networks

It has been shown that, under some service policies, a queueing network can be unstable even if the load of every station is less than one. Although the stability of queueing systems in some special cases (e.g. under First-Buffer-First-Served policy) has been well addressed, there are still difficulties in coping with more general networks. In this paper, we study the stability problem through depicting the mutual blocking effect among different classes and generalize the concept of servers in the context of queueing networks based on the sample path analysis. We show that the general servers have similar impacts on the system stability as physical stations and a queueing network is pathwise stable if and only if the effective traffic intensity of every general server does not exceed one. Through case studies, we show that the stability of queueing networks and the structure of general servers are sensitive and depend on various factors, including the service policies. Furthermore, we prove that queueing systems operating under the Work-in-Progress-Dependent service policies are always stable if every physical station has sufficient capacity.

Kinship care first? Factors associated with placement moves in out-of-home care

The type of care setting a child is placed in when they enter the child welfare system has long-lasting effects. Although numerous studies have examined factors associated with placement decisions and placement moves, few studies have paid attention to factors involved in both placing children into and removing children from kinship care. This study focused on kinship care as the top of the hierarchy of out-of-home placements and utilized data obtained from a U.S. mid-Atlantic State Automated Child Welfare Information System. The study followed children who were placed in out-of-home care over a three-year period. Descriptive, bivariate, and regression analyses were conducted to identify: (1) Among children experiencing the first out-of-home care placement (N = 3838), what factors were associated with an initial placement into kinship care versus non-kin foster care and group homes/residential treatment centers (RTCs); and (2) Among children experiencing a second out-of-home placement during this period (n = 1893; 49% of the original sample), what factors were associated with being moved from kinship care to a less-preferred care setting and vice versa. Two factors increased the odds of initially being placed in kinship care: Race of the child (African American children were more likely to be placed in kinship care) and presence of parental substance abuse; in contrast, the presence of child behavioral problems and disabilities, as well as advanced age, decreased the odds of kinship placement. For children experiencing a second move from kinship care into non-kin foster care, the associated factors were: Older children, behavioral problems, and parental incarceration. Finally, for children placed initially in non-kin foster care and moved to kinship care, moves were primarily associated with parental characteristics, including housing issues, substance abuse, and difficulty coping with the child. Implications for policy, research, and practice are discussed.

Attention-Based Automated Feature Extraction for Malware Analysis.

Every day, hundreds of thousands of malicious files are created to exploit zero-day vulnerabilities. Existing pattern-based antivirus solutions face difficulties in coping with such a large number of new malicious files. To solve this problem, artificial intelligence (AI)-based malicious file detection methods have been proposed. However, even if we can detect malicious files with high accuracy using deep learning, it is difficult to identify why files are malicious. In this study, we propose a malicious file feature extraction method based on attention mechanism. First, by adapting the attention mechanism, we can identify application program interface (API) system calls that are more important than others for determining whether a file is malicious. Second, we confirm that this approach yields an accuracy that is approximately 12% and 5% higher than a conventional AI-based detection model using convolutional neural networks and skip-connected long short-term memory-based detection model, respectively.

The Severity of Gambling and Gambling Related Cognitions as Predictors of Emotional Regulation and Coping Strategies in Adolescents

People with gambling disorder (GD) exhibit distorted cognitions and superstitious beliefs more often than the general population.Similarly, difficulties in coping and emotion dysregulation are more prevalent among those with GD, and could determine the onset of GD in particularly vulnerable groups such as adolescents. This study examines the relationship between gambling severity and gambling-related cognitions with coping strategies and emotion regulation. Also, it explores how accurately gambling severity and gambling-related cognitions were able to predict emotion regulation and coping strategies. Two groups were recruited and analyzed: a community sample comprising 250 adolescents and young adults from secondary education schools, and a clinical sample of 31 patients with similar age characteristics seeking treatment for GD. The participants from the clinical sample scored higher on gambling severity, emotion dysregulation, cognitive biases, and maladaptive coping strategies. In the community sample, cognitive biases mediated the relationship between sex and emotion dysregulation and disengagement. People with GD use more often than controls maladaptive emotion regulation strategies to manage negative emotional states. This perspective emphasizes the need to focus on coping with emotions, as opposed to coping with problems, as the best approach to tackle gambling problems.

The Effect of Brief Supportive Psychotherapy on Prevention of Psychiatric Morbidity in Women with Miscarriage: A Randomized Controlled Trial about the First 24-hours of Hospitalization.

ObjectivesMiscarriage is a common pregnancy complication causing substantial psychiatric complications. This study was designed to investigate whether the administration of brief supportive psychotherapy (BSP) is effective on the management of women with miscarriage when conducted in the first 24 hours of hospitalization in order to prevent symptoms of anxiety, depression, and grief at four-months post-miscarriage.MethodsWe conducted a randomized clinical trial on 79 women with miscarriage hospitalized in Ayatollah Rohani teaching hospital. The women were randomly assigned into two groups (39 in the experimental group and 40 in the control group). All interventions were implemented for two study groups during the first 24 hours of hospitalization in a private room in the hospital. The experimental group received a two-hour BSP. The objective outcomes were assessed using Hospital Anxiety and Depression Scale and Perinatal Grief Scale (PGS), which has three subscales (active grief, difficulty coping, and despair) and were measured before the intervention and at four-months post-miscarriage.ResultsThe results of pre-tests in the follow-up of the trial suggested that the participants who received BSP reported significant reductions in the mean scores of active grief (-34.2±9.7 vs. 28.1±-6.9), difficulty coping (27.1±6.4 vs. 23.3±4.3), despair (28.0±8.4 vs. 22.8±5.2), and total PGS (89.6±23.1 vs. 74.4±15.3), in contrast to participants in the control group who did not report such results. Further, the results of generalized estimating equations models revealed that brief supportive psychotherapy caused a significant decrease in the level of factors including active grief, difficulty coping, despair, total perinatal grief, anxiety symptoms, and depressive symptoms in subjects in the experimental group compared to those in the control group after miscarriage. Also, the frequency of anxiety symptoms (13.5% vs. 60.5%), depressive symptoms (32.4% vs. 71.1%), and grief symptoms (10.8% vs. 65.8%) was found to be significantly lower in the group receiving psychotherapy than in the control group at four-months follow-up.ConclusionsAdministration of BSP session during the first 24 hours of hospitalization for women with miscarriage can be considered a reliable method to prevent anxiety symptoms, depression symptoms, and perinatal grief at four-months follow-up.

What are the stressors and coping strategies adopted by undergraduate healthcare students during placement?

This paper aims to explore what the current stressors and coping strategies are in placements for students in undergraduate healthcare programmes.Pulido-Martos, Augusto-Landa and Lopez-Zafra (2012) suggest that stress levels among healthcare professionals are higher than other workers. Pryjmachuk, Easton and Littlewood (2009) found that approximately 25% of students withdrew from nursing courses due to emotional distress, difficulty in coping and placement. Literature highlights a lack of mentor support as a common stressor (Shivers, Hasson & Slater, 2017; Thomas & Westwood, 2016). However, the literature lacked any exploration into coping strategies. This research therefore focuses on the experiences of individuals from a variety of healthcare professions and explores the use of coping mechanisms.A qualitative approach was used in order to gain in-depth responses about personal thoughts and experiences (Denny & Weckesser, 2018). A focus group was carried out with participants attending university who were recruited via purposive sampling from a wider convenience sample (Liamputtong, 2011). The data was then analysed using thematic analysis (Clarke & Braun, 2017).The findings from this study demonstrate that several factors contribute to undergraduate healthcare student stress levels whilst on placement, affecting participants in different ways with some reporting thoughts of discontinuing the course. Five main themes were found in response to sources of stress: placement team, transport, academic factors, personal life and negative mood. Two common themes were found for coping strategies: socialising and distraction.Gaining students’ perspectives is valuable in understanding issues and beginning to resolve them. This study highlights factors that impact on healthcare students’ stress levels whilst on placement, that also contribute to negative moods such as feeling tired, demotivated and angry. This study demonstrates the benefits of using socialisation and distraction. While healthcare is and will likely remain a stressful career route due to the pressures of care (Pich, 2018), this study highlights areas for improvement.

SAT-663 The Impact of Anxiety on the Successful Management of a Type I Diabetic Patient

Background: Patients with both type 1 diabetes mellitus (T1DM) and generalized anxiety disorder (GAD) are known to be at increased risk for hypoglycemic events, long-term hyperglycemia, weight gain and vascular disease. However, little research has been conducted regarding management of anxiety in patients with T1DM. Clinical case: A 27 year old female with T1DM (controlled on an insulin pump), GAD, PTSD, and history of benzodiazepine abuse presented to the emergency department after experiencing multiple panic attacks the day of admission. Recently, patient had multiple bouts of emesis in addition to decreased oral intake. On admission, blood sugar was 54, which increased to 164 after administration of 1 amp of dextrose-50. Patient was obtunded and unable to provide much history. Overnight, insulin was not given due to patient’s poor oral intake. The following morning, patient had one cup of juice for breakfast. Accu-check shortly after revealed a blood glucose level over 500 and patient developed diabetic ketoacidosis (DKA) and was admitted to the ICU on our hospital DKA protocol. Once anion gap closed, patient was transferred out of the ICU for continued management of her diabetes. Patient went on to have multiple panic attacks for the duration of her hospitalization which were controlled with scheduled diazepam, valproic acid, lorazepam and quetiapine. Psychiatry was consulted and found that a major contributing factor to her developing recurrent DKA was her struggle with anxiety surrounding the responsibilities of managing her diabetes and its associated complications including gastroparesis and neuropathy. Further conversation revealed that her psychiatrist had passed away a few months prior to admission and that she had not established care with a new psychiatrist yet. Discussion: Given the life changing nature of T1DM, it is not uncommon for these patients to have difficulty coping with the daily challenges required to optimally treat their condition. It can be frustrating when the slightest shift in caloric intake or exogenous insulin leads to life-threatening situations such as DKA. The above case sheds light on the profound medical consequences and setbacks that poorly controlled anxiety can have on diabetic patients. Therefore, recognizing the impact of anxiety on our patients with diabetes is critical in preventing further complications, especially microvascular, macrovascular and potentially other life-threatening events.

The level of grief in women with pregnancy loss: a prospective evaluation of the first three months of perinatal loss

Objective To prospectively investigate perinatal grief in women with pregnancy loss. Methods A total of 215 women (mean (SD) age: 30.7 (5.9) years) who experienced pregnancy loss were included. Data on sociodemographic, marital and obstetric characteristics and Perinatal Grief Scale (PGS) (first 48 h, 1 week, 1 month and 3 months after the loss) were recorded. Results Active grief scores were lower (p ranged < .05 to <.01), while difficulty coping (p < .05 for each) and despair (p < .05 for each) scores were higher in the 3rd month as compared with prior assessments. All PGS scores at the 48 h and 3rd month assessments were significantly higher in assisted and planned pregnancies (p < .01 for each). Maternal age was positively correlated with 48 h active grief (r = 0.19, p < .001), despair (r = 0.13, p < .05) and total PGS (r = 0.13, p < .05) scores. Parity and the number of children were negatively correlated (r ranged from -0.35 to -0.20, p < .01 for each) with all PGS scores. Conclusion Our findings revealed decrease in active grief levels, whereas gradual increase in difficulty coping and despair in women with pregnancy loss within the first 3 months of losing a child. Our finding indicate association of older maternal age, primiparity, assisted and planned pregnancies with regular antenatal follow up with higher total PGS scores as well as active grief, difficulty coping and despair scores in women regardless of the time of assessment within 3 months after the pregnancy loss.

Working with children who are victims of abuse: emotions and representations of professionals in residential children’s communities

Professionals who work in residential children’s communities face many difficulties and, when the hosted children have a history of abuse and maltreatment, the risk of vicarious traumatization and professional burn-out, which has a negative effect on the professional’s work and well-being as well as on the effectiveness at work, is very high. This qualitative study aims to explore, via the content analysis of text recorded in some Photolangage® groups, the representations of social workers and educators in residential children’s communities on the theme of work management of physical and sexual abuse victims. The participants were 37 social workers from 6 residential communities for 0-6 years old child in the region of Palermo (Italy). The analysis of the discourse revealed four main themes: “emotional responses”, “difficulty in coping with emotions related to abuse”, “relationship with the institutional network” and “work methods/strategies”, which seem to guide and inform the social workers in our daily relationship with children. These results, which are in line with clinical observations, indicate the importance of supporting, through tools such as supervision and analysis of professional practices, professionals who work with maltreated and abused children, the only way to protect their well-being and the “therapeutic role” in the care and protection of children which they fulfil.

Educational Needs of Parents of Adolescent Suicide Attempters

Ergenlik dönemi, fiziksel değişiklere uyum çabasının olduğu ve rol karmaşasının yoğun olarak yaşandığı bir dönemdir. Karmaşık birdön em olmasından dolayı ergenlik döneminde birçok stresöre maruz kalınır. Stresörlerle baş etmede güçlük çeken ergenler, bir kurtuluş yolu olarak intihar davranışına başvurabilmektedirler.&#x0D; Ergenlik dönemi intiharları son yıllarda tüm dünyada yaygın olarak görülmeye başlamış ve önemli bir halk sağlığı sorunu haline gelmiştir. Ergenlerde intihar oranları artış göstermekle birlikte, Dünya Sağlık Örgütü intiharın önlenebilir bir davranış olduğunu ve önlenebilirliğinin sağlanmasında bütün topluma rol ve sorumluluklar düştüğünü belirtmektedir. Önlenebilirliğin sağlanmasındaki rol ve sorumlulukların büyük bir kısmı sağlık profesyonellerine aittir. Sağlık profesyonellerinden biri olan hemşireler klinik ortamda, ebeveynler ise ev ortamında intihar girişiminde bulunan ergenler ile en çok vakit geçiren kişilerdir. Hemşirelerin ve ebeveynlerin olası bir intiharı erken dönemde farkedebilme ve uygun müdahale edebilme konusunda yeterli bilgi ve donanıma sahip olmaları gerekir. Bu derlemede, intihar girişiminde bulunan ergenlerin ebeveynlerinin öğrenim gereksinimleri ve belirlenen gereksinimlere yönelik hemşirelik müdahaleleri literatür ışığında gözden geçirilmiştir.

Desert island therapy.

My senior partner was an experienced and kindly clinician with an encyclopaedic medical knowledge, often spotting the zebra of an unusual diagnosis in his packed surgeries. His father had been a doctor in the Punjab and their family had been forced to leave India at partition. This had left him with a heightened awareness of the fragility of security, and a lasting dislike for sectarianism. He and his wife had also managed the difficulty of coping with a chronically unwell child for whom he spent much time trying to ensure a safe future. After he retired, a patient transferred to my list. We discussed her various struggles with anxiety, rooted in unfortunate life circumstances, and she shared with me the advice that he had given …

P18 High satisfaction scores but high rates of unmet need- what is missing in breast cancer survivorship care?

Background and purpose Breast cancer survivorship care will become increasingly important as advances in treatment continue to increase survival. This study was a benchmarking project for a large metropolitan breast cancer service. Methods Participants consisted of 130 women who were >1 year since diagnosis of breast cancer, attending any Breast Service outpatient clinic. They were assessed for demographic and clinical characteristics and completed a series of self-report questionnaires examining service satisfaction, clinical benchmarks, prevalence of survivorship issues, ongoing service utilisation, and incorporating the externally validated Cancer Survivorship Unmet Needs (CaSUN) questionnaire. The questionnaire concluded with a ‘blue sky’ qualitative question asking for suggestions for future service improvement. Results 91.3% of participants were satisfied or highly satisfied with their overall breast cancer care. However, 67% of participants reporting at least one unmet need, with an average of 4.9 unmet survivorship needs per participant. The most prevalent unmet needs were fear of cancer recurrence, difficulty coping with stress, coordination of medical care, hospital parking, and information provision. Despite this, utilisation of available services such as cancer psychology, social work, and cancer care coordinators was low. ‘Blue sky’ suggestions for improvement largely related to practical assistance such as free parking and reduced clinic wait times. Conclusions Despite high satisfaction ratings, ongoing unmet survivorship needs and issues were common in this patient group, and usage of relevant multidisciplinary care was low. Improvements in survivorship care must focus on deliberately eliciting patient survivorship needs and connecting them with available services.

Self‐harm and self‐regulation in urban ethnic minority youth: a pilot application of dialectical behavior therapy for adolescents

Difficulties in coping with stress and regulating emotions are transdiagnostic risk factors for self-harming behavior. Due to sociocultural stressors, ethnic minority adolescents may be at greater risk for self-regulation difficulties and self-harm. Dialectical behavior therapy for adolescents (DBT-A) frames adaptive skill acquisition as a mechanism of change, but few studies have investigated its impact on ethnic minority adolescents' self-regulation (i.e. coping, emotion regulation). Therefore, this pilot study examined relations between self-regulation and self-harm among ethnic minority adolescents and investigated changes in their self-regulation upon completing DBT-A. A clinically referred sample of 101 ethnic minority adolescents (Mage =14.77; female=69.3%) completed questionnaires about a history of self-harm, coping (DBT Ways of Coping Checklist), and emotion regulation (Difficulties in Emotion Regulation Scale). Of the initial sample, 51 adolescents (Mage =14.73; female=80.4%) entered a 20-week DBT-A program due to self-harm and/or Borderline Personality features. In a pretreatment sample, the frequency of dysfunctional coping, but not of adaptive coping, differentiated self-injurers from non-self-injurers. Full information maximum likelihood estimation was used to address high attrition (60.8%) from DBT-A. Those who completed DBT-A (n=20) reported significantly improved emotion regulation. Adaptive coping at pretreatment predicted increased DBT skills use at post-treatment. This non-randomized pilot study highlights dysfunctional coping and emotion dysregulation as risk factors for self-harm and suggests that 20-week DBT-A may help improve emotion regulation. Future research should employ a randomized design to further examine the effect of DBT-A on these transdiagnostic processes of psychopathology. Due to cultural and environmental stressors, ethnic minority adolescents may be at greater risk for developing self-regulatory difficulties - transdiagnostic mechanisms known to underly self-harming behaviors; however, we know little about whether empirically supported treatments for self-harm will improve youth's coping and emotion regulation. In a clinically referred, pretreatment sample of ethnic minority youth, levels of BPD symptomatology, emotion dysregulation, and dysfunctional coping, but not of adaptive coping, differentiated teens who self-harmed from those who did not. Self-harming ethnic minority youth who participated in an uncontrolled, pilot trial of dialectical behavior therapy for adolescents (DBT-A) at an urban mental health clinic reported improved emotion regulation at post-treatment. Baseline emotion regulation skills were not predictive of treatment-related changes, suggesting that other factors, such as DBT-A, may have played a decisive role in improving teens' emotion regulation. In contrast, adaptive coping skills at pretreatment were linked to increased DBT skills use at post-treatment, indicating that patients' baseline coping skills may play a predictive role in psychotherapy outcomes. Future research should employ a randomized control trial to examine the effect of DBT-A on vulnerable ethnic minority youth's development of self-regulation. It should also investigate the hypothesized mediating role of self-regulation in effecting lasting clinical gains.

606 Establishing a Deep Sedation Program: Challenges and Successes from a Nursing Management Perspective

Abstract Introduction A burn center with a high volume of burn admissions was looking for ways to decrease the pain and anxiety experienced by patients during wound care. Patients requiring surgical dressing removal or demonstrating difficulty in coping during wound care were of particular concern. Discussions between anesthesia providers and the burn team led to the concept of anesthesia safely providing deep sedation in the inpatient wound care center for select dressing changes. Nursing management began to work through the challenges of implementing the Burn Center Deep Sedation Program. Methods Processes for identifying, scheduling, and recovering patients were established. All Burn Acute Care Unit (BACU) patients requiring a surgical dressing removal or demonstrating poor coping during wound care would qualify for deep sedation. Nursing management worked to create an online scheduling system, and designated a room which was set up with anesthesia equipment and supplies. Candidates were reviewed for deep sedation and a schedule created for the following day. All patients required a Burn Intensive Care Unit (BICU) nurse during the recovery period. A BICU room adjacent to the wound care center became the deep sedation recovery room, and was staffed by the BICU charge nurse. BICU nurses received additional training in post anesthesia care prior to the program implementation. Once all educational needs and logistical changes were addressed, the deep sedation program began operating seven days per week. Results Starting in January 2016 deep sedation has been provided to approximately 400 cases per year. No additional staff was required, only shifting responsibilities of existing nursing personnel. Designating a specific room for deep sedation has ensured that anesthesia providers have access to the appropriate equipment and has minimized disruptions to the flow of other dressing changes occurring throughout the day. The impact of the program on pain and anxiety is currently under evaluation. Informal feedback from patients and staff members has been very positive. Conclusions The challenge in developing this program was the amount of education and planning required prior to implementation. Once the program was active, the challenges that occurred involved the scheduling system. An additional benefit of the program was the teamwork required between BICU and BACU nurses to safely handoff patients. The deep sedation program has also strengthened the burn team’s relationship with the anesthesia providers, whose commitment to the project was appreciated by all involved. A team approach and a collective mission to improve care for burn patients have driven this project to its current success. Applicability of Research to Practice The collaboration between the burn team and anesthesia has resulted in an improved wound care experience for the patient.